Nancy Johnson

Mrs. JOHNSON of Connecticut

Mrs. JOHNSON of Connecticut. Mr. Chairman, I yield myself the balance of my time. I rise in strong support of my amendment and urge my colleagues to support it as well. It is far more aggressive in developing the science of pain management and advancing physician knowledge of pain management and increasing patient expectation of pain management. That is why the National Foundation for the Treatment of Pain, the American Pain Foundation and many other organizations, including the American Academy of Family Physicians, the Society of Critical Care Medicine, the Emergency Room Physicians, the Hospice and Palliative Nurses Association and many others support my amendment. It is also why many State medical societies support this in spite of the AMA's stand. Furthermore, it is very clear, according to the former counsel of the DEA office of the chief counsel, that under current DEA law and policy, physicians can prescribe controlled substances for pain management, but it is also true that this new bill contradicts the Department of Justice's and DEA's findings that the agency should defer to the medical community on appropriate standards for providing palliative care and that the PRPA would for the first time establish Federal criteria in statute to define ``legitimate medical purposes''. This is a departure from current law that would prevent deferring to State and medical standards and create a conflict with State medical guidelines as to the appropriate standard of medical care. It would create conflict with State law, conflict with State guidelines, conflict with the State agencies that have traditionally implemented this part of the DEA statute. It is a significant change in Federal statute, because for the first time it requires federal criteria as to what is ``legitimate medical purpose'' and requires DEA agents to judge the intent of a physician as he administers to a patient suffering acute pain during the concluding days of serious illness. I urge support of the amendment.

Mrs. JOHNSON of Connecticut. Mr. Chairman, I rise to speak in strong support of aggressive pain management and palliative care. We need the opportunity to oppose physician-assisted suicide and advance the cause of pain management without having to support an aggressive new Federal role in the practice of medicine. In the next several years, we will see tremendous growth of the elderly population. As we advance medical science to prolong life, we must also do all we can to make people's final months and days pain free. Too many patients with terminal illness and chronic conditions suffer extreme pain without receiving adequate treatment or even knowing the treatment options. Because acute prolonged pain is a significant cause of people seeking to end their lives, the substitute strikes at a major cause of suicide in an effective and progressive way. Our substitute amendment clearly opposes physician-assisted suicide. But it would also eliminate the need for such extreme measures by advancing the science of pain management and making it more available to patients. Our substitute would help broaden access to palliative care through the creation of family support networks and outreach programs. It would also help disseminate information to patients, their families, and physicians through a centralized health and human services Web site specific to pain management and far more accessible information than the existing Web site. It would also help develop the science of pain management and advance the state of medical practice at the patient's bed side. It would train and educate physicians at the local level through the use of peer review organizations and direct the National Institutes of Health to convene a conference to put new developments in pain research into practice and the health care system. It would create an 11-member advisory committee to coordinate efforts within the Federal Government to make recommendations about additional research needs, practice guidelines, and other areas of pain management practice. Finally, the amendment would instruct the Surgeon General to issue a report on the legal and regulatory barriers to pain management, the level of competence in treating pain by physicians around the country, the amount and quality of training received by medical students and residents, and other issues relating to pain management. I deeply respect the opposition to physician-assisted suicide of the gentleman from Illinois (Chairman Hyde). Congress has already stated its opposition when it overwhelmingly passed legislation to ban Federal funds and Federal health programs from funding assisted suicide. Most States, including my home State of Connecticut, ban assisted suicide, prohibit it as a matter of State law and as a matter of medical practice. Our substitute reflects the will of Congress in its clear language opposing assisted suicide, but it goes beyond that to strike at one of the most significant reasons people feel that suicide is the only answer: the sheer desperation and hopelessness that severe pain causes. Our amendment would address this desperation by promoting the development of pain management, advancing physician knowledge, and increasing patient expectations that their pain should be properly managed. In contrast, the underlying bill would discourage physicians from prescribing appropriate pain medications. I have a long list of quotes from physicians that demonstrates what a chilling effect this bill would have on current practice. This is why I have been trying to intervene when my colleagues were saying we do not change the law, because we do change the law, it will have a chilling effect on the willingness of physicians to deliver pain relief care. For the first time, under the Hyde language, DEA agents would be required to judge retroactively the intent of a prescribing physician. With little or no medical training, agents would have to judge if a physician intended to relieve pain even at the risk of death or intended to ``hasten death.'' Now, remember, Mr. Chairman, there is always a risk of death when prescribing controlled substances for extreme pain suffered by very ill patients. Patients build up resistance to medications and require stronger doses for relief. As a result, there is nearly always a risk of death to the patient. How is a DEA agent to judge whether the stronger dose was appropriate, though it risked death, which is legal under the Hyde language, or it was not appropriate because it hastened death? Does this House want to delegate to nonmedical professionals that kind of authority? Do we want the Federal Government writing regulations to implement this section of law? Pain management is a developing science and each terminal case has its own tragic reality. Under current practice, the DEA already has clear regulatory authority over physicians who are illegally trafficking drugs and misused controlled substances. On matters involving questions of medical judgment, however, the DEA defers to the State health agencies and State medical boards which have historically governed the scope and standards of medical practice. Why would we want to change this? Why would we ask DEA agents to judge the intention of physicians managing extreme pain in very sick patients? Ironically, a few weeks ago, this body passed legislation to prevent insurance companies from the second guessing of physicians. We should not now require DEA agents to second-guess physicians. I urge my colleagues to support the substitute amendment that addresses the desperation and hopelessness of suffering severe pain by developing the science of pain management, advancing physician knowledge, and increasing patient expectation and access to proper pain management. I urge support of my amendment. Mr. Chairman, I reserve the balance of my time.

