Blanche Lincoln

Mrs. LINCOLN

Mrs. LINCOLN. I thank the Senator from Montana. I thank him very much for what he is going to begin, a tax package that really does serve the men and women in uniform. I appreciate his hard work and leadership on that issue.

Mrs. LINCOLN

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

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

Mrs. LINCOLN. Mr. President, I compliment my colleague from Alaska for the intent of the previous amendment. Many of us in this body have children. We understand what it takes to raise our children. Across this country, we want to provide all families, all parents the ability to do as much as they possibly can for their children. I again compliment the Senator from Alaska for the intent of her amendment. My amendment expresses that it is the sense of the Senate that we should extend the refundable child credit for 3 years and that this can be accommodated within the revenue totals in the resolution as it currently exists. As the Senator from Oklahoma has said several times during this debate, we cannot write the tax cut on the budget resolution. The previous amendment was simply an attempt to increase the size of the tax cut, nothing more, nothing less. Although the intent of the amendment of the Senator from Alaska I think was good, I do think it is important that we make sure this tax cut actually goes in the child credit and we understand that the money already exists to do it. I ask for my colleagues' support of this amendment.

Mrs. LINCOLN

Mrs. LINCOLN. Mr. President, I rise today with great honor and pride to pay tribute to the men and women of our Armed Forces, tens of thousands of whom are deployed right now in the Middle East in military action against Iraq. I encourage all my colleagues in the Senate, and in the Congress, that we take a few moments out of each and every one of our days we are engaged in this conflict to come to the floor and speak to our constituents, speak to the American people, and speak to the servicemen and servicewomen who are so valiantly out there defending our freedoms and this great country that we believe in. We are going to take a few moments here today to talk about how important are these men and women in service to our country. We would like to encourage, again, all Members of Congress to come to the floor and spend a few minutes out of their day or out of their week to talk about the incredible lives of these individuals who are there on our behalf, defending our freedom. Over the course of the last week, since hostilities began in earnest on March 19, our troops have made tremendous progress toward the objectives of their mission. At the same time, we have seen a few setbacks, but these do not detract from what has been accomplished. For that, we have no one to thank but the courageous, hard-working men and women of the American service arm and the coalition of Armed Forces. We hear a great deal about the technology behind this war--missiles, aircraft, telecommunications devices, weaponry, and other equipment of battle. But we should all remember that even the best equipment and the best technology is of little value without the best soldiers and commanders to make it useful. Today we have over 230,000 troops representing air, sea, and land forces in the theater, with our allies in the coalition contributing an additional 45,000. These young men and women are serving in a wide variety of capacities but with a unifying mission--to liberate the Iraqi people from the brutal regime of Saddam Hussein, and to destroy his weapons of mass destruction which threaten our globe. They are separated from their families and their friends, placing themselves in great personal danger in order to provide for a safer, more secure world for all of us. I myself have a young man from my staff who is serving in the Middle East. He was called up on a Tuesday, left here on Friday, and I just recently heard from his mother. He is in Baghdad. Our thoughts and prayers go out to him. We want him to know we are thinking about him and that we are looking forward to his safe return to us here at home. We are all deeply grateful for the sacrifices our service men and women are making and the risks they are taking on all of our behalf. Those sacrifices and those risks will not be forgotten. In addition, I remind my colleagues that a large number of these troops come from the National Guard and the Reserve, nearly 217,000 at our last count. Over 2,000 of these guardsmen and reservists come from my home State of Arkansas. One of those soldiers is Major Stephen Wilson, of Rogers, AK. Major Wilson, who is 38 years old, is the operations officer for an Apache attack helicopter unit, the 2nd Squadron, 6th Cavalry of the 11th Aviation Regiment. We have all seen in recent days the difficult odds our attack helicopter crews work under. They are vulnerable to small arms fire from the ground, not