Ted Kennedy

Mr. KENNEDY

Mr. KENNEDY. But, I say to the Senator, as I understand it, when you offer your amendment, you will have 60 minutes and we will have 60 minutes. I think we could accommodate the other Senators. Senator Feinstein is here. We have probably two other Senators. We can let them speak at that particular time. So it is just a question of working out the remaining time this evening.

Mr. KENNEDY. Yes. I yield 10 minutes.

Mr. KENNEDY. Will the Senator be good enough to yield on that point?

Mr. KENNEDY. The Senator talked about the poverty line and the minimum wage. There is a third element, and that is productivity. As we pointed out in the earlier presentation, the productivity in the last 10 years has increased by 12 percent, and the total wages of all workers, 1.9 percent. The Senator, as a member of the Finance Committee, knows one of the key elements in an economic analysis is the issue of productivity. Here we have fallen so far behind, not only in the poverty rate but also in productivity growth.

Mr. KENNEDY. I yield 5 more minutes.

Mr. KENNEDY. I yield 3 more minutes.

Mr. KENNEDY. Mr. President, how much time does our side have?

Mr. KENNEDY. I yield 10 minutes to the Senator from Illinois.

Mr. KENNEDY. Mr. President, how much time do we have remaining?

Mr. KENNEDY. Mr. President, I yield myself 7 minutes. Mr. President, I think it is probably appropriate the Senate take a moment to look at what the majority leader has stated about increasing the minimum wage. Over the course of the afternoon, we have had a number of speakers who have made a powerful case in favor of increasing the minimum wage. Yet we have against this background what the majority leader, Senator Lott, said about our proposal: It will not go to the President. I can guarantee you that. So the American people ought to understand no matter how they might agree with us and are convinced of both the importance and the fairness of the issue, that is the position of the majority leader. That is part of the difficulty and the complexity we have been facing over this whole year. There has been this unalterable opposition to any break for the hardest working Americans, the ones at the lower rung of the economic ladder. Even if we are able to somehow be successful in winning this tomorrow morning, it is not going to go to the President. He is going to use every effort he possibly can to defeat this. Earlier this evening, the Senator from Oklahoma, Senator Nickles, pointed out CBO estimates of a loss of 100,000 to 500,000 jobs. Those are absolutely identical figures to what they said when we raised it in 1996 and 1997. They were found to be completely inaccurate. I ask unanimous consent to have printed in the Record the references to 27 different studies that have been done nationwide, looking at the economic impact of the last increase in the minimum wage that will indicate positively that there has been an expansion of employment.

Mr. KENNEDY. Mr. President, perhaps tomorrow we will be able to take the time to talk about what is happening to minimum-wage workers. As I mentioned earlier today, minimum-wage workers are teachers' aides, nursing home aides. Nursing home aides have a 94-percent turnover. The principal reason for the turnover is because they are paid so poorly. They are the people working to try to provide some care and attention to the elderly. I see our good friend from Connecticut who has been a leader in establishing day care. The turnover that is taking place in the day-care centers is very similar. It is not quite as high but very dramatic. These are our children. This is our future. This is as a result of failing to provide an adequate increase in the minimum wage. There are two final points I want to raise with regard to the Republican proposal. As has been mentioned earlier, the effect of the Republican proposal will mean that 3 years from now, the average minimum-wage worker will have made $1,200 less--$1,200 less--than they would have if we had passed the Daschle proposal. That is a lot of money for working Americans. That is 5 months of rent, a year of tuition, 6 months of utilities. This is important to hard-working Americans, make no mistake about it. It might not mean a lot to Members of the Senate who have just voted themselves a $4,600 pay increase. We are not deferring that pay increase for Senators 2 years or 3 years. We are saying the minimum wage ought to be over a 2-year period. But our Republican friends say, no, let's spread it over 3 years. We are not doing that with regard to our pay increase. I hope when Members go back and talk to their constituents, they are able to justify why we were worth $4,600 more this year while saying no to hard-working Americans--they are not worth 50 cents more next year and 50 cents more the year after. Finally, I want to mention one very important aspect of the Republican proposal that has not been addressed. I yield myself 2 more minutes, Mr. President. With this particular chart, we illustrate what we have been facing over this past year with regard to the Republican attack on working families: Resisting a pay increase with the minimum wage; balancing the budget on the backs of the working poor. Governor Bush pointed that out. You do not have to hear it from Democrats. We have seen some retreat on that by the Republican leadership. Then providing pensions for the wealthiest individuals as they do under this proposal; blocking workers' rights to organize, the salting bill; and undermining worker safety, providing the waivers of penalties for violations of OSHA; cutting workers' pay. You can say, where does that come in? Under the Republican proposal, they recalculate how overtime is going to be considered. This has not been done since 1945 when the proposal was struck down by the Supreme Court which said they basically, fundamentally undermine the Fair Labor Standards Act. If you take the Republican proposal on recomputing overtime, effectively you are undermining what many workers would be able to receive with an increase in the minimum wage. There has not been a word of that spoken by the proponents of this amendment. They tucked this right into their particular proposal.

