Ted Kennedy

Mr. KENNEDY

Mr. KENNEDY. Mr. President, the matter that I want to address, again, is the issue of the Patients' Bill of Rights. It is time for our Republican leadership to stop the blocking of the Patients' Bill of Rights. It is time for them to stop protecting the insurance company profits and start protecting the parties. It is time for them to stop manipulating the rules of the Senate to deny the American people the protections they deserve. It is clear what is going on here. It is clear to every Member of the Senate. It should be clear to the American people. The American people want Congress to pass strong, effective legislation to end the abuse by HMOs, the managed care plans, and the health insurance companies. The Patients' Bill of Rights, sponsored by Senator Daschle and Senate Democrats, provides the needed and long overdue antidote to the festering and growing abuses. Our goal is to protect patients and see that insurance plans provide the quality care they promise but too often fail to deliver. Two hundred groups of patients, doctors, nurses, and families have announced support for our bill and are begging the Republican leadership to listen to their voices. I have the list of the various groups supporting our legislation. They represent virtually all of the major doctor and nurse organizations and consumer groups, starting with the American Medical Association, the various cancer societies, the National Breast Cancer Coalition, and all of the American nursing associations. The supporters also include those groups that are most interested in the health care of children including the Children's Defense Fund and the American Academy of Pediatrics. These groups also represent our senior citizens including the National Council of Senior Citizens. The bill is also supported by groups that are most interested in mental health, the Mental Health Association, and those groups most concerned about disability policies including the Multiple Sclerosis Society, United Cerebral Palsy, the American Academy of Neurology, and the Center on Disability and Health. This, Mr. President, is only one page of a series of pages of different groups where it can be said, without contradiction, that every major medical association in our country supports the Daschle proposal which is sponsored by the Democrats. Virtually every single doctors organization, every single nurses organization, every single consumer organization, every organization that has represented children in our society, every association that represents cancer victims, every association that represents the disability community--every one of those organizations, plus many others, support our particular proposal. There is not one organization, not a single organization, that supports the alternative Republican proposal. We have asked day in and day out for them just to find one organization representing any of the doctors or nurses, children's groups, women's groups, cancer victims groups, disability groups, any of those groups in our society, and all we have is silence. This isn't a matter that we are advocating because of our particular interest. We are advocating on behalf of all of these organizations and all of the various patients and all of the various families that are part of this central concern about how we best can protect the families in this country. The best way those families can be protected is, at least, through debate on a Patients' Bill of Rights and, I believe, by the enactment of this legislation. As we have said on many different occasions, these are commonsense solutions to the kind of problems that are real problems out there and that are being faced by families every single day. If a child is sick and the parents of that child belong to one HMO, that ambulance has to drive by the nearest emergency room and go to an emergency room across town because it is on the list of that HMO. When that child is in an emergency situation, they ought to be able to go to the nearest hospital--that is one of our bills' protections. It is listed right here. We believe that child ought to have the opportunity to go to the nearest emergency room and have the kind of immediate attention, but also the follow-up attention that they need. That right would be guaranteed under our Patients' Bill of Rights. We want to debate that issue. That is a commonsense proposal. It is a commonsense proposal that any family can understand. If there is going to be an emergency affecting a child, it makes no sense to drive them by the nearest emergency room and take them clear across town to a more distant emergency room if that child needs immediate medical attention. That is common sense. That protection is here. We ought to be able to debate that particular issue, but we are denied that opportunity. We ought to be able to get to it. I believe it wouldn't take a great deal of time. The list goes on. Our bill was introduced in March. But, the Senate has taken no action because the Republican leadership has been using every trick in the procedural playbook to prevent a meaningful debate. The Republican leadership is abusing the rules of the Senate so that the health insurance companies can continue to abuse patients. That happens to be the fact. We have too many instances of reports from patients that say, every single day we fail to provide these guarantees, members of their family are put at risk. Every day we continue to deny women who have breast cancer the opportunity to be involved in clinical trials at places like the Lombardi Center, we are putting those particular women at risk. As I mentioned yesterday, out at the Lombardi Center they have eight professional individuals whose only job is to argue with the HMOs to permit the parties involved, access to the clinical trials their doctors say are necessary but that the HMO will not permit them access to. Our bill provides these kinds of protections. It is common sense. Without these kinds of protections, we are endangering the lives of those individuals who ought to be a part of the clinical trials. That is a very important protection. Every day, we are denied that kind of debate and resolution, but we still find that patients are abused by too many of the HMOs. The Republican leadership wants to gag the Senate so that HMOs can continue to gag the doctors who tell patients about needed treatments that are too expensive for the HMO balance sheet. I use those words ``gag the Senate'' because all we have had on the other side is the proposal that you can have one, two, or three amendments but no other. You can't have any others. We are not going to take the time of the U.S. Senate to do it, although we did find time to have a debate on the issue of salting; we had time to debate that issue. We had time to debate the issues on the Vacancies Act. We have had time to debate issues like bankruptcy which affects 1.2 million people. But our patient protections bill, which affects tens of millions of our fellow citizens, we evidently, haven't got the time to debate that. The Republican leadership wants to deny a fair debate on the Patients' Bill of Rights so HMOs can continue to deny the needed patient care. The Republican leadership wants to avoid accountability in the U.S. Senate so that managed care plans can avoid accountability with their unfair decisions, when their unfair decisions kill or injure patients. The Republican leadership has found time to call up the Vacancy Act, the salting bill, the Child Custody Act, the Bankruptcy Act, and the Internet tax bill. So it is clear that protecting patients from abuse by HMOs and health insurance companies is a priority for American families, but not for the Republican leadership. How else can that be explained? How else can you explain the fact that the Republican leadership has called up these different pieces of legislation, but denies us the opportunity to debate this issue, which is of essential importance? Listen to this, Mr. President. The Republican leadership, just yesterday, agreed to a unanimous consent agreement on the Internet tax bill that would have allowed all relevant amendments--no limitation on the number of amendments, no limitation on the time to debate each amendment, and no limitation on the time for the overall debate. We should have the opportunity to do that on the Patients' Bill of Rights, but, oh, no, we can't do that with the Patients' Bill of Rights--even though the failure to provide these protections puts at risk so many fellow citizens every single day. But no, the Republican leadership said instead we will have a consent agreement on the Internet tax bill. I wonder how many people here in the Senate, let alone those who are watching, would feel that particular issue is of more importance than the Patients' Bill of Rights. We have moved ahead now on the questions of that particular legislation, and I intend to support it. It is important legislation, particularly for a State like mine, Massachusetts, with a lot of high tech and similar kinds of issues. But, Mr. President, to put this bill on the same level as what we are talking about with the Patients' Bill of Rights, it just shouldn't be. Senator Daschle asked Senator Lott for a similar agreement on the Patients' Bill of Rights on June 25. He asked him for an agreement on July 29. He asked him on September 1, and he asked him on September 9. Each time, Senator Lott, the Senate Republican leader, said no. Do we understand that, Mr. President? On June 25, on this legislation--the Patients' Bill of Rights, Senator Daschle asked for the same kind of agreement made yesterday by the Republican leadership on the Internet tax bill. He asked for it on July 29. He asked for it September 1. He asked for it on September 9. Each time, Senator Lott and the Senate Republicans said no. Senator Daschle also offered to agree on May 12 and on July 16, to a far more restrictive agreement, limiting the number of amendments, but Senator Lott and the Republicans said no. Senator Lott and the Senate Republicans are perfectly willing to agree to essentially unlimited debate on the Internet tax bill, but they are not willing to allow any reasonable opportunity to debate, amend, and vote on the Patients' Bill of Rights. This record of abuse should be unacceptable to the Senate, and it certainly is unacceptable to the American public. What does our legislation do, and why is the Republican leadership so anxious to prevent its consideration? Our bipartisan Patients' Bill of Rights takes insurance company accountants out of the practice of medicine and returns decisionmaking to patients' doctors, where it belongs. That is it. When you come right down to it, there it is. When you are going to the emergency room, an accountant can say, ``No, you can't go there, you have to go across town.'' Our bill says if you have an emergency, go to the nearest one. If you need access to a specialist and the primary care physician says go to a specialist, you can go to a specialist. Or if you need a pediatric specialist, where a child has cancer--you can go to an oncology specialist for children. These are common sense protections. It is the doctors, the patients, the medical professions making the decision, not the accountants. That's the bottom line. Mr. President, when we say these are commonsense solutions, I daresay that 99 percent of the American people would agree that doctors and nurses ought to make the decisions with regard to health care issues for your family and for your children, not accountants. That is what we are trying to do and that is at the heart of this debate. But we are denied the opportunity to have that debate because once you go and say you are going to have the medical decisions affecting your family decided by doctors and trained medical professionals, it somehow may threaten the profits of the health delivery system, the HMOs. Those HMOs have layers of different individuals that say ``no.'' I am reminded of when President Clinton said just a week ago, ``You never find an accountant in an HMO that loses his job for saying `no.' They don't get fired. The ones that get fired are the ones that say `yes.' '' Yes, they need to go to a specialist; yes, they need additional kinds of important types of prescription drugs; yes, they need to have the kind of care that may be more costly, but, more importantly, may save the life of that individual; and, yes, it may very well be if those people get better, it would be less costly to the HMO over a long period of time. That is the issue, Mr. President. That is the bottom line. Our program simply guarantees people the rights that every honorable insurance company already provides, and provides an effective and timely means to enforce these rights. The good, honorable insurance companies do that, Mr. President, and so do some of the HMOs. But, many of them do not. And what happens is they obviously have the competitive advantage over the good ones. That is wrong. They have the competitive advantage because they shortchange the protection of their consumers, and that is what is at the heart of this whole debate. The protections we provide, as I mentioned, are commonsense components of good health care that every family believes they were promised when they purchased their health insurance and paid the premiums. Virtually all of the protections in this legislation are already available under medical care. As I mentioned, of these 15 protections which are at the heart of our legislation, over half of them are already in the law under Medicare. Over half of them have been unanimously recommended by the President's bipartisan commission--not in legislation, but recommended as being essential in terms of good health care. And we know that many of them have been recommended by various health care plans, and many have even been recommended by the insurance commissioners that have responsibility--made up of Republicans and Democrats alike. You cannot find on this list a single one of these commonsense protections that haven't been recommended by at least one of those four groups. And most of them have been recommended by two, or even three, of those groups. These aren't off-the-wall kinds of protections. These are commonsense protections. They are recommended by those who understand what the opportunity and the problems are in terms of health care delivery by HMOs. That is it. Why don't we have the opposition saying, ``Where did you find 5, or 6, or 7, or 10 of those various recommendations? Where in the world did they come from? Who thought those up?'' That isn't an argument that is made. All 15--are either recommended by the bipartisan President's commission, the health plan agencies themselves, Medicare, or the insurance industry themselves. That is why, when we say these are common sense, they are, Mr. President. If you are not going to find the various health plans responding to these recommendations and enforcing them, at some time you are going to have to go ahead with this. I daresay that the very good HMOs are complying with this now. They have nothing to fear. That is why many of the HMOs endorse this, because they are already doing it. The good ones are already doing it. The good ones have absolutely no fear about it. It is just the other ones. Those are the ones that result in the kinds of tragedies that have been listed by so many of our colleagues over the preceding weeks and months. These are commonsense rights that provide access to the appropriate specialists when the patient's condition requires specialty care. They allow people with chronic illnesses and disabilities to have referrals to the specialists that they need on a regular basis. They provide for a continuity of care so the people will not have to interrupt their course of treatment and find another doctor because their health plan drops their physician or because their employer changes health plans in the middle of a treatment, for example. When a member of the family is being treated with chemotherapy and has to have a combination of treatment over 6 or 12 months, or 18 months, to find out in the middle of that, after 5 months, with all the kinds of anxieties that people are affected by, that the particular company has changed HMOs and suddenly that doctor and the nurse and the treatment are pulled out from underneath you, we think that family ought to be protected. That individual who is going through that particular chemotherapy, or specialized care, ought to be able to complete that particular treatment. Is that such a radical idea, when you have an individual who has had all of these kinds of concerns--not just financial concerns, but the emotional, the pain, and the suffering--and finally to have what is so important, the doctor-patient relationship, the trust and confidence in that doctor, and then, because some bureaucratic decision is made to pull that doctor away from that particular patient--we think there ought to be a guarantee that there can at least be the continuation of care for that particular incidence of care. Is that so dramatic? Is that so unreasonable? Is that so outrageous? It seems to me that is common sense. No patient with symptoms of a stroke should be forced to delay treatment to the point where paralysis and disability are permanent because a managed care accountant does not respond promptly and appropriately. Patients with serious illnesses, like cancer, Alzheimer's, osteoporosis, or rheumatoid arthritis, who cannot be helped by standard treatment, should have the right to participate in the quality clinical trials that can help find a cure or offer the hope of improvement. Traditionally, insurance has allowed patients this opportunity. But, no; managed care is saying no to both the patients and medical personnel. Now, too many of the managed care companies are saying no to both. Patients and medical research are suffering. It was unthinkable 5 years ago that when a doctor recommended that a child participate in a clinical trial, the insurance wouldn't cover them. They all did. It has only been in the most recent times where it is becoming a pattern and practice of too many HMOs that say no, we are not going to permit you to participate, even though a doctor believes that it is in the health interests of the individual to participate in those particular clinical trials. Mr. President, the thing that is really so shocking is that we are now seeing extraordinary breakthroughs--every single week there are new medical breakthroughs. Particularly in the areas of cancer, there are new medical breakthroughs, and specifically in the area of breast cancer. Look at all of the work that has been done in terms of the mapping of the human gene and isolating the various DNA through research. Look at the extraordinary work that is being done out at NIH and a few of the other great research centers, and the new kinds of opportunities that are available through research that are targeting these kinds of illnesses and diseases. I personally believe that the next century is going to be the century of the life sciences. Just at a time when we have the greatest opportunity for cures of the most dreaded disease, we are closing down the opportunities for participating in these clinical trials. It is just extraordinary. In the testimony that we have seen, it is clear that there isn't really any additional cost to the various HMOs, because all they are asking for is continuity of care for the patient, and just to continue to pay the outlay--not for the particular analysis of the various clinical trials, not for the new kinds of medications that might be rare and expensive, not to do summations, or pay, or participate in terms of these other kinds of studies. Absolutely not. All the HMO has to do is the continuity of care--just provide the kind of care that they would otherwise be providing. That is the amazement of some of the top researchers who appeared before our forums, who were in charge of some of the most important clinical trials in this country, because they say it really doesn't cost the HMO any more. The fact is, if the patients participate, they may very well and so often do get much better, and it saves the HMO a great deal of resources and funding. That is why there is an absolute disbelief on the part of so many of the top researchers. They pointed out that not only were we disadvantaging so many individuals, particularly in the area of cancers, and specifically in the area of breast cancer and clinical trials, but also that the research progress was being hurt here in the United States because of the failure of participation of many of these patients. As I mentioned just a moment ago, in all of the various forums that we had, there were many different facts that stood out. But when you have the top clinicians say that at the Lombardi Clinical Research Center, here within the shadow of the Nation's Capitol, they have eight highly professional people who are spending all of their time all day long wrestling with HMOs based on the fact that doctors have recommended that their patients participate in these clinical trials, but yet still have to spend all of their time arguing with the HMO to permit those individuals to actually participate in these clinical trials. It is absolutely beyond belief to me, absolutely beyond belief.