to mention difficult weather conditions that we have all been seeing on the television. In spite of these difficulties, Major Wilson and his colleagues persevere in an extremely challenging but extremely necessary mission. He is a proud representative of our State and our Nation, and we are extremely proud of him for his service to this country. If there were a way to thank each and every soldier by name, I would do it. I would take the necessary time to make sure that each of them knows how important they are in this conflict and in our resolve. Since it is not possible for me to recognize who is serving today, allow me at least to give a sense of where these units come from all across our great State of Arkansas: Little Rock, North Little Rock, Fort Smith, Van Buren, Siloam Springs, West Memphis, Ozark, Charleston, Marked Tree, Fayetteville, Pine Bluff--and the list could go on. Furthermore, these units are comprised of individuals from all over the State, meaning that we have soldiers serving from virtually every community in our great State of Arkansas. It is a reminder that even from thousands of miles away, Arkansans have a very serious stake in this war. On behalf of the people of Arkansas, I wish to say we are proud of all of our troops, and we look forward to welcoming them back home soon and safely. It is also true that as of today we have suffered casualties, and we should not turn away from this fact. It is believed that up to 14 of our troops from both the U.S. and our broader coalition are missing or captured by enemy forces. Our prayers are that they will be returned to their units safely and timely. We also had a number of our troops wounded in battle, and we wish them the best in a speedy, full recovery from all of their injuries. Most tragically of all, over 40 troops from the U.S. and from Great Britain have been killed in action or in accidents. We extend our deepest sympathies to their families, their friends, their loved ones, and we vow that we will honor their service and their memories by finishing this great task in which they have given their lives. Those lives will not have been lost in vain. In the days and weeks to come, we will no doubt discover that others of our troops will have been captured, wounded, or cut down, but we must remain firm in our resolve that Operation Iraqi Freedom will continue to move forward. My own father, who passed away last October, was a veteran of the Korean war, and he taught me always to respect the great commitment made by our troops in fighting to protect our freedoms. He taught me better to understand the mind of a soldier when he shared with me the stories and experiences he had on the front lines of Korea. And also, sitting at the foot of the chair of my grandfather, who served in World War I--both of my grandfathers did--I listened to stories of his travels on trains from Helena, AR, west to Little Rock, to catch another train to boot camp, and then on to France. To better understand the minds of the men and women who serve us in the armed services, each of us must take the time to reflect on the personal stories of the family members, the neighbors, the friends, the staff, all of those who are so critically involved in this conflict in which we now find ourselves. I again encourage all of my colleagues to take those few moments out of their day, out of their week, to think about what these generous souls are giving on our behalf to be there, to defend so many of the freedoms we in this great country take for granted, to remember them and their families in our thoughts and prayers. Our troops of today's generation deserve the same respect for the work they do as when we look back at many of our family members who have served in previous wars. As I reflect today with my colleagues in the Senate, there is no one I think of more at this moment than one of my colleagues here in the Senate, who I would like to share my time with, someone who has a son overseas in the Middle East. I have to say, as a mother of twin boys who are now in the first grade, it is amazing to imagine how quickly our children grow up. The questions that I get at night from my children--Where they are going? What they are doing? What is our country involved in? Where will they be in 10 or 15 years from now?--it is so important for each of us to reflect on this as we lift up the service men and women who are there valiantly now defending our freedoms. They and their families will be in our hearts and in our minds and in our prayers in the coming weeks. We wish them Godspeed, God's safety, and a timely return home to this country and this land that we all love so much. I thank you, Mr. President. And I want to again tell my colleague, Senator Johnson, how much I appreciate him and his family for the incredible contribution they make with his son serving in the Middle East right now. It is an unbelievable gift, and we are all truly indebted.

