Ted Kennedy

Mr. KENNEDY

Mr. KENNEDY. Mr. President, I am proud to stand with Senator Jeffords, Senator Lieberman, Congressman Frank, and Congressman Shays to announce the introduction of the Employment Non-Discrimination Act of 1999, which has over 30 co-sponsors in the Senate and over 150 co- sponsors in the House of Representatives. Once this bill becomes law, it will ensure that all Americans have the opportunity to work without fear of reprisal because of their sexual orientation. It is the next important step for civil rights in America. This country has made great progress toward fairness and an end to bigotry in the workplace. Title VII of the Civil Rights Act of 1964 ensures that Americans--without regard to their race, ethnic background, gender, or religion--have the opportunity to obtain and keep a job. The Minimum Wage guarantees a basic standard of living. The Family and Medical Leave Act guarantees that working men and women can balance important family and employment responsibilities without fear of reprisal by their employer. The Americans with Disabilities Act establishes important protections for workers with disabilities. Now, Congress must take steps to achieve the same kind of fairness for gay men and lesbians who encounter blatant discrimination in the workplace. The Employment Non-Discrimination Act will accomplish that goal by prohibiting employers from using sexual orientation as a basis for hiring, firing, promotion, or compensation. The bill is important for what it does, as well as what it doesn't do. It does not require domestic partnership benefits. It does not authorize ``disparate impact'' claims. It does not apply to the Armed Services. It contains a broad exemption of religious organizations. It prohibits quotas and preferential treatment, and bars the EEOC from requiring the collection of statistical information on sexual orientation. A broad coalition of churches, businesses, and civil rights liberties organizations support the Employment Non-Discrimination Act. 68 percent of Americans from all regions of the country support its passage. The American people agree that workplace discrimination is wrong, and that clear protections are needed to prevent it. Some states already have such laws, and many businesses have policies similar to our proposal. But this patchwork of protection is inadequate. A national standard is essential for the protection of this basic right. The discrimination that exists today is a stain on our democracy. David Horowitz encountered this bigotry when he applied to be an Assistant City Attorney in Mesa, Arizona. He had graduated near the top of his law school class at the University of Arizona. While employed by a private law firm, he applied for a position with the City Attorney. He was not offered a position, but he was told he was the second choice. Six months later, he was called and interviewed for another job opening. The City Attorney asked David for references and told him that, ``I only ask for references when I'm ready to make someone an offer.'' In the interview, David told the City Attorney that he was openly gay, and the tone of the interview suddenly changed. David was told that his sexual orientation posed a problem, and three weeks later he received a rejection letter. What happened to David Horowitz was wrong, but he had no recourse under State or Federal law against this blatant discrimination. No American should be denied a chance to work because of prejudices. It is long past time to close this loophole in our civil rights law, and I urge the Congress to act this year to close it.

Mr. KENNEDY

Mr. KENNEDY. Mr. President, I thought we would be going back to the amendment of the Senator from California. I hope those Americans who have been watching the Senate for the last few minutes--and also for the past few days--have no doubt in their minds what this is all about. This hasn't got anything to do with the Senate rules at all or Senate procedure. It is about a very fundamental and basic issue; it's about whether the Senate of the United States is willing to take up the Patients' Bill of Rights, the core of which states that decisions affecting the medical treatment of an individual are going to be decided by the doctors and trained medical professionals and not by gatekeepers or insurance adjusters or insurance accountants. That is the basic issue. We can talk about 2-hour amendments, 4 days, a week, we can talk about four cloture motions, but the bottom line is that the Republican majority is refusing to permit the Senate to go about the people's business and schedule a Patients' Bill of Rights and permit the kind of orderly procedure that has been a part of this body for almost 200 years. That is what is going on here. Then they have the effrontery to talk about how they are going to change the rules in order to try and deny any opportunity to have a measure of this kind brought before the Senate. Let's be very clear what this is about. This is about something which is basic and fundamental to the families in this country. For 2 days, the Senator from California has been trying to bring up her amendment and get action on it. She has been precluded from doing so. The last action this evening--morning business at 5:10 on Thursday evening--has again precluded a debate and vote on her amendment. She was here yesterday at 9:30 in the morning. It doesn't take a Member of the Senate to understand what is going on. She is being denied a vote on the key issue of this whole debate, and that is whether insurance companies which cover American families are going to have to use a definition of what is ``medically necessary'' that will reflect the best medical training, judgment, and skill in the United States. That is what her amendment is. I have seen a lot of actions taken in order to preclude a Member of the Senate from getting a vote, but to go through the process of having four cloture votes next Monday, all in an attempt to deny the Senator from California an opportunity to get an up-or-down vote on her amendment, is a very clear indication of what is going on. This isn't about process. This is about substance. What kind of quality health care programs are we going to have in the United States of America? We are being denied the opportunity to make that decision. We were denied it last year and we are denied it again this year. We can listen to all the other bills left to do this year, and the Patients' Bill of Rights should be one of them. We tried to get it up last year, but we couldn't get it up under regular order. We have tried to get it up this year, but, again, we can't get it up under regular order. Earlier today, we heard reference to the process and procedure that was followed during Kassebaum-Kennedy. Let me remind my colleagues that the consent agreement to consider the Kassebaum-Kennedy legislation was reached on February 6 of that year. It said the bill must be brought up no earlier than April 15 and no later than May 3, with no time agreements or limitations on amendments. And we passed it, unanimously, under those terms. It seems to me that the last two days provide a very clear example of the majority effectively, I believe, abusing the process and procedures of the Senate, to deny the debate, discussion and the vote on an important issue in order to protect themselves on the issue of health care. We should be protecting the American people. They are going to understand it. There can be no other interpretation of what is happening on the floor of the Senate. I yield the floor.