Mr. KENNEDY. If I could just add to what the Senator has pointed out, would you believe that in the Republican proposal, for example, any medical procedure that wasn't over $1,000 could not be appealed? And so for the kind of situation that the Senator is talking about, under the Republican proposal, they say, oh, look, we have taken care of that, except if that medical procedure is less than $1,000. Then there is no opportunity for appeal. So, effectively, you are saying there are no MRIs for any child who falls off a bicycle, gets hit playing football, falls down or has an accident playing hockey. And the Senator from Illinois knows families as I do that deny their children the opportunity to play sports because they haven't got health insurance or because they are not going to be able to get any kind of coverage for sickness or illness. As bad as it is, as the Senator has pointed out, we ought to have an opportunity--would the Senator not agree, to debate this sort of phony protection advanced by the Republicans, saying we will guarantee some opportunity for appeal but not if it was under $1,000. Patients should have the right to appeal decisions of their plans to independent third parties. Today, if a health plan breaks its promise, there is no remedy that can provide relief in time to save a life or prevent a disability. Independent review was recommended unanimously by the President's Commission. It has worked successfully in Medicare for over thirty years. Families deserve the basic fairness that only an impartial appeal can provide. Without such a remedy, any ``rights'' of patients exist on paper only--and they are often worth no more than the paper on which they are printed. When the issues are sickness and health--and often as serious as life and death--no health insurance company should be allowed to be both judge and jury. In addition, when the misconduct of managed care plans actually results in serious injury or death, patients and their families should be able to hold the plans liable in court. Every other industry in America can be held responsible for its actions. Why should health plans, whose decisions truly can mean life or death, enjoy this unique and unfair immunity? Under current law--the Employee Retirement and Income Security Act-- patients whose lives have been devastated or destroyed by the reckless behavior of their health plan have no right to go to court to obtain an appropriate remedy under state law. ERISA ``preempts'' all state remedies. Patients are limited to the narrow federal remedy under ERISA, which covers only the cost of the procedure that the plan failed to pay for. You can be crippled for life by cancer because your plan refused to authorize a test costing a few hundred dollars to detect the cancer in its early stages--and all you can get back to help support your family is the cost of the test you failed to get. During the debate on the tobacco legislation, Republicans and Democrats alike voted overwhelmingly to support the principle that no industry in America should be exempt from accountability for its actions. Because of ERISA preemption, one industry alone--the health insurance industry--enjoys this protection today. That is wrong--and the Senate should say it's wrong. During the debate on welfare reform, many on the other side of the aisle spoke strongly in favor of the need for individuals to take responsibility for their actions. It is ironic that some of those who spoke most strongly for responsibility for poor single mothers are opposed to responsibility for a powerful industry that earns tens of billions of dollars in profits every year. What most Americans do not know--and what the opponents of change ignore--is that ERISA pre-emption does not apply to state and local employee health plans. Employees of the city government or state government, whose health benefits are provided by taxpayers, can hold their health plan accountable in court if it kills or injures them. But equally hardworking families down the street are defenseless--because they happen to work for private industry. Our legislation is truly a Patients' Bill of Rights that will provide these protections and more. It is a moderate, responsible, and effective response to the widespread problems patients and their families face every day. That is why it is supported by a broad and diverse coalition of doctors, nurses, patients, and advocates for children, women, and working families. That is why it enjoys bi- partisan support from members of Congress on both sides of the aisle, including a courageous physician, Dr. Greg Ganske, a Republican Congressman from Iowa, who has seen the abuses of managed care first- hand. The Republican leadership plan, by contrast, is not supported by any group of doctors or nurses or patients. It has no bi-partisan support. It is an industry profit protection program, not a patient protection program. It is not a Patients' Bill of Rights. It is a Patients' Bill of Wrongs. That is why we need a full debate--so that it can be amended and improved until it provides the protections patients need. If the Majority Leader will stop abusing the rules of the Senate and allow this debate to proceed, I believe that the Senate will pass strong reforms that will be signed into law by the President. The American people deserve real reform, and I believe that when the Senate votes in the clear light of day, it will give the American people the reforms they deserve. This issue is a test of the Senate's willingness to put a higher priority on the needs of families than on the profits of special interests. And it is time for the Senate to act. The choice is clear. The Senate should stand with patients, families, and physicians, not with the well-heeled special interests that put profits ahead of patients. The American people know what's going on. Movie audiences across the country erupt in cheers when actress Helen Hunt attacks the abuses of managed care in the film ``As Good As It Gets.'' Helen Hunt won an Oscar for that performance, but managed care isn't winning any Oscars from the American people. Everyone knows that managed care today is not ``as good as it gets.'' Too often, managed care is mismanaged care. No amount of distortions or smokescreens by insurance companies can change the facts. The Patients' Bill of Rights can stop these abuses. Let's pass it now, before more patients have to suffer. I thank the Chair. I thank the Senator.

Mr. KENNEDY. I am glad to yield for a question.

Mr. KENNEDY

Mr. KENNEDY. I thank the Senator, but I----

Mr. KENNEDY. Mr. President, I appreciate the courtesy of the Senator from Arkansas. And I ask unanimous consent that my comments be placed in the Record not to interfere with the debate that has been taking place and will take place further this evening on this important issue. And I will address the Senate on a different issue in question.

Mr. KENNEDY. I thank the Senator. I tried to have an opportunity to address the Senate through the course of the afternoon and appreciated the courtesies of our colleagues for that time. How much time do I have remaining on this?

Mr. KENNEDY. I yield without losing my right to the floor.

Mr. KENNEDY. Mr. President, I was yielded this time. I understand you are ready and the others are not.

Mr. KENNEDY. I will be glad to yield briefly, Mr. President.

Mr. KENNEDY. I am not either the manager nor the proponent of that, but I understand I do have the 30 minutes.

Mr. KENNEDY. What I was saying is that I indicated that if both those for it or against it wanted to move ahead with the vote, that I would not interfere with that. But I am told at this time that that is not the case, I say to the Senator.

Mr. KENNEDY. Mr. President, it is time now, as we reach the midpart of this week, and as we are looking forward to going into next week for the probably 6 days that remain in this session--maybe 7 days, maybe even a few more days, if necessary--we are running into the final days of this particular session. It does seem to me to suggest that we ought to spend our time addressing those matters which are of central importance and consequence and seriousness to the American people. I know on the issue that is before the Senate at the present time that this will be disposed of either later this evening--and I will not interfere should the managers themselves want to have the final disposition of that this evening--but I have understood that the final disposition on this particular proposal would probably carry over to tomorrow. So I wanted to address the Senate on another issue.