Mrs. JOHNSON of Connecticut. Mr. Chairman, I yield 2 minutes to the gentleman from New Jersey (Mr. Rothman).

Mrs. JOHNSON of Connecticut. Mr. Chairman, I demand a recorded vote.

Mrs. JOHNSON of Connecticut. Mr. Chairman, I yield 1 minute to the gentlewoman from New York (Mrs. Maloney).

Mrs. JOHNSON of Connecticut

Mrs. JOHNSON of Connecticut. Mr. Speaker, I thank the gentleman from Connecticut (Mr. Shays) for yielding me this time. United States Senator John Chafee. It is hard to believe John's gone. He was a man of extraordinary intellect, of a big warm heart, tremendous patience and tenacity, and a rich sense of human. Few people have made as much difference in the lives of others as Senator John Chafee. When we think of people in the business world, in the academic world, religious leaders, people who dedicate their lives in the social services or in our schools, few have touched so many as deeply as Senator John Chafee. Whether it was in environmental law, in health policy, or in children's services, or in tax and trade law, John was there. He was stalwart. He was principled. He was determined. He understood what it meant to negotiate. He understood why in a democracy as enormously complex as ours one had to come to agreement. But compromise for John never strayed from certain fundamental principles of the commitments that each of us must hold to one another in a free society that cares for its people. I have enormous respect for John. I learned from him. I relied on him. The Senate relied on him. New England Republican Members of both the House and Senate relied on him. We will miss him tremendously. I offer my heartfelt condolences to his wife and his family and hope that the knowledge of his extraordinary gift to this Nation, as well as to their lives, will ease their pain in his loss.

Mrs. JOHNSON of Connecticut

Mrs. JOHNSON of Connecticut. Mr. Speaker, I rise in strong support of this legislation and commend my House colleagues on funding it. It was frustrating to have the Senate vote 98 to 2 for it. But without any money and without the means, where is the promise? I want to just say that work may be the one thing that matters most in our lives. It is the means by which we achieve our dreams. It is the means by which we come to know ourselves. Stretching ourselves, challenging ourselves at work, develops our minds, develops our skills. We have passed in this Congress legislation to prevent discrimination against people with disabilities in the workplace. We have passed legislation to provide training and education for people with disabilities so they can participate in the workplace. Today we knock down what is probably the last and one of the biggest barriers to that freedom to work, the barrier of health insurance. With this bill, they will not have to fear losing their health insurance. If they want to work more hours, if they want to develop themselves further, they will know that, with a relapse, they will be able to come back to the program. This is for the people at Prime Time and throughout my district, the disabled who want to work and see us as standing in their way. We are getting out of the way with this bill.

