Nancy Kassebaum

Mrs. KASSEBAUM

Mrs. KASSEBAUM. No, I guess we are not. So if I may just for a moment respond to several of the amendments that have been put forward by Senator Helms. On the amendment that talks about promotion of homosexual activity. I certainly have great sympathy for wanting to limit what the activities might be supported. I will be introducing an amendment which addresses that same issue but perhaps not in the same way as Senator Helms. I will not get into a definition of the amendment. Since the unanimous-consent agreement has not been put forward yet, I am not sure whether we should go ahead and send our amendments to the desk, but perhaps we will get them all out and then we can decide what to do. Amendment No. 1858 (Purpose: To prohibit the use of funds for certain activities)

Mrs. KASSEBAUM. I send to the desk an amendment. I ask unanimous consent to set aside the amendments.

Mrs. KASSEBAUM. Well, I did not present my amendment regarding promotional activities until you had completed presenting all of your amendments. I wonder in the voting if they could not follow each other, so that we are----

Mrs. KASSEBAUM. The amendment I have sent to the desk will prohibit the use of the Ryan White CARE Act funds to support activities which promote homosexuality. This provision will assure that the funds allocated under this act would be used to provide treatment for individuals. There would be no funds to be used for promotion of homosexual activities. I offer this amendment because I am aware that some of my colleagues are concerned that the CARE activities may lead to increased sexual activity or to increased drug use. Specifically, some are concerned that needle exchange programs and prophylactic distribution programs may lead to increased homosexuality or drug abuse. Whether or not these concerns are valid, my amendment makes it clear that none of the funds expended under this act could be used for such promotion activities. Rather, this provision would assure that CARE Act funds would be used for treatment. In this regard, it is more narrow than the amendment that has been offered by Senator Helms in that it clearly states that the CARE Act funds are for treatment only, not prevention or homosexual promotion activities. I offer this amendment because I would like to have us fully consider some of the language and implications of that language, and that will be set aside at such time as we come to a vote on the legislation. Senator Helms also put forward an amendment to ensure that Federal employees will not be required to attend or participate in AIDS training programs. I would for myself think that is a very sensible amendment. Mr. President, it does seem to me that we should not have to require attendance of Federal employees for such programs. I would like to say, though, I do not believe that the intent was to design these programs to change the lifestyle of Americans. I think the intent was to really try to have an understanding of AIDS, what it was about, what type of disease it was. But I really myself strongly will support Senator Helms and say that in my mind it should not be a required attendance. Another amendment that Senator Helms put forward was on the funding. He would hold the funding levels to the same as they are in 1995. Mr. President, the House Appropriations Committee has appropriated $656 million for 1996. If we take the 1995 level, that is $651 million. But holding it until the year 2000 when AIDS cases are increasing at 20 percent a year seems to me to be a very difficult way for us to address this issue at this time. And I think it clearly should be left up to the appropriators. I know that the appropriators today--the Presiding Officer is on the Appropriations Committee--are not going to be frivolous in the moneys they spend. And I have a great deal of confidence that they will take into consideration the needs that are addressed that have to be met in the Ryan White CARE legislation and will consider wise and sensible use of those funds. So that amendment I would just have to oppose because I think putting that type of restraint until the year 2000 clearly would do a disservice to many who are in serious need. The other amendment was regarding funding equity. And I will be considering another amendment to address that issue because, as I mentioned earlier, it is of great concern. And one of the things where we would differ is what moneys go to research and is discretionary funding and what moneys come from, say, Medicare and Medicaid and the Social Security disability funding. That makes a big difference in the total amount, and I think it is important that there is an understanding regarding that difference. So, I will be putting forward another amendment on funding equity a bit later as we complete this debate. I yield the floor, Mr. President. Mr. KENNEDY addressed the Chair.

Mrs. KASSEBAUM. Mr. President, I ask unanimous consent that reading of the amendment be dispensed with.

Mrs. KASSEBAUM. I thank the Chair. Madam President, there are no further votes for this evening. I suggest the absence of a quorum.

