Nancy Kassebaum

Mrs. KASSEBAUM

Mrs. KASSEBAUM. Mr. President, today, together with a bipartisan group of colleagues, I am introducing the Animal Drug Availability Act of 1995. This legislation will reform the Food and Drug Administration's animal drug approval and export processes and policies. There is a serious lack of drugs for treating animals, in part because the drug review process at the Food and Drug Administration's Center for Veterinary Medicine is cumbersome and drugs. The FDA has approved only four new chemical entities (new drugs) for food-producing animals in the last 5 years. Further, an internal study by the Center for Veterinary Medicine found that the agency was taking an average of 58 months to approve drug applications. By law, the process should take no more than 6 months. The extra-label drug bill that was signed into law last year is a short-term response to this problem. It assures that veterinarians can legally prescribe drugs approved for one use or species for other uses or species. But all involved in the extra-label bill last year agreed that the real answer to the problem was reforming the animal drug approval process. Second, because our approval process is so slow, unpredictable, and cumbersome and our export policies very restrictive, many animal drug manufacturers are moving research and manufacturing facilities--and jobs--abroad to take advantage of more efficient and predictable review and approval processes and lucrative, growing world markets. This legislation has the broad support of the animal producer groups, the Animal Health Institute, and the American Veterinary Medical Association. I would welcome additional cosponsors of the Animal Drug Availability Act of 1995.

Mrs. KASSEBAUM

Mrs. KASSEBAUM. Mr. President, last week I spoke in favor of the pending amendment on medical liability and addressed, very briefly, the issue of Federal preemption. more fully my reasons for supporting a limited Federal preemption of State medical liability laws and to urge my colleagues to reject both the Simon and the Kennedy preemption amendments to the underlying McConnell-Kassebaum-Lieberman amendment. Mr. President, the Federal Government has a significant stake in reforming the health care liability system both because of the effect of the system on interstate commerce and because of the enormous amount spent by the Federal Government on health care. Last Thursday, I spoke of the need to achieve some degree of uniformity and certainty in the system. Without greater predictability, insurance rates will continue to reflect the potential for unlimited exposure to risk. And these higher insurance rates will continue to be passed along to the American consumer. the private sector deserves to benefit from the same type of protections that the federal government has afforded itself The Federal Government already has taken significant steps to limit its own exposure for costs associated with health care liability. For example, damages resulting from health claims disputes and redress in claims dispute cases are limited for Federal employees receiving health coverage under the Federal Employees Health Benefit Act [FEHBA], and for Medicare beneficiaries. There are no punitive or extra-contractual damages allowed under FEHBA or Medicare. See Hayes v. Prudential Ins. Co., 819 F.2d 921 (9th Cir. 1987); Homewood Professional Care Ctr., Ltd. v. Heckler, 764 F.2d 1242 (7th Cir. 1985). Moreover, responding to an outcry from Federal Community Health Centers about skyrocketing malpractice insurance premiums, Congress in 1992 limited the exposure of centers and their providers to malpractice claims by placing them under the Federal Tort Claims Act and taking steps that go well beyond the reforms in this legislation. In addition to having judgments paid from a Federal fund, that act: (1) allows liability to be determined by a judge rather than a jury (28 U.S.C. 2402); (2) contains a 2-year stature of limitations that is more restrictive than the one contained in this legislation (28 U.S.C. 2401); (3) prohibits the awarding of punitive damages (28 U.S.C. 2674); (4) places a cap on lawyers' contingency fees of 25 percent of a litigated claim and 20 percent of a settlement (28 U.S.C. 2678); disallows prejudgment interest (28 U.S.C. 2674), and requires claimants to exhaust administrative remedies before proceeding to court (28 U.S.C. 2675). Mr. President, I believe that the private sector is entitled to the same type of protections that the Federal Government has extended to its own health providers. as the largest single payer of health care services, the federal government has a compelling interest in health care liability reform While the Federal Government has limited its exposure to health care liability claims in certain instances, large gaps remain. In particular, liability for health care professionals and providers who treat Medicaid and Medicare patients remain subject to uneven and sometimes insufficient State medical liability reforms. One-third of total health care spending in this country is paid by the Federal Government. According to the Congressional Budget Office, Federal spending for Medicare will reach $177 billion in fiscal year 1995, while Medicaid grants to States will total $96 billion. Therefore, I believe that there is a direct, compelling Federal interest in reforming the Nation's outmoded medical liability system. federal legislation is necessary because of the increasingly interstate character of health care delivery Moreover, some degree of uniformity is essential because health care markets are becoming increasingly regional, if not national. Telemedicine, by its very nature, is designed to overcome barriers to the delivery of medicine, including long distances, geographic limitations, and political borders. Some of the finest medical facilities in the United States--such as the Mayo Clinic in Minnesota, Stanford University in California, Barnes Hospital in Missouri, the Cleveland Clinic in Ohio, and the Dartmouth Medical Center in New Hampshire--treat patients from across the Nation, and around the world. While I do not believe there is a need for absolute uniformity in all aspects of the health care system, I do believe that some minimum level of medical liability reforms are necessary to the continued development of a cost-effective private health care system. This is particularly true where, as under this legislation, insurers and other third party payers may be sued as defendants in health care liability actions. As health care providers continue to consolidate and form integrated networks of care in response to market forces, economic pressure, and emerging treatment patterns, the number of individuals who receive health care services in one State while having them financed by entities in another will continue to increase. While health care services generally are delivered locally, this does not necessarily mean that health care is delivered within State borders. To the contrary: more than 40 percent of Americans live in cities and counties that border on State lines; in 26 States, more than half of the population lives in cities and counties that border on State lines, and over 50 percent of the population in 26 States lives in border cities and counties. In these areas, it is even more likely that a patient will live or work in one State, receive health care services in another, and have his or her bills paid by a third-party payer in another State. A recent analysis of health services purchased across State borders found, for example: First, that Vermont and New Hampshire residents visit an out-of-State physician nearly one-quarter of the time; second, that Wyoming residents visit out-of-State doctors over one-third of the time, and third, that nearly 40 percent of the patients admitted to Delaware hospitals travel from out of the State. federal legislation is necessary because of state constitutional impediments Some have argued that this legislation is an unnecessary intrusion into an area of the law that traditionally has been the domain of the States. I would like to point out, however, that many of the opponents of Federal medical liability reform are, at the same time, aggressively challenging State tort reform efforts by arguing that the reforms are unconstitutional under State constitutions. As a result, many States have been frustrated in their efforts to pass meaningful tort reform. For example: First, statutes of limitations in health care liability actions have been held to violate State constitutions in Arizona; second, limits on punitive damage awards in health care liability actions have been held unconstitutional in Alabama, and third, periodic payment schedules for damage awards in health care liability actions have been held to violate State constitutions in Arizona, New Hampshire, and Ohio. preemption provisions in the mcconnell-lieberman-kassebaum amendment Mr. President, the preemption provisions contained in the McConnell- Lieberman-Kassebaum amendment are designed to give both the States and the courts clear guidance as to the scope of the reforms contained in the legislation. The amendment does not preempt State laws that: First, place greater restrictions on the amount of or standards for awarding noneconomic or punitive damages; second, place greater limitations on the awarding of attorneys fees for awards in excess of $150,000; third, permit a lower threshold for the periodic payment of future damages; fourth, establish a shorter period of time during which a health care liability action may be initiated or a more restrictive rule with respect to the time at which the period of limitations begins to run, or fifth, implement collateral source rule reform that either permits the introduction of evidence of collateral source benefits or provides for the mandatory offset of such benefits from damage awards. The amendment also states specifically that it should not be construed to preempt any State law which: First, permits State officials to commence health care liability actions; second, permits provider-based dispute resolution; third, places a limit on total damages awarded in a health care liability which such an action may be initiated, or fifth, provides for defenses in addition to those contained in the act. Last week and again yesterday, some of my colleagues argued that the so-called one-sided preemption provisions contained in the McConnell amendment were both novel and, somehow, unfair. I believe these arguments are without merit. For the record, I would like to make clear that the characterization that all of the preemption provisions in the legislation are ``one- sided'' is simply incorrect. Two examples are instructive. First, the preemption provisions allow State collateral source reform measures to differ widely from the provisions contained in the legislation. States not only have the flexibility under the McConnell-Lieberman-Kassebaum amendment to adopt evidentiary collateral source rules and mandatory offset rules that permit introduction of collateral source benefits after trial, but may, in fact, adopt a whole range of collateral source rule reforms that are more favorable to claimants than those contained in the amendment. Second, the amendment makes clear that State laws limiting attorneys fees for awards of $150,000 or less may be both more restrictive than the 33\1/3\ percent set forth in the legislation and less restrictive. In support of the preemption provisions contained in the McConnell- Lieberman-Kassebaum amendment, I would like to note further the long history of this Congress in setting minimum Federal standards and allowing the States significant flexibility beyond those standards. See, e.g., Clean Air Act Amendments of 1990, Pub. L. 101-549; Safe Drinking Water Act, Pub. L. 93-523; Civil Rights Act of 1964, Pub. L. 88-352; Americans With Disabilities Act, Pub. L. 101-336. Moreover, nearly every health care reform bill introduced last Congress--including President Clinton's ``Health Security Act''-- contained this type of Federal preemption for medical liability reforms. See, e.g., President Clinton's Health Security Act, H.R. 3600; Senator Dole and Senator Packwood's health care reform bill, S. 2374; Senator Chafee's Health Equity Access Reform Today Act, S. 1770; Representative Cooper's Managed Competition Act, H.R. 3222; the House Republican leadership plan, H.R. 3080; the bipartisan mainstream coalition health bill, and the House bipartisan health reform bill. Another recent and relevant example of liability reform legislation containing the type of Federal preemption language included in the McConnell-Lieberman-Kassebaum amendment is S. 1458, the General Aviation Revitalization Act of 1994. That legislation provided in part that no civil action for damages arising out of an accident involving a general aviation aircraft could be brought against the manufacturer of the aircraft or the manufacturer of any component part of the aircraft, if the accident occurred more than 18 years after the date of the aircraft's delivery or the component part's installation. S. 1458, which passed the Senate on March 16, 1994 by a vote of 91 to 8, preempts State law only to the extent that such law permitted civil actions to be commenced after 18 years. See Public Law 103-298. I believe that the underlying amendment is loyal to this tradition. In conclusion, Mr. President, I would like to point out that many of those who oppose the preemption principles embodied in this legislation have repeatedly and enthusiastically embraced those principles in other legislative contexts. For example, S. 7, the Family Health Insurance Protection Act, provides a clear example of one-sided preemption. Section 1011 provides that State laws will not be preempted only if they: First, contain preexisting condition waiting periods that are ``less than those'' established in S 7; second, limit variations in premium rates ``beyond the variations permitted'' in S. 7, and third, expand the size of the small group market to include groups ``in excess of'' the size set forth in the legislation. ction 1012 of that legislation contains even more expansive one-sided preemption provisions. It states that: ``Nothing in this Act shall be construed as prohibiting States from enacting [any] health care reform measures that exceed the measures established under this Act, including reforms that expand access to health care services--for example, higher taxes--control health care costs, and so forth, institute tighter premium caps or cost controls, and enhance the quality of care.Mr. President, as I said earlier, I do not believe there is a need for absolute uniformity in this area. But I do believe it is important to set some very clear minimum Federal standards that all States must meet. The standards in the McConnell-Lieberman-Kassebaum amendment are only a floor. The amendment does not preempt States from going further with medical malpractice reforms they may decide are necessary. I think this is the best way to balance the need for some State flexibility with the need for greater certainty and predictability in the system. Medical Malpractice Reform