Mrs. JOHNSON of Connecticut

Mrs. JOHNSON of Connecticut. Mr. Speaker, on rollcall No. 500, I was on the floor, inserted my voting card, but for some unexplained reason my vote was not recorded. I meant to have voted ``yea.''

Mrs. JOHNSON of Connecticut

Mrs. JOHNSON of Connecticut. Mr. Speaker, today I rise to commemorate the 150th anniversary of Central Connecticut State University (CCSU), a regional, comprehensive university in my hometown dedicated to learning in the liberal arts and sciences and the strengthening of our communities and economy. To appreciate the importance of this University to the state of Connecticut and the city of New Britain, we need to understand its remarkable history of anticipating the educational needs of our society as they have developed and responding with forward thinking, high quality courses and new partnerships. CCSU is Connecticut's oldest, publicly-supported institution of higher education. Founded in 1849 as the New Britain Normal School, a training facility for teachers, it moved to the site of its modern-day campus in 1922. Eleven years later it became the Teachers College of Connecticut and began offering 4 year Bachelor of Arts degrees. In 1959, with the capacity to offer liberal arts degrees, it became the Central Connecticut State College and in 1983, the Central Connecticut State University. The University now not only offers a wide range of undergraduate but also graduate programs. CCSU plays an important role in the state of Connecticut's education mission. It is the largest of four comprehensive Universities within the Connecticut State University System and enrolls 12,000 full-time and part-time students. Its 400 full-time faculty members, 350 lecturers and over 500 administrators and staff are dedicated to providing a quality educational experience to these students. One can learn a great deal about a university from how it defines itself. CCSU's mission statement clearly articulates its goal of not only educating its students but of preparing them for making positive contributions in the challenging, fast paced world of work and the equally important world of civic responsibility. ``With learning at the heart of all our activities, our fundamental responsibility is to empower students to attain the highest standards of academic achievement, public service and personal development. Preparing students for enlightened and productive participation in a global society is our obligation.'' Through CCSU's active participation in the State and the communities of New Britain and Central Connecticut, it not only provides a quality education to its students but provides them with an excellent example of community involvement and volunteerism. The State of Connecticut affords a special designation to those programs which contribute to the betterment of the State as a whole and CCSU has earned the ``Center for Excellence'' designation in both international education and technology education. CCSU has long been a generous partner with the people of New Britain as they look for ways to bring new businesses to the town and to promote a better quality of life for all of its residents. As manufacturing faced the challenges of competing globally, CCSU developed the state's first Masters degree in Industrial Technical Management to accelerate the modernization of manufacturing management to enhance quality and productivity. This not only better prepared students to help lead the rebirth of manufacturing, but made critical resources available to the multitude of small and medium sized manufacturers being challenged to meet new standards to succeed in serving globally competing companies. Following this development of its graduate courses, CCSU developed a Center for International Education and a Program in International Business as well as developed partnerships with educational institutions in 19 countries around the world. CCSU is the State's flagship university in international education. In its own neighborhood of New Britain and Central Connecticut, the University works with many city and community programs to promote the economic development of New Britain, including the Mayor's Development Cabinet, the Metro Economic Development Authority; the New Britain Marketing Collaborative and the Greater New Britain Network Group and the Initiative for a Competitive Inner City. The Center for Social Research (CSR) at CCSU is also involved in enhancing economic development by providing critical resources to our Neighborhood Revitalization Zones (NRZ) including the Broad Street NRZ, the Arch Street NRZ and the North and Oak Street NRZ. It conducted research to identify the unemployed and the underemployed in our city neighborhoods to enable the city to attract employers who could hire them. This approach promises to both strengthen the economic base of the community and improve people's lives without creating the urban and environmental problems that accompany commuters and their automobiles. CCSU serves as a resource for the community at large by performing needs assessment and public opinion surveys, developing training workshops, and using its resources to help community organizations address specific needs. It is also conducting surveys for the Main Street New Britain Project to identify the combination of shops and restaurants that will bring more people to downtown Main Street. In addition, it has partnered with the Klingberg Family Centers of New Britain, a day-school and residential facility for troubled children and families, to create a Community Outreach Center to better serve our families. CCSU's Tutor Corp, funded by Stanley Works, is a group of 40 students who work with 150 New Britain middle and high school students at risk for dropping out of school. The tutors also provide support to the Teen Pregnancy Prevention Program at Pathways Senderos. I pay tribute to CCSU's remarkable history of leadership in education and creative development of partnerships strengthening our community and economy. As Central Connecticut State University nears its 150th anniversary on October 23, 1999, I salute this fine institution that has served as a stable and generous source of information, expertise, guidance and charity throughout its history as it prepares the state's youths for adulthood and partners with communities to solve problems. We congratulate CCSU on her long and successful history and thank her for her leadership into the new millenium.

