Jim Jeffords

Mr. JEFFORDS

Mr. JEFFORDS. Mr. President, I would like to announce for information of the Senate and the public that a hearing of the Senate Committee on Health, Education, Labor, and Pensions will be held on Tuesday, January 25, 2000, 10 a.m., in SH-216 of the Senate Hart Building. The subject of the hearing is ``Reducing Medical Error: A look at the Iom report.'' For further information, please call the committee, 202/224-5375. subcommittee on employment, safety, and training

Mr. JEFFORDS. Mr. President, I would like to announce for information of the Senate and the public that a hearing of the Subcommittee on Employment, Safety, and Training, Senate Committee on Health, Education, Labor, and Pensions will be held on Tuesday, January 25, 2000, 2:30 p.m., in SD-430 of the Senate Dirksen Building. The subject of the hearing is ``Safe at Home: OSHA and the Modern Day Workplace.'' For further information, please call the committee, 202/224-5375. subcommittee on public health

Mr. JEFFORDS. Mr. President, I would like to announce for information of the Senate and the public that a hearing of the Subcommittee on Public Health, Senate Committee on Health, Education, Labor, and Pensions will be held on Wednesday, January 26, 2000, 9 a.m., in SD-430 of the Senate Dirksen Building. The subject of the hearing is ``Gene Therapy: Promoting Patient Safety.'' For further information, please call the committee, 202/224-5375.

Mr. JEFFORDS

Mr. JEFFORDS. Mr. President, I must set the record straight with regard to the Northeast Interstate Dairy Compact. Rarely in all my years in Congress have I witnessed such ill-considered comment and media hysteria as has occurred over the Dairy Compact in these last few days. I recognize that my Senate colleagues from the Midwest are, very understandably, raising the dairy issue to a new level of concern and I welcome the opportunity to respond to their call for productive changes in our dairy policy. As for my media friends, I appreciate the heightened scrutiny of our dairy policy, because we in the northeast share a common concern with our Midwestern Senate colleagues over the current state of our nation's dairy policy. To my Senate colleagues from the Midwest: I have worked on the dairy issue for all of my twenty-four years in the Congress. More than most, I appreciate the complexity and difficulty of this issue. There is nothing I would like more than to join with you in common cause to improve our nation's dairy policy. But let us be frank with each other. The key issue that has divided us in all my time here, and which continues to divide us, is your insistence that the Midwest should somehow be seen as the source of our nation's supply of fluid, or beverage, milk. This insistence has been and still remains simply contrary to the overwhelming will of this Congress. And this is not just an issue that divides the northeast and the Midwest; this is an issue that divides the Midwest from the rest of the country. The universal constituencies of every member of Congress, from every region including your own, demand a local supply of fluid milk. This is not a free market issue, not merely an issue of the best interests of dairy farmers. The real issue is the very nature of our basic food supply and so extends way beyond the mere interest of a single constituent group. Regionally and on behalf of the nation as a whole, the Congress simply will not yield to the destruction of our local supplies of fresh, wholesome drinking milk, and the inevitable result of the consumption of reconstituted milk. For now and for the foreseeable future, our nation's dairy policy will be based on the maintenance of local, regional supplies of fluid milk. You must recognize that we cannot compromise on this issue. This fact must and will define our national policy. The Midwest will never be called upon to provide the supply of fluid milk for the rest of the country. And so I call upon my Senate colleagues from the Midwest to look elsewhere than to reformation of the fluid marketplace for a solution to the problems your dairy industry faces. I make this call in the spirit of cooperation and with a positive spirit. To my media friends: I welcome this opportunity to respond to the specifics of the various misstatements and misinformation contained in the most recent descriptions of the Dairy Compact. Before doing so, I would like first to highlight for you a simple and incontrovertible fact about the Dairy Compact: Twenty-five of our fifty states have now passed dairy compact legislation patterned after the original compact language first adopted by the Vermont legislature in 1987. This means that twenty-five legislatures and twenty-five governors (more, if you count the number of governors who have supported the bill over the years) have committed their active support to this unique legislation. With this important fact in the background, I would like to respond to the charges and assertions that have recently been raised against the Dairy Compact. For purposes of this discussion, I will address directly the substance of the editorial that appeared yesterday in the Wall Street Journal. To summarize the editorial, the Dairy Compact is a ``price fixing cartel'' which benefits ``inefficient'' Vermont dairy farmers unfairly at the expense of their more efficient Upper Midwest counterparts. To compound this misery, the Compact unduly burdens milk consumers in the northeast, particularly the most vulnerable ``poor children'', ``to the tune of 20 cents a gallon.'' Now I would like first generally to ask this body: Who in their right mind would support such a clearly wrongheaded policy as so characterized by the Wall Street Journal? Who could support any measure which pits a relatively small number of farmers against a vastly greater constituency of consumers, and which disadvantages our most vulnerable citizens? Certainly not the twenty-five state legislatures and governors which have adopted Compact legislation. And certainly not the 40 Senators and over 160 House Members who co-sponsored legislation to approve Compact legislation here in the Congress. Certainly not the Compact's bi-partisan supporters in the Congress and around the country, who represent the country's most rural and most urban constituencies. And such an initiative could never have been embraced simultaneously by our nation's most divergent regions--the northeast and the deep south. Just look at the list of co-sponsors here in the Senate. Senator Jesse Helms joins Senator Ted Kennedy. Senator Schumer from New York is a co-sponsor along with Senator Thurmond from South Carolina. Need I say more about the diversity of support for the Compact? And so I call upon the media to look at the Compact with a fresh gaze. If you will do so, I think you will find that the reason for this unusual if not truly unique support for the Compact is really quite simple: The Compact manages to respond simultaneously to all of the divergent interests at play in today's dairy marketplace. The Compact does not just respond to the needs of dairy farmers. Consumers, processors, retailers, as well as farmers, all find their place in the regulatory process created by the Compact. Because the consumer ultimately pays, the consumer controls the decision as to whether the price should be raised. Perhaps most importantly, because the Compact is made up of individual sovereign states, the sovereign right of each state to control its own regulatory fate is ultimately protected by the Compact. In short, the Compact truly promotes the public interest. Let me see if I can further advance the discussion by clearing up at least some of the cloud of confusion which the Journal and others have cast around the Compact. Let's begin with the claim that the Compact is a ``price-fixing cartel''. Along with the Journal, the Washington Post also yesterday referred to the Compact as a ``cartel'' in an editorial. And our supposed ``newspaper of record'', The New York Times, has repeatedly described the Compact as a cartel in its coverage of the Compact. For the benefit of all these erudite commentators whose stock in trade is the precise use of the English language, let's consider the dictionary definition of a cartel. Webster's dictionary defines ``cartel'' as follows (1) a written agreement between belligerent nations; (2) a combination of independent commercial enterprises designed to limit competition; (3) a combination of political groups for common action. The definition contained in the Random House dictionary similarly describes a ``cartel'' as: (1) an international syndicate, combine, or trust generally formed to regulate prices and output in some field of business; (2) a written agreement between belligerents, esp. for the exchange of prisoners; (3) (in French or Belgian politics) a group acting as a unit toward a common goal; (4) a written challenge to a duel. Notwithstanding use of this term by our most respected media commentators, it becomes quickly obvious that the Compact in no way shape or form resembles such a ``cartel.'' Indeed, were I to challenge these commentators to a duel in writing, that absurd challenge would actually be a more accurate use of the term cartel than is their use of the term to describe the Compact. I guess our political commentators have now tilted so far away in their zeal to embrace the so-called free market that they recognize no role for the government in regulating the marketplace. Or, I guess, they simply no longer trust the government. Even so, is their distrust of government so great that they cannot give even simple recognition to the simple distinction between businesses price-fixing for private gain and states regulating in the public interest? Such regulation in the public interest, which provides the basis for the Compact, is central to our system of government. Even the most ardent free-marketeers recognize the need for the government to play at least some role in the policing of the marketplace in the public interest. The basic function of the Compact is this: To determine whether the price received by dairy farmers must be adjusted in the public interest. Not solely in the interest of farmers, but in the public interest of all those who participate in the fluid milk marketplace-- processors, wholesalers, retailers and consumers, including low-income consumers. Adjustment may mean an increase in price, or simply stability in price. Presently, the Compact provides for both some increase in price as well as price stability. I will address the various concerns raised by the increase in price in a minute, but first I would like to address the issue of price stability, because it brings home the fact that the Compact serves the larger public interest, of which farmers comprise only one part. Various stories have alluded to the problem of erratic wholesale prices and their adverse impact on consumers. Indeed, nobody really benefits, other than retailers, from an increasingly market-driven farm price for milk. This is an issue addressed by the Compact. The Compact, in the public interest, provides for price stability, to the benefit of all market participants. (Even retailers.) Now about the increase in price resulting from operation of the Compact in New England. Here are some simple numbers. Over the last two years, the Compact has raised the price of farm milk by no more than ten cents per gallon. No more than ten cents. Not twenty cents, as we have heard over and over and over and over. As they say, you could look it up, so let me repeat: Ten cents. Period. And that is just the impact on the farm price. What of the impact on consumer prices. You can look this up, as well. If you do so, you will find that prices in New England are actually lower than in the corresponding New York City market, where the Compact is not in place. And what of the impact on ``poor children''? Under current operation of the Compact, the WIC program and the School Lunch Program are both exempt. There is no impact on participants in these programs. Let me repeat: No impact on participants in the WIC and School Lunch programs. Period. In conclusion, let me again speak directly to my troubled colleagues from the Upper Midwest. As we look to the new millennium and our future, I wish my Midwestern colleagues again to understand that I will strive to work with them in common purpose. Our farmers from the northeast and Midwest are so similar. They are among the yeoman farmers who built this country so proud. We must be responsive to their common plight. Surely we should be able to reason together based on those issues we share in common rather than continue to dispute over issues which divide us. In all the recent discussion about the Dairy Compact, one key fact seems to have gotten overlooked. Twenty-five of our fifty states have now passed dairy compact legislation. One-half of the states have embraced the Compact idea. This means that twenty-five state legislatures and twenty-five governors (more, if you count the number of governors who have supported the bill over the years) have adopted the Compact approach as the best way to solve the dairy issue we all find so vexing. I call upon my colleagues, especially those Members on my side of the aisle, to give due deference to the rights of the states to assist the Congress in defining policy. The states have spoken and are telling us that the free marketplace does not work with dairy pricing. We should listen to their wise counsel. These Interstate Compacts are not all about dairy policy, but about the rights of states to work together under the compact clause of the constitution. It's a states right issue that deserves to be heard and understood. I hope my colleagues will take the time to understand the law and the purpose of this important state initiative. I fully believe that those Members who have today spoken against them may see Dairy Compacts in a new light if they will view them from the perspective of the states which have adopted them. Instead of seeing cartels, they will see a regulatory framework that operates in the public interest. Instead of seeing a system of price supports that works only for dairy farmers, they will see a regulatory mechanism that benefits all the citizens of the states--consumers, processors and farmers, alike. This is the way our federalist system is supposed to work--the states talk and we listen. As an issue of states rights, I urge the Judiciary Committee to take this issue up when next we consider it.