Mrs. KASSEBAUM

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

Mrs. KASSEBAUM. Mr. President, I thank the Senator from Washington. Senator Gorton has provided, I believe, a very important vehicle in his product liability legislation to which we are wanting to add this amendment and want to do so in a constructive way that will be an addition to the product liability bill before us. I know that Senator McConnell, Senator Lieberman, and myself want to do all that we can to be supportive of the product liability bill and we want to work to make any changes in the medical liability reform amendment that would fit with the broader product liability bill. To that end, I think, as the Senator from Washington knows, we will do all we can to be helpful. Thank you, Mr. President. I yield the floor. I suggest the absence of a quorum.

Mrs. KASSEBAUM. Mr. President, I rise in strong support for and to offer a few remarks on behalf of the amendment put forward by my colleague Senator McConnell, Senator Lieberman, and myself. I think this amendment is a moderate, measured approach to medical liability reform. It is very difficult for us to debate any type of liability reform in the Congress, in the Chamber of the Senate or in the House of Representatives, without getting into worst case scenarios. There is none that we are more sensitive regarding, I think, than medical liability reform. I have a great deal of confidence in the Senator from Kentucky [Mr. McConnell] and the Senator from Connecticut [Mr. Lieberman], who have spent a lot of time trying to bring forth the difficult aspects of this issue in the most acceptable consensus that really does give us some successful and constructive results to a problem that really troubles everyone in one way or another. I know that we have already heard some of the specific provisions of the McConnell amendment, but if I may, Mr. President, I would like to reiterate some of them that I think are particularly useful and important to remember. One, that there is full recovery of economic and noneconomic damages. complete compensatory damages. It places no limitations on the amount claimants may recover for economic damages such as out-of-pocket medical expenses, rehabilitation costs, lost wages, cost of domestic services, and noneconomic damages such as pain and suffering, mental anguish, and loss of companionship. The amendment that is before us currently contains a cap on punitive damages of $250,000 or three times the economic losses, whichever is greater. I understand there are discussions ongoing now with Senator Snowe and others about punitive damages. I would just like to say for myself, Mr. President, whatever agreement can be reached--I think Senator McConnell as well is a party to this--if we can reach an agreement with the chairman, Senator Gorton, on what type of punitive damages language we would want to have, I think there would be strong support for that. So that is still ongoing and debated. There is a limit on attorneys' fees to ensure that injured patients recover a greater share of their medical liability awards. The attorneys' contingency fees are limited to 33\1/3\ percent of the first $150,000 award and 25 percent of awards in excess of $150,000. This is identical to the provisions contained in the bill that Senator Kennedy introduced last year. There is also the State alternative dispute resolution. Many in the legal profession and outside the legal profession believe we need to do more to encourage alternative dispute resolution, to promote the resolution of claims in a more convenient and timely--and let me stress timely--manner because years can go by in which most of those who need assistance are frequently tied up in the courts waiting to see what happens. This will be a means of getting a more timely redress and in an affordable manner. The amendment encourages States to experiment with the alternative dispute resolution and requires the U.S. Attorney General to provide technical assistance to States regarding various ADR mechanisms. Finally, thanks to the contributions of Senator Jeffords, the amendment requires the Agency for Health Care Policy and Research, in consultation with public and private sector entities, to establish guidelines on quality assurance, patient safety, and consumer information. This is a small step in the right direction and one that has to be taken with some care, but I think we would all agree that a better means of obtaining information for consumers would be beneficial and useful. Much has been said in the Chamber today both pro and con, and I do not like to be repetitive, but I think there are some things that are worth repeating. While we have different thoughts on this, I think all of us are struggling to find some better means of addressing tort reform and answering the problems that exist today in a society in which we have all become so very litigious, that as we weave this web of ever greater litigiousness, I think we are doing a great disservice to those perhaps most in need of redress in the courts. The current liability system carries great human and economic costs. It does not work well for anyone--not for doctors, not for hospitals, not for families, and not for injured patients. Under the present system, it takes an average of 5 years from the time a patient is injured to resolve a malpractice case. That is really inexcusable. The Rand Corp. has found that only 40 cents of every dollar spent in medical liability litigation reaches injured patients. The rest goes to court costs and attorneys' fees. The United States has the world's most expensive tort system. At 2.3 percent of GDP, U.S. tort costs are substantially higher than those of any other country and two and a half times the average of all developed countries. The Harvard Medical Practice Study, based on a review of 31,429 medical records in 51 New York hospitals, found that only 1 in 16 injured patients actually received compensation. On the other hand, the study concluded that half of the malpractice claims that were filed were without merit. Moreover, according to a 1992 survey by the American College of Obstetricians and Gynecologists, 12.3 percent of the OB/GYN's nationally gave up obstetrics in 1992 as a direct result of liability concerns. I know in my own State of Kansas, it is becoming increasingly difficult, if not impossible, to find obstetricians and gynecologists who will go into the smaller, more rural communities because of the high cost of insurance that they must carry versus the number of patients that they may see. So it becomes an increasingly difficult problem in ways that we perhaps do not realize. I would just like to say a few additional words about the preemption provisions of the McConnell amendment. I know this is a concern to some and I am sympathetic to that. How far do we go at the Federal level to preempt the various State laws that provide, in this case, guidance for litigation? I do not believe there is a need for absolute uniformity in this area. But I do believe it is important to set some very clear, minimum Federal standards that all States must meet. Let me just explain why I think that is important. The amendment does not preempt States from going further with medical malpractice reforms that they may decide are necessary. They may go further. California, for instance, now caps noneconomic damages at $250,000. I think this is the best way to balance the need for some State flexibility with the need for greater certainty and predictability in the system. When I mention California capped noneconomic damages, let me just reiterate, this amendment does not cap noneconomic damages. But California would not be preempted because it would go even further. What this does, to a certain extent, is set a floor below which there could not be changes made and, therefore, it adds a certainty and a predictability that I think will enable cases to be resolved in a timely fashion. Without some sense of specificity, I think we lose this timeliness, lose the ability to move the process forward. I believe that setting a minimum level of medical liability reforms is necessary to continue development of a cost-effective private health care system. Moreover, there is a direct and compelling Federal interest in reforming our outmoded medical liability system. One-third of the total health care spending in this country is paid by the Federal Government through Medicare and Medicaid Programs. Finally, as my colleague, Senator Frist, knows perhaps better than anyone else in this body, health care services are increasingly becoming regional, if not national. Senator Frist from Tennessee was a surgeon prior to his coming to the U.S. Senate. For example, some of the finest medical facilities in the United States, such as the Mayo Clinic in Minnesota, Stanford University in California, Barnes Hospital in Missouri, and the Cleveland Clinic in Ohio--and I do not want to leave others out--are examples of important regional centers that treat patients from across the Nation and around the world. That is why, it seems to me, the more we can begin to start with some very important but moderate approaches to medical liability reform, I think we take a big step forward in assuring not only the access and timely access to redress, but we also provide the stability and some assurance of what actually is out there in the way of costs. It should not, in any way, close the doors to those who need redress in the courts. But it should make us all mindful of being able to change the system that is getting out of hand. And in our own responsibility, whether it is here on the floor of the Senate or individually, we have to address and take responsibility for a growing environment that I think creates problems for each and every one of us. Mr. President, I would just like to strongly urge my colleagues to support the McConnell-Lieberman-Kassebaum amendment. I know that we have a somewhat bumpy path ahead on this, but I am hopeful that we can move forward with the debate. Those who object have laid out some of their objections. But I think it is time for us to vote and move forward and get to the heart of the matter. I yield the floor. Mr. GORTON addressed the Chair.