Mrs. JOHNSON of Connecticut

Mrs. JOHNSON of Connecticut. Yes, but in a context that functions very differently than this language does.

Mrs. JOHNSON of Connecticut. Mr. Chairman, will the gentleman yield?

Mrs. JOHNSON of Connecticut. Mr. Chairman, the concurrent care, that is what the word ``concurrent'' means, it is during that 48-hour period. In the longer 14-day period, that language does not appear. It is appropriate when they have only 48 hours and they look at whether the person can stay in the hospital then it ought to be as quick as possible, and it is the same argument the gentleman gave me about why it is important.

Mrs. JOHNSON of Connecticut. That may be true but it is not in context, if the gentleman will yield. It is in the context of a totally different ability to sue with all the different definitions. The gentleman talked earlier about the discretion language.

Mrs. JOHNSON of Connecticut. Mr. Chairman, I am very pleased that we are having this debate on the floor of the House tonight. I believe that, due to the real intense focus of a group of Members on this issue over the last few months, we have before us three very thoughtful bills. I do not want the citizens of this country who are watching this debate to miss a very important fact, and that is that any one of these bills would force accountability for health care decisions made by HMOs and able patients to get the care they need. It is essential that we act during this Congress to pass meaningful patient protections because patients need it, doctors need it, and HMOs need it. For the first time, a national independent external review process will help us identify those plans that routinely deny necessary care. If we hold them publicly accountable, I guarantee they will change their ways or dramatically lose their patient enrollment. We will also identify those plans that are providing timely access to quality care and give them the public attention and support they deserve. Most importantly, a strong external appeals process will reestablish the role of physicians in the health care delivery system as plans must use physicians to review claims internally, and the external review can be made only by physicians with appropriate specialty of training. So there are many bills before us tonight, but they all have certain core benefits in common. This internal-external appeals process for the first time makes evident nationally controversial decisions made by health plan. And that will provide us with the information we need and the power we need to guarantee that patients get the care they need in a timely fashion. All the bills provide access to OB-GYN care, access to specialists, access to better pediatric care, access to emergency services, continuity of care, access to far better information about benefits, access to clinical trial coverage, and prohibits gag clauses and incentive plans that discourage the delivery of appropriate care. One can hardly say this is a partisan debate when the two parties have come together in agreement on the majority of the issues at hand, and when passage of these positions would address major concerns of the American people and have a substantial impact on the way Americans receive their health care coverage. Now, there is an additional issue that is controversial and, unfortunately, has turned partisan. Many of us have come to the conclusion that assuring all Americans the right to sue is an important component in increasing health plan accountability. Unfortunately, many of us are also keenly aware that if we create this right to sue in the wrong way that we will create so many opportunities for litigation that the cost of insuring all those possibilities will drive premiums up. This is an important point, because many Members have said there have not been many suits. Of course there have not been many suits. There is no clear right to sue. But if we look back at physician liability, we can see how suits do drive up costs and how one has to insure to the possibilities not just to the existence. The possibilities of suit contained in the Norwood-Dingell bill will, without fail, increase the number of the uninsured because it will drive premium costs up. Equally important, if employers perceive themselves as liable, and this is just as big a point, if employers perceive themselves as liable by sponsoring a plan or negotiating benefits, they will drop plans, whether we say they are technically protected or not. So this bill is fraught with dangers, and we must do this job right. My goal is to place doctors and patients back in the driving seat of health care decisions. Many who have spoken today have worked long and hard to make that kind of reform of the system possible and to assure that patients get the care they need at the earliest stage of their illness. In my opinion, the Dingell-Norwood bill would create systemic incentives to choose lawsuits over timely, independent, external reviews, driving up costs, forcing small employers to drop plans to protect themselves against the possibility of suit, and increasing the number of uninsured Americans. Without nationwide public review of care decisions, as the external and internal appeals process will provide us, we, as a society, and health insurance, as a product, cannot develop a health care system capable of providing appropriate, timely, and affordable health care. That is why adding the right to sue must be done exactly right and must not be done in a way that creates an explosion of litigation with all the attendant consequences. I am a cosponsor of the Coburn-Shadegg coalition substitute, because I believe lawsuits are a necessary remedy for patients who have been wronged by their managed care plan's decisions, but I oppose opening up opportunities for lawsuits where none should exist. Let me give my colleagues an example of what I believe to be the systemic incentives to lawsuits contained in the Dingell-Norwood bill. In laying out the appeals process, internal and external, that bill says the decision must be made within 14 days or as soon as possible, given the medical exigencies of the case. Now, first of all, imagine the Department of Labor writing regulations to define what the medical exigencies are; and imagine the medical community trying to figure out how to comply with those regulations. That is a problem. But the bigger problem is that this passage now creates a case-by-case deadline for the reviewers to meet that can be reevaluated retroactively. So it is not a 14-day decision. It is a 14-day decision unless it can be done earlier. And that can be a point that can be litigated when we start from the back end of the line and go back and say this process could have made this decision earlier and, therefore, harm has been done and liability is established. It is that kind of phrase in the Dingell-Norwood bill that gives that legislation, and there are many others I could quote, that create within that legislation a systemic incentive for litigation. Mr. Chairman, let me close by saying that my goal is to put doctors and patients back in the driving seat of health care decisions. Lawyers driving these decisions is no more desirable in America than insurance companies driving these decisions. The right answer is the 85 percent of these bills that provide greater access to specialists and timely access to appropriate medical care. On the issue of the right to sue, we must guarantee it protects patients who are harmed by the egregious practices of health plans, and we must provide a clear simple process that avoids the ambiguities that delight trial lawyers, explodes litigations, drives up costs, and drives small employers out of the business of providing health care. The Coburn-Shadegg substitute is the right answer.