Mr. JEFFORDS

Mr. JEFFORDS. Mr. President, first I ask unanimous consent Lu Zeph and Tom Valuck, fellows on my staff, be granted the privilege of the floor during consideration of the conference report.

Mr. JEFFORDS. Mr. President, I see the Senator from Iowa, with whom I have worked all these years, was here just a moment ago. I would like to wish him a happy 60th birthday. I am sure all of us would like to join in that, and I will move on now and get to the purpose of being here today. Mr. President, I am thrilled that the Senate will soon send to the President the Work Incentives Improvement Act of 1999. This landmark legislation will open doors to jobs across the country for disabled Americans. As we all know, the Federal Government often sets policies with the best of intentions, and the least of common sense. There are lots of examples, but today's policy for disability benefits takes the prize. If you are disabled and don't work, you have access to federally funded health care. If you are disabled and you do work, you lose access to federally funded health care. Does it make any sense to you? No, it does not to me, either. Access to health care is important to everyone, of course, but to severely disabled people it is absolutely vital for the everyday needs of life. And the price tag for this care can be astronomical. Three years ago, this paradox was brought to my attention, and I began the process of trying to figure out how we could solve it. I realized that, unless and until we gave individuals with disabilities access to health care, they would not, could not work to their full potential. That is why I am so proud that we are on the verge of changing the law that will, at last, change the lives of 9.5 million individuals with disabilities who have been waiting, pleading that we take this step. These millions of Americans want and will use the job training and job placement assistance that this legislation authorizes. They will benefit from the advice and guidance that will be available on the complicated work incentives options in Federal law. They will go to work, work longer hours, work more hours, and seek advancement knowing that their health care will be there when they need it. For those who look beyond what this legislation means in human terms, to its monetary applications, I say, you will see results. The taxpayer rolls will expand. Use of Federal and State public assistance programs will decrease. Data on the health care needs and costs of working individuals with severe disabilities will be collected. Private employers and their insurers will have data from which they may calculate risks and craft health care insurance options for employees with disabilities. This conference report represents sound federal policy. Last night our colleagues in the House, on a vote of 418 to 2, endorsed this policy. We must do the same. Let us celebrate and confirm the consensus we have achieved. Individuals with disabilities are waiting to show us how they are ready, willing, and able to join the workforce, support their families, and contribute to their communities and our national economy. The action we are taking is the next logical step in our efforts to ensure that disabled Americans can fully participate in our society. In 1975 we guaranteed each child with a disability a free appropriate education through the precursor to the Individuals with Disabilities Education Act. In 1978, we prohibited discrimination based on disability in all services, programs, and employment offered by or through the federal government. In 1988, for the first time, we recognized and addressed the need to provide assistive technology to individuals with disabilities. And in 1990, we enacted the most comprehensive civil rights law for individuals with disabilities, the Americans with Disabilities Act. Each of these actions was a building block toward true independence for individuals with disabilities. But the promise of employment rights under the ADA was an empty one for millions of Americans who couldn't afford to take advantage of their rights. Today, we are making good on that promise. I want to again commend the principal cosponsors of this legislation, Senators Kennedy, Roth, and Moynihan for their incredible contributions. Five months ago, the four of us joined President Clinton in a room just off the Senate floor to call for enactment of this legislation. I was confident then that the day would soon come, and I am elated that it finally has. It is the end of the session, we are all tired, and some tempers are frayed. But Mr. President, as we conclude our work for the year and return to our states, this is one accomplishment of which we can all be proud.

Mr. JEFFORDS

Mr. JEFFORDS. Mr. President I am delighted to stand before you today, to speak about an extremely important piece of legislation. The bill we are sending to the President today, a bill I know he is eager to sign into law, will have a tremendous impact on people with disabilities. In fact, this legislation is the most important piece of legislation for the disability community since the Americans with disabilities Act. My reason for sponsoring this particular piece of legislation is quite simple. The Work Incentives Improvement Act of 1999 addresses a fundamental flaw in current law. Today, individuals with disabilities are forced to make a choice . . . an absurd choice. They must choose between working and receiving health care. Under current federal law, if people with disabilities work and earn over $700 per month, they will lose cash payments and health care coverage under Medicaid or Medicare. This is health care coverage that they need. This is health care coverage that they cannot get in the private sector. This is not right. Once enacted, the Work Incentives Improvement Act of 1999 will allow individuals with disabilities, in states that elect to participate, continuing access to health care when they return to work or remain working. In addition, those individuals who seek it, will have access to job training and job placement assistance from a wider range of providers than is available at this time. Currently, there are 9.5 million individuals with disabilities across the country who receive cash payments and health care coverage from the federal government. Approximately 24,000 of these individuals live in my home state, Vermont. Once enacted, the Work Incentives Improvement Act will actually save the federal government money. For example, let's assume that 200 Social Security disability beneficiaries in each state return to work and forgo cash payments. That would be 10,000 individuals out of the 9.5 million individuals with disabilities across the country. The annual savings to the Federal Treasury in cash payments for just these 10,000 people would be $133,550,000! Imagine the savings to the Federal Treasury if this number were higher. Clearly, the Work Incentives Improvement Act of 1999 is fiscally responsible legislation. I began work on this bill 1996. Though it was a long and sometimes difficult task, many hands made light work. Senator Kennedy, Ranking member on the HELP Committee, joined me in March 1997. Senators Roth and Moynihan, Chairman and Ranking Member on the Finance Committee signed on as committed partners in December of 1998. Last January, 35 of our colleagues, from both sides of the aisle, joined us in introducing S. 331, the Senate version of this legislation. One week later, in a Finance Committee hearing, we heard compelling testimony from our friend, former Senator Dole, a strong supporter of this legislation. A month later, we marked this legislation out of the Finance Committee with an overwhelming majority in favor of the bill. Finally, on June 15th, with a total of 80 cosponsors, we passed this legislation on the floor of the United States Senate, with a unanimous vote of 99-0. Four months later, over 35 of our colleagues in the House of Representatives, took to the floor of their chamber, and spoke eloquently for their version of this legislation. Later that day, the bill passed the floor of the House with a vote of 412-9. Since then, the Senate and House Conferees have been working diligently in effort to reach common ground. I am very pleased today, that the differences in policy in the two different bills have been resolved and consensus has been reached on a conference agreement. This agreement does not compromise the original intent of the legislation, retaining key provisions from S. 331. From my perspective, the Work Incentives Improvement Act of 1999 represents a natural and important progression in federal policy for individuals with disabilities. That is, federal policy increasingly reflects the premise that individuals with disabilities are cherished by their families, valued and respected in their communities, and are an asset and resource to our national economy. Today, most federal policy promotes opportunities for these individuals, regardless of the severity of their disabilities, to contribute to their maximum potential--at home, in school, at work, and in the community. I have been committed to improving the lives of individuals with disabilities throughout my Congressional career. Providing a solid elementary and secondary education for children with disabilities, so that they will be equipped, along with their peers, to benefit from post-secondary and employment opportunities is crucial. When I came to Congress in 1975, Public Law 94-142, the Education for all Handicapped Children Act, now the Individuals with Disabilities Education Act (IDEA), was enacted into law. IDEA assures each child with a disability, a free and appropriate public education. I am proud to be one of the original drafters of this legislation which has reshaped what we offer to and expect of children with disabilities in our nation's schools. In addition, I have been committed to providing job training opportunities for individuals with disabilities. In 1978, I played a central role in ensuring access to programs and services offered by the federal government for individuals with disabilities through an amendment to the Rehabilitation Act. I believe that this amendment alone laid the foundation for significant legislation that followed, including the Technology-Related Assistance for Individuals with Disabilities Act of 1988, now the Assistive Technology Act of 1998, both of which I drafted. Most importantly, this legislation opened the doors for the most comprehensive piece of legislation of all, the Americans with Disabilities Act of 1990. This legislation prohibits discrimination on the basis of disability in employment, public services, public accommodations, transportation, and telephone service. These laws have forever changed the social landscape of America. They serve as models for other countries who recognize that their citizens with disabilities are an untapped resource. In our country, individuals with disabilities are seen everywhere, doing everything. Just this past weekend, thousands of physically disabled individuals participated in the New York City Marathon, as they have been doing for years. The expectations that these people set for themselves and the standards we apply to them have increasingly been raised, and now in many circumstances equal those set and applied to other individuals. Unfortunately, one major inequity remains. That is, the loss of health care coverage if an individual on the Social Security disability rolls chooses to work. Individuals with disabilities want to work. They have told me this. In fact, a Harris survey found that 72 percent of Americans with disabilities want to work, but only one-third of them do work. With today's enactment of the Work Incentives Improvement Act of 1999, individuals with disabilities will no longer need to worry about losing their health care if they choose to work a forty-hour week, to put in overtime, or to pursue career advancement. Individuals with disabilities are sitting at home right now, waiting for this legislation to become law. Having a job will provide them with a sense of self-worth. Having a job will allow them to contribute to our economy. Having a job will provide them with a living wage, which is not what one has through Social Security. In addition to continuing health care coverage and providing job training opportunities for individuals with disabilities, this legislation offers many other substantial long-term benefits. The Work Incentives Improvement Act of 1999 will give us access to data regarding the numbers, the health care needs, and the characteristics of individuals with disabilities who work. Furthermore, this legislation will provide the federal government as well as private employers and insurers, the facts upon which to craft appropriate future health care options for working individuals with disabilities. It will allow employers and insurers to factor in the effects of changing health care needs over time for this population. Hopefully, it will even improve the way in which employers operate return-to-work programs. Through increased tracking of data, we will learn the benefits of intervening with appropriate health care, when an individual initially acquires a disability. We will also learn the value of continuing health care to a working individual with a disability. If an individual, even with a severe disability, knows that he or she has access to uninterrupted, appropriate health care, the individual will be a healthier, happier and thus more productive worker. I would like to take the time now to briefly outline the major provisions which have remained as part of this legislation. The conference agreement retains the two state options of establishing Medicaid buy-ins for individuals on Social Security disability rolls, who choose to work and exceed income limits in current law, as well as for those who show medical improvement, but still have an underlying disability. For working individuals with disabilities, the conference agreement extends access, beyond what is allowed in current law, to Medicare. In addition, the legislation before us today retains several key provisions from S. 331, including, the authority to fund Medicaid demonstration projects to provide access to health care to working individuals with a potentially severe disability; the State Infrastructure Grant Program, to assist states in reaching and helping individuals with disabilities who work; work incentive planners and protection and advocacy provisions; and finally, most of the provisions in the Ticket to Work Program. In order to control the cost of this legislation, compromises were made. Although the purpose of the State Infrastructure Grant Program and the Medicaid Demonstration Grant Program remain the same, the terms and conditions of these grants were altered in conference. As a result, states are not required to offer a Medicaid buy-in option to individuals with disabilities on Social Security, who work and exceed income limits in current law, prior to receiving an Infrastructure or a Medicaid Demonstration Grant. Also in Conference, the extended period of eligibility for Medicare for working individuals with disabilities has been changed from 24 to 78 months. During this extended period, the federal government is to cover the cost of the Part A premium of Medicare for a working individual with a disability, who is eligible for Medicare. S. 331 would have extended such coverage for an individual's working life, if he or she became eligible during a 6-year time period. I would like to note two changes to the Ticket to Work program made during Conference. The new legislation shifts the appointment authority for the members of the Work Incentives Advisory Panel from the Commissioner of Social Security to the President and Congress. In addition, language regarding the reimbursements between employment networks and state vocational rehabilitation agencies was deleted in Conference. The new legislation gives the Commissioner of Social Security the authority to address these matters through regulation. Although several changes have been made from the original Work Incentives bill, I am still very pleased with what we are adopting today. This is legislation that makes sense, and it will contribute to the well-being of millions of Americans, including those with disabilities and their friends, their families, and their co-workers. Today's vote provides us the opportunity to bring responsible change to federal policy and to eliminate a misguided result of the current system--if you don't work, you get health care; if you do work, you don't get health care. The Work Incentives Improvement Act of 1999 makes living the American dream a reality for millions of individuals with disabilities, who will no longer be forced to choose between the health care coverage they so strongly need and the economic independence they so dearly desire. In closing, I would like to thank the many people who contributed to reaching this day. I especially thank the conferees, Majority Leader Lott, Senators Roth and Moynihan, and in the House, Majority Leader Armey, and Congressmen Archer, Bliley, Rangel, and Dingell. I also thank their staff who worked so closely in effort to reach this day. From my staff, I thank Pat Morrissey, Lu Zeph, Leah Menzies, Chris Crowley, and Kim Monk. I want to recognize and extend my appreciation to the staff members of my three fellow sponsors of this bill; Connie Garner in Senator Kennedy's office, Jennifer Baxendell and Alexander Vachon with Senator Roth, and Kristen Testa, John Resnick, and Edwin Park from Senator Moynihan's staff. Finally, I wish to thank Ruth Ernst with the Senate Legislative Counsel for her drafting skill and substantive expertise, her willingness to meet time tables, and most of all, her patience. In addition to staff, we received countless hours of assistance and advice from the Work Incentives Task Force of the Consortium for Citizens with Disabilities. These individuals worked tirelessly to educate Members of Congress about the need for and the effects of this legislation. Finally, I would like to urge my colleagues in both chambers to set aside any concerns about peripheral matters and to focus on the central provisions of this legislation. Let's focus on what today's vote will mean to the 9.5 million individuals with disabilities across the nation. At last, these individuals will be able to work, to preserve their health, to support their families, to become independent, and most importantly, to contribute to their communities, the economy, and the nation. We are making a statement, a noble statement and we must do the right thing. Let's send this bill to the President.