Mr. KENNEDY

Mr. KENNEDY. Mr. President, I support the conference report on the Fiscal Year 1999 Defense authorization bill. The House and Senate conferees have produced a worthwhile defense bill that deserves to be approved. Before the conference, the House version contained several provisions that the administration had threatened to veto. We worked effectively in our deliberations with the House to resolve these differences and find satisfactory solutions. Gender integration in basic military training is the first of these important issues. In the Fiscal Year 1998 Defense Authorization Act, Congress established a bipartisan panel to review gender integration in basic military training. That commission has started its work and will report to us next year. The conference compromise on this issue will enable the commission to finish its work, while requiring each of the services to provide separate, safe and secure housing for male and female recruits with the sleeping areas separated by permanent barriers and limited access. The second of these issues is production of tritium for the nation's strategic arsenal. The Secretary of Energy has already initiated a comprehensive analysis to determine the best way to produce this material. That study will be concluded by December 31, 1998. The conference report includes a provision to withhold funds for the implementation of the Secretary of Energy's recommendation until full and complete congressional review next year. The conference report provides needed support for our military forces while maintaining a realistic balance between readiness to take care of immediate needs, and investment in new systems for the future. The report also includes a fully funded and well-deserved 3.6 percent pay raise for military personnel. We also tried to deal with the important and complex issue of military retiree health care. The report includes a provision for the Department of Defense to initiate a comprehensive test plan to evaluate the best method to provide health care to retired military personnel and their families. The Department of Defense will establish two demonstration plans, which will be evaluated before any future implementation. The first plan will allow selected retirees to enroll in the Federal Employees Health Benefit Plan. The second plan will implement a redesigned pharmacy benefit for Medicare-eligible DOD beneficiaries at two sites. This plan will also provide needed information for reducing out-of-pocket costs for military retirees. Protecting the safety of our service men and women was also high on our priorities in the conference. The daily operations of our military forces have obvious risks and dangers. All branches of the Armed Forces have made progress in improving safety, but more remains to be done. I commend the Department of Defense for its accelerated installation of needed additional safety systems on military aircraft that carry passengers. The conference report includes additional funding for aircraft safety modifications. Our troops are at risk from high tech attacks as well. The growing frequency and sophistication of such attacks on the Pentagon's computer networks demonstrate the need for improved protection of critical networks. The conference report recognizes the importance of this effort and supports the Air Force cyber-security program. In the past 8 years, the Navy-Marine Corps team has responded to over 90 contingencies--almost one per month. As the ranking Democrat on the Seapower Subcommittee of the Armed Services Committee, I am pleased that the conference report provides the support necessary for our naval forces as they modernize to meet the challenges of tomorrow. The report includes the necessary advance procurement funding for fiscal year 1999 for the Navy's next aircraft carrier, CVN-77. The Navy's procurement schedule for this carrier, revised from its budget submission of last year, will be under the cost cap mandated in last year's Defense Authorization Act. Also, much of the new technology being developed for the next generation aircraft carrier, the CVX, will be included in CVN-77. The budget request for the 30 Navy F/A-18E/F Super Hornet fighters is included in the report. The Super Hornet combines the outstanding characteristics of earlier F/A-18 models with cutting edge technology in an affordable aircraft with significantly improved performance and endurance. In addition, the Marine Corps' MV-22 Osprey tilt-rotor aircraft procurement for next year was increased to eight. The Osprey is a vertical take-off and landing aircraft designed to replace the Marine Corps' aging fleet of CH-46 and CH-53 helicopters. The constructive compromises we reached during the conference on critical issues have produced a comprehensive bill which provides effectively for our national security, and which contains no provisions that would draw a veto. I also join in commending the distinguished leadership of the chairman of the Senate Armed Services Committee, Senator Thurmond. He has worked effectively with all of us to see that our national security and the needs of our service men and women are met in this legislation. It has been a privilege to work with Senator Thurmond as chairman, and I look forward to continuing our work together on this important issues. It is especially fitting that this bill is named in his honor. I urge my colleagues to support the Strong Thurmond National Defense Authorization Act for Fiscal Year 1999.