Mr. KENNEDY. I yield for a question.

Mr. KENNEDY. This Senator is saying there will be an overtime payment, but the overtime payment will be calculated in a way that will diminish, in a significant way, the actual overtime workers should be entitled to and the way it has been computed for the last 45 years. It is a dramatic change in the Fair Labor Standards Act. The Supreme Court has said, as I said, if that provision had been accepted when it was offered in 1945, it effectively emasculates the overtime provision of the Fair Labor Standards Act. The overtime words will be there, there will be a base pay that they will pay overtime on, but not the way they are being paid now. The Republican proposal will undermine, in a significant and dramatic way, the way that hourly workers are being paid in the United States.

Mr. KENNEDY. The Senator is absolutely correct. It is one of the reasons why we ought to have an opportunity to debate this in the light of day, not under the time limit. We are forced to take these time limits in order to at least have a vote on the minimum wage. But this issue is too important to working families to be dismissed lightly. I hope, for reasons I have outlined briefly, the amendment of the Senator from New Mexico will not be accepted. The Senator from Connecticut desires time. I know the Senator from Iowa wants time. Mr. President, how much time remains?

Mr. KENNEDY. I yield 5 minutes to the Senator from Connecticut.

Mr. KENNEDY. Mr. President, as I remember, the consent request was that this hour was to be used for debate on bankruptcy prior to 3. Is the time evenly divided, or how is the time designated?

Mr. KENNEDY. Mr. President, I ask unanimous consent that the following be granted the privilege of the floor for the bankruptcy bill: Kathy Curran, Jennifer Liebman, Lisa Bornstein.