Mr. JEFFORDS

Mr. JEFFORDS. Mr. President, I rise today to support an extremely important provision in the budget agreement. A provision which will mean the difference for many dairy farmers around the country on whether they will stay in business or not. The dairy compromise that is included in the budget agreement will help bring stability to the price dairy farmers around the country receive for their product--as well as protect consumers and processors by helping to maintain a fresh local supply of milk. The agreement extends the very successful Northeast Dairy Compact and overturns Secretary Glickman's flawed pricing rule, saving dairy farmers around the country millions of dollars in lost income. Take one look at this chart and you will know why the dairy compromise in the budget agreement is so important to the survival of this country's dairy farmers. Why, because every farmer in every state in the red would lose money out of their pockets if Secretary Glickman's flawed pricing rule known as option 1-B were to be put in place. The dairy compromise corrects this and creates a pricing formula that is fair for both farmers and consumers. For three years the farmers in New England have had a program that works. It's called the Northeast Dairy Compact. Because the Dairy Compact pilot program has worked so well--no less than twenty-five states have approved Compacts and are now asking Congress for approval. Today, I am so pleased two of the people responsible for creating the idea of the dairy compact are here in Washington today. Bobby Starr and Dan Smith are two Vermonters that over 10 years ago put their heads together in an effort to help protect the Vermont way of life. It was my hope and the hope of the majority of the Senate that we could have expanded the compacts into other regions so other states could benefit from having a means of stabilizing prices for both their farmers and consumers. Unfortunately, this time we were not able to expand the dairy compact into other regions. However, a great deal of progress has been made as more and more states are seeing the benefits of protecting their dairy farmers and rural economies through the use of Interstate Compacts. Given the broad support for compacts among the states, we all know that the issue of regional pricing is one that will continue to be debated. I am pleased with the tremendous progress the Southern states and other Northeastern states have made to move their compacts forward. While the debate continues, this reasonable compromise allows the Northeast Compact to continue as the pilot project for the concept of regional pricing The Northeast Dairy Compact has given farmers and consumers hope. The Compact, which was authorized by the 1996 farm bill as a three-year pilot program, has been extremely successful. The Compact has been studied, audited, and sued but has always come through with a clean bill of health. Because of the success of the Compact it has served as a model for the entire country. Mr. President, I am of course aware that some of my colleagues oppose our efforts to bring fairness to our states and farmers by continuation of the Dairy Compact pilot project. Also, unfortunately, Congress has been bombarded with misinformation from an army of lobbyists representing the national milk processors, led by the International Dairy Foods Association (IDFA) and the Milk Industry Foundation. These two groups, backed by the likes of Philip Morris, have funded several front groups to lobby against this compromise. Their handy work has been seen recently in misinformed newspaper editorials, deceiving advertisements and uninformed television ads. Yesterday Senator Leahy and I came to the floor to correct the misinformation contained in the Wall Street Journal Editorial. Mr. President, I would like to take this opportunity to set the record straight about the operation of the Northeast Compact. It is crucial that Congress understand the issues presented by dairy compacts on the merits, rather than based on misinformation. When properly armed with the facts, I believe you will conclude that the Northeast Dairy Compact has already proven to be a successful experiment and that the other states which have now adopted dairy compacts should in the future be given the opportunity to determine whether dairy compacts will in fact work for them as well. Contrary to the claims of the opposition, regional compact regulation remain open to the interstate commerce of all producer milk and processor milk products, from whatever source. Compacts establish neither ``cartels'', ``tariffs'' nor ``barriers to trade'' and are not ``economic protectionism.'' According to the opponents characterizations, dairy compacts somehow establish a ``wall'' around the regions subject to compact regulation, and thereby prohibit competition from milk produced and processed from outside the regions. These are entirely misleading characterizations. It is really quite simple and straightforward: All fluid, or beverage milk sold in a compact region is subject to uniform regulation, regardless of its source within or outside the compact region. This means that all farmers, including farmers from the Upper Midwest, providing milk for beverage sale in the region, receive the same pay prices without discrimination. It can thus be seen that there is no economic protectionism or the erection of barriers to trade. Except for uniform regulation, the market remains open to all, and the benefits of the regulations are provided without discrimination to all participating in the market, including those who participate in the market from beyond the territorial boundaries of the region. Next, I would like to address the actual and potential impact of dairy compacts on consumer prices. In short, opposition claims about the actual and possible impact of dairy compacts on consumers, including low income consumers, are unfounded and grossly distorted. Over the years, while farm milk prices have fluctuated wildly, remaining constant overall during the last ten years, consumers prices have risen sharply. The explanation for this is apparently that variations in store prices do not mirror the wild fluctuations in farm prices. In other words, when farm prices go up, the store prices go up, but when the farm prices recede, the store prices do not come back down as quickly or at the same rate. Hence, and quite logically, if you take away the fluctuations in farm prices, you take away the catalyst for unwarranted increases in store prices. When the 1996 Farm Bill granted consent to the Northeast Dairy Compact as a pilot program, Congress gave the six New England states the right under the compact clause of the Constitution to join together to help regulate the price paid to farmers for fluid milk in the New England region. The six New England states realized that in order to maintain a viable agriculture infrastructure and an adequate supply of milk for the consumers they needed to work together. When the compact passed as part of the 1996 Farm Bill, the opponents were so sure the compact would not operate as its supporters had promised, they asked the Office of Management of Budget to conduct a study on the economic effects of the Northeast Dairy Compact. The opponents of the dairy compact intended for the OMB study to discredit the dairy compact. The study did just the opposite. Instead, the OMB study proved just what we had thought--that the dairy compact works and it works well. The OMB studied the economic effects of the Northeast Dairy Compact and especially its effects on the federal food and nutrition programs. The study also examined the impacts of milk prices at various levels on utilization and shipment of milk, and on farm income both within and outside the Compact region. Here's what the study concluded: The New England retail milk prices were $.05 cents per gallon lower on average then retail milk prices nationally following the first six months of operation of the Northeast Dairy Compact. The compact over-order payments made in New England through the Compact Commission have had little impact on the price consumers pay as a result of the compact. Consumers, who are well represented on the Compact Commission, are very pleased with how the Dairy Compact has operated. The Northeast Dairy Compact has not added any costs to federal nutrition programs, such as the Women, Infants and Children (WIC) and the school lunch and breakfast program, due to compensation procedures implemented by the New England Compact Commission. A program that helps protect farmers and consumers with no cost to the federal government. The OMB study found that the Dairy Compact was economically beneficial to dairy producers. It increased their income from the milk sales about six percent. The study concluded that the retail prices in New England were lower than the national average and it increased the income of dairy producers. No wonder twenty-five states are interested in having compacts in their states. And it's no wonder why governors, state legislatures, consumers and farmers alike support the continuation of the Northeast dairy compact. Also, the OMB study concluded that there were no adverse affects for dairy farmers outside the Compact region and the study noted that some dairy producers outside the region actually received increased financial benefits through the sale of their milk into New England. The OMB study helped Congress understand just how well the compact works. The opponents of the compact did not get what they had hoped for--instead we all have benefitted, both opponents and proponents of the compact, with the facts. Despite what some of my colleagues have said, the Northeast Dairy Compact is working as it was intended to. Instead of trying to destroy an initiative that works to help dairy farmers with no cost to the federal government, I urge my colleagues from the Upper Midwest to respect the states' interest and initiative to help protect their farmers and encourage other regions of the country to explore the possibility of forming their own interstate dairy compact in the future. Mr. President, the Northeast Dairy Compact has worked well. Just think if other commodities and other important resources around the country developed a program that had no cost to the federal government and benefitted both those who produce, sell, and purchase the product.