Mrs. KASSEBAUM

Mrs. KASSEBAUM. Mr. President, I rise today to introduce a revision of the ``Welfare and Medicaid Responsibility Exchange Act of 1995'' with my colleague Senator Brown. This legislation incorporates the changes which I indicated would be forthcoming when we introduced the ``swap'' legislation earlier this year. The basic principle embodied in both this and the earlier proposal is that true reform will occur only when there is a clear delineation of responsibilities between the federal and state governments. The legislation we are introducing today shifts to the states responsibility for the nation's largest welfare programs--Aid to Families with Dependent Children (AFDC), Supplemental Food Program for Women, Infants and Children (WIC), Food Stamps, and the AFDC portion of Medicaid. In exchange, the Federal Government will assume responsibility for that portion of the Medicaid program designed to provide acute care and long-term care to elderly and disabled Americans. Currently, the overlapping regulation and dual administration of the AFDC and Medicaid programs, in particular, has resulted in a significant lack of accountability. In contrast, this legislation makes a clear-cut decision about who will run the welfare programs, who will finance them, who will make key decisions, and who will be responsible for the outcomes. This legislation will allow both the States and the Federal Government to build a more cohesive safety net for the populations each sector is serving. At the end of a five-year transition period during which the States will be freed from the vast majority of restrictive Federal regulations, the States will have complete autonomy for designing welfare and medical programs for low-income individuals-- without Federal mandates, but with their own money at stake. The Federal Government will be able to improve the efficiency and effectiveness of the Supplemental Security Income (SSI) Medicaid program--a program which now consumes 70 percent of Medicaid costs yet serves only 30 percent of the Medicaid population--by better coordinating choronic care services for elderly and disabled Medicaid recipients, by promoting competition, and by allowing these individuals to have a broader choice of private health plans. To reduce the reliance on Medicaid, the revised legislation also includes tax incentives for the purchase of private long-term-care insurance and long-term care services, and standards for long-term care insurance. These provisions are similar to those contained in legislation which was introduced earlier this year by Senator Cohen. I would like to highlight some of the other key components of this revised swap legislation: State responsibilities: As in the earlier swap legislation (S. 140), the states will assume full costs for the AFDC, WIC, and Food Stamp programs. In addition, however, the states also will assume responsibility for providing health care for ``AFDC-related'' Medicaid recipients (non-elderly and non-disabled individuals). This population represents about 30 percent of current Medicaid expenditures. Federal responsibilities: Instead of assuming the full costs of the Medicaid program, under the revised legislation the federal government will assume financial responsibility for the ``SSI-related Medicaid'' program (elderly and disabled individuals). This group represents the remaining 70 percent of Medicaid costs. Five-year transition period: The revised legislation still contains a five-year transition period during which states will have freedom to design low-income assistance programs and time to build the infrastructure to support these programs. During this period, an independent Commission will work with Congress to develop the specific provisions of the federal Medicaid program for elderly and disabled individuals. Also, the federal government will continue to provide funding to states during this period so that no state will suffer significant losses of funding. State maintenance-of-effort: During the transition period, the states must spend the funds made available by the swap and any money previously used as a state match for AFDC, food stamps, WIC, and AFDC- related Medicaid, to provide cash and non-cash assistance to low-income individuals and families. Unlike S. 140, however, the states may direct up to 15 percent of these funds annually to savings or other uses. Medicaid during the transition: Under the revised legislation, federal Medicaid benefit and coverage requirements for children will be frozen at 1995 levels during the transition. Beyond that, however, the states will be given significant freedom to redesign the AFDC-related Medicaid program without applying for federal waivers. At the end of the transition period: Under the revised legislation, Congress must determine at the end of five years whether to continue this arrangement or, instead, to grant the states complete autonomy to design welfare and low-income medical care programs. If this complete swap goes into effect, states that experience a significant loss of federal funds and have the greatest need for public services will be eligible for a targeted grant program. Mr. President, if we are serious about returning substantial authority, autonomy, and responsibility to state and local governments; if we are serious about rejecting the ``one-size-fits-all'' approach to income support programs which has frustrated those who have sought innovative solutions; and if we are serious about breaking the cycle of dependence that has frayed the current social welfare system; then I believe we must make systemic changes that will have a profound and long-lasting impact on the way services are delivered to needy Americans. We must cross the threshold from a Washington that simply shares power with the states to a Washington that actually surrenders power. This legislation goes a long way toward achieving that goal. I hope my colleagues will join me in working toward its passage.