Mrs. LINCOLN

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

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

Mrs. LINCOLN

Mrs. LINCOLN. Mr. President, I rise very proudly today on behalf of the men and women who serve this great Nation as members of the National Guard and the Reserve units in all of our 50 States. We have an opportunity today to put ourselves, and I hope each of my colleagues in the Chamber will put themselves, in the shoes of these proud men and women who serve our country from the National Guard and the Reserves, to understand what it means not only when they are called up but when they are at home waiting to serve their country. Well over 20 percent of the Reserve and National Guardsmen in this country do not have health insurance when they are called up to active duty. We have to spend a tremendous amount of money simply getting them to a health condition that actually allows us to activate them and send them into harm's way. I think it is essential that this amendment be passed. I am proud to be joined by Senators Landrieu, Feingold, Pryor, Mikulski, and Kennedy.

Mrs. LINCOLN. I do not think it is too much to ask of this great Nation to find them health care.

Mrs. LINCOLN

Mrs. LINCOLN. I thank my colleague. Mr. President, as the daughter of a veteran and the granddaughter of two grandfathers who served in the war, and the mother of two small boys, I want to say how proud I am of the men and women who serve in our Armed Forces in this great country, those who go to the front lines to defend the freedoms and the conveniences we enjoy here every day. They have done a tremendous job, and they continue to do a tremendous job. I want them to all know that our thoughts and prayers and, more importantly, our pride is with each and every one of them as they perform a mission on our behalf. I also rise today on behalf of the men and women who serve our Nation as members of the National Guard and Reserves, who are out there today, as well, defending our rights and our freedoms. I am going to discuss an amendment that I will offer, when the time becomes appropriate, with Senator Landrieu, with a tremendous amount of help and background from many other Senators who have worked on this issue, particularly Senator Leahy--an amendment that will bring members of the National Guard and Reserve into the TRICARE health care program. Currently, Guard and Reserve families cannot enroll in the TRICARE program unless the Guard or Reserve member is activated with orders lasting over 30 days. Our amendment would allow members of the Guard and Reserves, as well as their families, to sign up for TRICARE health care coverage at any time regardless of whether the Guard or Reserve is activated. This amendment is paid for by reducing the size of the proposed tax cut by $20.3 billion over 10 years. Specifically, these numbers are backed up by a GAO report on this subject that was authorized by the fiscal year 2002 National Defense Authorization Act. And the study was completed in September of 2002. So we have the numbers to back up what we want to do on behalf of these incredible men and women in the National Guard and Reserves, who deserve the support of health care, as do their families. In recent years, our Nation has increasingly looked to our volunteer reservists and guardsmen for our defense and peacekeeping needs, requiring them to leave their jobs and families in defense of our Nation. Arkansas has sent over 2,000 Guard and Reserve members to contribute to the war on Iraq and the war on terrorism. They are among over 212,000 Guard and Reserve members who have been activated nationwide. Given the scope of their sacrifices, I do not think it is too much to ask their fellow Americans to sacrifice as well by accepting a smaller tax cut. Currently, over 20 percent of this Nation's Guard and Reserve soldiers lack health care coverage when they are not on active duty. That number is much greater in a State such as Arkansas where our overall numbers of uninsured are much greater than the national percentage. In this time of increased dependence upon the members of our National Guard and Reserves, it is imperative we increase benefits for them and their families for when they are not on active duty. I also want to acknowledge this amendment only provides funding for this program. It does not begin to detail how the extended TRICARE benefits should be structured. That test would be left up, and should be left up, to the Senate Armed Services Committee and the Senate Defense Appropriations Subcommittee. I am also aware that many Senators have been working, for some time, on the details of how to structure and provide these benefits. I hope my budget amendment will complement their efforts by solely allocating the necessary budget authority to provide these benefits to our Guard and Reserve members. I look to the leadership of Senators Leahy and DeWine and Daschle, as well as both the chairmen and ranking members of the Senate Armed Services Committee and the Senate Defense Appropriations Subcommittee, to develop the specifics of how these benefits will be provided. I am also aware that this amendment will only provide an estimate of the cost of providing these benefits. In fact, some estimates state that providing these benefits will cost much less than this amendment would provide. I hope that is the case. Nonetheless, this Nation's National Guard and Reserve members and their families deserve these benefits now. I was drawn into this by a recent visit from our National Guard and Reserve units in Arkansas. A human resource officer brought to me the fact that many of these individuals--Mr. President, I ask unanimous consent for an additional 2 minutes.

Mrs. LINCOLN. Mr. President, on a visit with our National Guard and Reserves, a human resource officer came to me and said: Do you realize that when these individuals are called up to active duty, we can't activate them because they have not had the proper medical care? These are individuals who have signed on the dotted line and said they are willing to go and defend this country. Yet in their private lives they cannot afford or have access to the appropriate health care that keeps them at a health care level that we could actually activate them when we need them. This amendment is just the tip of the iceberg with respect to this Nation's overwhelming amount of uninsured families. Statistics show us that one in five Americans do not have any form of health coverage at all. Congress must address the larger problem of uninsured families across this Nation, but the absolute least we can do is to provide full coverage to America's National Guard and Reserves and their families. The time is right. And this is the right policy and the right priority for our men and women serving in the Guard and the Reserves. Mr. President, I would also like to add Senator Pryor as a cosponsor to this amendment when we are prepared to offer it. I say to all those Americans listening, we all must make contributions. It is not too much to ask of our fellow Americans to delay a larger tax cut in order to provide the necessary health care that these individuals need to be called up to serve.

Mrs. LINCOLN. I thank the Senator from Nevada for his comments. It is so important for us to realize that these men and women in the Reserves and the National Guard are leaving their families. They are leaving their careers, their jobs. The least we can do is provide for them the ability to provide for their families the kind of health care they need. One of the most outrageous stories I heard was from our reservists in Arkansas who said: We had to spend unbelievable amounts of money just to get these individuals up to the health care level where we could actually activate them. These are people who have offered themselves and have pledged that they would leave their families, they would leave what they have worked their entire lives to build to go and defend our country. There is absolutely no reason that we cannot provide for them the ability to provide for their families and for themselves the health care they need to be ready when the time comes and we call on them. I thank the Senator from Nevada. For all of my colleagues listening to this debate, I do not think it is too much to ask for the rest of Americans of what we can do for those being called on more and more to serve this country. That is the National Guard and the Reserves.