Mr. KENNEDY. Mr. President, for over 100 years, Congress has supported a bankruptcy system that balances the needs of debtors in desperate financial straits and creditors who deserve repayment. Today, however, the tide is changing. Too often the complexity of the problems facing debtors is ignored. Critics, using the unfair rhetoric supplied by the credit industry, call bankruptcy an undeserved refuge for those who can't or won't manage their finances. Honest, hard-working, middle class families are unfairly characterized as dead-beats who abuse the bankruptcy system to avoid paying their debts. The result is the excessively harsh bankruptcy reform bill presented to the Senate. During this debate, every Senator must ask one essential question-- who are the winners and who are the losers if this bill becomes law. A fair analysis of the bill will lead members of the Senate to the same conclusion reached by House Judiciary Committee Chairman Henry Hyde, who counted dozens of provisions that favor creditors. But, decency and dignity need not be victims of reform. Balanced bankruptcy legislation is our goal. Though we must address the needs of creditors, we must also consider the specific circumstances and market forces that push middle class Americans into bankruptcy. Let's take the basic facts one by one. Fact No. 1: The rising economic tide has not lifted all boats. Despite low unemployment, a booming stock market, and budget surpluses, Wall Street cheers when companies--eager to improve profits by down- sizing--lay off workers in large numbers. In 1998, layoffs were reported around the country in almost every industry--9,000 jobs were lost after the Exxon-Mobil merger; 5,500 jobs were lost after Deutsche Bank acquired Bankers Trust; Boeing laid off 9,000 workers; Johnson & Johnson laid off 4,100. Kodak has cut 30,000 jobs since the 1980s and 6,300 since 1997. Often, when workers lose a good job, they are unable to recover. In a study of displaced workers in the early 1990s, the Bureau of Labor Statistics reported that only about one-quarter of these workers were working at full-time jobs paying as much as or more than they had earned at the job they lost. Too often, laid-off workers are forced to accept part-time jobs, temporary jobs, and jobs with fewer benefits or no benefits at all. Fact No. 2: Divorce rates have soared over the past 40 years. For better or for worse, more couples are separating, and the financial consequences are particularly devastating for women. Divorced women are four times more likely to file for bankruptcy than married women or single men. In 1999, 540,000 women who head their own households will file for bankruptcy to try to stabilize their economic lives. 200,000 of them will also be creditors trying to collect child support or alimony. The rest will be debtors struggling to make ends meet. Fact No. 3: Over 43 million Americans have no health insurance, and many millions more are underinsured. Each year, millions of families spend more than 20 percent of their income on medical care, and older Americans are hit particularly hard. A June 1998 CRS Report states that even though Medicare provides near-universal health coverage for older Americans, half of this age group spend 14 percent or more of their after-tax income on health costs, including insurance premiums, co- payments and prescription drugs. Fact No. 4: The credit card industry has engaged in a massive and unseemly nation-wide campaign to hook unsuspecting citizens on credit card debt. Credit card issuers logged 24 million telemarketing hours in 1996 and sent out 3.45 billion--billion--credit card solicitations in 1998. In an average month, 75 percent of all households in the country receive a credit card solicitation. In recent years, the credit card industry has also begun to offer new lines of credit targeted at people with low incomes--people they know can not afford to pile up credit card debt. Facts such as these have reduced the economic stability of millions of American families, and have led to the sharp increase in the number of bankruptcy filings. Two out of every three bankruptcy filers have an employment problem. One out of every five bankruptcy filers has a health-care problem. Divorced or separated people are three times more likely than married couples to file for bankruptcy. Working men and women in economic free fall often have no choice except bankruptcy. The bankruptcy system provides a second chance for these large numbers of Americans who would otherwise hit financial bottom. It offers an indispensable opportunity to stabilize their households after an economic crisis. Clearly, we must deal with those who take advantage of the system and abuse it. Reform is necessary to stop repeat filers, eliminate the loophole provided by the homestead exemptions in several states, and prevent wealthy Americans from abusing the system to avoid paying their debts. But the credit card industry is abusing the system, too. Congress needs to deal with their abuses realistically and fairly, in a way that protects millions of struggling middle class and low-income families. It would be irresponsible for Congress to act only in ways that reward the credit card industry for its cynical manipulation of these families. The drop in filings this year is ample indication that a harsh bankruptcy bill is not needed. Without any action by Congress, the number of bankruptcy filings is decreasing. It is estimated that there will be 100,000 fewer filings this year than in 1998--filings have dropped in 42 states. Leading economists believe that the bankruptcy crisis is self-correcting. As economics professor Lawrence Ausubel states, Lenders respond to an unexpected increase in personal bankruptcies by curtailing new lending to consumers teetering closest to bankruptcy, with or without new legislation. The high rates of default at the peak of the bankruptcy crisis began to impinge on the profitability of lending and--as a result--lenders tightened their underwriting standards. This is the non-legislative, free-market response which made the crisis abate. Despite these facts, the Senate is pursuing legislation that is a taxpayer-funded administrative nightmare for struggling debtors. Mr. President, I will include in the Record a list of the States that have seen a significant--and some not so significant--drop in the bankruptcy filings, comparing the second quarter of 1999 to the second quarter of 1998. It dropped more than 62 percent in the State of Oklahoma. It was down 1.19 percent in Arizona. Eight States have had some increase. It was two-tenths of 1 percent in Indiana, three-tenths of 1 percent in Utah, six-tenths of 1 percent in Wyoming. It was up nine-tenths of 1 percent in Montana, 3.3 percent in Oregon, 6 percent in South Dakota, 12 percent in Alaska, and 144 percent in Delaware. I ask unanimous consent that this list be printed in the Record.

Mr. KENNEDY. Mr. President, coming back to the basic and fundamental issue about who is supporting the legislation, who the winners are and who the losers are, I will include in the Record at this point the various organizations that are opposed to the legislation. I ask unanimous consent that this list of organizations be printed in the Record.