Mr. KENNEDY

Mr. KENNEDY. Mr. President, there are just a few remaining days in this Congress, and the Republican leadership continues to block action on a Patients' Bill of Rights. It is clear what is going on here. It is clear to every Member of the Senate. It should be clear to the American people. The American people want Congress to pass strong, effective legislation to end the abuses by HMOs, managed care plans, and health insurance companies. The Patients' Bill of Rights, sponsored by Senator Daschle and Senate Democrats, provides the needed and long overdue anecdote to these festering and growing abuses. Our goal is to protect patients and see that insurance plans provide the quality care they promise but too often fail to deliver, and to make sure that the plans, having given assurances to those who sign up for the plans, include the protections they say are going to be there. They aren't in too many of the cases today. And we want to remedy that. Our bill was introduced last March. Earlier legislation was introduced more than a year and a half ago, but the Senate has taken no action because the Republican leadership has been using every trick in the procedural playbook to prevent a meaningful debate. The Republican leadership is abusing the rules of the Senate so that health insurance companies can continue to abuse patients. The Republican leadership wants to gag the Senate so that HMOs can continue to gag doctors who tell patients about needed treatments that are expensive for HMO balance sheets. The Republican leadership wants to deny a fair debate on the Patients' Bill of Rights so that HMOs can continue to deny needed patient care. The Republican leadership wants to avoid accountability in the U.S. Senate so that managed care plans can avoid accountability when their unfair decisions kill or injure patients. This record of abuse should be unacceptable to the Senate, and it is certainly unacceptable to the American people. Almost 200 groups of patients, doctors, nurses and families have announced their support for our bill and are begging the Republican leadership to listen to their voices. Mr. President, here on the Senate floor we have listed some of the various groups that support the Patients' Bill of Rights, which, as I have pointed out, was introduced last March. We introduced similar legislation a year and a half ago. We were denied effectively any hearings; denied any consideration by the committee; denied any consideration here on the floor of the U.S. Senate. On this chart is the list of some of the organizations that support this legislation that we are trying to debate, even in the final days of the session, in which we have been denied the opportunity to debate. You can see them and read them. They have been put into the Record constantly: the American Medical Association, the American Cancer Society, the National Alliance for the Mentally Ill, the National Partnership for Women and Families, the National Association of Children's Hospitals, the AFL-CIO, the American Nurses Association, the American Heart Association, the National Breast Cancer Coalition, the Children's Defense Fund, the American Academy of Pediatrics, the National Council of Senior Citizens. There it is--the doctors, the nurses, representatives of the working families, the associations representing the children, the associations representing women--the National Lung Association, the Paralyzed Victims of America, the American Psychological Association, the Consumers Union. The list goes on and on, all the way to the Multiple Sclerosis Society, the American Academy of Neurology, and the Center for Disabilities, representing the various disability groups. All 170 of them are supporting our effort to bring this legislation to the floor of the Senate to enact it or debate it or even bring the proposal that our Republican friends want and permit us to have debate on it and attempt to amend it. Over the course of this debate, there are some who have criticized those of us who have been trying to have this legislation considered on the floor of the U.S. Senate. But it is interesting. They do not have a chart like this. They don't have a chart that lists the organizations that support their proposal because they haven't got any. I have stated repeatedly on the floor of the U.S. Senate that we are waiting for one of our colleagues who is supporting the Republican position, or who is part of the Republican leadership, to indicate to us one association that represents doctors, one association that represents nurses, one association that represents consumers, one association that represents any group of health professionals. Just give us one. They can't. There is silence over there. We have here the partial listing of virtually every single professional medical association in America, every nursing association, every consumer rights association, virtually every one of those associations. Mr. President, every one of them, as I will show in just a few moments, is advocating that we move ahead with legislation now-- not tomorrow, not the next day, but now. Move ahead, start the debate and see us resolve these issues in the period of the next few days. But what does the Republican leadership say? No, no. The Republican leadership says they have other things in mind. They want to debate and consider the Vacancies Act. This is what the Republican leadership is telling us--that the Vacancies Act is more important than debating and considering how we are going to treat a child with cancer in our country. That is effectively what they are saying. They want us to debate the Vacancies Act. They want us to debate the Internet tax issues. We are going to have a cloture vote tomorrow. We are not going to schedule the consideration of this legislation tomorrow. We are going to have a cloture vote on the Internet tax proposal. And we had, just last week, the consideration of the salting legislation--salting legislation. The Republican leadership said we ought to consider the salting legislation. Then they had other pieces of legislation they brought up--child custody, bankruptcy, affects 1,200,000 people every year. They wanted us to consider that legislation, which we did. There were initially close to 40 amendments on there and still the leadership scheduled it even when Senator Daschle had offered a more limited list of amendments if we considered the Patients' Bill of Rights. And now we are considering the financial services legislation. These are all pieces of legislation that we either had last week or this week or will have the first of next week while we are virtually silent on the consideration of legislation that is in such extraordinary demand across this country. Mr. President, just this week a letter arrived from 52 rehabilitation hospitals and other providers of rehabilitation services to people recovering from terrible injuries, strokes, heart disease or coping with disabilities. These facilities deal with some of the most seriously ill people in our society, and here is what they said. Here is what they said: We encourage you to continue your fight on this issue. We support S. 1890 because it offers the greatest level of protection for patients with disabilities and chronic conditions. We feel that enactment of S. 1890 should be of the utmost importance to Congress. Enactment of the Patients' Bill of Rights is a priority for patients needing rehabilitation services, but it is not a priority for the Republican leadership. This is effectively the total leadership in this country that is reflecting their concern and their support for the Patients' Bill of Rights, saying that we ought to act on it and we ought to act on it now. We are prepared to act on it. We are prepared to deal with this issue as the next order of business. We are prepared to call the roll on whether this legislation provides for the kind of protections that those individuals in our society who have physical and mental disabilities--I call them challenges--should be able to have. We ought to be able to debate that. Virtually every organization that represents those individuals says we want this now in this Chamber. But not the Republican leadership. No. No, not the Republican leadership. They say let's debate the Vacancies Act. Virtually every organization that is concerned about cancer in our society says start the debate and start on it now. Not the Republican leadership. No. No, they want to consider the Internet tax bill. Every child organization--the American Academy of Pediatricians, every group that represents children in our society says start the debate now, start calling the roll, start the debate on how we are going to protect the children in our society. We can't wait. Too many children are in need today. Not the Republican leadership. They say we want to debate salting. We want to debate salting; we are not going to listen to the various organizations that are out there representing children in our society. We are not going to listen to the organizations that are out there representing the cancer patients in our society. We are not going to listen to the organizations that are out there representing the disabled in our society. We are not going to listen to the organizations that represent the doctors and nurses and consumers in our society. No, because, as the Republican leader says, we are in the majority, and we are going to set the schedule. We are in the majority, and we are going to set the schedule. And the schedule they have set is financial services, bankruptcy, child custody, salting, and the Vacancies Act. And the list goes on. But not with regard to the Patients' Bill of Rights, Mr. President. Last week, there was a march on Washington by cancer patients and families of cancer patients from all over the country. Cancer is a disease that has touched almost every family in our country. It is perhaps the most dreaded diagnosis that any person can confront. The marchers called for expanded cancer research and assured access to the best possible care for every cancer patient. The Patients' Bill of Rights deals with both of those issues. That is why it is supported by virtually every major cancer organization in this country. The Patients' Bill of Rights guarantees access to quality clinical trials. It assures timely access to needed specialists and centers of excellence equipped to treat patients, particularly cancer patients. We have more than 14 cancer centers around this country that specialize in different forms of cancer. They have been enormously positive in terms of remedies and new modalities in the treatment of this disease. We have one in my own State of Massachusetts that deals with children's disease and the progress that has been made has been absolutely incredible--absolutely incredible. There should be no debate over a child who has cancer getting the kind of specialized care that that child needs and deserves. The progress we have made in the war on cancer over these past years has been greater in children than any other group, and they need specialty care; they need primary care, as all children do. They need preventive care, as all children do. Children are the healthiest group in our society. The totality of children only account for about 6 percent of the health budget in our Nation. They don't drain the health care budget, although more of them are living in poverty than any other group in our society. But we ought to be able to say, if a child is going to be attacked by cancer, we ought to give them a specialist. That is what this bill does, Mr. President. That is what this bill does. The Republican bill doesn't do it. If they think theirs is better, let's have the opportunity to debate it. Our legislation also, with regard to treating the particular needs of either children or those who are afflicted with cancer, requires the HMOs to give the patients access to the needed prescription drugs, not just the drugs that happen to be on the plan's list because they are the cheapest. I don't know how many of our colleagues remember the testimony that we had the other day from those who were representing many of the mentally ill and who were part of HMOs and what they were told when they needed certain kinds of prescription drugs--that they had to take the prescription drugs that were on the list of the HMO rather than the prescription drugs that was being recommended by the doctor. They had to take that and demonstrate that it wasn't working for them not just once but twice. And then the third time perhaps they would have the opportunity to be able to get the prescription drugs that were needed. The tragic circumstances that flowed from those kinds of requirements shouldn't happen here. When the individual was signing up, they could look over and they could see formularies that deal with some of the problems in terms of mental health. They figured that their particular needs, if they were going to require them, were going to be attended to. And then comes the time that they need those various prescription drugs and they say, no, you have to take these here, and you have to show they don't work. Then you come back again and you have to take them again and show that they don't work and have a doctor certify, and then maybe, maybe, we will give you the kinds of drugs that the doctor prescribed in the first place. That is happening today. That is happening today. And we want to remedy that. This legislation assures continuity of care so that someone in the middle of a course of a cancer treatment will not be forced to change doctors because their employer changes plans or because their health plan changes the providers in its network. We want to say that if you have a life-threatening situation and you are being treated with chemotherapy or a member of your family is, and then suddenly your employer goes out and changes delivery, we don't want the circumstance when you are at a time of enormous personal stress and tension to be told, Oh, no, you can't go to your doctor anymore. You have to go to another doctor. Oh, I know that doctor didn't know your case before. I know the doctor hasn't examined you before. I know the doctor hasn't been a part of this whole process over the last year, year and a half, but you are not able to go ahead and have your old doctor who has been treating you, with whom you have established a relationship, who understands your case, understands those particular needs of yours. No, no. You can just be dropped there. We prohibit that. We insist in those circumstances that a patient be able to continue that kind of care until there is some resolution of that particular illness. It is very important, Mr. President, very important, in terms of treatment, in terms of quality, in terms of what we as a society like to believe we have established in terms of a doctor-patient relationship--one of trust, one of intimacy, one of understanding, one of caring, which is so important. That has an enormous impact. All of that has an impact on recovery. If you provide the opportunity for a parent to be with a sick child at the time of a critical illness, they can demonstrate that the child's recovery is 30 to 40 times more rapid than it would be without that parent. We can demonstrate that. It has a dollar-and-cents saving, obviously; but the important point is that once in a while, at least we feel on this side, we ought to give some attention to the child and the parent and the family, and quality. That is what we are talking about when we insist that that doctor-patient relationship, in terms of special needs, is going to be protected, particularly in the area of cancer, but it is important in any critical illness. Access to the quality clinical trials is particularly important. These trials are often the only hope for patients with incurable cancer or other diseases where conventional treatments are ineffective. They are the best hope for curing these dread diseases. Insurance used to routinely pay the doctor and hospital costs associated with clinical trials. They used to always do that. But managed care plans are refusing to allow their patients to participate or to pay these costs. Our bill requires them to respond to this need. The Republican bill does not, and the Senate leadership does not want to debate this bill. Listen to what Bruce Chabner, who is the clinical director of MGH Cancer Center, a professor of medicine at Harvard University, and the chief medical officer at the Dana Farber Partners Cancer Care, one of the outstanding cancer researchers and cancer personnel in the country, has to say: I am here to support the bill that would require HMOs and insurance companies to support clinical research. I would like to explain briefly the role of insurance coverage in research. This is important, Mr. President, because we have heard so much about the costs of various proposals. Listen to this: Most of the costs in clinical research are associated with the cost of discovery. Laboratory experiments and the development of new treatments are supported by Government grants, by industry and by institutional commitments from hospitals and medical schools. These contributions provide the hundreds of millions of dollars that lead to new treatments and hope to millions of our patients with cancer. However, the clinical treatment of these patients requires support for the routine care associated with these clinical trials. The only source of such support for routine care costs is health care insurance and HMO contribution. This is the final step in proving that a new treatment or a new device actually works in people. Without this step, research is meaningless and has no impact on people, nor does it save lives. We are not asking the insurance companies and HMOs to support the vast effort to discover new treatments. Do we understand that, Mr. President? The researchers and the centers of research are not asking the HMOs for additional resources for breakthroughs. What they are basically asking is: We are not asking for support for the cost of analyzing data and support during the clinical trials. We are only asking them to continue support for patient care costs. Just continue the costs for treating the patients and permit them to go into these trials. That is the only thing they are asking. Isn't that amazing? One would think the HMO would say, ``Gee, if our patient gets better, it will be less costly for the HMO.'' One would think somebody in the financial system would say that. But, no, they just won't let them and, in too many instances, will not give them the assurance that if a doctor says it is in your best interest that you should be in a clinical trial because you have breast cancer--and the enormous progress we have made in the area of breast cancer is just absolutely extraordinary. Still, one out of every seven women in our society--is afflicted by breast cancer. That number is enhanced every year, tragically, even with the progress we have made. We are saying: Look, we have made important progress; we are continuing to make progress; let us have those individuals who can benefit go into these clinical trials at really no extra cost to the HMO. If that patient is going to be able to be cured, then, obviously, there is going to be less cost. The patient obviously is going to be better off. But the costs will be reduced as well. Dr. Chabner continues: I am sure that every Member of Congress, if faced with the awful dilemma of cancer, would want this kind of continued support for their family member. Meaning the clinical trials: This research provides the only hope our patients have of conquering this disease and the only hope our society has for curing cancer. There it is, Mr. President, with regard to cancer. Our bill insists on it, and no such provision is in their proposal at the current time, even though it is recommended by every part of the medical profession. But it is still not there. As Dr. Chabner points out, access to clinical trials is critical if we are to make progress in conquering this dread disease, but it is also critical for patients. Often, particularly in the case of cancer, clinical trials offer the only hope for cure or improvement. Too often, managed care is locking patients out of the clinical trials that offer potential benefit--in effect, passing a death sentence. Yesterday, I read extensively from the statement of Diane Bergin, a mother of two and a patient with ovarian cancer, about her struggles to obtain access to clinical trials and the emotional roller coaster she faced in dealing with her plan. I will not repeat her full statement today, but I would like to read the conclusion to her comments, because she speaks for similarly situated patients all over this country. She says: No one facing a serious illness should be denied access to care because that treatment is being provided through a clinical trial. Sometimes, it is the only hope we have. That is where we stand, Mr. President. That is where we firmly stand, those of us who believe in a Patients' Bill of Rights. We stand for hope for these patients. This is what she says: Sometimes, it is the only hope we have. And the benefit to me, whether short or long term, will surely help those women who come after me, seeking a cure, a chance to prolong their life for just a little while, just so they can attend a graduation, or a wedding, or the birth of a grandchild. That is what is at issue in this Patients' Bill of Rights, Mr. President. That is what we ought to be debating here. And still, the Republican leadership says, ``Oh, no; you have to debate the Vacancies Act, salting, child custody, and the Internet tax; you can't debate this kind of critical issue.'' We find that completely unacceptable. But Republicans have made the judgment and decision of denying, not just those of us in the U.S. Senate who support it--it isn't denying us, it is denying the representatives of all the medical societies in our country, the doctors, all the nurses, all the representatives of the cancer groups in this country. That is who they are denying, and it is denying the people they represent--their patients. Diane continues: I strongly support, and my family is right there with me, requiring insurers to pay for the routine costs---- Routine costs---- of care that are part of an approved clinical trial. I think the cures of the future depend on it. Diane Bergin is a patient at Georgetown University's Lombardi Cancer Center. Now listen to this, Mr. President. Listen to this. At the same forum where Diane spoke, we also heard from Karen Steckley, a nurse who is the director of clinical operations at the Lombardi Cancer Center, where Diane Bergin is a patient. She has eight full-time master's level nurses on her staff who spend virtually all of their time arguing with managed care companies that do not want to pay for clinical trials, even when that is clearly the best treatment available for a patient. Do we understand that, Mr. President? Let me just mention that. Here at the Lombardi Cancer Center, in the shadow of the Capitol, one of the great medical centers in this country, dearly named after one of the great American heroes of our Nation, here is the director saying they employ eight full-time professional nurses to spend their whole time arguing with HMOs to permit these patients to participate in these clinical trials when their doctors have suggested that that offered them the best hope and opportunity for survival. Imagine that. We hear from our friend from Texas about bureaucracy and red tape. Imagine having those top-flight nurses out there participating and working with doctors to try to ease the pain and be a part of a team to try to find some breakthroughs in these cancers. That is what is happening. Here is the documentation. And it is not just in the Lombardi Cancer Center, it is in all of these major centers across the country. And we cannot find time to debate whether that is in the interest of the health of our American people, Mr. President, when that is happening today? I do not know how many people are being turned back today. I do not know how many women who have breast cancer are being told no by their HMO and are being closed out from participating in those clinical trials at the Lombardi Cancer Center and are virtually taking a death sentence in many of those instances, Mr. President. I read into the Record yesterday what the results are when you do not have that kind of participation, particularly in the early times of diagnosis. But that is what is happening. Mr. President, the opponents of this legislation talk a lot about costs associated with our bill. We know that every independent analysis of our legislation has concluded that the cost will be negligible because it simply requires all health plans to provide the services they promise when they collect the premiums. That is basically what we are trying to do, Mr. President, to say when you go out and you sell this product--the HMO--make sure you are going to comply with what you represent. That is often not the case. I gave the tragic instance just a few days ago about what happened in my own State of Massachusetts when patients with mental illness were guaranteed a certain number of days in-house, and then they were denied them--tragic circumstances where a patient went out and committed suicide. He still had 17 days left, but the HMO would not put him in there. That had a devastating impact on the three children and the wife as a result of that decision by the HMO, and the fact that there is no recovery at all; that family is absolutely devastated, Mr. President. And we have remedies for them as well. Mr. President, 14 leading organizations of cancer patients, representing 8 million Americans surviving with cancer, and the 1.5 million Americans who will be newly diagnosed with cancer this year, have spoken out strongly on the need for this amendment. These are organizations that patients and physicians, alike, look to for guidance on cancer issues--the National Coalition for Cancer Survivorship, Cancer Care, Incorporated, the Candlelighters Childhood Cancer Foundation, the Susan G. Komen Breast Cancer Foundation, the National Alliance of Breast Cancer Organizations, the North American Brain Tumor Coalition, the American Society of Clinical Oncology, the Alliance for Lung Cancer Advocacy, Support and Education, the Friends of Cancer Research, the Leukemia Society of America and the Oncology Nursing Society. That is about it, Mr. President; all of them say, ``Pass this, and pass it now, there is nothing more important that we can do''-- every one of them. But no, the Republican leadership