Mr. KENNEDY

Mr. KENNEDY. Mr. President, as I understand, we are in morning business; is that correct?

Mr. KENNEDY

Mr. KENNEDY. Mr. President, did the leader ask consent?

Mr. KENNEDY

Mr. KENNEDY. Mr. President, I join with my friend from Illinois and others who have spoken before the Senate on the issue of the Patients' Bill of Rights, which, translated into layman's terms, means legislation that will give assurance to all Americans who are fortunate enough to have health insurance policies that medical decisions are being made by trained professional medical personnel and not by insurance company agents. That is the underlying concept of this legislation, as has been pointed out during the course of the morning with the examples that have been given, and there are scores more. If we get the chance during the debate on the provisions, hopefully later in the afternoon, we will be able to review the various protections that we are attempting to achieve and why they are important to the children and families of this country. Under the Republican program, there is a guarantee of getting direct access to a pediatrician for a child, but if that child has cancer, there is no guarantee the child will see a pediatric oncologist. Or if one has a disability, there is no guarantee that person will have access to the needed specialists. The guarantee they will have the best care available is important to patients, and there is no country which has better quality health care. We have a challenge nationwide regarding access to health care, and we have a challenge nationwide in terms of the cost of health care, particularly in a number of different areas. One that comes to mind now is the issue of prescription drugs. We are going to have an opportunity, hopefully in this Congress, to address that issue. On the issue of what we call quality, meaning that patients are going to get the best health coverage in terms of recommendations made by the professionals who have been trained and who have a wealth of experience in this area, we are trying to make sure that every medical decision will be based upon sound and meaningful medical teaching and experience. That is the heart of this legislation. It is very important we get this kind of protection. Otherwise, we will continue to have today, tomorrow, and the day after tomorrow the tragic circumstances we have experienced and are being experienced in communities and towns all over this country. Earlier in the day, we had some important statements and speeches by our colleagues. Senator Feinstein talked about a provision making sure every health insurance proposal has as its basis of treatment the best in terms of medical necessity. The best that is available will be the standard used in providing treatment for individuals. I took some time earlier today and illustrated how different health insurance programs have different definitions. Sometimes a definition works to the advantage of the HMO and works to the advantage of the insurance company but to the disadvantage of the individual. Such a definition can even threaten the life of that individual. It may be favorable to the HMO regarding its bottom line financially, but it certainly is not favorable to the patient. We ought to be about the business of doing what is important for the patient. Senator Feinstein has talked about this issue very eloquently and persuasively today. That certainly would be an area that we ought to be able to debate and discuss. I do not believe we have that kind of standard with the language which is included in the provision being advanced by our Republican friends. It is not only my opinion that this is important, but it is the opinion of the health practitioners in this country--the doctors, the American Medical Association, the nurses, the various specialists. They are concerned that the Republican proposal does not provide a good standard to protect the health and safety of children, of women, of patients in our country. We ought to be able to debate that issue. It is a very important issue. Senator Feinstein has spoken eloquently about that particular problem. But we cannot. We are virtually prohibited from being able to do so. We cannot even get this measure up. We were told yesterday to either take the whole package or we were not going to get anything at all. That has been repeated time in and time out. There appears to be the continuation of that policy now by the Republican leadership--delay and deny, delay and deny. Then later we had the excellent statement that was made by our colleague and friend, Senator Mikulski, who was talking about the importance of the kinds of protections that are guaranteed in our Patients' Bill of Rights, particularly with regard to women and children. She very eloquently pointed out how these gatekeepers who are part of these HMOs--the gatekeeper being the person who ultimately dictates to the doctor what they can effectively prescribe in terms of treatment and in terms of medicines--makes those medical judgments and decisions. That is what is happening out there; and that is startling. People can say, well, that really isn't happening in America. It is happening. We have given examples of the devastating results that occur as a result of that kind of interference. She illustrated the importance of having those kinds of specialists who