Mrs. KASSEBAUM. Mr. President, I rise today with my colleague from Kansas, Senator Dole, to introduce legislation to create a tallgrass prairie preserve in the Flint Hills of Kansas. At a time when some in Congress are asking hard questions about the cost and role of some units in the national park system, one may wonder why I am proposing the addition of another preserve to an already overburdened system. I am aware and sympathetic to those who complain that some members of Congress have taken a parochial interest in the park system, passing bills to create parks and historical sites more for their economic benefits to neighboring communities than because the area is nationally significant, either naturally or historically. James Ridenour, former director of the National Park Service under President Bush, calls this the ``thinning of the blood'' of park system and points out that we are spreading limited personnel and scarce funds too thin. As a consequence, we have been spending an increasing percentage of Federal dollars on sites with questionable significance and devoting less to protecting our Nation's naturally significant resources. However, Mr. Ridenour strongly supports the bill being introduced today as a unique solution to the creation of an important addition to the park system. This legislation was crafted in response to these concerns. It creates for the first time a private-public partnership, where capital from a private conservation organization is combined with limited funds from the Federal Government to create a national preserve open to the American public. We will be doing this at a fraction of the cost that the Federal Government would otherwise spend if it were to purchase the property for preservation. By taking this approach, we will be preserving for the first time an ecosystem that is found nowhere in the park service system. The approach taken in this bill is the kind of new thinking we in Congress must explore if we are to wisely spend scarce Federal dollars to protect important natural and historic areas in the future. For those who have never been to the Flint Hills of Kansas, let me explain why this area is so unique and special. From Nebraska to Oklahoma there remains a narrow swath of tallgrass prairie--the remnants of a once vast tallgrass prairie ecosystem that covered 400,000 square miles from Ohio to the Rocky Mountains, from Canada to Texas. Today, less than 1 percent of this ecosystem remains, much of it in the Flint Hills, which are too steep and too rocky to farm. There is no better example of this tallgrass prairie ecosystem in the Flint Hills than the 10,894-acre Spring Hill Ranch in Chase County. Hundreds of species of native plants and grasses grow on the ranch. Nearly 200 kinds of [[Page S5428]] birds, 29 species of reptiles and amphibians, and 31 species of mammals can be found on the property. The National Park Service, after an extensive survey of the property in 1991, concluded the property was nationally significant became of its natural resources and said it deserved conservation as a unit of the national park system. Beyond the natural splendor of the ranch, the property includes a house, barn, and several outbuildings listed on the National Register of Historic Places because of their unique second empire architectural style. Each of these buildings was built in the 1880s from hand-cut cottonwood limestone quarried in the area. They illustrate the elegance and style of the ranch's first owner, a local cattle baron. A mile way from the house, over a rise in the land, also sets a one-room prairie school built in 1882. For the past 4 years, I have been involved in efforts to preserve this ranch and open it to the public. Last year, the National Park Trust, a private conservation organization, purchased the ranch and has been working with members of the Kansas congressional delegation and officials with the Department of the Interior to develop legislation to preserve the ranch through a private-public partnership. The results, which have come only after painstaking negotiations with the Trust, Interior officials, and representatives of Kansas' agricultural and conservation groups, is reflected in the legislation I am introducing today. The Tallgrass Prairie National Preserve Act will allow the National Park Service to purchase or accept donations of up to 180 acres, or less than 2 percent of the ranch. In meetings I have had with Secretary of the Interior Bruce Babbitt, he has stated that he would like to see the National Park Service own, maintain, and operate this historic core area, which includes the house, barn, and outbuildings. The rest of the ranch will continue in private ownership, but the Secretary of the Interior is given the authority in this bill to enter into a cooperative agreement with the National Park Trust to provide interpretative and resource management assistance for the rest of the ranch, as well as police and emergency services. What is different about this proposal and why it makes such sense from the standpoint of the Federal Government is that the American people will have access to and use of the 10,894-acre ranch for the cost of operating a 180-acre site. The National Park Trust, in a letter that I will ask be printed in the Record following my statement, has committed to donating to the Federal Government at no cost up to the 180 acres of the ranch's historic core. This donation, estimated by the trust to exceed $2 million in value, was one of the elements we negotiated to make this bill a true private-public partnership. Mr. President, as Congress looks for innovative ways to make Government work better, I believe the approach taken in this bill signals departure from the way the Federal Government has protected important natural and historic areas in the past. I am pleased officials with the Department of the Interior have been so willing to work with me to explore this partnership. They have gone to great lengths to ensure the quality of this Park Service unit will not be compromised, while remaining open to suggestions to new ways of approaching issues. As former Director Ridenour says in a letter endorsing the legislation, this bill ``represents the kind of creative thinking that will have to take place to guarantee that we take care of our great parks in the future.'' In addition to the care that was taken to draft this private-public partnership, equal care was given to address the legitimate concerns of area ranchers. In this bill, National Park Service ownership is limited to 180 acres, and no further expansion is permitted. Language was incorporated into the bill to address concerns regarding fence maintenance and to require compliance with State noxious weed, pesticide, animal health, and water laws. The bill establishes an advisory committee consisting of conservationists, landowners, local community officials, and range management specialists to help determine how the ranch should be managed. The bill also incorporates language that requires the Federal Government to be a good partner with neighboring communities and work cooperatively to deliver emergency and other services. Mr. President, we have a wonderful opportunity to protect for future generations a portion of the tallgrass prairie--the only ecosystem not currently represented in the National Park System. Passage of this bill will give the American public an opportunity to enjoy and explore this beautiful area and grow to appreciate its history and importance. I ask unanimous consent that a letter from the National Park Trust and a letter from James Ridenour be included in the Record. Mr. President, I ask unanimous consent that the text of the bill and other material be printed in the Record.

Mrs. KASSEBAUM

Mrs. KASSEBAUM. Mr. President, I introduce the Youth Development Community Block Grant Act of 1995 on behalf of myself, Senator Domenici, Senator Inouye, Senator Stevens. The purpose of this initiative is to reallocate existing Federal funding for preventive youth program into a more effective and cohesive network of community- based youth development services for 6- to 18-year-olds. The United States has concentrated most of its efforts on behalf of youth on specific problems that have captured the attention of the American public. This well-intentioned response has had two major results: First, the creation of a maze of narrowly defined categorical programs to address the lack of local flexibility in determining how best to respond to the needs of youth in the community. These two factors, combined with our concern about the increasing vulnerability of the American family, have lead to the development of the Youth Development Community Block Grant Act. The central goal of the youth development community block grant [YDCBG] is to promote and support positive youth development. The bill will fund services focused on prevention--programs that help children and youth develop the values and life skills they need to succeed. It reflects the belief of leaders in the field of youth development, including the Carnegie Council on Adolescent Development and the Center for Youth Development and Policy Research, that youth programs should address the social, moral, emotional, and physical development of youth, in addition to their ability to think and reason. Likewise, the legislation reflects the strong consensus among these experts that youth development services should focus on the needs of youth in general, rather than segregate them into various categories of risk. It also emphasizes the use of participatory, hands-on-techniques which have been shown to be effective in getting youth involved and interested in learning critical life skills. Rather than wait until young people are in crisis, this legislation will fund preventive services. Rather than forcing service providers to define the needs of a youth to conform to the labyrinth of rules and regulations of a categorical program, they can identify the youth's needs based on what is actually needed. The youth development community block grant represents a comprehensive, coordinated approach to youth and to funding community-based services. The YDCBG incorporates many of the principles which policymakers and service providers have identified as necessary for effective Federal support for community-based human services--local control, flexibility, coordination, and accountability. Most existing youth development programs are provided not by government agencies but by community-based organizations. The youth development community block grant builds on the strength, credibility, and expertise of existing community-based resources. There is a broad and growing consensus among youth policy experts about the importance of increased investment in positive youth development programs. For example, in major studies, both the Chaplin Hall Center for Children at the University of Chicago and the Carnegie Council have concluded that, if youth are to succeed, there must be a well-developed infrastructure of youth development services in their communities. Provisions in the legislation concentrate on improving the quality of community-based youth development programs and improving the capacity of communities to design and deliver successful services for our youth. The YDCBG was developed in conjunction with the National Collaboration for Youth, a 15-member coalition of major youth-serving organizations. These organizations collectively provide direct services to over 25 million children and youth each year. Members of the National Collaboration for Youth endorsing the Youth Development Community Block Grant Act include: the American Red Cross, Association of Junior Leagues International, Big Brothers/Big Sisters of America, Boy Scouts of America, Boys and Girls Clubs of America, Camp Fire Boys and Girls, Child Welfare League of America, 4-H- Extension Service, Girl Scouts of the USA, Girls Inc., National Network of Runaway and Youth Services, The Salvation Army, WAVE Inc., YMCA of the USA, and YWCA of the USA. While these and other community-based youth organizations are providing important services to millions of youth, millions more go unserved or underserved. It is critical that the existing Federal dollars allocated for youth prevention be used in the most effective and efficient way--to build a cohesive network of locally driven services and programs. The legislation authorizes the youth development community block grant for 3 years at $2 billion per year. This authorization level represents a 10-percent savings over current Federal spending for the various programs consolidated under the YDCBG, the sum of the fiscal year 1995 appropriations for existing programs combined with the estimated appropriations level for crime bill programs aimed at youth prevention, less 10 percent. I hope other Members of the Senate join with us as cosponsors of the Youth Development Community Block Grant Act. Mr. President, I ask unanimous consent that additional material be printed in the Record.

Mrs. KASSEBAUM

Mrs. KASSEBAUM. Mr. President, I rise today in support of the nomination of Dan Glickman to become the next Secretary of Agriculture. Dan and I are long-time friends, and share a mutual appreciation and admiration for an agriculture system that provides the wholesome, abundant, and inexpensive food supply that all Americans now enjoy. For the past 18 years, Dan has ably and effectively served agriculture as a Member of the House of Representatives, representing Kansas' Fourth District. During his tenure, Dan provided outstanding leadership as a member of the House Committee on Agriculture. Many of us recognize the important role Dan has played in the effort to help U.S. agriculture compete in an increasingly global marketplace by expanding and strengthening our country's export programs. Dan also has been instrumental in congressional efforts to improve U.S. grain quality standards, making our commodity exports more attractive to potential foreign buyers. I know Dan to be a competent, thoughtful, and articulate spokesman for agriculture. He has forged strong relationships with producers, agribusinesses, and legislators. These relationships will prove invaluable as he begins his work as Secretary of Agriculture. Mr. President, rural communities depend on a vibrant and prosperous agriculture industry to support schools, churches, hospitals, community organizations, and main street businesses. I firmly believe that a key to our economic prosperity is the continued emphasis on American exports. During this year's farm bill debate, we must commit ourselves to crafting agriculture policy that allows our producers to compete in the 21st century, global marketplace, strengthening our rural communities in the process. It is also imperative that we continue to look for ways to improve effective programs, while eliminating costly, obsolete programs. Dan Glickman will play a vital role in achieving this ambitious, yet attainable goal.