Mrs. JOHNSON of Connecticut. If the gentleman will continue to yield, I will not support the Dingell-Norwood bill because this is one of the passages among many others that create a systemic explosion of litigations.

Mrs. JOHNSON of Connecticut. That is correct, I would not support that bill, unless it has a very good appeals process in place. We were one of the first States to do this, and now the gentleman wants to impose on our appeals process that is working. I do not mind shortening the time. That is not hard for a State to adjust to. But the gentleman wants to impose this language that is very hard to adjust to, and that really throws what is a simple clear system into an unpredictable, and uninsurable liability, I believe, system.

Mrs. JOHNSON of Connecticut. Mr. Chairman, will the gentleman yield?

Mrs. JOHNSON of Connecticut

Mrs. JOHNSON of Connecticut. Mr. Speaker, I rise in strong support of this legislation to provide access to health insurance by the uninsured. The number of uninsured people has risen dramatically, a very troubling fact, given the economy, the low unemployment and poverty rates. Health insurance is a critical component of personal financial fitness and we should be doing all we can to help people afford health insurance. You can be for patients rights and for coverage of uninsured Americans. This legislation provides tax deductions for people who pay 50 percent of the cost of health insurance and long-term care insurance. The GAO has said this will expand coverage to 40 million Americans, 25 million of whom are uninsured. Does it matter whether you help 25 million of the 43 million uninsured? You bet it does. And by making insurance more affordable, you can help them get into the health care system we all value and depend on. We spend $100 billion in tax breaks for people who have employer- provided insurance, regardless of their income, so why should we not treat those who pay their own premiums exactly the same way? It is a matter of fairness, it is a matter of access to critical benefits, health insurance. In addition, this bill expands availability to MSAs. I have visited a company in my district, a manufacturing company. These are working people, and they have chosen MSAs. They have a choice and they choose MSAs. Why? Because they can spend MSA dollars on dental benefits, vision benefits, home health care benefits, drug benefits, a far broader range of benefits than most employer plans provide, because they can spend those MSA dollars on anything eligible in the Tax Code. Why would we not want to offer them that choice? Do we not trust them? I think it is terrific to have sure coverage. And the sicker you are, the better off you would be in an MSA, because once you meet that deductible and you can spend it on everything, then you get catastrophic coverage, and that is the best deal for a really sick person. In addition, the bill provides new and more affordable choices for small businesses so they can offer coverage to their employees. In short, let me say that this is a great bill, we should support it, and if we do not open up access, we need our heads examined, because that is the real problem out there. We can do Patients' Bill of Rights and access this week in this House. Mr. Chairman, I am pleased to rise in strong support of this legislation that will help people afford health insurance. The number of uninsured people has risen dramatically over the past year--a troubling fact, given the growth in our economy and low unemployment and poverty rates. Health insurance is a critical component of personal financial fitness. We should be doing all we can to help people afford health insurance. This legislation will expand access to health insurance. First, it will offer tax deductions for people who pay at least 50% of the cost of their health and long-term care insurance. At my request, the GAO has examined the impact of a health deduction and concluded that 40 million people would have been eligible in 1997 for a tax deduction for health insurance. Of these 40 million, 25 million were uninsured. We are currently providing over $100 billion in tax breaks to people who have employer-provided insurance regardless of their income. We should do no less for people who have to pay their own premiums. It's a matter of fairness. It's a matter of access to health insurance. In addition to helping the uninsured through premium deductibility, this bill expands the availability of medical savings accounts (MSAs). MSAs are a preferred way for some people to cover their health insurance costs. I have visited a small company in my district that offers MSAs to their employees. I heard directly from the workers that they prefer MSAs because their health care dollars cover a far broader range of health benefits, better benefits than almost all employers provided plans--dental, vision home care drugs! And gain access to a broad range of doctors, instead of a narrow group covered through an HMO. In addition, this bill provides new and more affordable choices for small businesses to offer coverage to their employees. Only 28% of employers with less than 25 workers offer health insurance. The main reason for small employers not offering health insurance is the higher costs they face. Their small size means they cannot spread the risk associated with a few unhealthy employees. They also face higher administrative costs. If we are going to address the problem of uninsured Americans, we must help small businesses, which are one of the fastest growing employment sectors, afford to offer health insurance coverage. People working for small businesses account for 16% of the under-65 population, but 28% of the uninsured. This legislation will help small employers pool together to afford the cost of insuring their workers. It will also create access to health insurance and health care services for people in urban and rural areas by allowing community health centers to serve as insurance networks. It is critical that we address the problem of the uninsured. CBO estimates that for every 1% increase in health insurance costs, 400,000 people lose their health insurance. If we consider managed care reform legislation without taking steps to increase access to health insurance, we are turning a blind eye to the 44 million Americans who have no health insurance option plus those who will lose their litigation runs premiums up. Our efforts to improve health insurance quality must include equal commitment to increasing the number of insured Americans. H.R. 2990 takes these steps. I urge its adoption.