are particularly trained and understand the particular needs of women and children. She talked from her own personal experience in a very significant and important way about how she had a gallbladder operation and was able to stay in the hospital in order to recover. But if a woman had a mastectomy--and she used the word ``amputation'' because she said that is what a mastectomy is --she would still be required to leave the hospital that same day. She reminded us about the unsuccessful efforts we made in the committee to try to alter and close that gap in the Republican bill. It makes no sense how those efforts were defeated. It seems to me we ought to be able to have some debate. I do not think that issue would take a long period of time. I thought that Senator Mikulski, in about an 8- or 10-minute presentation, made a presentation that was powerful and convincing and compelling. Maybe there is a good argument on the other side. We certainly have not heard it yet. We never heard it in the committee when we were marking this bill up. We did not hear one. So maybe there is an argument on the other side that we haven't heard yet. A woman who is going to have a mastectomy ought to be under the care of the doctor, and the doctor and the patient ought to decide whether that person can leave the hospital that day or ought to be there 1 or 2 or 3 more days. Leave it up to the doctors and their recommendations. That is not permitted under the majority's bill. We heard a great deal of talk about that. That is not in the bill that is the Republican proposal. The specific amendment that the Senator talked about on the Senate floor would be an amendment that we ought to be able to debate. We ought to be able to debate why it is not in the Republican bill that will eventually, hopefully, be laid down before the Senate. There is not that protection for women in this country. There is not that protection that will permit the doctor to make a judgment about how long it will be medically necessary to keep that woman in the hospital if she has a mastectomy. That protection is not there. It was defeated when it was offered. Let's have a brief debate on that issue, and let's have the call of the roll. Why is it we are being denied that today? Why is it we are being foreclosed from that kind of an opportunity? Why is it we cannot have the kind of debate in relation to the excellent presentation that the Senator from California, Senator Feinstein, made, the excellent presentation that the Senator from Maryland, Senator Mikulski, made on two different kinds of phases? Yesterday we talked with our Democratic leader, Senator Daschle, about the importance of clinical trials and the necessary aspects of increasing the clinical trials. Historically, the insurance companies of this country have basically supported clinical trials. There is a very good reason why they should, because--besides the medical reason that it is important for the patient--if the person gets better they will not need as many services, and that means the insurance company will pay out less in the long run. That is something that should be a financial incentive for the insurance companies; and it is. Let me repeat that. While clinical trials make sense in terms of the treatment for the patient, they make sense for the insurance companies, too. But what we are seeing, under the health maintenance organizations, is the gradual squeeze and decline in terms of the insurance companies' payments for routine health needs of the particular patients. Under our proposal, they would only pay for routine costs, as they have historically. The research regime pays for the special kinds of attention, treatment, and tests that are necessary in order to review whether that particular pharmaceutical drug or other therapy is useful or not. That is not paid for by the insurance companies. So they only have to pay for the routine health needs--the costs that they would pay for even in the absence of a clinical trial. The regime, the testing group or organization or pharmaceutical company that is having that clinical trial, pays for the rest. But what we are seeing is virtually the beginning of the collapse of clinical research taking place. I will just make a final point on this issue. The group that has had the greatest amount of clinical research done on them in this country has been children. The greatest progress that has been made in the battle for cancer has been--where?--with children. Most of the clinical researchers who have reviewed this whole question of our efforts on cancer would make the case that one of the principal reasons that we have made the greatest progress in the war on cancer in children, in extending their lives and improving their human condition, is because of these clinical trials. We want to continue to encourage participation in clinical trials. They offer hope for the future. If the doctor says this is what is necessary for the life and the health of a woman who has cancer, that this is the one way she may be able to save her life, and there is a clinical trial available, we want to be able to say she ought to be able to go there. The opposition says: Let's study it. I say: Let's vote on it. I yield the floor. Mr. President, I suggest the absence of a quorum.

Mr. KENNEDY

Mr. KENNEDY. I will withdraw the request for the moment.