says, ``No. We're deciding--we're deciding what the agenda is going to be.'' And that legislation is not part of the agenda. Meanwhile, these abuses continue every single day, Mr. President. And here is what those groups in a joint statement said: ``Clinical trials represent the standard of care for cancer patients. Patient care in clinical trials is no more expensive than standard therapy.'' So now, Mr. President, we know what needs to be done. I can continue. I see my colleagues here on the floor of the Senate. I will just wind up with what we have said before, Mr. President, that every one of these protections in the Patients' Bill of Rights has either been recommended unanimously by a bipartisan group that was set up by the President of the United States--you had to have virtual unanimity in order to get the recommendation. The vast majority of these protections were recommended by that President's panel--not in the form of legislation, but as protections for consumers. The vast majority of these are in effect in Medicare, and they are working to provide protections for our senior citizens. A vast majority of these are recommended by the health plans themselves, the HMOs themselves. They say they ought to have these kinds of inclusions and protections, but they are not written into the law. A large proportion of them are recommended by the insurance commissioners, a bipartisan group, across this country. There is not a single protection on here that does not have the recommendation of one of these groups. This is a commonsense approach to try to ensure that we are going to have quality care for every American, supported by virtually every one of the health care provider groups in our society. All we are asking, Mr. President, is that we have the debate. It is no secret about the various provisions that we have included in this. There is no secret here, Mr. President. We all understand it. We all know we can debate these issues and reach a resolution. But let us get about doing the country's business. Let's do something in terms of protecting the American family. Let's do something about protecting children to make sure they get the specialty care; for women who have breast cancer, to make sure they are going to be in the clinical trials; to the emergency cases, to make sure they are not going to have the ambulances drive by the nearest hospitals. Let's go out and protect the doctors and the nurses so they can recommend the medical procedures in the best interests of those patients. Let's go out and protect the American people. Let's continue to demand that we are going to have the Patients' Bill of Rights as the piece of legislation that we are going to debate before this Congress adjourns. There are just a few remaining days in this Congress, and the Republican leadership continues to block action on a Patients' Bill of Rights. It is clear what is going on here. It is clear to every member of the Senate. And it should be clear to the American people. The American people want Congress to pass strong, effective legislation to end the abuses by HMOs, managed care plans, and health insurance companies. The Patients' Bill of Rights sponsored by Senator Daschle and Senate Democrats provides the needed and long-overdue antidote to these festering and growing abuses. Our goal is to protect patients and see that insurance plans provide the quality care they promise, but too often fail to deliver. Our bill was introduced in March. Earlier legislation was introduced more than a year and half ago--but the Senate has taken no action because the Republican leadership has been using every trick in the procedural playbook to prevent a meaningful debate. The Republican leadership is abusing the rules of the Senate, so that health insurance companies can continue to abuse patients. The Republican leadership wants to gag the Senate, so that HMOs can continue to gag doctors who tell patients about needed treatments that are expensive for HMO balance sheets. The Republican leadership wants to deny a fair debate on the Patients' Bill of Rights, so that HMOs can continue to deny needed patient care. The Republican leadership wants to avoid accountability in the United States Senate, so that managed care plans can avoid accountability when their unfair decisions kill or injure patients. This record of abuse should be unacceptable to the Senate--and it is certainly unacceptable to the American people. Almost 200 groups of patients, doctors, nurses, and families have announced their support for their bill and are begging the Republican leadership to listen to their voices. They range from the American Medical Association to the AFL-CIO, from the American Heart Association to the American Academy of Pediatrics, from the Consortium of Citizens with Disabilities to the American Cancer Society, from the National Alliance for the Mentally Ill to the National Partnership for Women and Families. Just this week, a letter arrived from 52 rehabilitation hospitals and other providers of rehabilitation services to people recovering from terrible injuries, strokes, heart disease, or coping with disabilities. These facilities deal with some of the most seriously ill people in our society--and here is what they said: ``We encourage you to continue to your fight on this issue. [We] support S. 1890 because it offers the greatest level of protection for patients with disabilities and chronic conditions. . . . We feel that enactment of S. 1890 should be of the utmost importance to Congress.'' Enactment of a Patients' Bill of Rights is a priority for patients needing rehabilitation services--but it is not a priority for the Republican leadership. Last week, there was a march on Washington by cancer patients and families of cancer patients from all over this country. Cancer is a disease that has touched almost every family in our country. It is perhaps the most dreaded diagnosis that any person can confront. The marchers called for expanding cancer research and assuring access to the best possible care for every cancer patient. The Patients' Bill of Rights deals with both those issues. That is why it is supported by virtually every major anticancer organization in this country. The Patients' Bill of Rights guarantees access to quality clinical trials; it assures timely access to needed specialists and centers of excellence equipped to treat the patients' particular cancer; it requires HMOs to give patients access to needed prescription drugs, not just the drugs that happen to be in the plan's list because they are the cheapest. It assures continuity of care, so that someone in the middle of a course of cancer treatment will not be forced to change doctors because their employer changes plans or because their health plan changes the providers in its network. Access to quality clinical trials is particularly important. These trials are often the only hope for patients with incurable cancer or other diseases where conventional treatments are ineffective. They are the best hope for learning to cure these dread diseases. Insurance used to routinely pay the doctor and hospital costs associated with clinical trials--but managed care plans are refusing to allow their patients to participate or to pay these costs. Our bill requires them to respond to this need--but the Republican bill does not, and the Senate leadership does not want a debate on this issue. Dr. Bruce Chabner, a distinguished oncologist, commented on the importance of this provision. As Dr. Chabner points out, access to clinical trials is critical if we are to make progress in conquering this dread disease. But it is also critical for patients. Often, particularly in the case of cancer, a clinical trial offers the only hope of cure or improvement. But, too often, managed care is locking patients out of clinical trials that offer potential benefit--in effect passing a death sentence. Yesterday, I read extensively from the statement of Diane Bergin, a mother of two and a patient with ovarian cancer, about her struggles to obtain access to clinical trials and the emotional roller coaster she faced in dealing with her health plan. I will not repeat her full statement today, but I would like to read the conclusion to her comments--because she speaks for similarly situated patients all over this country. She says, ``No one facing a serious illness should be denied access to care because that treatment is being provided through a clinical trial. Sometimes, it is the only hope we have. And the benefit to me, whether short or long term, will surely help those women who come after me, seeking a cure, a chance to prolong their life for just a little while, just so that they can attend a graduation, or a wedding, or the birth of a grandchild. ``I strongly support, and my family is right there with me, requiring insurers to pay for the routine costs of care that are part of an approved clinical trial. I think the cures of the future depend on it.'' Diane Bergin is a patient at Georgetown University's Lombardi Cancer Center. At the same forum where Diane spoke, we also heard from Karen Steckley, a nurse who is the director of clinical operations at the Lombardi cancer center, where Diane Bergin is a patient. She has eight full-time masters level nurses on her staff who spend virtually all their time arguing with managed care companies that do not want to pay for clinical trials, even when that is clearly the best treatment available for a patient. Often, they are able to get patients into trials--but sometimes they fail, and patients die or suffer needlessly as a result. Mr. President, the opponents of this legislation talk a lot about the costs associated with our bill. We know that every independent analysis of our legislation has concluded that the cost will be negligible, because it simply requires all health plans to provide the services they promise when they collect premiums from their subscribers and that good plans provide as a matter of course. But think of the high cost and waste in the current system--when patients are denied timely care, so that they must be treated when their illnesses have become much worse and much more costly to treat. And think of the criminal waste involved when eight master-level nurse practitioners must spend their time arguing with insurance companies instead of caring for patients. Fourteen leading organizations of cancer patients, representing the eight million Americans surviving with cancer and the 1.5 million Americans who will be newly diagnosed with cancer this year, have spoken out strongly on the need for this amendment. These are organizations that patients and physicians alike look to for guidance on cancer issues. They include the National Coalition for Cancer Survivorship, Cancer Care, Incorporated, the Candlelighters Childhood Cancer Foundation, the Susan G. Komen Breast Cancer Foundation, the National Alliance of Breast Cancer Organizations, the North American Brain Tumor Coalition, US TOO International, the Y-ME National Breast Cancer Society, the American Society of Clinical Oncology, the Alliance for Lung Cancer Advocacy, Support and Education, the Friends of Cancer Research, the Leukemia Society of America, and the Oncology Nursing Society. Here is what they say: ``Clinical trials represent the standard of care for cancer patients. Patient care in clinical trials is no more expensive than standard therapy. Cancer will strike roughly one in three Americans during their lifetimes. Even those who escape the diagnosis will have friends and family touched by the disease. Any patient rights or quality care legislation will be a shallow promise for people with cancer if it does not include provisions ensuring access to clinical trials.'' A shallow promise. Our program has it. The Republican plan does not. That is one of the reasons why these organizations and the patients they represent conclude: ``Among the various proposals being considered by the Congress to improve access and quality for the patients under managed care, the only one that provides meaningful relief for people with cancer is the one sponsored by Senators Daschle and Kennedy in the Senate and Congressmen Dingell and Ganske in the House, S. 1890 and H.R. 3605. We urge you in the strongest possible terms to support the Patients' Bill of Rights. This legislation . . . is a necessity for people with cancer. Nothing less is acceptable.'' These organizations also point to another issue that is critical for patients with cancer--access to specialty care. They say, ``the primary alternative proposals [to the Patients' Bill of Rights] does not offer significant assurances of access to specialty care that may mean the difference between life and death for a person with cancer.'' The difference between life and death for a person with cancer. That is what this debate is about--but the Republican leadership won't even bring legislation to the floor. The American public wants action to provide better care for cancer patients. They want to guarantee that any family member with a member afflicted by this dread disease will get the best possible care. But, too often, managed care plans say, ``no''. And now, the week after the great cancer march, the Republican leadership continues to say ``no'' to cancer patients and their families--and yes to protecting insurance company profits. That is just plain wrong. We have held a series of forums focussing on the needs of children, families, cancer patients, the disabled, small businesses, women and others. At each one, the message to the Republican leadership is the same. Stop delaying action through procedural maneuvers. Patients and families are suffering. Allow a full and fair debate, so that the Patients' Bill of Rights can pass. Stop putting industry profits ahead of patients. It is because patients and families and doctors and nurses all over this country understand the need to stop insurance company abuse with meaningful reform that almost 200 organizations representing them have endorsed the Patients' Bill of Rights, but not one has endorsed the Republican alternative. And all of these organizations want the Senate leadership to stop hiding behind procedural tricks and abuse of the rules and bring legislation to the floor. But Senator Lott continues to say no. Last Wednesday, Senator Lott even circulated a consent agreement that would have allowed unlimited debate and amendments to the Internet tax bill--with one exception. No health amendments. It is clear that the Republican leadership will go to almost any lengths to prevent a debate on the Patients' Bill of Rights. Earlier this month, they forced the Senate into a meaningless quorum call for six hours and then forced the Senate to adjourn--not just to block consideration of the Patients' Bill of Rights but to stop Senators from even talking about the issue. We have only two weeks left in this session. We have many bills to consider and act upon. But the Republican leadership would rather close down the Senate than allow even a discussion of managed care reform, much less a vote by the Senate. The Republican leadership was willing to shut down the entire federal government three years ago in order to slash Medicare and provide tax breaks for the wealthy. Now they're willing to shut down the entire Senate in order to protect the profits of HMOs. All we want is a fair and full debate on the Senate floor. But the Republican leadership continues to say, ``no,'' because they don't want the loopholes in their plan exposed and fixed. The fundamental flaws in the Republican bill mean greater profits for insurance companies and lesser care for American patients. Senator Lott does not want the Senate to vote to fix these flaws. He does not want a vote: on whether all Americans should be covered, or just one third of Americans as the Republicans shamefully propose, on whether there should be genuine access to emergency room care, on whether patients should have access to the specialists they need when they are seriously ill, on whether doctors should be free to give the medical advice they deem appropriate, without fear of being fired by their HMO, on whether patients with incurable cancer or Alzheimer's disease or other serious illnesses should have access to quality clinical trials where conventional treatments offer no hope, on whether patients in the middle of a course of treatment can keep their doctor if their health plan drops them from its network, or their employer changes health plans, on whether the special health needs of the disabled, and women, and children should be met, on whether patients should be able to obtain timely independent review of plan decisions that deny care, on whether health plans should be held responsible in court for decisions that kill or injure patients. The list of flaws in the Republican bill goes on and on. The Republican leadership's record on this issue is painfully clear. Their cynical strategy is to protect the insurance industry at all costs, by blocking any reform at all, or by passing only a minimalist bill so weak that it would be worse than no bill at all. This obstruction has been going on for more than a year. HMO reform never appeared on any priority list of the Republican leadership. The Republican Policy Committee issued periodic attacks on any attempt to prevent insurance abuses. No Senate committee was permitted to consider any legislation to protect patients and American families. Meanwhile, the momentum for reform across the country continues to grow. This summer, the stonewall strategy finally collapsed in the face of public pressure. So the Republican leadership did the next worse thing. They introduced a bill that had the name of reform--but not the reality. They dug in their heels again, and refused to allow a fair debate by the Senate to change that bill from a sham to genuine reform--from a bill that protects industry profits to a bill that protects patients--from a bill that would be deservedly vetoed by the President to a bill that could be signed into law as a genuine achievement for every family. Bill Gradison, the head of the Health Insurance Association of America, was asked in an interview published in the Rocky Mountain News to sum up the strategy of the special interests committed to blocking reform. According to the article, Mr. Gradison replied ``There's a lot to be said for `Just say no.''' The author of the article goes on to report that ``At a strategy session * * * called by a top aide to Senator Don Nickles, Gradison advised Republicans to avoid taking public positions that could draw fire during the election campaign. Opponents will rely on Republican leaders in both chambers to keep managed care legislation bottled up in committee.'' Instead of participating in a genuine debate on how to assure that all patients have the protections now available only to those fortunate enough to be enrolled in the best plans, insurance companies and their allies in the business community have heeded the call of the Republican leadership. A leadership aide told the industry to ``get off their butts and get off their wallets'' and block reform. They directed their special interests friends to write the ``definitive paper trashing all these bills.'' The Republican leadership could have called up the Patients' Bill of Rights at any time for a full and fair debate. Instead, they have proposed a series of phony ``consent'' agreements that would prevent fair debate and make passage of real reform impossible. These stalling tactics are clearly meant to run out the clock, so that managed care reforms cannot be passed before Congress adjourns, and so that the Republican leadership can avoid taking responsibility for its defeat. The record of Republican attempts to avoid the blame for inaction would be laughable, if the consequences for patients across the country were not so serious. On June 18, Senator Lott proposed to bring up the bill, but on terms that made a mockery of the legislative process. His proposal would have allowed the Senate to start considering HMO reform, but he would have been permitted to end the debate at any time. The proposal also barred the Senate from considering any other health care legislation for the rest of the year. So if Senator Lott did not like the direction the bill was headed, he could kill it and tie the Senate's hands on HMO reform for the remainder of the year. On June 23, 43 Democratic Senators wrote to Senator Lott to urge that he allow a debate and votes on the merits of the Patients' Bill of Rights. We requested that the Senate take up this issue before the August recess. In response, on June 24, Senator Lott repeated his earlier unacceptable offer. On June 25, Senator Daschle proposed an agreement in which Senator Lott would bring up a Republican health care bill by July 6, so that Senator Daschle could offer the Democratic Patients' Bill of Rights, and other Senators could offer amendments on HMO reform. We would agree to avoid amendments on any other subject. Only amendments related to the Patients Bill of Rights would be eligible for consideration. Senator Lott rejected this offer as well. On June 26, he offered once again an agreement that allowed him to withdraw the legislation at any time, and bar any further consideration of any health care legislation for the remainder of the year. On July 15, Senator Lott made yet another offer. This time, he proposed an agreement that permitted only one amendment. He could bring up his bill. We could bring up ours. And that would be it--all or nothing. No votes on key issues. On July 29 and on September 1, the Republican leadership offered variations of this proposal, with amendments restricted to three for Democrats and three for Republicans. The reason the Republican leadership wants to restrict amendments so drastically is obvious. Senator Lott knows his legislation is deeply flawed, and that it cannot possibly be fixed with just three amendments. He believes that he and his special interest friends can hold most of the Republican Senators for a few votes, but he fears that they will not be willing to stand before the American people on the Senate floor and cast vote after vote for the special interests and against the interests of American families. Our Patients' Bill of Rights was introduced in March--and a predecessor bill was introduced by Congressman Dingell and myself more than eighteen months ago, at the beginning of this Congress. Senator Daschle, in an effort to be responsive to the Republican Leader's ultimatum that an agreement on the terms of the debate must be reached before the debate can begin, has offered reasonable proposal after reasonable proposal--and every one was rejected. Yet the Republican leader has allowed the Senate to debate many other bills this year, with ample time and ample opportunity for amendments. We had 7 days of debate on the budget resolution, and considered 105 amendments. Two of those were offered by Senator Nickles. We had 6 days of debate on the defense authorization bill, and considered 150 amendments. Two of those were offered by Senator Lott and he cosponsored 10 others. We 8 days of debate on IRS reform and considered 13 amendments. We had 17 days of debate on tobacco legislation--a bill we never completed--and considered 18 amendments. We had 5 days of debate on the agriculture appropriations bill and 55 amendments. We had nineteen days of debate on the highway bill, with 100 amendments. The Republican leadership has allowed five days of debate and 24 amendments to the bankruptcy bill. They have allowed 36 amendments and two days of debate on the FAA bill passed last Friday. All these bills were important, and all deserved reasonable debate and opportunities for amendments. They were brought up without any undue restrictions on debate. That is the normal way of doing business on important pieces of legislation in the Senate. The Republican leadership was willing to have an adequate opportunity to debate and vote on these other important measures. But when the issue is protecting American families instead of insurance industry profits, different ground rules apply to protect the industry and deny the rights of patients. Senator Daschle has offered yet another reasonable approach to resolve the impasse that Senator Lott has created by his efforts to prevent meaningful reform. He offered to agree to let the Senate debate other bills during the day, and use evenings to debate the Patients' Bill of Rights. The American people expect us to work for them--and if that means a few late nights, so be it. Senator Lott continues to say my way--or no way. And his way is not the way that serves the interests of the American people. The American people deserve a Senate that works as hard as they do. They deserve managed care reform. Last Friday, we recessed at 1:00 pm. Most of the time the Senate was in session was spent in morning business rather than doing legislative work. Monday, we did not come in until noon and we did not do legislative business until 3:30. Throughout this year, we have effectively worked less than a four day week. There is no excuse for our not doing the people's business--and one of the highest priorities for American families is a Patients' Bill of Rights. There is no excuse for not acting this year. If the Majority Leader will stop abusing the rules of the Senate and allow this debate to proceed, I believe that the Senate will pass strong reforms that will be signed into law by the President. The American people deserve real reform, and I believe that when the Senate votes in the clear light of day, it will give the American people the reforms they deserve. This issue is a test of the Senate's willingness to put a higher priority on the needs of families than on the profits of special interests. And it is time for the Senate to act. The choice is clear. The Senate should stand with patients, families, and physicians, not with the well-heeled special interests that put profits ahead of patients. The American people know what's going on. Movie audiences across the country erupt in cheers when actress Helen Hunt attacks the abuses of managed care in the film ``As Good As It Gets.'' Helen Hunt won an Oscar for that performance, but managed care isn't winning any Oscars from the American people. Everyone knows that managed care today is not ``as good as it gets.'' Too often, managed care is mis-managed care. No amount of distortions or smokescreens by insurance companies can change the facts. The Patients' Bill of Rights can stop these abuses. Let's pass it now, before more patients have to suffer. Mr. DORGAN addressed the Chair.