Mrs. KASSEBAUM

Mrs. KASSEBAUM. Mr. President, on behalf of myself and Senators Kennedy, Hatch, Pell, Jeffords, Frist, Dodd, Coats, and Simon, I introduce the Ryan White CARE Reauthorization Act of 1995. The CARE Act has played a critical role in improving the quality and availability of medical and support services for individuals with HIV disease and AIDS. The most significant assistance under this act is provided through titles I and II. Title I provides emergency relief grants to cities disproportionately affected by the HIV epidemic. Title II provides formula grants to States and territories to improve the quality, availability, and organization of health care and support services. As the HIV epidemic continues, the need for this important legislation remains. There is a need as well to modify its provisions to take into account the changing face of the HIV epidemic since the CARE Act was first enacted in 1990. Once primarily a coastal urban area problem, the HIV epidemic now reaches the smallest and most rural areas of this country. In addition, minorities, women, and children are increasingly affected. This reauthorization bill builds on the successful four-title structure of the current CARE Act and includes many important improvements. Chief among these are changes in the funding formulas which would ensure greater funding equity and which provide a single appropriation for titles I and II. The General Accounting Office [GAO] has identified large disparities and inequities in the current distribution of CARE Act funding. This legislation, developed with GAO input, authorizes equity formulas for titles I and II based on an estimation of the number of individuals currently living with AIDS and the costs of providing services. In addition, the new title II formula includes an adjustment to offset the double-counting of individuals by States, when such States also include title I cities. The purpose of these changes is to assure a more equitable allocation of funding, based on where people with the illness are currently living. With any formula change, there is always the concern about the potential for disruption of services to individuals now receiving them. To address this concern, the bill maintains home-harmless floors designed to assure that no entity receives less than 92.5 percent of its 1995 allocation over the next 5 years. In an effort to target resources to the areas in greatest need of assistance, the bill also limits the addition of new title I cities to the program. Beginning in fiscal year 1998, current provisions which establish eligibility for areas with a cumulative AIDS caseload in excess of 2,000 will be replaced with provisions offering eligibility only when over 2,000 cases emerge within a 5-year period. The legislation makes a number of other important modifications: First, it moves the Special Projects of National Significance Program to a new title V, funded by a 3-percent set-aside from each of the other four titles. In addition, it adds Native American communities to the current list of entities eligible for projects of national significance. Second, it creates a statewide coordination and planning process to improve coordination of services, including services in title I cities and title II States. Third, it extends the administrative expense caps for title I and II to subcontractors. Fourth, it authorizes guidelines for a minimum State drug formulary. Fifth, it modifies representation on the title I planning councils to more accurately reflect the demographics of the HIV epidemic in the eligible area. Sixth, for the title I supplemental grants, a priority is established for eligible areas with the greatest prevalence of comorbid conditions, such as tuberculosis, which indicate a more severe need. I believe that the changes proposed by this legislation will assure the continued effectiveness of the Ryan White CARE Act by maintaining its successful components and by strengthening its ability to meet emerging challenges. Putting together this legislation has involved the time and commitment of a wide variety of individuals and organizations. I want to acknowledge all of their efforts, and I particularly appreciate the constructive and cooperative approach which Senator Kennedy has lent to the development of this legislation. It is my hope that the Senate can act promptly in approving this measure. I ask unanimous consent a summary of this bill be made a part of the Record.

Mrs. KASSEBAUM

Mrs. KASSEBAUM. Mr. President, how much time is remaining?

Mrs. KASSEBAUM. Mr. President, I yield 5 minutes to the Senator from Georgia [Mr. Coverdell].

Mrs. KASSEBAUM. Mr. President, if I may just restate what this amendment is about. It is an amendment which would bar any Federal funds from being spent to implement the Executive order that was issued by the President last week. That Executive order would effectively prohibit Federal contractors from exercising their legal right to hire permanent replacement workers--a right that has been the law of the land for 60 years. Mr. President, we have heard a lot about this debate being one thing or children. I believe, Mr. President, and perhaps I am naive in thinking so, that this vote should not be viewed as a test of the President's leadership, nor should it be viewed as a test of Republican clout. I hope that it would not be viewed as a vote for labor or a vote for business. I wish that this amendment would be taken for what it is. No one wants to see workers dismissed gratuitously and replaced by permanent replacement workers. That is not what is at issue either. This is not the beginning of a series of assaults on working class families. This is a debate on an Executive order issued by the President which effectively changes labor law in a significant way. What this debate is all about, in my mind--and I think it is an important point--is the separation of powers between Congress and the executive branch. It is about whether our national labor policy should be determined by the President rather than by an act of Congress. The question at stake is whether we are prepared to allow the President to overturn 60 years of established labor law with the stroke of a pen. We can debate this issue at another time. We have debated it before, and I am sure we will again. There are those who suggest we may be able to find some compromises that can bring all sides together. But what the current law has done in over 60 years is to provide the balance to which the Democratic leader spoke. It has provided a balance between labor and management, and that should be preserved. It has been mentioned that there were other Executive orders which were undertaken, and we have debated this before. Just to reiterate, however, no previous Executive order by President Bush or President Reagan went this far in contradicting both the law and the will of Congress. President Reagan's order banned illegally striking air traffic controllers from Federal employment. This was well within his rights and was not contrary to existing law. President Bush's order on Beck was merely enforcing existing law. President Bush's order on prehire contracts was not preceded by extensive debate and defeat by Congress, as has been the case with striker replacement legislation. He may well have exceeded his authority on that Executive order on prehire contracts, but it was never an order that was challenged by the courts or challenged in Congress. I think we are seeing here that under this Executive order Federal contractors will effectively be barred from exercising a longstanding legal right--just as labor has the right to strike--that all other companies are permitted to do under existing labor law. Regardless of which side we might take on the issue of striker replacements, we should all be concerned, Mr. President, about the precedent this Executive order would set for future Presidents. What if a new administration decided to debar any contractor whose workers decided to go on strike? Would we feel the same way about an Executive order that infringed on the equally longstanding right to strike? It has also been argued that this Executive order will have only a limited impact, that perhaps only a dozen companies would be affected. Mr. President, the Federal Government contracts for close to 180 billion dollars' worth of goods and services. Many defense contractors would be affected, and that is why it is fitting this is added as a debate to the defense supplemental bill. This order will potentially affect tens of thousands of companies.

Mrs. KASSEBAUM. I yield myself 2 additional minutes. The Defense Department alone has contracts of value greater than $100,000 with over 20,000 different companies. This Executive order would cover Federal construction projects, potentially colleges and universities with Federal research contracts, hospitals and health care providers that contract with the Federal Government. It is very unclear as to what exactly this Executive order might apply. As was pointed out by the Senator from Mississippi and the Senator from Oklahoma, the Secretary of Labor has a great deal of discretion under this Executive order to decide when it may or may not apply. Over 30 years ago, the Supreme Court overturned President Truman's attempt to seize control of the steel mills by Executive order. I believe Justice Black's opinion in the Youngstown case is relevant here. He said: In the framework of our Constitution, the President's power to see that the laws are faithfully executed refutes the idea that he is to be a lawmaker. The Constitution limits his functions in the lawmaking process to the recommending of laws he thinks wise and the vetoing of laws he thinks bad. I believe the President has exceeded his authority here by attempting to make the law, dictating the terms of our national labor policy, by means of the Executive order in direct contravention of current law. Congress makes the law, not the President, and we should not relinquish our role in setting national labor policy by allowing this Executive order to stand. I urge my colleagues to support cloture in order to reassert the authority of the Congress and to bring this debate to a close. I yield the floor, Mr. President.

Mrs. KASSEBAUM. I would like to yield myself 5 minutes.

Mrs. KASSEBAUM. Mr. President, I would like to yield 5 minutes to the Senator from Oklahoma.

Mrs. KASSEBAUM. Mr. President, I yield 5 minutes to the Senator from Mississippi [Mr. Lott].

Mrs. KASSEBAUM. Mr. President, I yield 5 minutes to the Senator from Texas [Mr. Gramm].

Mrs. KASSEBAUM

Mrs. KASSEBAUM. Mr. President, I regret that we have been unable to have a final vote on my amendment. There are those who do not wish to see it come to a resolution with an up-or-down vote, and that is their right. I respect that. The Executive order that we have been talking about--whereby striking workers now cannot be permanently replaced, as has been the law for some 60 years and which will now be overturned by this Executive order--is very important and very troubling. The implications of the Executive order go far beyond just saying there will only be a few companies affected and it really will not make a lot of difference. It is very important for us to understand what, indeed, the ramifications of the order will be. I would argue that using Executive orders in this way can affect labor as well as management. And it will further destabilize the relationships in the work force. So I just want to say, Mr. President, I will be back. This is an issue of vital importance and I intend to bring it up again and again because I think it is so very important. Mr. President, I appreciate the fact that it has been a good debate. There have been, I think, some well-stated views on both sides. I suggest that this issue is one that will not be laid to rest until, I hope, we can reach some resolution on what basically is at stake here-- and that is the separation of powers between the executive and legislative branches. I yield the floor.