Mr. JEFFORDS

Mr. JEFFORDS. Mr. President, I rise today to pay tribute to an outstanding Vermonter, Lisa Lindahl. Ms. Lindahl is know to many as an artist, inventor and entrepreneur. She made her mark in the business world by designing the first sports bra and becoming the CEO of the company that successfully marketed the ``Jogbra'' until its sale in 1990 to a major corporation. Ms. Lindahl is also know as a long-time advocate of people with epilepsy. Lisa is deeply committed to bringing to the forefront medical issues which are unique to women living with epilepsy. Her unwavering commitment toward improving the health status of such individuals serves as a testament to us all. She is a stunning example of how one person can positively affect so many. There are now over one million American women who have epilepsy. Lisa has brought national attention to the inequities that exist in the field of research regarding men and women with epilepsy. She launched the National Epilepsy Foundation's Women's Health Campaign and chaired the Women and Epilepsy Task Force. Today, the Women's Health Campaign is a major program for the Epilepsy Foundation in cities and states across the nation. Lisa's efforts have played a significant role on the local level as well. She is a long-standing board member of the Epilepsy Foundation of Vermont and the Epilepsy Foundation of America, where she has served as Chair of the Public Relations Committee, the Resource Development Committee, and as Executive Vice President. Vermont has much to be grateful for when it comes to Lisa's steadfast commitment to improving the quality of life for people living with epilepsy, not only in Vermont, but throughout the country. For that, we owe her our deepest gratitude. Thank you, Lisa.

Mr. JEFFORDS

Mr. JEFFORDS. Mr. President, it is with great pleasure that I rise today in honor of an extraordinary Vermont woman, Sister Elizabeth Candon. On January 1, 2000, Sister Elizabeth will retire from her post as Professor of English at Trinity College, and from a long career in public service. Whether in the role of teacher, college President, or public official, Sister Elizabeth has been a steadfast leader for women and a true advocate for those in need. She is and will remain a stunning example of how one person can positively affect so many. In 1939, Sister Elizabeth Candon began her life of public service when she became a Religious Sister of Mercy. Educated at Trinity College and Fordham University, Sister Elizabeth started her career in 1954, when she returned to her alma mater as an Associate Professor of English and Director of Admissions. In 1966, she became a full Professor of English and Trinity College's President, a post she would hold until 1976. In 1977, Sister Elizabeth left the world of academia to try her hand at state government. At the request of Vermont's Governor, Richard Snelling, Sister Elizabeth took the helm of Vermont's largest agency as Secretary of Human Services. As the first woman in Vermont history to serve as Secretary and the only woman in the Governor's cabinet, Sister Elizabeth quickly became a role model for Vermont women. Her tenure as Secretary also provided her with an opportunity to effect change and help those in need. Under her leadership, community based programs were developed and as a result, the Windsor State Prison and Vergennes' Week's School were both closed. This restructuring allowed the beneficial programs administered at these sites to be relocated throughout the state. Sister Elizabeth was and continues to be tireless in her efforts to institute programs on behalf of those in need of mental health and developmental disabilities services. To this day she is remembered for her motto, ``anything is possible if it matters not who gets the credit.'' Consequently, this legacy has woven its way into the mission of the Agency of Human Services. Since returning to teaching at Trinity as Professor of English in 1983, Sister Elizabeth has continued to bring the beauty and inspiration of Shakespeare and Chaucer to her students. During this time, her steadfast leadership in community and public service has continued. I should also acknowledge that throughout her career, Sister Elizabeth has served on many boards and Councils, further extending her influence on the issues important to her and to Vermonters. She sat on the Vermont Council on the Humanities and Public Issues, the Board of Directors for the United Community Service of Chittenden County, and the Board of Directors of Howard Mental Health Services. She also served as Trustee of Middlebury College and as Chairperson of the State Task Force on Funding for Special Education. She remains a trustee at the Richard A. Snelling Center for Government and a Director of the Vermont Ethics Network. As we celebrate Sister Elizabeth's 46 year career of service to the people of Vermont, I know she will continue to contribute in the years to come. As a Sister of Mercy, she brings honor to her religious community and touches the lives of those around her. While she is retiring at the end of this millennium, her legacy will live on well into the next.

Mr. JEFFORDS

Mr. JEFFORDS. Mr. President, in 1986, the Vaccine Injury Compensation Act was signed into law. The act created the National Vaccine Injury Compensation program which serves two important functions: it provides timely and fair compensation to those few children who are injured from routine immunization and it reduces the adverse effect of the tort system on vaccine supply and cost. Prior to enactment of this bill, the number of U.S. manufacturers of children's vaccines dropped from seven to two due to a flood of lawsuits filed in response to a network television broadcast claiming that vaccine causes brain injuries. This program has been very successful. However, it has come to our attention that the act requires an amendment which I, and the Senator from Massachusetts and the Senator from Tennessee offer today. A vaccine becomes part of the compensation program if it is recommended for routine use in children by the Centers for Disease Control. At such time, the Congress must also enact a Federal excise tax on the vaccine (currently at $.75 per antigen in the vaccine). The excise tax revenues are housed in a Federal trust fund, the sole purpose of which is to pay claims and administer this program. The program and the fund is jointly administered by the Department of Health and Human Services (HHS) and the Department of Justice. HHS publishes a table listing all covered vaccines and events that may be associated with those vaccines as determined by valid scientific studies. Events that are listed on the table, if they occur within the listed time frame, are automatically compensated by the program unless there is demonstration that some other circumstances created the injury. For an event/injury not listed on the table, the claimant must prove causation. If a vaccine is covered under the Vaccine Injury Compensation program, all claims against it must first be filed and processed through the program. Once a claim is adjudicated (and either an award is made or the claim denied), a claimant can reject the program's determination and opt to file a lawsuit. Since the benefit of taking a vaccine accrues not only to the recipient but to society as a whole, the Congress decided that it was also society's responsibility to compensate those who are injured by creating a no-fault program that removes the costliness and uncertainty of the tort system. At the time this law was enacted, parameters were established to permit claims for those serious adverse events that were known to be associated with those vaccines that were then available. The statutory proxy for a serious injury is that the residual effect from the injury must be of six months' duration or longer. Recently, however, a new situation has developed that was not foreseeable at the time of enactment of this law. In October 1999, the CDC's Advisory Committee on Immunization Practices (ACIP), after a review of scientific data from several sources, concluded that intussusception occurs with significantly increased frequency in the first 1-2 weeks after vaccination for rotavirus, particularly after the first dose. Thus, the ACIP withdrew its recommendation for vaccination of infants for rotavirus in the United States. While most cases of intussusception require only minimal treatment, a few cases require hospitalization and surgery. Under the current law, these cases would not be compensable by the United States Claims Court under the Vaccine Injury Compensation Program, since the statute grants jurisdiction to resolve vaccine cases only in instances in which claimants have suffered the residual effects or complications of a vaccine-related injury for at least six months, or died from the administration of a vaccine. For this reason, we are offering this bill to amend the law and grant jurisdiction to the Claims Court to resolve compensation cases under the Program in cases in which both hospitalization and surgical intervention were required to correct the ``illness, disability, injury or condition'' caused by the vaccine. Mr. President, this language has been shared with, and is supported by officials at HHS and the American Academy of Pediatrics. To our knowledge, the amendment would only apply to circumstances under which a vaccine recipient suffered from intussusception as a result of administration of the rotavirus vaccine. The amendment is not intended to expand jurisdiction to other vaccines listed in the Program's Vaccine Injury Table. We note that this amendment does not address the issue of whether the condition is in fact caused by the vaccine; this is a matter for resolution under other provisions of the no-fault compensation law. Among these are the requirement that the condition either be listed in the Vaccine Injury Table or be established to have been caused in fact by the vaccine. Determinations of this type should only be made after thorough consideration of the scientific evidence by experts in the field; the law commits this issue to the Secretary for consideration in the context of changes to the Vaccine Injury Table through rulemaking, and to the Claims Court for determinations of causation in fact.

Mr. JEFFORDS

Mr. JEFFORDS. Mr. President, exactly one year ago today, Mike Tighe of Barnard, Vermont boarded a commercial aircraft for a flight to Los Angeles, California. As the plane cruised at about 35,000 feet, Mr. Tighe suffered a deadly heart attack. To make a long story short, Mike is alive and well today, because the aircraft in which he was a passenger had, only two days before that fateful flight, installed an Automated External Defibrillator for use in such an emergency. Today, Mr. President, I am proud to say that the Senate has passed a bill, the Cardiac Arrest Survival Act of 1999, that will make it much easier for federal, state and local government to place these lifesaving devices in public buildings and emergency response units. Automated External Defibrillators, known as AEDs, are small, easy-to- use, laptop size devices that can analyze heart rhythms to determine if a shock is necessary and, if warranted, prompt the user to deliver a life-saving shock to the heart. Research shows us that for every minute that passes before a cardiac arrest victim is defibrillated, the chance of survival falls by as much as ten percent. Research also shows that 250 lives can be saved each day from cardiac arrests by using the AED. This legislation will help reduce unnecessary and life-threatening minutes of delay, ensuring that public access to defibrillation programs are implemented in the hundreds of thousands of federal buildings. The Cardiac Arrest Survival Act of 1999, which was introduced by Senator Gorton and referred to the committee that I chair, the Committee on Health Education, Labor and Pensions, has broad bipartisan support, as well as the strong support of the American Heart Association, American Red Cross, and representatives of thousands of first response units across America. I would like to congratulate and thank all my colleagues for passing this legislation today, and especially Senator Gorton, who introduced this bill in August, and has worked tirelessly to get it completed before adjournment. But most of all, Mr. President, I would like to congratulate Mike Tighe as he celebrates the one year anniversary of the deadly heart attack that he survived because the airplane that he was traveling in was equipped with an Automated External Defibrillator. I hope the bill we passed today moves through the legislative process and is signed into law just as soon as possible next year, so that the estimated 1000 Americans who suffer from sudden cardiac arrests each day will have the same chance that Mr. Tighe did.

Mr. JEFFORDS

Mr. JEFFORDS. Mr. President, I ask unanimous consent that morning business be extended until 1 p.m. with the time equally divided in the usual form.

Mr. JEFFORDS. Mr. President, I thank the Senator from Massachusetts. I would be happy if he desires to more fully discuss what we have done. I was not here to hear his full speech. I thank him. We have worked together. He was here years before I came to the Senate. In 1975, we had the initial big step forward for the disabled and were able to set up the 94142, as it was called then, to make sure all children got a good education, and specially those with disabilities. As we have walked through this over a period of many years, we have fought year by year to remove block by block what the disabled community has had to face. Finally, we are at that point where we are opening the final door to allow them to do what all disabled want to do, and that is to have a meaningful life, to be able to seek employment, and get employment without having the doors slammed because they lost their benefits. I can't thank the Senator enough for what he has done. Also, there are others, some who have left this body, such as Bob Dole, who was another leader for the disabled. I praise him also for the work he did, and especially in this area where he helped us introduce the bill that we were so happy to be able to cosponsor and to see it put into the final steps. I thank the Senator from Massachusetts profusely for all he has done. I would be happy to yield for any further comment.