Mr. KENNEDY. Mr. President, here is the letter that is being sent by the ``American Bankruptcy Service,'' ``Re: Fresh Start VISA distributorship'': Dear counselor: Do you know who the counselors are? Do you know who those counselors are? They are counselors for the people who have gone bankrupt--the lawyers for people who have gone bankrupt. Here is their friendly ``American Bankruptcy Service.'' We offer a unique opportunity that could be of great benefit to your firm and your clients. By becoming a distributor, you will have the ability to market unsecured VISA credit cards. We call it the ``Fresh Start'' card to your clients who: Have filed a chapter 7 bankruptcy; Have completed the 341 meetings of creditors; Have not yet received their discharge; Have attached a copy of their bankruptcy notice. No deposit required. This industry is out soliciting from attorneys who have represented women and workers who have been downsized, those who have gone bankrupt and belly up because of health care bills they just can't afford to pay. Now you have the credit card industry writing to the attorneys and saying: Look, you can get in on the goody trail, too, because if you represented one, you probably represented others, and you can get on and be part of our credit card distributorship as well. That is what they are saying here. You can read this letter right through. Our firm is interested in distributing the Fresh Start

Mr. KENNEDY

Mr. KENNEDY. Mr. President, Paul Kirk, who is well known to many of us as a distinguished past chairman of the Democratic Party, recently wrote an eloquent and insightful article on the state of politics in America today. Entitled ``What We Can Do For Democracy,'' Mr. Kirk's article discusses the growing political apathy of Americans, and challenges citizens to take a more active role in government. This issue goes to the heart of our democracy, and I believe that all of us who are concerned about it will be interested in Mr. Kirk's ideas. I ask that his article may be printed in the Record. The article follows: [From the Boston Globe, Nov. 3, 1999] ``What We Can Do for Democracy'' (By Paul G. Kirk, Jr.) Alarms have sounded; no one has panicked; the response has been universal. Much time and an estimated $200 billion have been spent on readiness and remediation plans to avert a Y2K computer calamity. But how well are we responding to a Y2K alarm of greater consequence--the distressed health of America's democracy? John Kennedy once admonished: ``Democracy is never a final achievement . . . it is a call to an untiring effort.'' In this twilight of ``America's Century'' and before the dawn of a new millennium, now seems a logical time to take stock of our effort. A few weeks ago the Kennedy Library observed its 20th anniversary by inviting more than 75 distinguished business leaders, college presidents, public officials, nonprofit executives, and journalists to begin the assessment. They found the following symptoms: An all-time high level of cynicism, disaffection, and citizen disconnect from politics coincides with an all-time high level of powerful interest money being spent on political campaigns. Money is now the all-consuming obsession of candidates and parties, the deterrent to political competition, the barrier to equal representation, the controlling factor in nominations and elections, and the corrupting influence of public policy decisions. 62 percent of Americans eligible to vote in the 1998 midterm election chose not to, while less than a majority voted in the 1996 presidential election. Those of us who know less, care less, participate less, and vote less than other eligible voters are the 18- to 24-year- olds. Personal consumption and borrowing are at an all-time high while our savings rate is at an all-time low. Record market growth and new prosperity will likely result in the largest transfer of individual fortune and economic capital to the next generation in our history. Concurrently, the abrogation of any obligation to transfer to the next generation some appreciation of civic capital and public responsibility is more palpable than ever in our history. Writing of an earlier democracy, historian Edward Gibbon put our symptoms in perspective: ``When the Athenians finally wanted not to give to society but for society to give to them, when the freedom they wished for most was freedom from responsibility, then Athens ceased to be free.'' Let's face it. We, too, have become so obsessed with self- gratification and gain that we view our rights and freedoms as entitlements and ignore the civic duties and responsibilities that ensure them. George Santayana warned: ``Those who fail to remember the past are condemned to repeat it.'' To avert a repeat of an Athenian calamity, Americans' attitudes must change. When the Kennedy Library conference asked what we must do to strengthen citizenship and service for the future, the attendees responded: The present ``access for sale'' culture must be replaced with comprehensive campaign finance reform that provides some public financing and free TV time to candidates who agree to reasonable spending limits. Only this can renew citizens' trust that our votes matter and our voices will be heard equally. Civic literacy education must be ingrained from grade school through college with extra-curricular citizenship activities that include possible school credit for community service. An attitude of welcome inclusion and continuing citizenship education must be available to all ``new'' Americans. Each measure is critical, but who will assure their adoption? John W. Gardner counseled that the ``plain truth is that government (and other powerful institutions) will not become worthy of trust until citizens take positive action to hold them to account.'' You and I can ignore the alarm, thus contributing to the calamity, or we can take positive action to rescue our democracy. Citizens must launch a campaign to renew our national character and the spirit of citizenship and participation. One by one, our individual response can inspire a collective national chorus reminding others that our freedom and democracy are directly dependent on our own patriotism, active citizenship, unselfish service, respect for pluralism, and intolerance of the present condition. Mark my words. If you and I commit ``an untiring effort'' to this national civic campaign, communities, organizations, educators, religious and business leaders, the media and opinion shapers, political candidates and parties, and, yes, the President of the United States whom we elect one year from now will follow. Think about it. It's called ``consent of the governed.'' It's our democracy, and it's a noble campaign you'll be proud to win.