Mrs. LINCOLN

Mrs. LINCOLN. Mr. President, on behalf of all Arkansans, I want to congratulate the University of Arkansas Razorback Track and Field program on their 17th NCAA Indoor Track and Field championship this past weekend at the Randal Tyson Track Center in Fayetteville, AR. This is the program's 37th overall NCAA crown under the direction of Head Coach John McDonnell. At the University of Arkansas, Coach McDonnell has led his teams to more national championships, triple crowns and conference titles than any other coach in history. His most extraordinary accomplishment is winning 29 consecutive conference cross country championships. He has coached 20 Olympians and over 140 athletes to All-American status. We celebrate Coach John McDonnell's success at the University of Arkansas and his continued dedication to the Razorback Track and Field and Cross Country programs.

Mrs. LINCOLN

Mrs. LINCOLN. Mr. President, I rise to pay tribute to a true American hero from my State--Mr. Roy Rowe of Mena, AR. In the coming weeks, Mr. Rowe will be awarded a Presidential Unit Citation for his service in the U.S. Army during the Second World War, an honor that is richly deserved. Roy Rowe was inducted into the U.S. Army in October 1942. Serving in the Pacific theater, Mr. Rowe was assigned to the 96th Infantry Division. Over the course of three months beginning in April 1945, the 96th Division landed on the beaches of Okinawa as part of the greatest concentration of land, sea, and air power ever assembled in the Pacific. The battle for Okinawa was the costliest single battle of the Pacific war for both sides. In terms of U.S. casualties, Okinawa was second only to the Battle of the Bulge. Of U.S. Army personnel, 4,436 were killed in action, and 17,343 were wounded. Of U.S. Marines, 2,793 were killed and 13,434 were wounded. Japanese casualties numbered 107,539 killed in action and 10,755 captured. It was a terrible price to pay for both sides, but the result brought the Allied forces to Japan's doorstep and helped to precipitate the war's end in August 1945. I should also note that, following the war's end, the United States and Japan entered into a long period of geopolitical alliance, cultural goodwill, and economic partnership, and to this day we count the Japanese people among our closest friends in the world community--a fortunate result stemming from a long and difficult war. As rifleman, Roy Rowe fought alongside his fellow soldiers to secure Okinawa as a base for launching an attack on Japan. He was awarded numerous decorations for his service, including the Purple Heart, the Asiatic-Pacific Ribbon, the Philippine Liberation Ribbon, the American Theater of Operation Ribbon, and the Silver Star Medal. Mr. Rowe's service ended in October 1945, three years after it had begun. His is a service record that he can be proud of, and we're proud of him for it. Through his service to his country and his willingness to endure great personal sacrifice to defend our freedoms, Roy Rowe represents the most admirable qualities in the American spirit. In this new century, in these difficult times, when a new generation of young Americans is taking up arms to defend our freedoms against the threats posed by international terrorism and rogue nations, let's remember Roy Rowe's example of courage, patriotism and selflessness. I am honored to pay tribute to him on the floor of the Senate today.