Mrs. KASSEBAUM. Further, Madam President, I ask unanimous consent that any votes occurring after 12:30 p.m. as a result of this agreement be postponed to occur at a time to be determined by the two leaders.

Mrs. KASSEBAUM. Madam President, I think we have now reached an agreement. I ask unanimous consent that the following amendments be the only amendments in order to S. 641, and that no second-degree amendments be in order to the amendments: the pending amendment is No. 1854. Then following, Helms amendment 1855; Helms amendment 1857, regarding funding equity; Helms amendment 1856, regarding training; Kassebaum amendment 1860, regarding funding equity; a Kassebaum amendment regarding promotion, 1858; a Gregg amendment regarding FDA, and a Kennedy amendment regarding FDA. Further, that all debate time be used on the above-listed amendments this evening with the exception of the amendment to be offered by Senator Gregg, and the amendment to be offered by Senator Kennedy. Further, that at the hour of 9:15 a.m. on Thursday, Senator Reid be recognized for up to 15 minutes for general debate on the bill, to be followed at 9:30 by Senator Gregg, to be recognized to offer his amendment on which there would be 1 hour to be equally divided in the usual form. I further ask that following the conclusion of the debate on the Gregg amendment, Senator Kennedy be recognized to offer his amendment regarding FDA, on which there would be 30 minutes to be equally divided in the usual form, and that following that debate the Senate proceed to vote first on the Helms amendment 1854, followed in sequence with two back-to-back votes on other amendments in the order in which they were offered, and that there be 10 minutes for explanation between each of the remaining votes, to be equally divided in the usual form, and that following the disposition of the above-listed amendments, the Senate proceed to third reading and final passage, all without any intervening action or debate.

Mrs. KASSEBAUM. It is my understanding we are close to being able to put forward the unanimous-consent agreement. I think there still needs to be a couple of additional checks made. Mr. HELMS addressed the Chair.

Mrs. KASSEBAUM. I ask unanimous consent that further proceedings under the quorum call be dispensed with.

Mrs. KASSEBAUM. I ask unanimous consent that the name of the Senator from New Mexico, Senator Domenici, be added as a cosponsor.

Mrs. KASSEBAUM

Mrs. KASSEBAUM. Mr. President, I suggest the absence of a quorum for a minute until we look at the language and get some comparison, so maybe we can accept that.

Mrs. KASSEBAUM. No, I have no problem--I was just asking the Senator if he knew if that was not correct that each State is required to set up its own?

Mrs. KASSEBAUM. Mr. President, maybe, as a clarification of what we did last year, it is my understanding that, in law, from what we had before, that each State is required to set up its own notification system. Is that correct?

Mrs. KASSEBAUM. Mr. President, I send an amendment to the desk and ask for its immediate consideration.