Mr. KENNEDY

Mr. KENNEDY. Mr. President, over the past few decades, we have made extraordinary advances as a nation in science and medicine. Unfortunately, those advances are not benefitting all of our citizens equally. Minority communities suffer disproportionately from many severe health problems. We know that poverty, lack of health insurance, and other barriers to care continue to undermine the health of minorities. Clearly we need to do more to give all Americans the fair chance for a healthy future that they deserve. The Administration has taken important steps to address this challenge. Last year, the President announced the Initiative to Eliminate Racial and Ethnic Disparities in Health. This initiative, led by the Department of Health and Human Services, has identified several areas where new commitments, new ideas, and new resources are necessary. The goal is to eliminate disparities in the areas of cardiovascular disease, cancer screening and management, diabetes, infant mortality, HIV/AIDS, and immunizations by 2010. This ambitious goal cannot be met without a major effort to improve research on the health of minorities and develop the steps needed to reduce these disparities. Today, Senators Akaka, Inouye, Lincoln, Wellstone, and I are introducing the Health Care Fairness Act of 1999, to secure the commitment and resources needed in each of these areas to ensure that minorities have a fair chance for improved health. Minority populations suffer disproportionately from cardiovascular disease. They have a greater risk of developing high blood pressure, and are less likely to receive treatment to manage the condition after it develops. As a result, African Americans are 40 percent more likely to die from coronary heart disease than whites. A Georgetown University study published in the New England Journal of Medicine last February found that bias in the decisions made by doctors is a factor in the treatment that African Americans receive when they suffer from heart disease. These findings are based on an experiment where physicians volunteered to view a video of actors posing as patients with significant symptoms of heart disease. The physicians were asked to prescribe further interventions for each ``patient,'' all of whom had identical medical histories, insurance coverage, and occupations. While 91 percent of the white males, white females, and African American males in the study were referred for cardiac catheterization, a more effective but more expensive diagnostic procedure, only 79 percent of the African American females in the study were referred for this test. A study published in the New England Journal of Medicine last month found similar disparities in the treatment of lung cancer. Patients whose tumors are discovered early are often able to be cured with surgery. This study found that African American patients with tumors small enough to be surgically removed were treated surgically in only 64 percent of cases, compared with 77 percent of white patients treated surgically. As a result, African Americans have only a 26 percent chance of surviving lung cancer, compared with a 34 percent survival rate for whites. Other types of cancer also strike racial and ethnic minorities in disproportionate numbers. Vietnamese American women are five times more likely than white women to contract cervical cancer. Hispanic women are twice as likely to contract cervical cancer. Native Hawaiian men are 13 percent more likely to contact lung cancer. Alaskan Native women are 72 percent more likely to contract colon cancer and rectal cancer, when compared with whites. In addition, African Americans and Hispanic Americans are more likely to be diagnosed with cancer once the disease has reached an advanced stage. For African Americans, the result is a 35 percent higher death rate. The Institute of Medicine, issued a report last February concluding that federal efforts to research cancer in minority communities are insufficient. The report recommended an increase in resources and the development of a strategic plan to coordinate this research. The results of this study confirm that while NIH has been extremely successful in producing medical breakthroughs that improve health care, those breakthroughs do not always reach into racial and ethnic communities. The same troubling differences are found with HIV/AIDS. The powerful new drugs that have dramatically decreased AIDS deaths and prevented or delayed progression from HIV to AIDS for so many citizens are not reaching minorities in proportion to their need. Racial and ethnic minorities make up approximately 25 percent of the total population, but these groups account for over half of all AIDS cases. The disparity is even greater for African American and Hispanic women, who account for nearly 80 percent of the AIDS cases reported among women. In spite of recent bipartisan efforts to increase access to health care for