Mr. JEFFORDS. Mr. President, again, I thank the Senator from Massachusetts for those comments and for all the work he has done. I am delighted to stand before you today, to speak about an extremely important piece of legislation. The bill we are sending to the President today, a bill I know he is eager to sign into law, will have a tremendous impact on people with disabilities. In fact, this legislation is the most important piece of legislation for the disability community since the Americans with Disabilities Act. My reason for sponsoring this particular piece of legislation is quite simple. The Work Incentives Improvement Act of 1999 addresses a fundamental flaw in current law. Today, individuals with disabilities are forced to make a choice . . . an absurd choice. They must choose between working and receiving health care. Under current federal law, if people with disabilities work and earn over $700 per month, they will lose cash payments and health care coverage under Medicaid or Medicare. This is health care coverage that they need. This is health care coverage that they cannot get in the private sector. This is not right. Once enacted, the Work Incentives Improvement Act of 1999 will allow individuals with disabilities, in states that elect to participate, continuing access to health care when they return to work or remain working. In addition, those individuals who seek it, will have access to job training and job placement assistance from a wider range of providers than is available at this time. Currently, there are 9.5 million individuals with disabilities across the country who receive cash payments and health care coverage from the federal government. Approximately 24,000 of these individuals live in my home state, Vermont. Once enacted, the Work Incentives Improvement Act will actually save the federal government money. For example, let's assume that 200 Social Security disability beneficiaries in each state return to work and forgo cash payments. That would be 10,000 individuals out of the 9.5 million individuals with disabilities across the country. The annual savings to the Federal Treasury in cash payments for just these 10,000 people would be $133,550,000! Imagine the savings to the Federal Treasury if this number were higher. Clearly, the Work Incentives Improvement Act of 1999 is fiscally responsible legislation. I began work on this bill in 1996. Though it was a long and sometimes difficult task, many hands made light work. Senator Kennedy, Ranking Member on the HELP Committee, joined me in March of 1997. Senators Roth and Moynihan, Chairman and Ranking Member on the Finance Committee signed on as committed partners in December of 1998. Last January, 35 of our colleagues, from both sides of the aisle, joined us in introducing S. 331, the Senate version of this legislation. One week later, in a Finance Committee hearing, we heard compelling testimony from our friend, former Senator Dole, a strong supporter of this legislation. A month later, we marked this legislation out of the Finance Committee with an overwhelming majority in favor of the bill. Finally, on June 15th, with a total of 80 cosponsors, we passed this legislation on the floor of the United States Senate, with a unanimous vote of 99-0. Four months later, over 35 of our colleagues in the House of Representatives, took to the floor of their chamber, and spoke eloquently for their version of this legislation. Later that day, the bill passed the floor of the House with a vote of 412-9. Since then, the Senate and House Conferees have been working diligently in effort to reach common ground. I am very pleased today, that the differences in policy in the two different bills have been resolved and consensus has been reached on a conference agreement. This agreement does not compromise the original intent of the legislation, retaining key provisions from S. 331. From my perspective, the Work Incentives Improvement Act of 1999 represents a natural and important progression in federal policy for individuals with disabilities. That is, federal policy increasingly reflects the premise that individuals with disabilities are cherished by their families, valued and respected in their communities, and are an asset and resource to our national economy. Today, most federal policy promotes opportunities for these individuals, regardless of the severity of their disabilities, to contribute to their maximum potential--at home, in school, at work, and in the community. I have been committed to improving the lives of individuals with disabilities throughout my Congressional career. Providing a solid elementary and secondary education for children with disabilities, so that they will be equipped, along with their peers, to benefit from post-secondary and employment opportunities is crucial. When I came to Congress in 1975, Public Law 94-142, the Education for all Handicapped Children Act, now the Individuals with Disabilities Education Act (IDEA), was enacted into law. IDEA assures each child with a disability, a free and appropriate public education. I am proud to be one of the original drafters of this legislation which has reshaped what we offer to and expect of children with disabilities in our nation's schools. In addition, I have been committed to providing job training opportunities for individuals with disabilities. In 1978, I played a central role in ensuring access to programs and services offered by the federal government for individuals with disabilities through an amendment to the Rehabilitation Act. I believe that this amendment alone laid the foundation for significant legislation that followed, including the Technology-Related Assistance for Individuals with Disabilities Act of 1988, now the Assistive Technology Act of 1998, both of which I drafted. Most importantly, this legislation opened the doors for the most comprehensive piece of legislation of all, the Americans with Disabilities Act of 1990. This legislation prohibits discrimination on the basis of disability in employment, public services, public accommodations, transportation, and telephone service. These laws have forever changed the social landscape of America. They serve as models for other countries who recognize that their citizens with disabilities are an untapped resource. In our country, individuals with disabilities are seen everywhere, doing everything. Just this past weekend, thousands of physically disabled individuals participated in the New York City Marathon, as they have been doing for years. The expectations that these people set for themselves and the standards we apply to them have increasingly been raised, and now in many circumstances equal those set and applied to other individuals. Unfortunately, one major inequity remains. That is, the loss of health care coverage if an individual on the Social Security disability rolls chooses to work. Individuals with disabilities want to work. They have told me this. In fact, a Harris survey found that 72 percent of Americans with disabilities want to work, but only one-third of them do work. With today's enactment of the Work Incentives Improvement Act of 1999, individuals with disabilities will no longer need to worry about losing their health care if they choose to work a forty-hour week, to put in overtime, or to pursue career advancement. Individuals with disabilities are sitting at home right now, waiting for this legislation to become law. Having a job will provide them with a sense of self-worth. Having a job will allow them to contribute to our economy. Having a job will provide them with a living wage, which is not what one has through Social Security. In addition to continuing health care coverage and providing job training opportunities for individuals with disabilities, this legislation offers many other substantial long-term benefits. The Work Incentives Improvement Act of 1999 will give us access to data regarding the numbers, the health care needs, and the characteristics of individuals with disabilities who work. Furthermore, this legislation will provide the federal government as well as private employers and insurers, the facts upon which to craft appropriate future health care options for working individuals with disabilities. It will allow employers and insurers to factor in the effects of changing health care needs over time for this population. Hopefully, it will even improve the way in which employers operate return-to-work programs. Through increased tracking of data, we will learn the benefits of intervening with appropriate health care, when an individual initially acquires a disability. We will also learn the value of continuing health care to a working individual with a disability. If an individual, even with a severe disability, knows that he or she has access to uninterrupted, appropriate health care, the individual will be a healthier, happier and thus more productive worker. I would like to take the time now to briefly outline the major provisions which have remained as part of this legislation. The conference agreement retains the two state options of establishing Medicaid buy-ins for individuals on Social Security disability rolls, who choose to work and exceed income limits in current law, as well as for those who show medical improvement, but still have an underlying disability. For working individuals with disabilities, the conference agreement extends access, beyond what is allowed in current law, to Medicare. In addition, the legislation before us today retains several key provisions from S. 331, including, the authority to fund Medicaid demonstration projects to provide access to health care to working individuals with a potentially severe disability; the State Infrastructure Grant Program, to assist states in reaching and helping individuals with disabilities who work; work incentive planners and protection and advocacy provisions; and finally, most of the provisions in the Ticket to Work Program. In order to control the cost of this legislation, compromises were made. Although the purpose of the State Infrastructure Grant Program and the Medicaid Demonstration Grant Program remain the same, the terms and conditions of these grants were altered in conference. As a result, states are not required to offer a Medicaid buy-in option to individuals with disabilities on Social Security, who work and exceed income limits in current law, prior to receiving an Infrastructure or a Medicaid Demonstration Grant. Also in Conference, the extended period of eligibility for Medicare for working individuals with disabilities has been changed from 24 to 78 months. During this extended period, the federal government is to cover the cost of the Part A premium of Medicare for a working individual with a disability, who is eligible for Medicare. S. 331 would have extended such coverage for an individual's working life, if he or she became eligible during a 6-year time period. I would like to note two changes to the Ticket to Work program made during Conference. The new legislation shifts the appointment authority for the members of the Work Incentives Advisory Panel from the Commissioner of Social Security to the President and Congress. In addition, language regarding the reimbursements between employment networks and state vocational rehabilitation agencies was deleted in Conference. The new legislation gives the Commissioner of Social Security the authority to address these matters through regulation. Although several changes have been made from the original Work Incentives bill, I am still very pleased with what we are adopting today. This is legislation that makes sense, and it will contribute to the well-being of millions of Americans, including those with disabilities and their friends, their families, and their co-workers. Today's vote provides us the opportunity to bring responsible change to federal policy and to eliminate a misguided result of the current system--if you don't work, you get health care; if you do work, you don't get health care. The Work Incentives Improvement Act of 1999 makes living the American dream a reality for millions of individuals with disabilities, who will no longer be forced to choose between the health care coverage they so strongly need and the economic independence they so dearly desire. In closing, I would like to thank the many people who contributed to reaching this day. I especially thank the conferees, Majority Leader Lott, Senators Roth and Moynihan, and in the House, Majority Leader Armey, and Congressmen Archer, Bliley, Rangel, and Dingell. I also thank their staff who worked so closely in effort to reach this day. From my staff, I thank Pat Morrissey, Lu Zeph, Leah Menzies, Chris Crowley, and Kim Monk. I want to recognize and extend my appreciation to the staff members of my three fellow sponsors of this bill; Connie Garner in Senator Kennedy's office, Jennifer Baxendell and Alexander Vachon with Senator Roth, and Kristen Testa, John Resnick, and Edwin Park from Senator Moynihan's staff. Finally, I wish to thank Ruth Ernst with the Senate Legislative Counsel for her drafting skill and substantive expertise, her willingness to meet time tables, and most of all, her patience. In addition to staff, we received countless hours of assistance and advice from the Work Incentives Task Force of the Consortium for Citizens with Disabilities. These individuals worked tirelessly to educate Members of Congress about the need for and the effects of this legislation. Finally, I would like to urge my colleagues in both chambers to set aside any concerns about peripheral matters and to focus on the central provisions of this legislation. Let's focus on what today's vote will mean to the 9.5 million individuals with disabilities across the nation. At last, these individuals will be able to work, to preserve their health, to support their families, to become independent, and most importantly, to contribute to their communities, the economy, and the nation. We are making a statement, a noble statement and we must do the right thing. Let's send this bill to the President. Thank you, Mr. President.