Mr. KENNEDY. I apologize to the Senator. If I could make that request----

Mr. KENNEDY. I think the matter has been cleared.

Mr. KENNEDY. Mr. President, will the Senator yield for just a brief question? The Senator, as he knows, is recognized for 30 minutes. I would like to ask that 30 minutes be reserved on this side as well.

Mr. KENNEDY

Mr. KENNEDY. Mr. President, I ask unanimous consent to speak in morning business.

Mr. KENNEDY

Mr. KENNEDY. Is there a limitation of 5 minutes or 10 minutes?

Mr. KENNEDY. I understand we are in morning business until the hour of 2 o'clock.

Mr. KENNEDY. Mr. President, I yield myself such time as I may use.

Mr. KENNEDY

Mr. KENNEDY. Mr. President, last evening Senator Daschle was prepared to offer an amendment to the agricultural bill that was at the heart of the Patients' Bill of Rights. I believe that will be offered shortly on behalf of the Senator from California, Senator Feinstein. We will have an opportunity to get into that discussion and debate. I am hopeful, as are others, that we can work out a process and procedure by which we can have a full discussion and debate on this issue, and where we can have an orderly way of disposing of various amendments on the Patients' Bill of Rights. I am, however, somewhat distressed and disturbed by some of the comments I have read this morning on the AP relating to my friend from Oklahoma, Senator Nickles, the Republican assistant majority leader. He said he was willing to vote on the issue if the Democrats would agree to limit debate, but he said he was worried that Democrats will pressure some Republicans into supporting amendments that will increase the cost of health care, and therefore the number of Americans without any insurance. He also said he was worried the Democrats will force votes that can be misconstrued for political purposes. He would rather allow a yes or no on the entire package with only a handful of amendments. I have more confidence than the assistant majority leader in our colleagues' ability to make discerning decisions about the merit of these various amendments, and that having been elected by the people, we are charged to make judgments on these measures. This is a new reason for not bringing legislation to the floor. Apparently, one of the leaders is concerned the members of their party would not be able to exercise a balanced and informed judgment in the best interests of the particular States the Senators represent. Of course, if that is going to continue to be the position of the leadership, it does not bode well for a full discussion and debate on this issue. We have seen for the last 2 years a policy of delay and denial of the ability to debate the issues that we referred to yesterday and on other occasions, and which we will have an opportunity again to debate today. But it is out of frustration that Senator Daschle has used the unusual procedure of offering this legislation on an appropriations bill, in the hopes we can work out an orderly process or procedure. I certainly support that process, since we have effectively been closed out from any opportunity to debate this issue. It is a simple, fundamental, basic issue: whether decisions relating to the health of patients in this country are going to be decided by the health care professionals who have the training and skill and competency to make those judgments and decisions, or whether the decisions will be made by accountants in the insurance companies or the HMOs. That is really the basis of this whole debate and discussion. That is why virtually every leading health care organization, virtually every major professional health organization--the spokesmen and spokeswomen for children, for women's health, for the disabled, and for the patients' coalitions--has universally supported our proposal. It is not, certainly, because it says ``Democrat'' on it. These organizations support measures on the basis of the merits, whether they are proposed by Democrats or Republicans. There is uniformity among the various groups and organizations that the basic, fundamental issue of who decides what is medically necessary is really at the heart of the whole debate. It is reflected in different ways, as we illustrated in the course of the discussion over the past few days and today, but that is basically what is at the core of this proposition. The Democratic leader indicated that if we took up the Republican proposal that was passed out of committee on a party-line vote--even though we had more than 20 amendments at that time dealing with the substance of the issues--we would limit our side to 20 amendments. He indicated he would be willing to limit discussion of these various amendments to a reasonable time period, expecting the opposition would have similar amendments. Frankly, though, if the Republicans have the opportunity to put their bill before the Senate, I do not understand why they would need a great many more amendments. They already have their bill. If we had our bill before the Senate, we would not have to have a great many amendments because it is our bill. I think we can all understand the logic of that. If we have a particular proposal before us, we ought to be able to debate the changes that may be offered from the other side. The other side has the right, their right as the majority, to lay their bill down. So when we say we need 20 amendments and they say they will need 20 as well, I do not quite follow that. But so be it. I think we will find from the discussions taking place at the leadership level, and I heard the exchanges last evening, I heard from our leader he was prepared to move ahead. He urged there be cooperation by all Members. That certainly would be the case, I know, for those who are most involved in the Patients' Bill of Rights. They would be willing to expedite consideration of various appropriations bills with the understanding we will have an opportunity to debate this issue in a reasonable period of time with a chance to offer amendments. We will hold the Senate accountable to answer the questions that parents have about their children and medical care: Will you will be able to get specialty care when a child has special needs, or just be given access to a general pediatrician? Will you get a pediatric oncologist if the child has cancer? What about access to new prescription drugs? Will children and others have access to the clinical trials? The opposition fails to mention that gap in their program. The most they do about it is to include a study about clinical trials. I think most American families understand the importance of clinical trials in their family's life experience or their health care. They may not have been part of a clinical trial themselves--although my family has, my son has, and very successfully, I will add. But I doubt if there is a family that does not have a member of their extended family who has not been involved in those programs. Patients need to have access to necessary prescription drugs. This is so important to many different groups in our society: those challenged with mental illness, those with disabilities or other chronic conditions. There are many in our communities who require those essential prescriptions drugs. We do not see those guarantees in the Republican plan. There was reference to those: They will get access to those--but at exorbitant prices. They didn't mention that. They said: We'll make sure they have access to those drugs--but the plan can charge exorbitant prices. We will have an opportunity to come back to the issue on prescription drugs, though probably not on this piece of legislation. But there are important guarantees which we provide in our Patients' Bill of Rights. We will come back to those measures. They are important. I will say a few words now about the subject matter that will be included in the amendment offered by the Senator from California. It will deal with medical necessity. This is an interesting concept, because it reaches the heart of this issue, this debate. When consumers sign up for health care coverage, they assume, I think--it is not presumptuous to assume this--they assume they will be able to get from their doctors and their health care facilities the best care