all children, racial and ethnic disparities exist among young Americans as well. Minority children are less likely to receive prescription medications, and they have lower immunization rates than white children. Inadequate health care places a barrier in the path of healthy development for minority children, and that is an unfair disadvantage. The Health Care Fairness Act of 1999 addresses these racial and ethnic health disparities in many ways. It contains sections on research, data collection, medical education, and outreach. Each of these aspects has an important role to play in the reduction and eventual elimination of these unacceptable health disparities. Title I establishes a Center for Research on Minority Health at the National Institutes of Health. The Center will oversee the development of an NIH-wide strategic plan for minority health research. This step will enable those concerned with the advancement of research on minority health, both inside and outside NIH, to monitor the progress of NIH in this area. The Center will award Centers of Excellence grants to institutions across the country that serve under-represented populations. These funds will be used to conduct research into the nature, causes, and remedies for health disparties, to train minorities to become biomedical research professionals, to improve the infrastructure for conducting biomedical research on health disparties, and to provide long-term stability to these biomedical research programs. Changing attitudes about race and ethnic backgrounds are an ongoing challenge for all sectors of our society. The Georgetown study does not conclude that most doctors are racist. No such assumptions are drawn from its results. What is shown is that health care providers, like all members of our society, enter their profession with perceptions and biases related to race. Many industries have confronted racial sensitivity issues in their training programs. This study shows that such training must also be a part of medical education, for both new students and experienced practitioners alike. To help health care providers improve their ability to work with patients of different backgrounds, we must also develop educational techniques that are effective in improving this aspect of health care delivery. Title II of the Health Care Finance Act establishes demonstration projects to develop effective educational techniques such as courses that focus on reducing racial and ethnic disparties in health care. The close connection between race and poverty in this country has had a significant negative impact on the access of minority communities to quality health care. Reducing racial and ethnic health disparties will require a better understanding of issues beyond effective treatments and other questions of basic science. Barriers to care, poor quality health services, and the lack of useful outcome measures are all part of this complex problem. Title III of our bill strengthens the federal commitment to these social science aspects of health disparties. It directs the Agency for Health Care Policy and Research to conduct and support research in these areas, to promote effective interventions in minority communities, and to develop outcome measures to assess and improve health care for minority populations. Measuring our progress in reducing these racial and ethnic disparties will also require reliable and complete data on miniority health. In order to provide reliable information on the health status of minority communities, Title IV of our bill directs the National Academy of Sciences to conduct a study of the data collection and reporting systems at the Department of Health and Human Services that include race and ethnicity. This study will evaluate the effectiveness of data collection at HHS and recommend improvements for ensuring that reliable and complete information on racial and ethnic health disparties is available. The estimated cost of these provisions for fiscal year 2000 totals just under $350 million. The estimated cost in subsequent years is approximately $260 million. This is a small price when compared to the damage that racial and ethnic health disparties are causing in so many communities. We all know that in the long run better health is always less expensive than sickness and hospitalization. We know that many other structural, personal, and historical factors contribute to racial and ethnic disparties in health care. Our legislation asks that we make the elimination of these disparties a higher priority. It asks that we do all we can to develop the knowledge necessary to do better. The result will be a fairer chance for the healthy future that all Americans deserve, and I look forward to early action by Congress on this needed legislation. Mr. President, I ask unanimous consent that the full text of the bill and the accompanying letters and statement of support be printed in the Record.