Mr. KENNEDY

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

Mr. KENNEDY

Mr. KENNEDY. Mr. President, I supported Senator Wellstone's amendment to the Higher Education Act and I regret that it was not included in the conference report. The amendment would have increased educational opportunities for people on welfare. It passed the Senate with a bipartisan majority, but was rejected by House Republicans, even though it was also supported by the White House, and by more than 150 social welfare groups. The goal of this amendment is to correct a serious deficiency in the harsh welfare reform law enacted two years ago. Too often, welfare reform around the country has focused on immediate work experience as a means to achieve financial independence, but the focus is excessive, because it reduced options for welfare recipients who wish to complete to two- or four-year college degrees. Welfare reform around the country has tended to focus on immediate work experience as a means to achieve financial independence. The new direction of welfare reform at both state and federal levels has generally reduced the options available for welfare recipients who wish to complete a two- or four-year college degree. It is extremely difficult for single parents to be full-time students and work part- time and still give adequate time to their families. The welfare reform program called Temporary Assistance to Needy Families, is based on the idea that work is the best way to achieve independence, especially if the work comes with job security and fair wages. For many people, education is the best road to jobs that achieve these goals. Higher education is often the best way to earn higher wages, achieve independence from welfare, and provide protection from future poverty and unemployment. Recent studies have found that the average wage for a person who was previously on welfare and then earned a degree is $11.00 an hour, and that each year of education completed by welfare recipients increases wages by as much as $1.14 per hour. A study of 4,500 working mothers in the Census Bureau's Survey of Income and Program Participation found that a college degree is worth an additional $2.58 per hour for working mothers, compared to the wages of high school graduates. The special importance of higher education for women is emphasized by other data showing that women need a college degree to make the same amount of money that men earn with only a high school education. The results of these studies are hardly surprising. We know the importance of higher education and the advantages it opens up. The Bureau of Labor Statistics reported in March 1995 that adult workers with less than a high school diploma earned an annual average of only $13,697. Adult workers with a high school degree earned $20,248. With an associates degree, they earned $26,363, and with a bachelor's degree they earned $37,224. The job and career benefits of higher education are also demonstrated by the poverty statistics of the Department of Labor. In 1995 only 1.5 percent of those with a four-year college degree were living in poverty compared to 3.3 percent of those with an associates degree, 6.1 percent of those with a high school diploma, and 17.2 percent of those without a high school diploma. The evidence for the Wellstone amendment is overwhelming, and a bipartisan majority of the Senate was right to pass it. Under its provisions, 24 months of post-secondary education or vocational educational training would be permissible work activities under welfare reform. I commend Senator Wellstone's leadership on this important issue. States should have the flexibility to create responsible ways to move people from welfare to work, by allowing welfare recipients to include higher education as a part of their effort to achieve financial independence and provide effectively for their families. The House conferees were wrong to reject this positive reform, and we should do all we can to enact it as soon as possible.