that the medical profession has to offer. Right? Wrong. Our bill will ensure that the best care is given. Their bill does not. You say: I do not understand that. Let me clarify it. The Republican legislation that was reported out of the Health committee permits the HMO to decide what is medically necessary. They let the HMOs decide what is medically necessary. Then, when you have a certain illness and your doctor believes you should receive X, Y, or Z treatment, but the HMO defines ``medical necessity'' in a particular way, your doctor is restricted in the kind of treatment they can give you to whatever it says in the particular contract. I do not think most consumers, when they sign up for health insurance, look into or read the various definitions in those contracts. You have scores of different definitions, each allowing for abusive actions that can have devastating effects on the health of patients across the country. We have one included in here from a HMO that happens to be in Missouri. This is what it says: X company, I will not mention the name here, will have the sole discretion to determine whether care is medically necessary. Here it is--a small provision in the contract that an individual may never see. If they came in and said: The doctor says you may very well need to have this kind of treatment. And then the HMO says: Oh, no, they do not need that treatment, it is too expensive. And the patient says: Why? Is that in my best interests of my best health? Maybe the doctor will say: Yes. Then the person says to the HMO: My doctor says it is in the best interest of my health to have that treatment. Then the HMO says: Let me tell you something. Our definition of what is medically necessary for you is in the sole discretion of our HMO. We say you don't need that treatment. You signed that contract, and that is what you are going to get. Then the person says: I appeal. I appeal this. I appeal. I want the best. Under the Republican proposal--listen to this--the HMOs will decide who will listen to that appeal. They will also decide that appeal on the basis of what the contract says. That person gets an appeal, and then it goes to their HMO. The appeal officer looks at this and says: Here it is, it is their sole discretion whether care is medically necessary. And that is it; you are out. Then that person says: Maybe I will bring a case. Let's get this out into the courts. This is absolutely outrageous. It is violating the basic, common law of good medical treatment. The patient does not get to the courts. It is nonappealable under the Republican proposal. You are stuck there, your child is stuck there, and your wife may be stuck there. A member of your family is stuck there. What does our bill do? It says that plans must use the best evidence and practices to determine what is medically necessary. It uses the best up-to-date scientific information or, if that is not available, clinical practices. At a hearing in our committee earlier this year, there was some question about the definition and the use of various words in our proposal. We said: You develop the words. We have tried to take those words, which have been recommended by the best practitioners and by the medical associations, and put those in the bill. If the opposition has better words, we welcome them, we will embrace them, we will include them. Work with us, and we will work with you. Do they understand what we are trying to get at? We want to ensure that any individual who signs up with a plan is going to get what professionals in a particular field believe is in their best interest. I have in my hand 30 definitions of what is medically necessary, depending on the HMO. Why should American citizens play roulette, and allow their health care to depend on which HMO they are a member of? That is what is happening. Is this such a revolutionary idea? It is not. This basic concept has been supported not only by the medical societies, the medical associations, nurses associations, but countless other patient groups and others. The only people who oppose it are those who seek to preserve the status quo. It is similar to what is used to treat our parents and our grandparents under Medicare, and we do not hear any complaints about it. I ask any Member on the other side to bring in a single letter which demonstrates how that best standard of medically necessary is either being abused or not effective for those people under Medicare. Bring them in. Shouldn't that be the answer? Mr. President, 39 million Americans are being treated that way. Bring in the examples. I will give my colleagues examples on the other side. Let's debate that issue. Let the Senate decide. I will give my colleagues examples. If my colleagues want to take a little time, I will go right through these and let the Senate hear this debate. They may say on the other side: Is that some new idea, some crazy Democratic concept? We know it is being used today to treat our parents. They welcome it. It is good and sound. We want to make sure people are protected. That is what we are concerned with. That is why this issue reaches the heart of the whole debate and why the whole question of medical necessity is of such importance. If that is not a core factor, if we do not have the best judgments guiding what is medically necessary, and if we do not have the assurance this is going to protect the doctor to make that judgment, then this legislation is not worth the paper on which it is written. We can name any bill a Patients' Bill of Rights. But if it has a medical necessity definition that is so construed as to deny people adequate protection or that and they are able to question the doctor giving the best information on the best medical process and procedure, we are not giving those assurances that the consumers of this country need and deserve, and we will not avoid the human tragedies which we have heard mentioned day after day in the Senate. We hear instance after instance where timely treatment is being denied because doctors are not able to practice what is medically necessary. This is the heart of this debate today. I can mention some other definitions. I see other colleagues in the Chamber who want to address the Senate. I am going to come back and review with the Senate some other definitions that have been included in the HMOs and how they have worked in ways which have been tragic to the medical profession. I have a definition from another major HMO, one of the largest in the country. I am not interested in using names, but I will be glad to if Members are questioning this issue. This is their definition in use today: Health care services that are appropriate and consistent with the diagnosis in accordance with accepted medical standards and which are likely to result in demonstrable medical benefit and which are-- Listen to this-- the least costly of alternatives. There it is, ``least costly of alternatives.'' Not what is in the best interest of the patient, not what can save that person's life, not what can reduce pain and suffering and offer the best hope and opportunity for the future but which is least costly. Here is another HMO. This is the definition of medical necessity in another very prominent HMO: . . . the shortest, least expensive or least intensive level of treatment, care or services rendered or supplies provided. How many Americans, when they go in to look at their HMOs and sign that contract, say: Look, I have a health insurance proposal. Look what it's going to do. It's going to cover me and going to cover my family and going to cover my children, and going to cover my wife. This is what it's going to cost. This is what the drug benefit is. How many are going to look at the fine lines and look into ``medical necessities'' and are going to wonder whether they are using the most modern and comprehensive care for ``medical necessity.'' Virtually none of them are going to. That is why we have so many examples of the kinds of tragedies that have been mentioned. We will talk about those later in the day. I see my friend and colleague from California. We all look forward to hearing from her on the amendment she will be proposing. Mr. President, I yield the floor. Mr. REID addressed the Chair.