Mr. JEFFORDS

Mr. JEFFORDS. Mr. President, I will take a moment to react to an editorial which I read this morning in the Wall Street Journal which had so many errors and erroneous comments that it shocked me to find out that such a fine newspaper as the Wall Street Journal would carry this. I have been in Congress now 24 years, and as a result of unusual circumstances, for many years I had been sort of the leader of dairy for the Republicans in the House. That occurred because I was elected during the Watergate year. During the Watergate year, there were 92 freshmen Representatives who were elected and only 16 were Republicans. So all of us who came in that year immediately got seniority because there were not any other Members around. I got to be the ranking member on the dairy subcommittee my first year. During that time, some 24 years, one thing I could be assured of was that any time something was going to come to the benefit of the dairy farmers, the Wall Street Journal, the New York Times, and the Washington Post would all write adverse editorials. Why is that? Well, do the dairy farmers buy any advertising in these newspapers? Of course, they don't. Who does buy the advertising? It is those who purchase milk. What is their motivation? To keep the dairy farmers getting the least money possible so they can maximize their profits. And they have done a masterful job. But they also have a propensity, either because they, without any checking, believe everything told to them by the processors who pay for their ads or they just ignore the truth. The Wall Street Journal article of this morning was a very typical example. I will run through some of the facts that were utilized in this great paper to point out the errors. First of all, they make statements which are just not true. They say we have to have a compact because our farmers are less efficient than the Midwestern farmers. Well, that is absolutely not true. Both are very efficient. The differences in the two areas are dramatic, but they are not relative to efficiency. Obviously, the Midwest farmers have an advantage because they are closer to the grain markets. They have more people producing cheese, and they have soils that are preferable to many of the other areas of the country, especially New England. So they have an advantage, not a disadvantage, by being not only efficient--and I don't think our farmers are any more efficient than theirs --but having lower costs to start with. So to make the statement that it is all based upon inefficiency is absolutely ridiculous. Then this statement: Never mind that this milk costs consumers to the tune of about 20 extra cents a gallon. This is absolutely false. In fact, one of the ironic aspects of this whole argument occurred back when the compact first went into effect and the Midwestern farm representatives said: We will show them. We will show that this is all due to efficiency and all those kinds of things. So they asked OMB, not GAO or whoever else. Why? Because OMB was sympathetic to the administration at that time and they wanted help from the White House to try to back up their arguments. Well, what happened? OMB did an analysis of the impact of the compact and found out just the opposite. Do we hear them quote that anymore? No. I have to bring it up every time. They still--either their friends in the newspapers that make the money off advertising or sometimes they do it themselves--ignore the fact that the study they asked for came back saying that, contrary to what they were telling people, actually the consumers in New England, where the compact was in effect, paid 5 cents less a gallon--not 20 cents more a gallon, 5 cents less a gallon--than the average in the rest of the country. But they still print something which they know is absolutely incorrect. Also, for a conservative newspaper such as the Wall Street Journal--I wouldn't give that same label to the New York Times and the Washington Post--the Wall Street Journal should recognize that all of these States, all six States, are taking advantage of the Constitution which says that States can, if they want to, ask Congress for permission to create a commission to allow them to join together to sort of control or impact interstate commerce. Well, the States have the right to do that and the States did do it. The New England States got together and said: Well, let us take a look and see what we can do to have a more organized pricing system. One has to understand a little bit about how the farming goes. If you are a dairy farmer, you have milk and you have to get rid of it. It is going to last about 3 days before you will have to throw it out. So you are at the mercy of the market. You can form cooperatives and things such as that, but no matter what you do, the milk has to go somewhere or it is going to spoil. The thought was, instead of leaving ourselves at the mercy --and this is the basic part of the situation--of the processors, the people who buy the milk, who can sit there 2\1/2\ days and say: Well, it is going to be worthless tomorrow; I will give you 5 cents a gallon--well, it never gets quite that bad, but that is the kind of power they have. They don't want to lose that power. They want to be able to dictate to the dairy farmers the price they are going to get. The New England farmers got together and worked with their various legislators and decided, why don't we set up a commission that would have consumers represented, processors represented, farmers represented, and the general interest of the public represented. We will set what the price will be, keeping in mind that we don't want to end up with a huge surplus. We want to make it fair but make sure the consumers don't lose on this--in fact, maybe even gain--and the dairy farmers will gain because they will have a stable market situation. It worked so well that, as I said, the price to consumers actually went down. I could speak at length on that, but it went down. The farmers got a significantly better price overall. They were happy. The processors got a fair price, and they haven't screamed, those that are participating in it. It is a good system. That is the problem with it. It is a good system. Why does that scare the processors? They would rather get the lowest price possible to pay to the farmers and so they have lost that control. But to the Midwest, it shakes them up because what was their dream? Their dream was that all of the dairy farmers in the United States would go out of business except in the Midwest. And they are so sure they could provide all the milk the country needs, so why do we not put them out? Well, the commission worked. The price to consumers has gone down, the farmers are getting a fair price, and the processors are not being injured in any way. That is why 25 States, now a total of 25, including New England, have said that is a great idea. Everybody is happy. What a wonderful situation. The processor is happy, consumers are paying less in price, and everybody is happy. So why don't we join? Well, that, of course, has now made it a big threat to the Midwest. Because if the whole country goes to compacts, the farmers will stay in business, and the market expansion that the Midwest was hoping for won't occur. That is why we are here today. The States have recognized that it is essential to make sure their farmers survive. Why is that? The basic concept of the law right now, from the 1930s and rewritten in the Farm Act of 1947, said it is critical that we ensure that every area of this Nation has an adequate supply of fresh milk. That is basic law; that is, to make sure that when you go to your store, there is always some fresh milk for you there. That is the basic law. All these States that are going into compacts are saying: We want to make sure that our area of the country has an adequate supply of fresh milk, and we ought to be able to do that. So that is what the real fight is about. We have already had the editorial I anticipated in the Post. The Wall Street Journal came through right on time with one I anticipated. Theirs is so incredibly inaccurate in what they cite, it was a little embarrassing, on behalf of the paper, to read that. I expect the New York Times will follow suit probably in the next couple of days. I want to make sure these facts are out there. What this Nation needs is stable farming. We all love our farmers. I can't think of Vermont or New England without the cows on the hillside. I can't think of what the Southeast would be without the ability of their farmers to produce milk. And they have, because of the weather situation and all, special problems in the Southeast, being able to produce milk at reasonable prices. But they are doing very well. They want to form a compact. The same is true in other parts of the country. What is wrong with people in the region getting together and deciding how to do it? Another argument raised, which will be one for other editorials, is that it causes higher prices for WIC--Women, Infants and Children--and food. That is all taken care of by the commission. Farmers in the Midwest, right now, on an average, receive significantly more in the checks they get on a weekly or monthly basis--what they call the ``mailbox price.'' They do better than the rest of the country. So they are not the ones suffering. They have advantages, as I pointed out, in cost of production and those things. They are doing well. They just want to be sure they can perhaps have a better future by shipping more milk. Incidentally--and I will leave you with this because the statements are that this is somehow infringing on commerce and the ability of people to sell--they can bring their milk down now and sell it in the New England area. Why don't they? It costs too much to ship it down there. But the market is open; it is not closed out. There are no barriers built up to where the farmers can ship milk. In fact, the New England compact is in place right now, but a great deal of the milk comes from New York, Pennsylvania, New Jersey, and wherever else anyone wants to ship it. The New England area itself is a negative producer. So we depend upon milk coming from other areas. When you come in, you know you are going to be bound by the price that is established by the commission. That, again, represents consumers, producers, the dairy farmers, the processors, the people who buy it, and it protects programs such as WIC. It is working so well. That is the problem. Just remember, the reason for all the controversy right now is that this program is working so well for consumers, processors, and the producers, and it is a danger to those who want to do away with our local farming businesses. Mr. President, I see no other Member present, so I suggest the absence of a quorum.

Mr. JEFFORDS

Mr. JEFFORDS. Mr. President, I ask unanimous consent that the period for morning business be extended to the hour of 2:30 p.m. and that the time be equally divided in the usual form.

Mr. JEFFORDS. Mr. President, I yield myself such time as I may consume, or whatever.

Mr. JEFFORDS

Mr. JEFFORDS. Mr. President, it gives me great pleasure to stand before the Senate today and pay tribute to a man who has greatly influenced the cultural maturity of my home state of Vermont. Graham Stiles Newell will be honored as Citizen of the Year by the Vermont Chamber of Commerce on December 4, 1999. Graham has made extraordinary contributions to Vermont in many areas throughout his life. And he has made his biggest contributions in one area in which I have spent a great deal of legislative energy--education. Graham Newell probably learned to read before he learned to walk. I understand that he first secured a library card at the Saint Johnsbury Atheneum when he was in the first grade. Since then, he has been passing on his knowledge to anyone willing to learn, and that number is larger than you can imagine. After graduating from the University of Chicago in 1938, he launched an incredible career in education, one that touched three generations of many Vermont families. Graham has been a leader in Vermont education in both the professional and legislative arenas. In the last seven decades he has been a teacher at the Junior High, High School, and College level, and will undoubtably keep teaching well into the next millennium. Graham began his teaching career at his alma mater, Saint Johnsbury Academy, in 1938, and remained on the faculty for nine years. From 1945 to 1982 he taught history at Lyndon State College full-time. After ``retiring'' in 1982, he returned to the Academy to teach Latin, where you will still find him today. He also continued to teach one or two history classes a semester at Lyndon State College until 1996. Most people consider Latin a dead language, but if you were to enter Graham's classroom today you would find it to be as alive and enjoyable as ever. A testament to Graham's teaching skills was demonstrated at the Academy in 1997, when 47 of his 52 Latin students, over 90 percent, made honors on the National Latin Exam, an extremely challenging test taken by over 90,000 students across the United States. Graham's contributions to education do not end in the classroom. While teaching, he also served in the Vermont Legislature for over 25 years. He was a member and chair of the Vermont Senate Education Committee during the 1960s, helping to create Vermont's education laws. Indeed, the self proclaimed Ambassador of the Northeast Kingdom has positively affected every single student in the state of Vermont over the last 30 years. In fact, his influence has even reached students outside of Vermont, due to his tenure on the New England Board of Higher Education. But Graham always remained supremely faithful to the students in his classroom, once even teaching class over the phone from the Vermont Statehouse. One can look at Graham's education accomplishments alone and see a lifetime of work and success. However, his influence has touched many in other fields as well. As President of the Vermont Historical Society from 1965 to 1969, his many successes included securing a permanent home for the organization in the historic Pavilion Office Building in Montpelier. He has also served on a number of commissions, including the Commission on Interstate Cooperation, the Historic Sites Commission, the Commission to Study State Government (or ``Little Hoover'' as we called it), the Vermont Civil War Centennial Commission, the board of managers of the Council of State Governments, and the Education Commission of the States. In addition, the thousands of people who check into the Northeastern Vermont Regional Hospital each year should be thankful to Graham as he is largely responsible for its existence. I could go on, but I'm afraid it would take the remainder of this session of congress to do so. I am thankful for the opportunity to provide my colleagues with a shining example of a real Vermont renaissance man. I join countless Vermonters in offering my heartfelt congratulations and gratitude to Graham Stiles Newell for his many years of hard work and dedication to the citizens of Vermont.