Mr. KENNEDY

Mr. KENNEDY. I thank the Chair. Mr. President, I had voted in favor of moving ahead with the legislation itself because it is important. However, I daresay that I want to take a few moments of the Senate's time here to review the bidding about where we are on legislation and where we are not on legislation.

Mr. KENNEDY

Mr. KENNEDY. Mr. President, at other forums we heard about the need for access to specialty care--one of the most important ways in which managed care plans shortchange patients. This is a right guaranteed in our Patients' Bill of Rights but not in our Republican plan. Dr. Mirtha Casimir, a distinguished oncologist from Houston, Texas, outlined the tragedy she sees every single day because HMOs unduly restrict access to specialists. This is what Dr. Casimir's statement was: Cancer patients today are facing a painful irony. At a time of unprecedented progress in the understanding of the genetic and cellular origins of cancer, as well as parallel advances in drug development and design, the insurance industry is exposing new cost containment. Many medical oncologists are concerned about timely access to cancer care and how the significant delays and referrals are impacting early diagnosis and the outcome of therapies in the first and subsequent courses of treatment. Not uncommonly, I now see in my practice delays of 2 to 4 months in a diagnosis of a new primary cancer or the detection of a recurrence. And what the doctor continues to point out is that when she finally sees these cases, it is often too late. For example, she sees women in her practice who have started out with a very, very small tumor in their breast, and then they have been delayed access to a specialist and denied various kinds of treatment. Their appeals go on and on through the HMOs, and finally, when they get to a skilled oncologist, after weeks and months, often it is too late--often it is too late. The tumor has spread too far. And Dr. Casimir said that more often than not when she flips to the front part of the chart, she will see that the patient is covered by an HMO. She will see that the initial request was denied for the kind of treatment that she could provide. And more often than not, she believes, as a skilled physician, that she could have saved the life of that individual if they had been able to get the prompt kind of a treatment and care. She wraps up in her statement by saying: Poor quality of care is always more expensive, both in human terms as well as in the resources expended to try to right the wrong. If the Patients' Bill of Rights is not passed, patients will continue to experience the hostility of this turbulent health care environment in which care is constrained, physicians are controlled, needs of cancer patients are not addressed, and critically important quality of life interventions are viewed as dispensable. That is the statement from one of the top oncologists in the country, and the rest of the testimony spells out additional reasons in support of those points. On September 15, we heard from the past president of the American Academy of Neurology, Dr. Ken Viste from Wisconsin: This country needs fair and compassionate legislation establishing the national standard for all health plans in order to help not harm people with chronic conditions or disabilities. The American Academy of Neurology said: The House Republican leadership's bill, which passed the House, fails to protect the rights and address the needs of patients. There it is, Mr. President, from the American Academy of Neurology. Dr. Viste continued: It is critical for people who need a medical specialist's care to be able to seek the treatment from them directly, immediately, and without penalty. The Daschle-Kennedy bill answers this need by assuring that people with complex, chronic conditions have direct access to specialists within a health plan. And, if no specialist exists in the plan, consumers have a right at no cost to seek a specialist outside of the plan. We believe any adequate patient protection legislation must include these provisions. Willis Lester, one of the speakers at the rally, explained when his employer switched to a managed care plan, his new primary care doctor took him off his blood pressure and cholesterol medications. Consequently, Lester suffered a stroke. According to Dr. Nancy Futrell . . . the stroke is a direct result of high blood pressure and high cholesterol, which would have been controlled by his medications. Dr. Futrell added that Lester's plan has limited his physical therapy, ``essentially impairing his recovery.'' Explains Dr. Viste: With the rise of managed care, we've seen many patients with chronic conditions denied access to quality, specialized medical care that they need. As a result, some of these patients suffer long-term effects and end up on disability, driving up costs to employers. Patients need a law with ``teeth'' that guarantees they will be able to see a specialist, appeal to obtain a medically necessary drug when denied such under a prescription plan, and appeal denial of care to an independent decison-making body. Not only will the patient benefit, but in the end, the employers, as well. The Epilepsy Foundation, the National Multiple Sclerosis Society, United Cerebral Palsy, the American Parkinson's Disease Foundation, the Brain Injury Association, the Consortium for Citizens with Disabilities joined the [American Academy of Neurology] leaders and members . . . in advocating the passage of S. 1890. The Epilepsy Foundation, National Multiple Sclerosis Society, United Cerebral Palsy, Parkinson's Disease Foundation, Brain Injury Association-- every one of these groups say that our legislation provides the protections which are necessary for our families, and the GOP bill does not. We don't even have an opportunity to debate or discuss this. The majority refuses to debate. We are still waiting to hear the name of that first major medical society that supports the Republican proposal. We are still waiting. They haven't been able to come up with one, not one. Virtually every major health care group supports our program. They all do. We will make adjustments and changes in any legislation to try and move the legislation forward, but we are not going to compromise on vital protections. Every major medical professional group supports ours. None, not one, support theirs. The list goes on. This is from a statement of Jeanne Carpenter, the president of the Epilepsy Foundation, in support of the Patients Bill of Rights: The Epilepsy Foundation historically has been a strong advocate for patients rights. We support affordable and quality health care for all Americans. And that begins with giving consumers the choice of health plans, a feature we are pleased to see included in the proposed legislation. We especially support several key provisions [in the legislation]--access to specialists and provider choice, detailed patient information, independent internal and external review of service denials, and coverage for nonformulary prescriptions where medically necessary. Many patients and families tell us they are deeply frustrated being denied referrals to specialists and the full range of treatment options that specialized treatment centers can provide. Not only is patient quality of life adversely affected, but denial of services is a false economy. It produces added cost for unnecessary emergency room and dental services, lost productivity and other seizure-related expenses. Seizure control for many epilepsy patients is a complex matter with important subtleties not always recognized in the primary care setting. Families whose children continue to have seizures need and deserve the opportunity to have their cases reviewed by third parties with full knowledge of the disorder and rapid progress is now being made in its treatment. Patients' rights legislation is long overdue. Each day of delay, there are children whose chances in life are being jeopardized because of ongoing seizures. We strongly urge passage of these protections during the current session of Congress and at the earliest possible moment. Do we hear that? Every day of delayed debate and inaction we are putting at risk children whose lives are being jeopardized because of ongoing seizures. How many are being jeopardized if we don't complete the Vacancies Act? Or the salting act or the Internet tax or the financial services legislation? How many? Here, Mr. President, are the real issues. This is what is really important in our remaining time this year. It is very clear why all of these organizations support this proposal. We have built into it not only the guarantee of specialty care, but real internal and external appeals. I will make a brief comment about the appeal procedures under the Republican proposal. Under their plan, the decision to allow a patient to proceed to a so-called independent appeal will be made by the HMO itself, in consultation with their lawyers. Talk about having the fox guard the hen house, this is putting the fox in there. Do you know what will happen under the Republican House plan? Even if the patient wins on the appeal, the plan doesn't have to accept it. If they choose, they don't have to follow it. So they can show a brochure to anybody buying insurance, look you have an appeal. But they probably don't explain that it is decided by the plan and that the plan doesn t have to follow the ruling if it benefits the patient. Our Republican friends say yes, we have an appeal provision. They say yes, we have it in our proposal. But this is the appeal they have. It doesn't work in quite the same way as ours. I see two of my good friends and colleagues here, so I will wind up. It is important to understand that this issue is not going to go away. As I have mentioned many times, the provisions listed on this chart and included in our legislation have either been recommended by the President's bipartisan commission--which required unanimous support by its members-- or were put in Medicare by the Congress or have been endorsed by the National Association of Insurance Commissioners or recommended by the American Association of Health Plans, which represents HMOs across the country. And, while the President's Commission did not specifically draft legislation, they did not rule out legislation either. They simply said that all Americans should have these protections. Most of our bill reflects the Commission's recommendations. Many of these provisions currently protect our seniors in Medicare. There is a lot of overlap here. The HMO trade group and the State insurance commissioners--again, Republicans and Democrats alike--have said these are important protections. Virtually all of our proposals have been recommended or adopted by other health care programs or experts. Talk about a modest proposal. This is really a reflection of the best of those who understand this issue and have studied it for some period of time--probably for 8 to 10 years. That is what this is all about. It is sensible. It is responsible. It is common sense. It is common sense to take a sick child to the nearest emergency room and not across town. It is common sense to get a specialist to take care of a particular kind of need. That makes sense. It is common sense to give the best medical prescription drug to somebody who is ill. It is common sense, with the breakthrough technologies and unprecedented progress that we are making in medicine, to allow people who can benefit from clinical trials to be able to participate in those clinical trials. It doesn't cost the HMOs very much more because they are going to have to pay for the basic routine care in any event, and that care will continue. The clinical trial pays for the additional treatment. So the cost isn't that great. But too many patients don't have this right, and those who think they do are increasingly denied it. The list goes on. These are common sense proposals, Mr. President. It is common sense to hold people accountable for their actions. When you hold them accountable, you get better performance. The best testimony on the issues of appeals and accountability that we heard was when Senator Specter had his excellent hearing. We learned that court cases rarely occur, even when patients can hold their plans accountable. The 23 million employees of state and local governments can take their plans to court, as can the 15 million patients with individual health insurance. We know how that works. It is rarely used. Why? Because it is there. In most cases, the internal and external appeals resolve it before it needs to go to court. In the end, with few exceptions, it doesn't involve a court case. But what is clear--and the testimony is overwhelming because it is there--is that you get better quality. These plans can be held accountable for their actions, but we see that there is not as great a need when that right exists for patients. That is what we are interested in. We are interested in the best quality. We believe the American people should be entitled to it. These are some of the stories that we have heard in recent times. We can go right down the list of protections in our bill and in every one of these areas on this chart, you can find compelling stories. We just ask to debate and vote on these issues. All we ask is that we cut back on some of the quorum calls that we have had here lately. All we ask is that we follow Senator Daschle's suggestion that we may debate these in the course of the evenings, at the end of this week and part of next week, and have some resolution of these issues. All we ask is that we give the American people at least an understanding that this institution is addressing something that is fundamentally important to their lives and the lives of their loved ones. I yield the floor. Mr. GRAHAM addressed the Chair.