Mr. KENNEDY. I yield it to the leadership here, Senator Reid, to allocate in whatever way he desires.

Mr. KENNEDY

Mr. KENNEDY. Will the Senator yield just for another moment? It is now approaching 3 o'clock. To the best of my recollection, the good Senator from California, Senator Feinstein, has been here since 10 o'clock this morning, prepared to go ahead and introduce her amendment and has still not been able to do it. There has been an extension of the time limits, evidently because of some negotiations about which all of us are hopeful. But I think we probably could have disposed of the amendment of the Senator and probably the proposal of the Senator from Rhode Island also. I do not know whether the Senator would agree with me or not.

Mr. KENNEDY. Mr. President, I ask for 6 more minutes evenly divided.

Mr. KENNEDY. If I understand the Republican proposal, if you had a child, for example, with cancer, and you had a pediatrician, but what you needed was an oncologist for that child, one who is a specialist in pediatrics, and the HMO denied you that, and you believed this was enormously important for the treatment for the child, under the Republican proposal you have no right to appeal that particular decision. I understand that the right to an independent appeal applies only to certain decisions, and a denial of access to a specialist is not one of them. I believe I am correct. We heard our wonderful friend, Dr. Frist, yesterday talk about how any child who had cancer would be guaranteed a specialist and everybody said: Doesn't that do the trick? No. We know you need not just a pediatrician, but as the Senator from Rhode Island knows--as one who has been a leader in the Senate on children's issues regarding access, and has introduced special legislation on this--that child needs a pediatric oncologist. That kind of specialist is absolutely crucial, if that child is to have a fighting chance; but denial of access to that particular specialist would not be eligible for appeal under the majority's program.