Mr. JEFFORDS

Mr. JEFFORDS. Mr. President, I am proud to stand before my colleagues today and pay tribute to a couple who have so positively influenced the people of Washington County, Vermont over the course of their lives. William and Olene Doyle will be honored as the Washington County Citizens of the Year by the Green Mountain Council of Boy Scouts on November 22nd, 1999. My old friend Bill Doyle has navigated a well rounded career as a teacher, politician, and author. Since 1958, he has been teaching history and government at Johnson State College. In 1968, he was elected to serve as one of Washington County's three State Senators, a role in which he has thrived for over three decades. As a skilled teacher and a master of parliamentary rules, Bill has been an invaluable mentor and mediator in the Vermont State House. Bill has written two books, including The Vermont Political Tradition, which is regarded by many to be a ``must read'' on Vermont political history. He has also taken his passion for government and politics and created the annual ``Doyle Poll,'' our yearly gauge of public opinion on the hottest and sometimes most controversial issues facing Vermonters. While admittedly unscientific, the poll's results are soundly reflective of Vermont sentiment. As the son of an art teacher, I have always held a deep respect for the arts and for those who are able to inspire creativity in our nation's young people. Olene Doyle has taught art in elementary, secondary, and higher education institutions in the central Vermont region. Her dedication to arts and education led her to volunteer positions on the local school board in Montpelier, as well as on the board of the Wood Art Gallery, where, incidently, I now hold the annual Congressional Arts Competition. Bill and Olene raised three wonderful children. However, they have never stopped teaching as evidenced by their ongoing community service and involvement in their local church and non-profit organizations. Given the countless hours they dedicate to community service, it is noteworthy that the couple finds the time to pursue personal hobbies such as golf and gardening. And while I have never had the privilege of seeing the Doyle gardens, I have been told they are a vibrant reflection of the dedication which Bill and Olene give to everything they do. I am thankful for the opportunity to express my heartfelt praise. I can think of few couples more worthy of this award. Years of partnership and devotion to each other have inevitably spilled over into the Vermont community, where Bill and Olene have truly made their mark as two of Vermont's most influential and giving people.

Mr. JEFFORDS

Mr. JEFFORDS. Mr. President, there has been considerable attention rightfully paid by our colleagues this year to the issue of providing prescription drug coverage for our older American citizens. Estimates of the number of older Americans without some form of added coverage for prescription drugs vary between a low of 16.7 percent to 50 percent. About 7.7 million Medicare beneficiaries with annual incomes below 200 percent of poverty have no prescription drug coverage, despite some evidence indicating they are in poorer health than those beneficiaries with coverage. Those without added coverage for prescription benefits spend approximately 50 percent of their total income on out-of-pocket health care costs, and there are anecdotal reports that some elders forgo taking their prescribed medicines in order to have food to eat. Finally, there are econometric studies that conclude that a $1 increase in pharmaceutical expenditure is associated with a $3.65 reduction in hospital care expenditure. The problems posed by the lack of prescription drug coverage for the neediest elders is compounded by the well-documented effects of inappropriate drug use among the elderly. In 1995, the General Accounting Office (GAO) found that inappropriate drug use among elders is acute and that elders were particularly susceptible to unintended, adverse drug events (ADEs), due in part to the natural aging process and also to the likelihood that they are taking multiple medications. One study of drug use by the elderly, done by the Vermont Program for Quality in Health Care, found that it was not uncommon for elders to be taking more than a dozen drugs at one time. In fact, the Vermont study actually documented one case in which ``a single individual received prescriptions for 71 different drugs in a single year, several of which probably should not have been taken in combination.'' The GAO report also cited studies showing that hospitalizations for elderly patients due to ADEs were six times greater than for the general population, with an estimated annual cost of $20 billion. However, a recent Journal of the American Medical Association article indicated that the level of ADEs could be reduced 66 percent, if a pharmacist participated in grand rounds. Clearly, more must be done to recognize the importance of medication management programs that ensure the quality of drug therapy, including patient evaluations, compliance assessments, and drug therapy reviews. We are all aware that prescription drug costs continue to grow at an alarming rate. Seniors are being forced to spend greater and greater portions of their fixed incomes on prescription drugs which they need to live. Research and development of prescription drugs have come a long way since Medicare was originally enacted in 1965. Today, drugs are just as important as hospital visits, and in many cases more important, and it just doesn't make sense for Medicare to reimburse hospitals for surgery but not to provide coverage for the drugs that might prevent surgery. We need to modernize the Medicare program so that it does not go bankrupt in the next 10 to 15 years, and at the same time we must ensure that any Medicare reform proposal we consider includes a prescription drug benefit that helps all seniors. Mr. President, I have already introduced two measures that will help our older citizens obtain the medicines they need and at prices they can afford. My first bill, S. 1462, the ``Personal Use Prescription Drug Importation Act of 1999,'' allows Americans of all ages to avail themselves of the lower prices for prescription medicines that are available in Canada. A second measure, S. 1725, the ``DrugGap Insurance for Seniors Act of 1999,'' would provide for a more comprehensive access to prescription drugs by Medicare beneficiaries through reform and modernization of the Medicare Supplemental, Medigap, program. Under this approach, all existing Medigap plans, and three new drug-only Medigap plans, would provide various levels of prescription drug benefits from which seniors could choose. And our neediest elders' needs would be supported through Federal contributions for the cost of their premiums. During the 1st Session of the 106th Congress, no fewer than eight bills have been introduced in the Senate to provide a prescription drug benefit for Medicare beneficiaries--with most proposals estimated to cost between $5 billion and $40 billion per year. While I'm hopeful that we will all work hard to include a prescription drug benefit for Medicare beneficiaries, I am also concerned that at the end of the Congress we may not be successful. That is why I am introducing a measure today, the ``Pharmaceutical Aid to Older Americans Act,'' which will serve as a backstop for our neediest elders. This program builds on State pharmacy assistance programs that are already in place, and it encourages States to begin them where they don't already exist. Fifteen States are cutting new and innovative paths for providing prescription drug coverage for their neediest citizens. Most of these programs are for elder citizens (more than half also cover people with disabilities), and cover a wide variety of drugs--though some are limited to certain drugs or conditions, some require cost sharing for prescription medicines, and some have annual enrollment fees or monthly premiums. As of 1997, these programs aided over 700,000 people. The Pharmaceutical Aid to Older Americans Act is designed to assist States in their efforts to provide medicines and appropriate pharmacy counseling benefits for their neediest elders. This Act will strengthen the Older Americans Act by authorizing two discretionary grant programs, subject to appropriations, to fund State- based pharmaceutical assistance and medication management programs. Under this measure, States would develop models that work best for them and would have the latitude to design and implement innovative approaches for providing benefits to their neediest elders. States awarded grant money would agree to: match Federal funds with 30 percent new or existing State funds or in-kind contributions and not supplant current State expenditures with Federal funds. In-kind contributions counting toward the match requirement could include assistance from pharmaceutical companies and organization- and community-based pharmacies, thereby making this approach a truly public-private partnership. Each application for pharmaceutical assistance funds must include a medication management program that ensures the quality of drug therapies through patient evaluations, compliance assessments, and drug therapy reviews. Federal funds could be used to provide drug coverage benefits only to eligible beneficiaries, defined as Medicare beneficiaries with incomes up to 200 percent of poverty but without any other coverage for prescription drug benefits (States could expand eligibility with State resources). All senior citizens could utilize the medication management portion of the program. This is not government control of drug prices or price-fixing. The States can purchase pharmaceuticals from any willing seller, including pharmaceutical manufacturers, pharmaceutical distributors, wholesalers, pharmacy benefit management firms (PBMs), and chain or local pharmacies, without any Federal requirement for wholesale prices or Medicaid-based rebates. In some instances, it's likely that States may be able to negotiate better purchasing prices than any of those set by some artificial, imposed ceiling. Finally, for those States that choose not to provide pharmaceutical benefits, the Act authorizes grants to States to create or support stand-alone Medication Management Programs that will involve the States in collaborative efforts with community, chain-based, and institutional pharmacists to implement medication management programs. As I mentioned earlier, Mr. President, I am fully committed to providing a prescription benefit for all our elders as we move forward on comprehensive reform of the Medicare program. I am equally committed to seeing that the Older Americans Act is reauthorized this Congress, and I will work diligently to get these jobs accomplished. However, if the latter effort succeeds and the former doesn't, then the Pharmaceutical Assistance for Older Americans Act will be in place to provide much-needed medicines for our neediest elders. I'm very pleased Mr. President, that this measure has received endorsement of two of the key advocacy organizations associated with the Older Americans Act, the National Association of Area Agencies on Aging and the National Association of State Units on Aging. Note that these guardians of the aged support this measure, like me, if and only if we are unsuccessful in passing a prescription drug benefit for the Medicare program. Mr. President, I ask unanimous consent that the bill and the text of these letters and this measure be printed in the Record.