Mr. KENNEDY

Mr. KENNEDY. Mr. President, what is the pending business?

Mr. KENNEDY

Mr. KENNEDY. Mr. President, I strongly support the current reauthorization of the Developmental Disabilities Act, and I commend Senator Jeffords for his leadership in making this reauthorization a priority. I also commend the members of the Health, Education, Labor, and Pensions Committee and the administration for their leadership in developing this bipartisan bill. I especially want to recognize Tom Harkin for his leadership and continued commitment to individuals with disabilities. I also commend all the staff members for their skillful work to make this process successful. Today, I particularly want to take this opportunity to say thank you to my sister Eunice Kennedy Shriver for her many years of extraordinary dedication and commitment to children and adults with mental retardation and their families. Had it not been for her vision and commitment on behalf of people with mental retardation, the Developmental Disabilities Act would not be the impressive success it is today. For many years, since the Developmental Disabilities Act was first signed into law by President Kennedy in 1963, developmental disabilities programs in the states have worked effectively to improve the lives of children and adults with mental retardation and other developmental disabilities. The act serves as the foundation for a network of programs that offer them real choices on where to live, work, go to school, and participate in community life. Through these programs, the 4 million individuals with mental retardation and other developmental disabilities are able to obtain the support they need to participate in all aspects of the community. They receive needed assistance in education, and early intervention efforts are used to provide appropriate health care services and support. For millions of Americans these services can mean the difference between dependence and independence, between lost potential and becoming contributing and participating members of their communities. Throughout the preparation of this legislation, we have listened to consumers, advocates, families, and program administrators--all of whom have contributed significantly to this legislation. Their commitment to constructive compromise will improve the lives and choices of all people with disabilities and their families. This reauthorization builds on the gains of the past three decades, while addressing critical and emerging needs of individuals with disabilities. It improves the accountability of the programs under the Act by emphasizing better coordination, and by concentrating on activities related to child care, health care, housing, transportation, and recreation; It offers wider training opportunities by strengthening the network of university centers that provide technical assistance to persons with disabilities, to their families, and to service providers across the country; It supports stronger protection and advocacy services to prevent abuse and neglect, so that people with disabilities can live safely; It targets funds for the development of statewide self-advocacy organizations, so that people with disabilities will have a stronger voice in determining their lives and their future; It helps states to develop support programs for families with a disabled family member, so that living at home and becoming part of the community is a real choice for persons with disabilities; and It provides funds to develop a new educational curriculum and establish scholarship opportunities for support workers who assist people with developmental disabilities. This bill gives us an excellent opportunity to do more to keep the promise of the Americans with Disabilities Act--by ensuring that individuals with mental retardation and other significant developmental disabilities, and their families, have realistic opportunities to obtain the support and services they need to reach their dream of being contributing members of their communities. Disabled people are not unable. We are a better and stronger and fairer country when we open the door of choice and opportunity to all Americans, and enable them to be full partners in the American dream. For countless persons with mental retardation and other developmental disabilities across the country, this legislation will continue to help to make that dream come true. This bill deserves the support of every Member of Congress, and I look forward to its prompt enactment into law.