Mr. KENNEDY. Will the Senator yield?

Mr. KENNEDY. I was just asking whether the Senator's understanding is the same understanding as mine? If the Senator would just reflect on the significance of that, I would appreciate it. How important, really, is specialty care access, I ask the Senator, as an expert on this issue for the treatment of a child?

Mr. KENNEDY

Mr. KENNEDY. Mr. President, in recent decades, the nation's schools have made great progress in ensuring that young girls receive an equitable education. Gender gaps in math and science performance have narrowed. More girls are taking algebra, geometry, pre-calculus, trigonometry, and calculus than ever before. More girls are taking honors and advanced placement level courses in calculus and chemistry. Schools are making progress in other areas as well. More and more schools are instituting programs to address the problems of sexual harassment and abuse. Increasing numbers of girls are participating in high school athletics and receiving college athletic scholarships. While these improvements are commendable, they are not enough. Continued progress is necessary. The Educating America's Girls Act addresses some of the most pressing issues in educational equity: access to technology, school safety, high school athletics, and dropout rates. Technology education is particularly important for all students, but girls' needs are particularly acute. While gaps between boys and girls in math and science are narrowing, the gender gap in technology is growing. Girls tend to come to the classroom with less exposure to computers and other technology than boys. Girls often believe that they are less adept at using technology than boys are. They tend to be more cautious than boys in the ways that they interact with technology. Girls are also dramatically under-represented in advanced computer science courses, making them less eligible than boys for high wage, high-tech jobs. The fact that girls are less likely than boys to take advanced computer science courses actually helps perpetuate a cycle of disadvantage in educational technology. Because fewer girls will have the skills to enter high-tech fields, fewer women will be developers of educational software and fewer role models will be available for young girls. For girls to have equal access to the growing job market in the computer field, immediate steps must be taken to close the technology gap between boys and girls. The Educating America's Girls Act addresses problems with girls' access to technology by providing professional development to assist teachers in dealing more effectively with the technology needs of girls. It gives local and state governments and private and pubic schools and institutions of higher education the opportunity to meet their needs in their applications for federal grants. Finally, the Act states that the Title III provisions authorizing support for development of education technology must give special consideration to programs incorporating the technology learning needs of girls. School safety is another concern for America's girls. Recent studies reveal that 85 percent of girls have experienced some form of sexual harassment. Sixty-five percent of girls who have been harassed were harassed in the classroom, and 73 percent were harassed in school hallways. Eighty-one percent of girls who have been harassed do not report the harassment to an adult. Thirty-three percent of girls report not wanting to go to school because of anxiety and stress caused by harassment. Nearly one quarter of girls report staying home from school or cutting classes because of harassment. These numbers are clearly unacceptable. It is imperative that our schools do a better job of recognizing and eradicating sexual harassment in schools. As the recent Supreme Court ruling in Davis v. Monroe County Board of Education makes clear, school districts may now be sued for damages if they fail to respond to student sexual harassment of other students. The Educating America's Girl's Act provides $10 million for district level programs to train teachers and administrators in identifying and preventing sexual harassment. In addition, the Act makes high rates of sexual harassment in schools a consideration in determining the distribution of state grants for violence prevention programs. It also requires that sexual harassment and abuse prevention be among the activities included in a school's comprehensive drug and violence program. Finally, the Act requires the National Center for Educational Statistics to collect data on sexual harassment and abuse in schools as a means of identifying and addressing the problem more effectively. The Act supports girls' participation in high school athletics. Since the passage of Title IX over a quarter century ago, increasing numbers of girls are participating in organized sports, although boys continue to participate at higher rates. Studies show that girls who do so are emotionally and physically healthier than girls who do not. Involvement in sports can also lead to higher self-esteem and confidence, more positive attitudes toward school, an improved sense of physical well-being, social recognition in the school and community, and a reduction in destructive behavior. In addition, higher rates of athletic participation for girls are associated with lower rates of sexual activity and pregnancy. Girls who participate in sports are also less likely to drop out of school and less likely to smoke cigarettes. Girls who engage in physical activity in high school are less likely to suffer from heart disease, breast cancer, and osteoporosis in late life. Participation in sports also has a positive effect on students' academic performance. Students involved in sports and other extracurricular activities perform better on assessments in reading and mathematics. In addition, for many girls, high school athletic opportunities translate into college scholarships. Although there is ample evidence that physical activity and athletics are beneficial to girls, they are less physically active and less involved in high school athletics than boys are. In order to determine in what ways girls are affected by athletic participation, it is vital that accurate data on girls' participation in physical education and high school athletics be collected and made available. Unfortunately, current nationwide data is limited, making it difficult to determine progress toward equity in athletics, as required by Title IX. The Act helps ensure that girls' interests are being met by requiring data collection on the participation of high school students, by gender, in physical education and athletics. The Act also addresses concerns about the dropout rate among pregnant teenagers. Almost one million girls in America become pregnant each year, and 80 percent of these pregnancies are unintended. Education is the means for all girls, including pregnant and parenting teens, to achieve economic success. Yet girls who become pregnant as teenagers are most likely to drop out of school, jeopardizing not only their own economic security but that of their children as well. The younger a girl is when she becomes pregnant, the more likely she is to drop out. Two-thirds of girls who become pregnant before age 18 will not complete school. Girls who drop out of school are less likely to return than boys. While teenage pregnancy rates have declined in recent years, they are still too high and a reason for grave concern. The Act focuses on the needs of pregnant and parenting teens by supporting mentoring and support programs that encourage girls who are pregnant or have children to stay in school. It is also important that the Women's Educational Equity Act be reauthorized. WEEA stands for the federal commitment to help schools eradicate sex discrimination and ensure that girls' futures are not limited by their gender, but are determined by their interests, aspirations, and abilities. Since its enactment in 1974, it has provided critical support in combating inequitable educational practices. It provides resources for teachers, administrators, and parents seeking proven methods to ensure equity in schools and communities. It provides materials and tools to help schools comply with Title IX. It provides research and model programs to back up Title IX's promise to students of a non-discriminatory education. It helps girls become confident, educated, and self-sufficient women through projects to prevent teen pregnancy; to keep girls in school; to guide them toward careers in math, science, and technology; and to provide them with mentors. It has funded over 700 programs since 1974, including programs on math and science education and careers, sexual harassment, gender-biased teaching practices, and women's history. The Educating America's Girls Act will continue all this vital work on behalf of girls and young women by reauthorizing the Women's Educational Equity Act. Significant strides have been made in securing more equitable education for the nation's young women and girls, but we cannot afford to be complacent. We must keep moving forward to guarantee that girls are full participants in the economic and social development of our country. Measures to assure gender equity in education are a key means of accomplishing this goal. Passage of the Educating America's Girls Act is a vital next step for increasing gender equity in education.