Mrs. KASSEBAUM. Mr. President, I would like to answer, some of the questions that were raised by the Senator from North Carolina. I know how much Senator Helms genuinely cares about this issue. I would like start by saying that many of the 64 cosponsors of this legislation were cosponsors of the legislation in 1990. So they, I hope, are familiar with what was in the bill then and what is in the bill now. We have had a through hearing on this bill. A GAO report on the funding equities and distribution, which had been requested by Senator Brown of Colorado and myself was used as the basis for that hearing. The report had been requested because of our concern about equity of funding for all individuals with AIDS. I share with Senator Helms a concern about the fact that sometimes we are not able to do the type of oversight that we should, but with the hearing and the GAO report we were able to propose in this bill changes to provide equity in the distribution of funds. It is sad, but true, that there are many who have been victims of HIV. Some individuals like Ryan White contracted this disease through contaminated blood. Unfortunately, this illness has had a ripple effect with involvement of individuals from many walks of life but also the family members of those infected have also suffered. So we have to be mindful of all who have suffered. I think that this epidemic must be viewed in the broader sense of the epidemic and the tragedy. Senator Helms quoted figures related to the amount of money that has been expended for the major causes of deaths in this country. I lost a niece, several years ago to cancer. She had two small children. I remember through the years of her struggle with cancer discussing Federal Government funding levels for cancer. She questioned why there could not be more expended for cancer research than we were spending on AIDS. I spent time researching this important question in hopes of finding an answer. One thing that became apparent to me was that money that goes into research for HIV is also very valuable for other illnesses like cancer. The figures that Senator Helms gave were only for research, and I would like to give figures that include not only the research expenditures but also the moneys that come from Medicare, Medicaid, Social Security disability funding, and the Public Health Service moneys. For HIV and AIDS, it is about $5.4 billion a year; for cancer, about $15 billion a year; for heart disease, about $34 billion a year. One of the reasons that the Ryan White CARE legislation came into being, Mr. President, was to help provide assistance to those who were not eligible for Medicare; because they were not yet of age to receive Medicare or to receive Medicaid, because they had an income level which would not allow them to qualify. As we all know such medical care services even those that are basic can be very costly. That was the genesis of the Ryan White legislation. It has grown significantly in funding since 1990, but so have the number of AIDS victims. I suggested in 1990 that we do such sums. I do not think that this a good approach for defining the level of authorizations. I would propose an amendment, if this would be of any benefit, to say define the funding level for the first year which would be consistent with the appropriated levels reported recently by the House of Representatives. The House appropriation figure just recently passed is $656 million for 1996; then such sums in the following years. At least that puts a benchmark which gives some consistency between the House and Senate. Senator Helms mentioned a new title, title V, which was is slated to receive a small amount of funding, $17 million, in this year's authorization. I would like to explain this program a bit further. Title V is for AIDS Education Training Centers [AETC]. This title is not new. It has been moved from the health professions bill to this legislation. It seemed appropriate to consolidate those efforts related to AIDS into one legislation. AETC's are not a new program. It has been funded for many years. Under this program, health providers are educated and trained in the best ways to treat individuals with AIDS, particularly children and women. Given the complications and numerous illnesses which individuals with AIDS often acquire, health providers benefit from this type of education. I believe that patients also benefit from better trained physicians and other providers. This explains why there is a new Title V, although we must remember that this is not new, but rather a program moved from the Health Professions program to this legislation. Mr. President, this is not a piece of legislation that is enthusiastically embraced by everyone. It raises fears. It raises concerns. It certainly raised emotional levels and questions of morality, which Senator Helms has noted. I think the Senator from California earlier today, Senator Feinstein, spoke with real eloquence, of two people she personally knew, and how it affects so many. Sometimes people who do not fit the pattern that Senator Helms has mentioned are also infected. AIDS touches people, not only those who are ill and/or dying, but it touches many others as well. That is why the Ryan White bill came into being--not to take his name in vain. The intention was to provide services that could be of help to families who are suffering--and to patients--who are infected with this disease. I yield the floor. I do not know whether there are other amendments to be considered. Amendment No. 1853 (Purpose: To require spousal notification in cases in which an individual is diagnosed with infection with the human immunodeficiency virus)

Mrs. KASSEBAUM. Mr. President, I appreciate the comments of the Senator from North Carolina. I am glad to start off with such a positive amendment and share with him that I think it is important to debate these amendments, just the value of amendments as they are presented. I think that we both share the desire to move forward on this legislation. I appreciate the comments of the Senator from North Carolina.

Mrs. KASSEBAUM. I move to lay that motion on the table. The motion to lay on the table was agreed to.