Mrs. KASSEBAUM. Mr. President, I would say these comments represent my point of view on this issue at this point. The majority leader is in discussions now. I think he will announce the outcome of those discussions in a few minutes.

Mrs. KASSEBAUM. Mr. President, I suggest the absence of a quorum.

Mrs. KASSEBAUM

Mrs. KASSEBAUM. Mr. President, on behalf of Senator Kennedy, Senator Frist, and myself, I rise today to introduce legislation aimed at improving the supply and distribution of health professionals for our Nation's underserved communities. The Health Professions Consolidation and Reauthorization Act of 1995 would consolidate over 44 different health professions programs administered by the U.S. Public Health Service. Furthermore, this legislation would target Federal health professions funding to support training initiatives designed to improve the health of citizens in our Nation's underserved areas. For three decades, through the Public Health Service and Medicare, the Federal Government has funded the training of health professionals. Once perceived to be in undersupply, physicians are now in oversupply as a result of this Federal intervention. However, the uneven distribution of physicians still leaves many areas underserved. Furthermore, many believe the Nation now has too many subspecialist physicians and too few primary care providers. To correct these problems, a better targeted Federal health professions strategy is needed. Currently, through titles III, VII, and VIII of the Public Health Service Act, the Federal Government provides over $400 million for 44 separate initiatives. When the title VII and VIII programs were last reauthorized in 1992, the General Accounting Office [GAO] was requested to review their effectiveness in: First, increasing the supply of primary care providers and other health professionals; second, improving their representation in rural and medically underserved areas; and third, improving minority representation in the health professions. GAO recommended that Congress or the Secretary of Health and Human Services should establish: First, national goals for the title VII and VIII programs. Second, common outcome measures and reporting requirements for each goal; Third, restrictions limiting the use of funds to activities whose results can be measured and reported against these goals; and Fourth, criteria for allocating funding among professions based on relative need in meeting national goals. The Health Professions Consolidation and Reauthorization Act of 1995 builds on GAO's recommendations and is based on defined goals for these programs. In addition, all programs would include a strong evaluation component to ensure that they are really improving national, regional, and State work force goals. The act targets Federal funding based on the following goals: First, Federal health professions education programs and distribution programs should assure health through: improvements in the distribution of and quality of health professionals needed to provide health services in underserved areas; and enhancement of the production and distribution of public health personnel to improve the State and local public health infrastructure. Second, the bureaucracy required to administer the current 44 independent programs should be simplified and reduced. Under this proposal, future Federal support for health professionals programs would be targeted to: primary and preventive care; minorities and the disadvantaged; community-based training in underserved areas; advanced degree nursing; and the National Health Service Corps. In recognition of the need for fiscal restraint, funding for these programs would be decreased by 10 percent at the end of 4 years. Mr. President, the Health Professions Consolidation and Reauthorization Act of 1995 maintains the traditional goal of Federal health professions programs, which is to improve the supply and distribution of health professionals in underserved areas. I believe, however, that it offers a more effective and targeted approach by moving away from small, narrowly defined categorical programs toward broad areas of focus. In addition, my proposal places an emphasis on outcomes measurement--a feature sadly lacking in our current efforts. As discussion of these issues develops, I would welcome any suggestions my colleagues or others may have for improving this legislation. Mr. President, I ask unanimous consent that a summary of the bill be printed in the Record. be printed in the Record, as follows: Summary of the Health Professions Education Consolidation and Reauthorization Act of 1995 background Titles III, VII, and VIII of the Public Health Service Act authorize 45 different programs. The goal of these programs is to improve the supply and distribution of a variety of types of health professionals and to improve the representation of minorities and disadvantaged individuals in the health professions. The focus of Title VII programs is on the training of physicians, general dentists, physician assistants, allied health personnel, public health professionals, and veterinarians. Title VIII provides for nurse training. Title III deals with the National Health Service Corps, which helps to place providers in underserved areas. These Titles include programs for direct student assistance, such as loans and scholarships, loan repayments programs, and expansion and maintenance of training programs. summary I. Primary care and preventive medicine training Under this provision, funds for family physician, general pediatrician, general internists, preventive medicine physician, and physician assistant training would be authorized. These providers are generally needed to fill both rural and underserved health professional shortage areas and to help improve staffing in public health departments. Generally, priority would be given to programs which have a history of training health professionals who eventually enter practice in rural and urban underserved areas. II. Minority and disadvantaged training Under this provision, the Secretary would have broad discretion to fund projects which improve the number and quality of minority and disadvantaged health professionals. Many believe that an increased number of minority and disadvantaged providers would result in improvements of services in underserved areas, because such individuals are more likely to practice in those areas than are others. Generally, most minorities are currently under-represented in the health professions relative to their representation within the entire U.S. population. III. Community-based training in underserved areas This authority would be similar to the current Area Health Education Center program. These centers are located in underserved areas. They train medical students and other health professionals to provide services in rural and underserved areas. Exposure to these settings is generally recognized as a determinant in whether a health professional would return to practice in such settings. In addition, these centers help support practicing providers in such areas through continuing medical education support. IV. Consolidated student assistance This section would have a few authorities, but only one appropriation. This proposal would combine most of the current scholarship and loan programs into the current National Health Service Corps Scholarship and Loan Repayment program. As such, individuals would receive financial support only in return for service provided in primary care underserved areas. This would help to eliminate the 4,000 positions currently available in underserved areas. In addition, transfer of the current funding for scholarship programs to the Corps would help it fund more applications. Currently the National Health Service Corps is only able to provide scholarships in return for service to one out of every 10 applicants. In addition, the current scholarship programs for minority and disadvantaged individuals would be consolidated into a single scholarship program for disadvantaged students. The authorities which would be left in place from current law are those which do not require appropriations, but rather are revolving loan funds which currently exist at schools. V. Nursing The provisions of this proposal would be similar to those included in the Nursing Education Act reauthorization which was approved by the Senate last year. Under it, six current nursing programs would be consolidated into three to emphasize primary care nursing and the production of minority and disadvantaged nurses. VI. Other priority areas The Secretary could fund any number of other projects for health professionals training which meet national workforce needs to improve health services in underserved areas. For instance, under this provision, the Secretary could fund projects to train allied health professionals. VII. Other provisions from last year's Minority Health Improvement Act Conference Report Office of Minority Health The authority for the office would be extended through FY 1999. Furthermore, the provision assures that the office is only coordinating services--not conducting its own services and research program. The authorization would be $19 million for each fiscal year through FY 1999. This would be a 10% reduction from the current appropriation of $20.668 million. (This is consistent with the general reductions in authorizations throughout the health professions bill). State Offices of Rural Health There would be ``such sums as necessary'' authorized through FY 1997. The cumulative appropriations would be capped at $20 million. In FY 1998, after these offices have been established in every state, the program would be repealed. The current appropriation for this program is $3.875 million. Birth Defects An enhanced program for an intramural program on birth defects at the Centers for Disease Control and Prevention (CDC) would be authorized. Through this program, research centers would be established, epidemiologic review of data would occur, and a national information clearing house would be established. This program is consistent with current CDC plans in this area. No funds would be authorized specifically for this program, but funding would occur under the general CDC program authority. Traumatic Brain Injury This provision is identical to that in the conference report. It would provide for the National Institutes of Health (NIH) to conduct research on traumatic brain injury without an authorization for a separate appropriation. It would also authorize $5 million a year for a demonstration program to be administered through the Health Resources and Services Administration, subject to the availability of funding, for the development of state systems of care for persons with traumatic brain injury. Finally, the provision would authorize a consensus conference at NIH regarding the treatment of individuals with this illness. Health Services for Pacific Islanders This would extend the Pacific Islanders initiative, with technical changes only. The program would be authorized at $3 million in FY 1996 and in each year through FY 1999. Finally, a study would be authorized to determine the usefulness of this initiative. Demonstration Projects Regarding Alzheimer's Disease There would be $5 million authorized in each of the fiscal years from FY 1996 through FY 1999. There are many technical revisions. Miscellaneous Centers for Disease Control and Prevention Provisions Epidemiologic Intelligence Service officers, funded through state and local governments, would not count in FTE determinations of CDC. Current fellowship programs at CDC would be authorized. minority and disadvantaged training Purposes: (1) Provide for the training of minority and disadvantaged health professionals to improve health care access in underserved areas and to improve representation in the health professions; and (2) Provide administrative flexibility and simplification. General Description: Under this provision, the Secretary would have broad discretion to fund projects which improve the number and quality of minority and disadvantaged health professionals. Many believe that an increased number of minority and disadvantaged providers would result in improvements of services in underserved areas because such individuals tend to practice in those areas more than others. Generally, most minority groups are currently under- represented in the health professions relative to their representation within the entire U.S. population. Current Law Authorities Consolidated: (The numbers before each program are keyed to the Labor Committee document: ``Health Professions Education: Summary of Federal Training Programs.'' 9. Centers of Excellence in Minority Health 10. Health Careers Opportunity Program 11. Minority Faculty Fellowships 12. Faculty Loan Repayment Summary of Provisions: Eligible entities Schools of medicine, osteopathic medicine, dentistry, pharmacy, podiatric medicine, optometry, veterinary medicine, public health, allied health professions schools; schools offering graduate programs in clinical psychology; state or local governments; a consortia of health professions schools; or other public or private nonprofit entities could apply. Activities Grants and contracts would be made, as appropriate, to plan, develop, or operate: 1. Demonstrative programs. 2. Minority faculty development and loan repayment programs. 3. Programs to develop the pipeline for individuals from disadvantaged backgrounds to enter and remain in health professions schools. 4. Programs of excellence in the health professions education for minority individuals, including centers of excellence at certain historically black colleges and universities. 