Mr. KENNEDY

Mr. KENNEDY. We will have to listen to the explanation coming from the other side. We know what the spokesman for the health insurance industry has said. We know what their answer has been, and that is to virtually instruct the Republican leadership just to say no. We know what the leadership on the other side has said about this: We are not going to get a chance to debate this issue. People can draw their own conclusions. They have indicated this will not be permitted to come up, even though it is the people's business. I see the Senator from Rhode Island on the floor. I yield 5 minutes.

Mr. KENNEDY. Finally--because I see others on the floor; and this issue is going to be addressed in the Daschle proposal--I am wondering whether the Senator would agree with Justice William Young, a Federal judge on the Federal bench in Massachusetts, who was appointed by President Ronald Reagan, who said, after a very tragic case--and I will not review all of the facts here, but it was quite clear that there was responsibility by the insurance companies; and it will be self-evident in his quote; and there was a real injustice done--this is what Judge William Young, appointed by President Reagan, who prior to the time he served on the bench was a Republican, said: Disturbing to this Court is the failure of Congress to amend a statute that, due to the changing realities of the modern health care system, has gone conspicuously awry from its original intent. This Court has no choice but to pluck the case out of State court . . . and then, at the behest of Travelers [Insurance Company]-- That is effectively the culprit-- slam the courthouse door in [the wife's] face and leave her without any remedy. ERISA has evolved into a shield of immunity that protects health insurers . . . from potential liability for the consequences of their wrongful denial of health benefits. That is the statement from the bench of a distinguished Federal judge who came down and eventually effectively testified about the injustice of this provision. As I understand it, the Daschle proposal addresses that inequity and unfairness, which the Senator has outlined.

Mr. KENNEDY. Mr. President, I will just take a moment.

Mr. KENNEDY. The Senator has referred to the loss in terms of coverage by the General Accounting Office. Will the Senator share that letter which allegedly reached that conclusion? Will the Senator put that in the Record at this time so we have a full statement of the General Accounting Office rather than just using the figure that the Senator used? Will the Senator make that whole letter a part of the Record?