Mr. KENNEDY

Mr. KENNEDY. I would again like to thank my colleagues for their leadership on this vital technology and for clarifying the congressional intent of this funding. advanced materials intelligent processing center

Mr. KENNEDY. Mr. President, I would like to take this opportunity to again thank Senator Stevens and Senator Inouye for their efforts and leadership in putting the Fiscal Year 1999 Department of Defense Appropriations Conference Report together. I would also like to thank my colleagues for their continued support of photonics research and their leadership in providing continued funding for one of our most critical technologies. The vital nature of this photonics effort has been highlighted in recent Critical Technologies Reports to Congress. Mr. President, I would like to clarify one point in the Conference Report before us, and to confirm the legislative intent of the Committee. I would like to ask the senator from Alaska, Senator Stevens, and the Senator from Hawaii, Senator Inouye, if the $2.5 million provided for photonics research in the RDT&E/Army section was intended to be provided to the Photonics Research Center which was funded in the Fiscal Year 1996 Defense Appropriations Bill?

Mr. KENNEDY

Mr. KENNEDY. Mr. President, I commend my colleagues on the Labor Committee for their skillful work on this bill. Senator Jeffords worked hard to accommodate all the concerns of all the members of the Committee, and kept the interests of students firmly in mind. Senator Coats and Senator Dodd likewise contributed to the bipartisan spirit. I also thank the following: On Senator Jefford's staff, Susan Hattan, Jenny Smulson, Scott Giles, Cory Heyman, and Pam Moran. From Senator Coats' staff, Townsend Lange. From Senator Dodd's staff, Suzanne Day and Megan Murray. From my own office, Marianna Pierce, Jane Oates, and former fellows Gloria Corral, Jennifer Kron, Maria McGarrity, and Eileen O'Leary. I also thank Debb Kalcevik from CBO; Margot Schenet, Jim Stedman, and Barbara Miles from CRS; and Mark Sigurski from the office of legislative counsel. They have all done an excellent job, and deserve a large share of the credit for this achievement. Mr. President, I want to single out, in particular, Marianna Pierce who is my chief of staff in the area of education. The members of the staff performed absolutely superbly and have played an indispensable role in helping all of us reach this point. I am enormously grateful to her and the other staff. Mr. JEFFORDS addressed the Chair.

Mr. KENNEDY. Mr. President, the Higher Education Act of 1998 is a strong, bipartisan bill that deserves the support of all Members of the Senate. It renews our commitment to make higher education more affordable and more accessible for all qualified students. The House and Senate passed their original versions of the bill almost unanimously, and the conference report preserves most of the best features of both bills. It enhances benefits for students, and particularly for students who want to be teachers. It increases the maximum authorization for Pell grants for the neediest students, and expands the formula for calculating their financial need in order to protect a larger amount of income of working parents and students. The bill also reduces the cost of student loans by almost one percentage point. This reduction can make a significant difference for students who may face a mountain of debt when they graduate. This change will result in savings of $700 on the average debt of $13,000, and savings of over $1,000 on a debt of $20,000. I am disappointed, however, that we could not extend this benefit to all recent graduates. Under the bill, the rates for consolidation loans will be permanently lowered in both programs from their previous statutory rates. The bill does create a short window for recent graduates to consolidate their existing loans under the Direct Lending program at the same low rates applicable for new loans. This opportunity will be available for another 4 months, in addition to the 3 month-window already in effect, so students will have a total of 7 months to consolidate their loans. One of the key features of the bill is improving the training of teachers. The legislation supports local partnerships that include elementary and secondary schools and colleges, and it also provides competitive grants to states. This assistance is urgently needed to strengthen teacher training. The bill also provides assistance for recruitment of new teachers, a critical need for many school districts. In addition, it provides loan forgiveness on student loans of up to $5,000 for those who teach for five years in high-need schools. I hope that we can build on this incentive in future years, as an important way to encourage more students to become teachers. The bill also includes an early intervention initiative to encourage more middle-school students to understand that college is not out of reach. It incorporates ideas from the Administration and from Senator Jeffords in a new program, ``Gear Up.'' We need to reach out to middle- school children to help them understand that a college education is attainable and affordable. The bill also continues the program of Graduate Assistance in Areas of National Need, as a critical investment in graduate education. I am particularly pleased that the conference report preserves the portable Javits Fellowships for talented students in the arts, humanities, and social sciences. The bill contains a new program based on initiatives sponsored by Congresswoman Meek in the House and by myself in the Senate to encourage a higher quality of college teaching for students with disabilities. In recent years, it has become possible for many more students with disabilities to achieve the dream of a college education, and we need to do more to ensure that faculty members have the experience to teach them. This bill reaches out to all colleges and universities, and can include training for graduate teaching assistants--the faculty of the future. The bill also expands federal aid for learning through distance education. Distance learning can open the doors of higher education to many students who cannot attend classes on college campuses because they live in remote areas, or because of their job and family responsibilities. The Department of Education will monitor the institutions participating in the distance program, and report to Congress on the results. Our goal is to ensure that distance education is of the same high quality as traditional education. The bill also helps improve the delivery of federal financial aid, by creating a Performance Based Organization in the Department of Education. Its goal is to streamline and improve the financial aid functions of the Department, and give it more flexibility to deal with many aspects of federal aid. A principal goal of the PBO is to improve services for students, and the bill creates a new position called the Student Loan Ombudsman, which student groups have urged. The bill also encourages improvements by guaranty agencies, by enabling them to enter into voluntary, flexible agreements with the Secretary of Education. Under these agreements, the agencies can do more to prevent defaults, instead of collecting from students after they have defaulted on loans. These voluntary flexible agreements will encourage the agencies to be more business-like and responsive to students. This bill sets the stage for future reforms in student loans. The controversy about what level to set interest rates on these loans makes clear that Congress should stop setting the rates for banks. The best solution is to accept a market-based system for student loans, and let competition set the rates for lenders. Many Members on both sides of the aisle and in both Houses are interested in this fundamental change, and I am pleased that the bill calls for a study of competitive mechanisms for the loans. This study will help Congress make thoughtful changes in a system that is now far too costly and inefficient. I am disappointed that the conference report does not contain the amendment to the welfare reform act proposed by Senator Wellstone and passed by the Senate. Senator Wellstone's amendment would help welfare recipients attend college for two years. We have heard from many students who have been forced to abandon their pursuit of college education because of the harsh provisions of the welfare reform law. Senator Wellstone's amendment is well-designed to reduce this serious problem, and it deserves to be enacted. Overall, the numerous positive changes in this legislation will strengthen higher education. I commend the constructive bipartisan spirit that has brought us to this point. It is fitting to enact this legislation at the beginning of the academic year, and I look forward to its adoption and its successful implementation. Mr. President, on the teacher training provisions of this Act, which our friend and colleague, Senator Reed, is so very interested in, one of the new features is a loan forgiveness program--$5,000 for a teacher who teaches for 5 years. This is a very modest forgiveness, but it really builds on the old National Health Service Corps which provided loan forgiveness for doctors to go into underserved areas. The forgiveness program was an important incentive and was really very, very important and has been effective. We hope this program will be as well. Also, I want to mention the new program that builds on some initiatives of Senator Jeffords and the TRIO Program, which targets middle school classes to move the whole class toward continuing education. This has worked in different parts of the country. Now we have a program to encourage other schools to do that. If any one of us goes to any school in this country, in an elementary and secondary class, and asks children, even in the most underserved part of our Nation, how many want to go to college, before you even get the words out of your mouth, every hand goes up. They get discouraged in later years. If they know they have the opportunity to continue their education if they apply themselves to their studies, it can have a dramatic impact in reducing dropouts and also antisocial behavior. This is a modest program, but it is very important. I want to also mention, Mr. President, that this bill sets the stage for future reforms in student loans. The controversy over what level to set interest rates on these loans makes clear that Congress should stop setting the rates for banks. The best solution is to accept a market- based system for student loans and let competition set the rate for the lenders. We believe in competition. This is a good area in which to try it. We have many examples in different public policy areas of where auctions work. There is an excellent initiative in the House of Representatives by Republican Congressman Petri to try an auction-based system. I am very hopeful we can find a bipartisan effort in this area to find the savings and return them to the students. It makes sense. That is a way we should proceed. We have a study of that program in this conference report. Finally, I agree with my other colleagues. I am disappointed the conference did not accept what I think is the superb amendment of Senator Wellstone, which was adopted in this body, about continuing education and how this dovetails with the welfare reform program. Senator Wellstone will be over here to speak to that issue later on. I regret he was not successful, and I will certainly support his efforts later on to try to implement that program.

Mr. KENNEDY. I yield 4 minutes to the Senator from Rhode Island.

Mr. KENNEDY. I yield 4 minutes to the Senator from Connecticut, 4 minutes to the Senator from Rhode Island, and I will yield myself, now, 4 minutes. Mr. President, I want first of all to express my appreciation to my friend and colleague from Vermont, Senator Jeffords, for his leadership in this area. It follows a long tradition of Vermont Senators being committed to education policy. Senator Stafford, a long-time friend, was strongly committed to education. At a time when there are differences that are all too obvious between the two political parties, Senator Jeffords constancy and commitment in the area of higher education, I think, have been very, very impressive. All of us have enjoyed the opportunity to work with him. I commend my friend and colleague, Senator Dodd, who has been extremely active and involved in the workings of the higher education legislation, both in the committee and the conference, and has been a key player in his involvement and commitment in higher education. I see, as well, my friend Senator Reed, who has a particular interest in teacher training programs and has a long tradition, with Senator Pell of Rhode Island, and also in the House, of commitment to higher education. We have a number of others who I will describe in greater detail as time permits, but I am particularly appreciative of my colleagues' strong support. The Education Act of 1998 is a strong and bipartisan bill that deserves the support of all Members. It renews our commitment to make higher education more affordable and more accessible to qualified students. The House and Senate passed the original versions of the bill almost unanimously, and the conference report preserves most of the best features of both bills. It enhances benefits for students, particularly for students who want to be teachers. It increases the maximum authorization for the Pell grants for the neediest students and expands the formula for calculating their financial need in order to protect a larger amount of income for working parents and students with greater opportunity for eligibility for those Pell grants. The bill also reduces the cost of Pell grants by almost 1 percentage point. This reduction can make a significant difference for students who may face a mountain of debt when they graduate. This change will result in savings of $700 on the average debt of $13,000, and savings of over $1,000 on a debt of $20,000, which is enormously important to make these loans--and college--accessible for the sons and daughters of working families. I am disappointed, however, we could not extend this benefit to all recent graduates. Under the bill, the rates for consolidation loans will be permanently lowered in both programs from their previous statutory rates. The bill does create a short time window for recent graduates to consolidate their existing loans under the Direct Lending Program at the same low rates applicable for new loans. This opportunity will be available for another 4 months in addition to the 3-month window already in effect, so the students will have a total of 7 months to consolidate their loans. Many of us would have liked to have had a longer period of time, but budgetary restraints constricted us. I think it is going to be enormously important that students and their parents look into the consolidations that can save them a great deal of money. One of the key features of the bill is improving the training of teachers. The legislation supports local partnerships that include elementary-secondary schools and colleges and provides competitive grants to States. This assistance is urgently needed to strengthen teacher training. If we are to find an area of greatest need, probably in our whole education system, it is putting a well-qualified teacher in every classroom in this country. Mr. President, I reserve the remainder of my time and I yield 4 minutes to the Senator from Connecticut.

Mr. KENNEDY. Mr. President, as I understand it we have 15 minutes; is that correct?