5. For the provision of technical assistance, work force analysis, and information dissemination. Any grant which is funded could incorporate one or all of these activities. In addition, a preference would be given to projects which involve more than one health profession discipline or training institution and, beginning in fiscal year 1999, for centers of excellence at certain historically black colleges and universities. which have the greatest chance of improving minority representation in the health professions and which have an above average record of retention and graduation of individuals from disadvantaged backgrounds. Outcomes evaluation Each program would be required to set performance outcomes and would be held accountable for meeting such outcomes. The performance outcome standards would be consistent with state, local, and national work force development priorities. Non-Federal matching The Secretary would have discretion to require institutional or state and local government matching grants to ensure the continuation of the project once federal aid ends. Transition Current grantees would continue to operate under existing authorities through the remainder of their funding cycles. The new provisions would apply only to new grants. Authorization There would be $51 million authorized for fiscal year 1996 and such sums as necessary through fiscal year 1999. Combined funding for these authorities in fiscal year 1995 is $50.806 million. For fiscal years 1996 through 1998, there would be a 4.25% setaside for the centers of excellence at certain historically black colleges and universities. primary care and preventive medicine training Purposes: (1) Provide for the training of primary care providers and preventive medicine public health personnel to improve access to and quality of health care in underserved areas and to enhance state and local public health infrastructure; (2) Provide administrative flexibility and simplification. General Description: Under this provision, funding for family physician, general pediatrician, general internist, preventive medicine physician, and physician assistant training would be authorized. These providers are generally needed to fill both rural and underserved health professional shortage areas and to help improve staffing in public health departments. Generally, priority would be given to programs which have a history of training health professionals who eventually enter practice in rural and urban underserved areas. Current Law Authorities Consolidated: (The numbers before each program are keyed to the Labor Committee document: ``Health Professions Education: Summary of Federal Training Programs.'') 1. Family Medicine Training 2. General Internal Medicine and General Pediatrics Training 3. Physician Assistant Training 5. Preventive Medicine and Dental Public Health 12. Geriatric Medicine and Dentistry Faculty Development Summary of Provisions: Eligible entities Health professions schools, academic health centers, or other public or private nonprofit entities could apply. Activities Grants and contracts would be made as appropriate to develop, operate, expand, or improve: 1. Departments (or academic administrative units) of family medicine. 2. Residency training programs in family medicine, general internal medicine, general pediatrics, or preventive medicine. 3. Physician assistant training programs. 4. Faculty development initiatives in primary care, including geriatrics. 5. Medical school primary care training initiatives. Departments of Family Medicine Departments of family medicine would be funded. Such units lead to a greater number of medical students choosing careers in primary care. Residency Training Programs Family medicine, general internal medicine, and general pediatrics residency programs would compete with one another for funding. Two outcome standards would be established to determine a funding preference. First, those programs with the highest percentage of providers who enter primary care practice upon the completion of training would receive a priority. In addition, programs which successfully produce professionals who go on to provide service in underserved areas would receive a preference. Preventive medicine residencies would not compete for funding with family medicine, general internal medicine, or general pediatrics. Rather, they would receive an appropriate amount of funding, as determined by the Secretary. A preference would be given to those programs which train a high percentage of individuals who enter practice in state and local public health departments. Physician Assistant Training Programs Physician assistant training programs would receive an appropriate amount of funding, as determined by the Secretary, from the appropriation for this section. Those programs which have a higher output of providers who eventually enter practice in underserved areas would receive a preference for funding. Faculty Development The Secretary would determine which type of faculty development projects to fund based on national and state work force goals. Geriatric fellowships and faculty development could be funded. Medical School Primary Care Training Primary care training activities at medical schools would be funded through departments (or administrative units) of family medicine, general internal medicine, or general pediatrics. Applications from general internal medicine and general pediatrics administrative units would be required to demonstrate their institution's commitment to primary care education by: (1) A mission statement which has a primary care medical education objective; (2) faculty role models and administrative units in primary care, and general pediatrics; and (3) required undergraduate community-based medical student clerkships in family medicine, internal medicine, and pediatrics. Outcomes evaluation Each program would be required to set performance outcomes and would be held accountable for meeting such outcomes. The performance outcome standards would be consistent with state, local, and national work force development priorities. Non-Federal matching The Secretary would have discretion to require institutional or state and local government matching grants to ensure the continuation of the project once federal aid ends. Transition Current grantees would continue to operate under existing authorities through the remainder of their funding cycles. The new provisions would apply only to new grants. Authorization There would be $76 million authorized for fiscal year 1996 and such sums as necessary through fiscal year 1999. Combined funding for these authorities in fiscal year 1995 is $75.285 million. Family medicine departments would receive no less than 12 percent of the overall funding. This is consistent with the current set-aside that such departments receive. community-based training in underserved areas Purposes: (1) Provide support for training centers remote from health professions schools to improve and maintain the distribution of health providers in rural and urban underserved areas; (2) Provide the Secretary the option of funding geriatric training centers; (3) Provide administrative flexibility and simplification. General Description: This authority, most similar to the current Area Health Education Center (AHEC) program, would enhance the community-based training in underserved areas of various health professionals. This goal would be achieved through greater flexibility in the design of such programs and through the leveraging of state and local resources. AHECs are generally located in underserved areas remote from academic health centers. They train health professionals to provide services in rural and underserved areas. Exposure to these settings is generally recognized as a determinant in whether a health professional returns to practice in such settings. In addition, these centers help support practicing providers in such areas through continuing medical education programs. Finally, the current program for funding geriatric training centers could continue at the discretion of the Secretary. Current Law Authorities Consolidated: (The numbers before each program are keyed to the Senate Labor Committee document: ``Health Professions Education: Summary of Federal Training Programs.'') 40. Area Health Education Centers 41. Health Education and Training Centers 42. Geriatric Education Centers 43. Rural Health Interdisciplinary Training Summary of Provision: Eligible entities Health professions schools, academic health centers, state or local governments, or other appropriate public or private nonprofit entities. Activities Grants and contracts would be made as appropriate to plan, develop, operate, expand, conduct demonstration projects, and to provide trainee support, for projects which: 1. Improve the distribution, supply, quality, utilization, and efficiency of personnel providing health services in urban and rural underserved populations. 2. Encourage the regionalization of educational responsibilities of the health professions schools into urban and rural underserved areas. 3. Are designed to prepare individuals effectively to provide health services in underserved areas through: preceptorships, the conduct or affiliation with community- based primary care residency programs, agreements with community-based organizations for the delivery of education and training in the health professions, and other programs. 4. Conduct interdisciplinary training of the various health professions. 5. Provide continuing medical and health professional education to professionals practicing in the underserved areas served by the grantee. A preference would be given to projects which involve one or more health professions discipline or training institution, train individuals who actually enter practice in underserved areas, and have a high output of graduates who enter primary care practice. geriatric training centers if the Secretary determines such entities are needed to improve the geriatric skills of health providers. Outcomes evaluation Each program would be required to set performance outcomes and would be held accountable for meeting such outcomes. The performance outcome standards would be consistent with state, local, and national work force development priorities. Non-Federal matching The Secretary would have discretion to require institutional or state and local government matching grants to ensure the continuation of the project once federal aid ends. Transition Current grantees would continue to operate under existing authorities through the remainder of their funding cycles. The new provisions would apply only to new grants. Authorization There would be $39 million authorized for fiscal year 1996 which would be reduced to $25 million by fiscal year 1999. Combined funding for these authorities in fiscal year 1995 is $39.159 million. The $14 billion in funding reductions over the three-year period is equivalent to the current combined appropriations for the Health Education and Training Centers, Rural Health Interdisciplinary Training Programs, and the geriatric training centers. Funding will be phased down to allow for the completion of current project funding periods. health professions work force development Purpose: Provide support to strengthen capacity for the education of individuals in certain health professions which the Secretary determines to have a severe shortage of personnel and for improving the care of underserved populations and other high-risk groups. Current Law Authorities Consolidated: (The numbers before each program are keyed to the Labor Committee document: ``Health Professions Education: Summary of Federal Training Programs.'') 4. Public Health Special Projects 6. Health Administration Traineeships and Special Projects 13. Geriatric Optometry Training 14. General Dentistry Training 15. Allied Health Advanced Training and Special Projects 16. Podiatric Primary Care Residency Training 17. Chiropractic Demonstration Projects 45. AIDS Dental Services Summary of Provisions: Eligible Entities Schools of medicine, osteopathic medicine, public health, dentistry, allied health, optometry, podiatric medicine, chiropractic medicine, veterinary medicine, pharmacy, or graduate programs in mental health practice. Activities Grants and contracts would be made as appropriate to plan, develop, or operate programs to strengthen the capacity for health professions education and practice. The Secretary shall have broad discretion to fund projects, but shall give priority to projects which would improve care for underserved populations and other high-risk groups and which would increase the number of practitioners in any health professions field for which the Secretary determines there is a severe shortage of professionals. In general, funds under this section could be used to provide for faculty development, model demonstrations, trainee support, technical assistance, or work force analysis. Outcomes evaluation Each program would be required to set performance outcomes and would be held accountable for meeting such outcomes. The performance outcome standards would be consistent with state, local, and national work force development priorities. Non-Federal matching The Secretary would have discretion to require institutional or state and local government matching grants to ensure the continuation of the project once federal aid ends. Transition Current grantees would continue to operate under existing authorities through the remainder of their funding cycles. The new provisions would apply only to new grants. Authorization There would be $20 million authorized for fiscal year 1996 which would be reduced to $5 million by fiscal year 1999. Combined funding for these authorities in fiscal year 1995 is $20.264 million. The three-year period to phase down this funding would allow for the completion of current project award periods.