Mrs. JOHNSON of Connecticut

Mrs. JOHNSON of Connecticut. Mr. Chairman, I thank the gentlewoman for yielding this time to me. I rise in strong opposition to H.R. 2436 and in strong support of the substitute bill. H.R. 2436 would make it a Federal crime to knowingly damage a fertilized egg during an assault against a pregnant mother. Now I absolutely agree that it is a tragedy for a woman to lose a pregnancy during a crime, and I strongly support the approach that many States have taken to toughen penalties for an assault against a pregnant woman, and that is, in fact, the approach that my colleague is taking in her substitute. However, Mr. Chairman, H.R. 2436 would do nothing to protect the woman further, but instead would create for the first time a legal definition that a fertilized egg is entitled to protection under the law as a person. This bill is indeed breathtaking in its scope. While the examples used are drawn from criminal assaults of women in advanced stages of pregnancy, its real concern reaches to the impact of the violence on the embryo. Roe v. Wade makes a distinction between the embryo in the first trimester and the post viability embryo, and that is the distinction that State laws honor. This bill makes no such distinction because it deals with the fertilized eggs at all stages of development; and, therefore, it opens the opportunity that if a woman is assaulted in sort of a routine assault and battery case and 3 weeks later has a miscarriage, that miscarriage can up the assault and battery charges to murder though she did not know she was pregnant at the time and neither did the assaultant. So this bill goes way beyond what it appears to do, and while I certainly think that a woman in an advanced stage of pregnancy who is assaulted and the fetus killed, that assaultant deserves a punishment that is far more severe than if he had not been attacking a pregnant woman. I think this bill goes way beyond that by dealing with a fertilized egg and opening up the kinds of possibilities I cite, and the next step, which is not contained in this bill, but it is the only logical next step, is to disregard the intent of the assaultant. Why, if it is a criminal assault, should it be seen as a crime? When it is simply the destruction of the fetus, it should not be seen as a crime? Mr. Chairman, that is why those of us who support a woman's right to abortion are deeply concerned about this legislation. It does clearly in its language exclude abortion, but the only difference between an abortion and a criminal attack is the criminality of the attacker and the criminal intent. But the effect on the fetus is the same, and all my colleagues focus on in this bill is the fetal effect, and they define ``fetus'' as fertilized egg even before the woman knows she is pregnant. So I urge opposition to the bill and support for the substitute.

Mrs. JOHNSON of Connecticut

Mrs. JOHNSON of Connecticut. Mr. Chairman, first I would like to commend the gentleman from Florida (Mr. Bilirakis) on the underlying bill, the Health Research and Quality Act which I consider to be a very progressive modernization of the mission of the Agency for Health Care Policy and Research, and I commend him on the thoughtful work done to enable that agency to serve us in the future in a focused and aggressive manner. I also would like to thank the subcommittee chairman, the gentleman from Florida (Mr. Bilirakis), for his support of a solution to the problem that our children's centers faced. He has been a strong advocate of our children's centers, and a great help to me as we moved this matter forward. I would like to thank also the chairman, the gentleman from Virginia (Mr. Bliley) of the Committee on Commerce who also has been helpful in the support of the gentleman from