Mrs. KASSEBAUM. Mr. President, I rise to offer this amendment on behalf of myself and Senator Kennedy, the ranking member of the Labor and Human Resources Committee. This amendment is aimed at preventing the prenatal transmission of HIV from mothers to newborn infants. Because new research findings show that when pregnant women with HIV take AZT--which is a treatment that shows positive results for those who have contacted the AIDS virus--it can protect their infants if taken at the right time. I believe we should make testing and treatment available to all who could benefit from this approach. Our amendment would begin to meet this objective. As many of my colleagues know, the Centers for Disease Control and Prevention recently released guidelines for voluntary HIV counseling and testing of pregnant women. These guidelines call for health providers to offer HIV testing to all women. The CDC guidelines were developed after recent research showed that HIV transmission to newborns from infected mothers could be dramatically reduced. If pregnant women with HIV take AZT during pregnancy, they can decrease the transmission rate to their newborns from 25 to 8 percent--this is a dramatic reduction. In response to these findings, and from a desire to protect the health of newborns, the amendment we offer would require States with the greatest number of HIV-infected newborns to implement the CDC guidelines. Under this proposal, 11 States plus the District of Columbia, which account for 80 percent of all newborn HIV cases, would qualify to receive grants from the Public Health Service to help offset some of the costs of testing and treatment. I offer this amendment as an alternative to a proposal which is being advanced in the House of Representatives, by Congressman Coburn of Oklahoma. To address this problem, the Coburn amendment would test newborn infants for HIV. I believe this is the wrong approach. It seems to me that it is most important that we test the mother at a time in the process in which we could potentially intervene. The Coburn amendment would allow for voluntary testing of the mother but would mandate testing of those babies whose mother had failed to be tested during her pregnancy. I regret that, under the Coburn amendment, it seems to me, that testing of newborns would not prevent HIV transmission. This why I think it is important to start the process at an earlier period of time, rather than after the birth of the newborn infant. As many of my colleagues know, I would actually prefer mandatory testing of all mothers during pregnancy for HIV. I support such an approach because I believe it would be the most effective way to prevent HIV transmission to newborns. However, I am not advancing a mandatory testing approach at this time because of the concerns that have been raised by many. These include increased Federal Medicaid expenditures, unfunded State mandates, and a decrease in pregnant women seeking prenatal care. For all of those reasons I decided it was best to not make it mandatory, but to follow the CDC guidelines in the 11 States where 80 percent of the cases have, in the past, occurred. I believe this amendment, which will provide funding to States to implement the voluntary CDC HIV counseling and testing guidelines, and is an effective way to protect our Nation's newborn infants. As such, I urge colleagues' support for this measure.

Mrs. KASSEBAUM. Mr. President, I ask unanimous consent that reading of the amendment be dispensed with.

Mrs. KASSEBAUM. Mr. President, I move to reconsider the vote by which the amendment was agreed to.

Mrs. KASSEBAUM

Mrs. KASSEBAUM. Mr. President, I appreciate being able to see a copy of what perhaps was before, which was an amendment on the appropriations bill, not the Ryan White legislation. And it did not have a definition in it either. Again, it was language designed to prohibit funds to be used for promotion activities. As I said, I certainly think there would be concurrence with that. If the Senator from North Carolina wants the legislation in the amendment that he has presented to be voted on without any need of amending it, I certainly respect that and we will have an up-or-down vote. I will intend later on to offer an amendment which would be the same language as the Senator from North Carolina but without the definition part, and would suggest perhaps, if we want to go ahead with the second amendment, as the Senator says, we could have back-to-back votes.

Mrs. KASSEBAUM

Mrs. KASSEBAUM. Mr. President, I thank the Senator from California, Senator Feinstein, for a very powerful statement. The reasons that she laid out as to why there should be support for this legislation, I think, will particularly help, and I appreciate her comments. The Senator from North Carolina, Senator Helms, had some amendments that he wished to offer. Senator Byrd has requested about 10 minutes as in morning business. I think as long as Senator Helms is not here, I am prepared to offer an amendment as soon as Senator Byrd finishes, if, indeed, Senator Helms is not here. But I think he is ready to go as well. I ask unanimous consent that Senator Byrd be allowed to speak as in morning business.

Mrs. KASSEBAUM

Mrs. KASSEBAUM. I also ask unanimous consent that there now be a period for the transaction of routine morning business with Senators permitted to speak for up to 5 minutes each.

Mrs. KASSEBAUM

Mrs. KASSEBAUM. Madam President, I am happy to yield to the Senator from Virginia if he has a question.