Mrs. KASSEBAUM

Mrs. KASSEBAUM. Mr. President, I would like to express my appreciation to the Senator from Massachusetts for being understanding of the necessary absence of the Senator from Utah. He very much wanted to be a part of the debate and the vote and his absence is one of the reasons that the cloture vote has been postponed until Wednesday. I also appreciate the understanding of the Democratic leader. There has been a desire from all of you to move ahead. The defense supplemental legislation is an important measure, but it seems to me that we are having a good debate. Mr. President, I would like to explain what this debate is about. This debate is not about the Contract With America. It is not about all of the other issues that have been raised, including school lunches and child care. Those are important issues to be debated at another time. The issue before us at this particular moment is an Executive order that President Clinton has issued that says large contractors doing business with the Federal Government should be prohibited from hiring permanent replacement workers. There are people with strong views on both sides of the striker replacement issue. I feel that we have debated this issue thoroughly during the past Congress and again in this Congress, and we will be debating it further, I am sure, in years ahead. What troubles me is that the President, through this Executive order, is able to change major labor law. The Senator from Massachusetts mentioned in his opening comments today that Presidents in the past-- President Bush and President Reagan--issued Executive orders and nothing was said. Let me just, once again, go through those three Executive orders and why I believe they are very different from the Executive order that we are debating today, and the amendment which would say that no moneys could be used to implement that Executive order. President Reagan issued an Executive order that replaced striking air traffic controllers with permanent replacement workers because the air traffic controllers had been striking illegally. There was never any question about hiring permanent replacement workers at that time. During the years following that Executive order there were several measures debated on the Senate floor about rehiring those striking air traffic controllers which did not pass. President Bush issued one Executive order which required the posting in the workplace of all of the rights of employees. This was, by law, something that should have been done and was not in any way changing the law of the land. The second Executive order issued by President Bush concerned prehire contracts, and that I think is a bit unclear. One of the major differences between that Executive order and this one is the fact that the prehire contract had never been debated in this Chamber. On the other hand the use of permanent striker replacement workers has been an issue debated in both the House and Senate at great length. While one may question whether President Bush by Executive order could put into place the rule that prehire contracts could not be entered into, it had never been debated by Congress. If we were to have changed it, then Congress, logically, should have been the place to make a change. But the prehire contracts Executive order was never challenged by either the Congress or the Supreme Court. So I think the difference is very clear. This Executive order is being challenged in Congress and is going to be challenged in the courts. It is by its very nature a troubling effort by the executive branch to, by executive fiat, change what has been the law of the land, and a major part of labor law, for some 60 years. This Executive order is troubling because, on the one hand, labor's right to strike has been upheld, but on the other hand management's right to hire permanent replacement workers, just as much a part of existing labor law, is being attacked. I would like to quote a paragraph from the lead Washington Post editorial this morning. It says: The law is contradictory. The National Labor Relations Act says strikers can't be fired; the Supreme Court has nonetheless ruled that they can be permanently replaced. The contradiction may be healthy. By leaving labor and management both at risk, the law gives each an incentive to agree. For most of modern labor history, management in fact has made little use of the replacement power and labor hasn't much protested it. Perhaps this is where we are today, trying to ponder this contradiction. We can ask ourselves if, in revisiting the National Labor Relations Act we need to address it in some different ways to meet the changing labor markets. The current balance has worked well. On the other hand, I am sympathetic to those who say management should not immediately hire permanent replacement workers because, if that is the case, the employees have lost some leverage which they would have with the right to strike. On the other hand, if the employees take advantage of a company such as Diamond Walnut, which has been debated here before, and strike right at the beginning of the season in which all of the crop must be harvested, is it not a calculated strike to force management to its knees? Is there not some means to balance these competing interests without causing a problem? I am absolutely certain, Mr. President, that the President has made a serious mistake by issuing the Executive order and changing so fundamentally labor law that has on the whole worked well. Initiating an Executive order that will countermand legislative language is a slippery slope that can then work to any President's advantage. I think it calls into question the separation of powers between the executive and legislative branches. While it is the right of the President to issue an Executive order, when it overturns the law of the land, I think we have to approach it carefully. The Senator from Massachusetts said that there are those who argue it would lead to more strikes. I am not sure that it necessarily would. But I think what it would do would certainly lead to far lead to far greater uncertainty in relations between management and labor. I think prohibiting permanent replacements would pose enormous difficulties on both sides and certainly increase the potential for longer strikes, because what would be the incentive for those on strike to go back to work? It seems to me that we simply must uphold a balanced approach, and neither side should be able to unbalance the relationship. Yes, we have to be just as cautious of management in taking that opportunity as we would with labor. But the mechanism is already in place for collective bargaining to work--which is the heart of the matter--and for both sides to be able to bargain in good faith. I believe this is what we in the legislative branch owe both labor and management when they go to the bargaining table. It is up to them, both labor and management, to accomplish that. I really believe that regardless of the merits of this issue and where people stand on either side, we should think carefully about the issue before us and the implication that by Executive order a major principle of labor law can be turned on its head. This, it seems to me, is what each and every one of my colleagues should consider as we approach a cloture vote on Wednesday. I think that the merits of permanently replacing striking workers could be debated at another time. We debated it last year. We will be debating it again. But it is the Executive order that we have to deal with at this particular time. Mr. President, I yield the floor. Mr. KENNEDY addressed the Chair.

Mrs. KASSEBAUM

Mrs. KASSEBAUM. Mr. President, no, I do not. I would simply, though, make a statement. This is not about the Contract With America. This is not about whose side one is on. I would say to the Senator from Wisconsin, what this is about is the ability of the President, by an Executive order, to change the labor law of the land which has existed for 60 years. The debate on whether to have a permanent replacement of workers can come at a different time. I am sure it will. It has through the past two Congresses. But that is what troubles me--and I know the Senator from Wisconsin has the floor. It is not a question so much as to state indeed what this debate is about.

Mrs. KASSEBAUM

Mrs. KASSEBAUM. I thought I heard the Senator from Massachusetts suggest that permanent replacement workers would not be able to offer the same type and quality of work. Would you feel any safer with temporary replacement workers, because this Executive order permits temporary replacements? So I think, if the question was what type and quality of work will be done by the permanent replacements, I suggest it could be far more risky with temporary workers.