California (Mr. Thomas) who is chairman of the Subcommittee on Health of the Committee on Ways and Means and for the help and assistance and guidance of the gentlewoman from Ohio (Ms. Pryce) who has been so very interested in the work of the children's hospital and is so conscious of the excellent opportunity they provide for children with complex, difficult illness. Mr. Chairman, I offer this amendment, and I ask the support of my colleagues because our children's medical centers are facing an unprecedented financial crisis that threatens future advances in children's health care. All our teaching hospitals are facing a terrible challenge in just maintaining the resources needed to treat medically complex patients, the uninsured and the poor, and in addition, to maintain their training and teaching capabilities. It is increasingly difficult to get Medicare, Medicaid, and private payers to reimburse at a rate that is adequate to cover the unique responsibilities of our medical centers including the additional added costs of training physicians and conducting health care research. In today's price-competitive health care market, private payers no longer are willing to cover the costs of the public mission of training our physician work force. Children's teaching hospitals face an additional and unique burden because they receive no significant Federal support for their graduate medical education programs. Mr. Chairman, GME is principally funded through the Medicare program. Teaching hospitals receive funding based on the number of Medicare patients that they treat. Because children's hospitals treat very few Medicare patients, they receive no significant support for their teaching programs from the Federal Government. Freestanding children's hospitals receive on average less than one- half of 1 percent of what other teaching facilities receive in Federal GME funding. The grant program embodied in this amendment would provide GME support for children's hospitals. That is just commensurate with Federal GME support that other teaching facilities receive under Medicare. This amendment merely establishes interim assistance to our children's hospitals to maintain their teaching programs while Congress reforms the way we as a Nation fund medical education. Mr. Chairman, the grant program would provide $280 million in fiscal year 2000, $285 million in fiscal year 2001; that is, authorize that money. Since comprehensive GME reform will take more time to develop, this amendment would provide immediate financial assistance through a capped time limited authorization of appropriations. Mr. Chairman, freestanding children's hospitals are responsible for the pediatric training of almost 30 percent of the Nation's pediatricians and almost half of pediatric specialists. They also provide training to substantial numbers of residents of other institutions who require pediatric rotations. Even though they make up less than 1 percent of all hospitals, 59 facilities, freestanding teaching children's hospitals educate and train over 5 percent of all residents nationwide. Make no mistake about it, Mr. Chairman. Top notch training programs are critical to ensure quality health care for our children. Kids with unusual and medically complex diseases depend on the sophisticated resources of our children's medical centers. Quality pediatric care depends on high-quality training of pediatric specialists and sub- specialists, and improvements in diagnosing and treating disease depend on sophisticated basic and clinical research carried out in our children's hospitals. This grant program has broad bipartisan support. It is co-authored by over 190 Members, including the chairs and ranking members of the critical committees, and I urge my colleagues' support of it here today.