Mr. JEFFORDS

Mr. JEFFORDS. Mr. President, there has been considerable attention rightfully paid by our colleagues this year to the issue of providing prescription drug coverage for our older American citizens. Estimates of the number of older Americans without some form of added coverage for prescription drugs vary between a low of 16.7 percent to 50 percent. About 7.7 million Medicare beneficiaries with annual incomes below 200 percent of poverty have no prescription drug coverage, despite some evidence indicating they are in poorer health than those beneficiaries with coverage. Those without added coverage for prescription benefits spend approximately 50 percent of their total income on out-of-pocket health care costs, and there are anecdotal reports that some elders forgo taking their prescribed medicines in order to have food to eat. Finally, there are econometric studies that conclude that a $1 increase in pharmaceutical expenditure is associated with a $3.65 reduction in hospital care expenditure. The problems posed by the lack of prescription drug coverage for the neediest elders is compounded by the well-documented effects of inappropriate drug use among the elderly. In 1995, the General Accounting Office (GAO) found that inappropriate drug use among elders is acute and that elders were particularly susceptible to unintended, adverse drug events (ADEs), due in part to the natural aging process and also to the likelihood that they are taking multiple medications. One study of drug use by the elderly, done by the Vermont Program for Quality in Health Care, found that it was not uncommon for elders to be taking more than a dozen drugs at one time. In fact, the Vermont study actually documented one case in which ``a single individual received prescriptions for 71 different drugs in a single year, several of which probably should not have been taken in combination.'' The GAO report also cited studies showing that hospitalizations for elderly patients due to ADEs were six times greater than for the general population, with an estimated annual cost of $20 billion. However, a recent Journal of the American Medical Association article indicated that the level of ADEs could be reduced 66 percent, if a pharmacist participated in grand rounds. Clearly, more must be done to recognize the importance of medication management programs that ensure the quality of drug therapy, including patient evaluations, compliance assessments, and drug therapy reviews. We are all aware that prescription drug costs continue to grow at an alarming rate. Seniors are being forced to spend greater and greater portions of their fixed incomes on prescription drugs which they need to live. Research and development of prescription drugs have come a long way since Medicare was originally enacted in 1965. Today, drugs are just as important as hospital visits, and in many cases more important, and it just doesn't make sense for Medicare to reimburse hospitals for surgery but not to provide coverage for the drugs that might prevent surgery. We need to modernize the Medicare program so that it does not go bankrupt in the next 10 to 15 years, and at the same time we must ensure that any Medicare reform proposal we consider includes a prescription drug benefit that helps all seniors. Mr. President, I have already introduced two measures that will help our older citizens obtain the medicines they need and at prices they can afford. My first bill, S. 1462, the ``Personal Use Prescription Drug Importation Act of 1999,'' allows Americans of all ages to avail themselves of the lower prices for prescription medicines that are available in Canada. A second measure, S. 1725, the ``DrugGap Insurance for Seniors Act of 1999,'' would provide for a more comprehensive access to prescription drugs by Medicare beneficiaries through reform and modernization of the Medicare Supplemental, Medigap, program. Under this approach, all existing Medigap plans, and three new drug-only Medigap plans, would provide various levels of prescription drug benefits from which seniors could choose. And our neediest elders' needs would be supported through Federal contributions for the cost of their premiums. During the 1st Session of the 106th Congress, no fewer than eight bills have been introduced in the Senate to provide a prescription drug benefit for Medicare beneficiaries--with most proposals estimated to cost between $5 billion and $40 billion per year. While I'm hopeful that we will all work hard to include a prescription drug benefit for Medicare beneficiaries, I am also concerned that at the end of the Congress we may not be successful. That is why I am introducing a measure today, the ``Pharmaceutical Aid to Older Americans Act,'' which will serve as a backstop for our neediest elders. This program builds on State pharmacy assistance programs that are already in place, and it encourages States to begin them where they don't already exist. Fifteen States are cutting new and innovative paths for providing prescription drug coverage for their neediest citizens. Most of these programs are for elder citizens (more than half also cover people with disabilities), and cover a wide variety of drugs--though some are limited to certain drugs or conditions, some require cost sharing for prescription medicines, and some have annual enrollment fees or monthly premiums. As of 1997, these programs aided over 700,000 people. The Pharmaceutical Aid to Older Americans Act is designed to assist States in their efforts to provide medicines and appropriate pharmacy counseling benefits for their neediest elders. This Act will strengthen the Older Americans Act by authorizing two discretionary grant programs, subject to appropriations, to fund State- based pharmaceutical assistance and medication management programs. Under this measure, States would develop models that work best for them and would have the latitude to design and implement innovative approaches for providing benefits to their neediest elders. States awarded grant money would agree to: match Federal funds with 30 percent new or existing State funds or in-kind contributions and not supplant current State expenditures with Federal funds. In-kind contributions counting toward the match requirement could include assistance from pharmaceutical companies and organization- and community-based pharmacies, thereby making this approach a truly public-private partnership. Each application for pharmaceutical assistance funds must include a medication management program that ensures the quality of drug therapies through patient evaluations, compliance assessments, and drug therapy reviews. Federal funds could be used to provide drug coverage benefits only to eligible beneficiaries, defined as Medicare beneficiaries with incomes up to 200 percent of poverty but without any other coverage for prescription drug benefits (States could expand eligibility with State resources). All senior citizens could utilize the medication management portion of the program. This is not government control of drug prices or price-fixing. The States can purchase pharmaceuticals from any willing seller, including pharmaceutical manufacturers, pharmaceutical distributors, wholesalers, pharmacy benefit management firms (PBMs), and chain or local pharmacies, without any Federal requirement for wholesale prices or Medicaid-based rebates. In some instances, it's likely that States may be able to negotiate better purchasing prices than any of those set by some artificial, imposed ceiling. Finally, for those States that choose not to provide pharmaceutical benefits, the Act authorizes grants to States to create or support stand-alone Medication Management Programs that will involve the States in collaborative efforts with community, chain-based, and institutional pharmacists to implement medication management programs. As I mentioned earlier, Mr. President, I am fully committed to providing a prescription benefit for all our elders as we move forward on comprehensive reform of the Medicare program. I am equally committed to seeing that the Older Americans Act is reauthorized this Congress, and I will work diligently to get these jobs accomplished. However, if the latter effort succeeds and the former doesn't, then the Pharmaceutical Assistance for Older Americans Act will be in place to provide much-needed medicines for our neediest elders. I'm very pleased Mr. President, that this measure has received endorsement of two of the key advocacy organizations associated with the Older Americans Act, the National Association of Area Agencies on Aging and the National Association of State Units on Aging. Note that these guardians of the aged support this measure, like me, if and only if we are unsuccessful in passing a prescription drug benefit for the Medicare program. Mr. President, I ask unanimous consent that the bill and the text of these letters and this measure be printed in the Record.

Mr. JEFFORDS

Mr. JEFFORDS. Mr. President, I would like to commend Paula Duggan who is retiring after 13 years as a senior policy analyst at the Northeast-Midwest Institute. She has been instrumental on a variety of labor market, education, and fiscal federalism issues. Paula, for instance, was the key force behind labor market information provisions within the Workforce Preparedness Act, and she has worked diligently to ensure that the law is well implemented. She was one of the first analysts to make the connection between worker education and business productivity. And she has written numerous reports explaining how federal allocation formulas are structured and how federal funds are distributed among the states. I have benefitted from Paula's expertise and experience in my capacities as chairman of the Health, Education, Labor, and Pensions Committee and as co-chair of the Northeast-Midwest Senate Coalition. Paula consistently has provided unbiased and insightful research that has advanced bipartisan efforts on behalf of this region and the nation. As she begins her well-earned retirement, Mr. President, I again want to thank Paula Duggan for her fine work.

Mr. JEFFORDS

Mr. JEFFORDS. Mr. President, I rise today to recognize the importance of the Refugee Protection Act of 1999 and to honor those most affected by this legislation. The Refugee Protection Act of 1999 will continue a tradition that is as old as the United States itself. Our great country was founded by men and women who left their homeland for a better life in the new world. Many of these individuals escaped persecution in their home countries, made the difficult decision to leave what they knew behind and to take their chances in a new country where many did not know the language and customs or have friends or family. The Refugee Protection Act helps to continue this tradition by ensuring that those who seek entrance to the United States as refugees are given fair consideration and due process. The Refugee Protection Act of 1999 would reinstate important protections against the deportation and refusal of refugees and asylum seekers who enter the United States from countries in which they face danger and persecution, whether it is due to ethnic, religious or political beliefs. Over the past few years Vermont has seen an increase in the number of refugees who have come to live in our great state. These refugees are well served by a number of agencies in Vermont which provide them help and promote their interests, including the Vermont Refugee Resettlement Program, the Tibetan Resettlement Project, the Tibetan Association of Vermont and Vermont Refugee Assistance. The Refugee Protection Act of 1999 will continue the example set in the state of Vermont, by welcoming refugees to our country and ensuring that all are given the full extent of protection they deserve.

Mr. JEFFORDS

Mr. JEFFORDS. Mr. President, last year Congress passed and the President signed a significant measure that will, as funds are provided, provide compassionate compensation payments to hundreds of individuals. Public Law 105-369, the Ricky Ray Hemophilia Relief Act of 1998, authorizes payments for hemophiliacs treated with blood products infected with HIV during the 1980s as well as their infected spouses and children. Last year, Mr. President, you and I, and all of our colleagues gave our unanimous consent to this measure because we all knew it was the right thing to do. But we accomplished only part of the job. We provided compassionate compensation to only a portion of the Americans who, through indecisiveness and inaction on the part of federal government, became infected with HIV. So today I am introducing legislation that will set the record straight and finish what needs to be done, and I hope that our colleagues will once again in the name of fairness and compassion give this measure their unanimous support. I am on the floor today to introduce legislation that will bring much needed fairness to hundreds of our citizens. This bill, the Ricky Ray Fairness Act of 1999 will finally include those people, other than hemophiliacs, who were infected with HIV and contracted AIDS through HIV contaminated blood products or tissues. The blood crisis of the 1980s resulted in the HIV infection of thousands of Americans who trusted that the blood or blood product with which they were treated was safe. The tragedy of the blood supply's contamination has brought unbearable pain to families all over the country. I have heard from dozens over the past months. These are people like any of us--like our children and our grandchildren--who went to hospitals for standard procedures, emergency care, or were transfused due to complications in childbirth. Many children and adults were secondarily infected: children through childbirth or HIV-infected breast milk and adults through their spouses. Lives were lost and futures were ruined. Not only were there physical and emotional costs, but there exists a tremendous drain on personal finances as a result of lost income and extreme medical expenses. In the minds of these and in the minds of members who advocated for the Ricky Ray bill, the federal government played the determining role in the tragedy. Mr President, these people were infected with HIV because the federal government failed to protect the blood supply during the mid-1980s when it did not use its regulatory authority to implement a wide range of blood and blood-donor screening options recommended by the Centers for Disease Control and Prevention. Had the federal government taken the recommendations of the CDC, thousands of American men, women and children would not have contracted AIDS through HIV-contaminated blood and blood products. Sadly, and unfairly, the Ricky Ray Hemophilia Relief Fund Act as passed last year does not include all victims of the blood supply crisis. I feel strongly that the Act must be amended to include compensation for not only hemophiliacs, but also people who received a blood transfusion or blood product in the course of medical treatment. Though it was right for us to pass the Ricky Ray Act last year, it remains an inequity and a tragedy that the federal government did so without including victims of transfusion-associated AIDS. Unlike a few individuals, most people infected with HIV through blood and blood products have been unable to track the source of their infection; nor have they been able to obtain some judicial relief through the courts. The community hit by this tragedy has found it nearly impossible to make recovery through the courts because of blood shield laws in most states that raise the burden of proof for product liability claims for blood and blood products. In addition, all States have statutes of limitations that prohibit litigation if the suit was not filed within a certain period of time. I am introducing today what can be the final chapter in our Country's responsibility for not adequately protecting the blood supply during the 1980s. The Ricky Ray Fairness Act of 1999 provides compassionate payments to those infected with HIV contaminated blood, blood components, or human tissues. While the change to include transfusion cases increases the cost of this bill, many have already noted that this bill is not about money, it's about fairness. I urge my colleagues to join me in recognizing the terrible tragedy the blood supply crisis of the 1980s cast upon all of its victims.