Mr. KENNEDY

Mr. KENNEDY. Mr. President, over the past few decades, we have made extraordinary advances as a nation in science and medicine. Unfortunately, those advances are not benefitting all of our citizens equally. Minority communities suffer disproportionately from many severe health problems. We know that poverty, lack of health insurance, and other barriers to care continue to undermine the health of minorities. Clearly we need to do more to give all Americans the fair chance for a healthy future that they deserve. The Administration has taken important steps to address this challenge. Last year, the President announced the Initiative to Eliminate Racial and Ethnic Disparities in Health. This initiative, led by the Department of Health and Human Services, has identified several areas where new commitments, new ideas, and new resources are necessary. The goal is to eliminate disparities in the areas of cardiovascular disease, cancer screening and management, diabetes, infant mortality, HIV/AIDS, and immunizations by 2010. This ambitious goal cannot be met without a major effort to improve research on the health of minorities and develop the steps needed to reduce these disparities. Today, Senators Akaka, Inouye, Lincoln, Wellstone, and I are introducing the Health Care Fairness Act of 1999, to secure the commitment and resources needed in each of these areas to ensure that minorities have a fair chance for improved health. Minority populations suffer disproportionately from cardiovascular disease. They have a greater risk of developing high blood pressure, and are less likely to receive treatment to manage the condition after it develops. As a result, African Americans are 40 percent more likely to die from coronary heart disease than whites. A Georgetown University study published in the New England Journal of Medicine last February found that bias in the decisions made by doctors is a factor in the treatment that African Americans receive when they suffer from heart disease. These findings are based on an experiment where physicians volunteered to view a video of actors posing as patients with significant symptoms of heart disease. The physicians were asked to prescribe further interventions for each ``patient,'' all of whom had identical medical histories, insurance coverage, and occupations. While 91 percent of the white males, white females, and African American males in the study were referred for cardiac catheterization, a more effective but more expensive diagnostic procedure, only 79 percent of the African American females in the study were referred for this test. A study published in the New England Journal of Medicine last month found similar disparities in the treatment of lung cancer. Patients whose tumors are discovered early are often able to be cured with surgery. This study found that African American patients with tumors small enough to be surgically removed were treated surgically in only 64 percent of cases, compared with 77 percent of white patients treated surgically. As a result, African Americans have only a 26 percent chance of surviving lung cancer, compared with a 34 percent survival rate for whites. Other types of cancer also strike racial and ethnic minorities in disproportionate numbers. Vietnamese American women are five times more likely than white women to contract cervical cancer. Hispanic women are twice as likely to contract cervical cancer. Native Hawaiian men are 13 percent more likely to contact lung cancer. Alaskan Native women are 72 percent more likely to contract colon cancer and rectal cancer, when compared with whites. In addition, African Americans and Hispanic Americans are more likely to be diagnosed with cancer once the disease has reached an advanced stage. For African Americans, the result is a 35 percent higher death rate. The Institute of Medicine, issued a report last February concluding that federal efforts to research cancer in minority communities are insufficient. The report recommended an increase in resources and the development of a strategic plan to coordinate this research. The results of this study confirm that while NIH has been extremely successful in producing medical breakthroughs that improve health care, those breakthroughs do not always reach into racial and ethnic communities. The same troubling differences are found with HIV/AIDS. The powerful new drugs that have dramatically decreased AIDS deaths and prevented or delayed progression from HIV to AIDS for so many citizens are not reaching minorities in proportion to their need. Racial and ethnic minorities make up approximately 25 percent of the total population, but these groups account for over half of all AIDS cases. The disparity is even greater for African American and Hispanic women, who account for nearly 80 percent of the AIDS cases reported among women. In spite of recent bipartisan efforts to increase access to health care for all children, racial and ethnic disparities exist among young Americans as well. Minority children are less likely to receive prescription medications, and they have lower immunization rates than white children. Inadequate health care places a barrier in the path of healthy development for minority children, and that is an unfair disadvantage. The Health Care Fairness Act of 1999 addresses these racial and ethnic health disparities in many ways. It contains sections on research, data collection, medical education, and outreach. Each of these aspects has an important role to play in the reduction and eventual elimination of these unacceptable health disparities. Title I establishes a Center for Research on Minority Health at the National Institutes of Health. The Center will oversee the development of an NIH-wide strategic plan for minority health research. This step will enable those concerned with the advancement of research on minority health, both inside and outside NIH, to monitor the progress of NIH in this area. The Center will award Centers of Excellence grants to institutions across the country that serve under-represented populations. These funds will be used to conduct research into the nature, causes, and remedies for health disparties, to train minorities to become biomedical research professionals, to improve the infrastructure for conducting biomedical research on health disparties, and to provide long-term stability to these biomedical research programs. Changing attitudes about race and ethnic backgrounds are an ongoing challenge for all sectors of our society. The Georgetown study does not conclude that most doctors are racist. No such assumptions are drawn from its results. What is shown is that health care providers, like all members of our society, enter their profession with perceptions and biases related to race. Many industries have confronted racial sensitivity issues in their training programs. This study shows that such training must also be a part of medical education, for both new students and experienced practitioners alike. To help health care providers improve their ability to work with patients of different backgrounds, we must also develop educational techniques that are effective in improving this aspect of health care delivery. Title II of the Health Care Finance Act establishes demonstration projects to develop effective educational techniques such as courses that focus on reducing racial and ethnic disparties in health care. The close connection between race and poverty in this country has had a significant negative impact on the access of minority communities to quality health care. Reducing racial and ethnic health disparties will require a better understanding of issues beyond effective treatments and other questions of basic science. Barriers to care, poor quality health services, and the lack of useful outcome measures are all part of this complex problem. Title III of our bill strengthens the federal commitment to these social science aspects of health disparties. It directs the Agency for Health Care Policy and Research to conduct and support research in these areas, to promote effective interventions in minority communities, and to develop outcome measures to assess and improve health care for minority populations. Measuring our progress in reducing these racial and ethnic disparties will also require reliable and complete data on miniority health. In order to provide reliable information on the health status of minority communities, Title IV of our bill directs the National Academy of Sciences to conduct a study of the data collection and reporting systems at the Department of Health and Human Services that include race and ethnicity. This study will evaluate the effectiveness of data collection at HHS and recommend improvements for ensuring that reliable and complete information on racial and ethnic health disparties is available. The estimated cost of these provisions for fiscal year 2000 totals just under $350 million. The estimated cost in subsequent years is approximately $260 million. This is a small price when compared to the damage that racial and ethnic health disparties are causing in so many communities. We all know that in the long run better health is always less expensive than sickness and hospitalization. We know that many other structural, personal, and historical factors contribute to racial and ethnic disparties in health care. Our legislation asks that we make the elimination of these disparties a higher priority. It asks that we do all we can to develop the knowledge necessary to do better. The result will be a fairer chance for the healthy future that all Americans deserve, and I look forward to early action by Congress on this needed legislation. Mr. President, I ask unanimous consent that the full text of the bill and the accompanying letters and statement of support be printed in the Record.