Mrs. JOHNSON of Connecticut. Mr. Chairman, I offer an amendment.

Mrs. JOHNSON of Connecticut. Mr. Chairman, it really is a pleasure to have the gentleman from Connecticut here and in support of the remarkable Children's Hospital in Hartford, Connecticut, but I think it gives us a good example of why this is so urgent and why my colleague, the gentleman from Florida (Mr. Bilirakis) has been so generous as to let us bring this on this bill. Truly, in the environment in which our hospitals are operating, our remarkable little Children's Hospital is a good example of the terrible circumstances these children's centers face. They serve mostly children. Medicaid reimburses much worse than Medicare reimburses, to begin with, and then they are right in the middle of Hartford so they have many, many uninsured children, many very poor children, who need a lot of special care, and yet they get not one cent or hardly a cent of reimbursement for their teaching and research initiatives. We just cannot let this happen. In the interim, we need this money to help them survive this period of extraordinary change in reimbursements. I just appreciate the gentleman's long working relationship with them, the help he has been on this bill. I would also like to just take a moment to thank the ranking member, the gentleman from Ohio (Mr. Brown), who has been a long solid advocate of children's hospitals and worked hard on this amendment for the year and a half or 2 years we have been working on it.

Mrs. JOHNSON of Connecticut. Mr. Chairman, will the gentleman yield?

Mrs. JOHNSON of Connecticut

Mrs. JOHNSON of Connecticut. Mr. Chairman, I rise in strong opposition to the amendment and in support of the underlying bill. The issue really here is about food supply and food quality, but it is also about the quality of life in America. Farms preserve open space; they provide living evidence of man's dependence on the Earth and our responsibility for sound management of our environment. In 1996, Congress recognized that we needed to reform the milk marketing order system; not that we needed to repeal it, but that we needed to reform it. And, in fact, the Option 1-A, just as the Option 1-B, was compiled by economists and professional staff of the USDA's agricultural marketing service. It takes into account more realistically transportation costs for fluid milk, regional supply and demand issues, costs of both producing and marketing milk, and the need to assure that milk can be produced in all the regions of the United States. It is simply a fairer option. It is real reform. The system will be simpler, but it will be also sensitive to regional issues. That is why it is in everyone's interest to support the 1-A option in the underlying bill.

Mrs. JOHNSON of Connecticut

Mrs. JOHNSON of Connecticut. Mr. Chairman, I thank the gentleman for yielding this time to me. I rise in strong support of the Shays-Meehan campaign finance reform bill. We need to restore public confidence and accountability to our federal election system, and Shays-Meehan will advance these goals most effectively and forthrightly. In addition to a ban on soft money, the bill closes one of the biggest loopholes in our current system of campaign finance laws by simply imposing the same rules, the same standards of public reporting, on groups that fund issue ads as we impose on candidates. In recent elections we have watched special interest money go to campaign issue ads in congressional elections across the country. One study shows that between 275 and 340 million special interest dollars were spent on these ads in the 1997 to 1998 election cycle, yet no citizen could find out who contributed those dollars spent on these ads, though they can find out every dollar, who contributed every dollar to any candidate running in a federal election. Shays-Meehan will simply clamp down on these special interest dollars, Mr. Chairman, and I urge support for this important election reform.