Mrs. LINCOLN

Mrs. LINCOLN. Mr. President, I rise today to introduce the ``Access to Diabetes Screening Services Act of 2003'' with my friends Senators Collins and Bingaman. This bill will help to bring the epidemic of diabetes under control by providing Medicare coverage for laboratory diagnostic tests and other services which are used to screen for diabetes. Medicare cannot currently provide these screening services because they are prohibited to do so by Federal law. Diabetes has reached epidemic proportions among adults in the United States. The latest figures published by the Centers for Disease Control, CDC, in the January 1, 2003, edition of the ``Journal of the American Medical Association'' show that 7.9 percent of the American population has diabetes. The CDC believes that if trends continue, more than 10 percent of all Americans will have diabetes by the year 2010. Even today our Nation is feeling the effects of this disease--diabetes is the Nation's sixth leading cause of death. Diabetes strikes even harder in our nation's minority and emerging majority populations. Today, the CDC estimates that 11.9 percent of the African American population and nine percent of the Hispanic population has diabetes. Without a doubt, diabetes is now truly the epidemic of our time. These rising rates are especially evident among our Nation's aging population. Currently almost seven million Americans age 65 and older, or over 20 percent of seniors, have diabetes. Roughly 20 percent of seniors age 65 and older have a newly identified condition called pre- diabetes, which if left untreated will develop into diabetes. An additional 40,000 people living with diabetes and end-stage renal disease under the age of 65 participate in the Medicare program. Even more distressing is the fact that approximately one third of the 7 million seniors with diabetes, or 2.3 million people, are undiagnosed. They simply do not know that they have this very serious condition--a condition whose complications include heart disease, stroke, vision loss and blindness, amputations, and kidney disease. My own home State of Arkansas has had first-hand experience with the rising diabetes rates. Arkansas ranks fifth in the Nation for diabetes incidence. Recent studies show that 8.9 percent of all Arkansas adults had diagnosed diabetes, and over one million Arkansans are at risk for undiagnosed diabetes. Our Nation is not yet doing enough to manage this preventable and controllable disease. Last week, the National Institutes of Health, the CDC and the American Diabetes Association announced that the direct costs of treating diabetes grew by more than 50 percent between 1997 and 2002, from $44 billion to $91.8 billion. One of every ten dollars spent on healthcare in America is now spent on diabetes, and the average per capita cost of healthcare for a person living with diabetes is $13,243 versus $2,560 for a typical American without diabetes. Those in the medical community and the federal government are only too aware of the rising prevalence and serious nature of diabetes. The Centers for Disease Control, National Institutes of Health, and the Department of Health and Human Services recently joined together in a national education campaign to inform people about diabetes and encourage people age 45 and older to get screened for diabetes. Unfortunately, current law does not allow Medicare to reimburse for diabetes testing, even if a patient presents serious risk factors for diabetes such as obesity, high blood pressure, or high cholesterol. Most shockingly, even if a patient is experiencing early evidence of diabetes complications, such as blindness or kidney disease, Medicare still cannot reimburse a physician for diabetes testing. This nonsensical omission of diabetes screening coverage is even more shocking in light of the fact that about 25 percent of the Medicare budget currently is devoted to providing medical care to seniors living with diabetes. In 1999, Arkansas spent $1.6 billion on direct and indirect costs of diabetes. The amount Arkansas spent on diabetes in 2002 is undoubtedly higher in light of the cost data available. Why are we continuing to react to diabetes and its complications instead of proactively screening our Medicare beneficiaries for this common and costly disease? This screening can identify the disease, even before any symptoms have appeared, and has the potential to save and improve thousands of lives. In addition, this screening will potentially help prevent countless cases of end-stage renal disease, blindness and amputations--preventable complications of the diabetes that are draining Medicare of vital resources. The American Association of Clinical Endocrinologists strongly believes that patients with diabetes should be identified as early as possible in their illness. We have the technology to do this through screening. I cannot overstate the need for this legislation. When faced with the rising prevalence of diabetes, the high percentage of seniors who already have the disease, the alarmingly high number of seniors who have diabetes but do not know it yet, the growing number of seniors living with preventable diabetes complications, and the high cost associated with diabetes treatment, it is obvious that Medicare should provide coverage for diabetes screening. Our Nation must do more to battle the epidemic of diabetes through prevention, detection and treatment. This legislation will make detection of a deadly disease available to all Medicare enrollees. The American Diabetes Association has identified Medicare screening coverage as a top legislative priority, and I have worked closely with them to craft this legislation. I urge all of my colleagues to give serious consideration to cosponsoring and actively supporting the Diabetes Screening Act of 2003.

Mrs. LINCOLN

Mrs. LINCOLN. Madam President, I support the prevention package amendment offered today by Senators Murray and Reid to reduce the high rates of unintended pregnancy in our country as well as improve access to prenatal and postpartum care for pregnant women. I urge my colleagues to support this commonsense approach to the health of women and their babies. If Senators really want to make our country a better place for babies, women, and their families, they should support this amendment. Half of the 4 million pregnancies that occur in the United States every year are unintended. This amendment seeks to curb that trend by helping women better plan their pregnancies, improving knowledge of and access to contraception, and expanding insurance coverage for prenatal and postpartum care. If the provisions in this amendment were already law, I sincerely believe we wouldn't be here debating the underlying bill. A recent report showed that abortion rates are at their lowest level since 1974. Most of this decline is attributed to women becoming better educated about how to care for their bodies. We are gaining greater access to safe contraceptive measures. That is the good news. However, while there was an overall decline in abortion rates, the abortion rate among women of lower economic status actually rose. These women face greater barriers to contraception. To really reduce abortions in our country, we need to ensure that all women--poor and wealthy--have access to affordable and timely contraceptives. This prevention amendment makes significant progress towards that goal. First, the amendment makes contraception more affordable for privately insured women, an important provision based on bipartisan legislation introduced by Senators Snowe and Reid. This provision establishes parity for prescription contraception by requiring private health plans to cover FDA-approved prescription contraceptives and related medical services to the same extent that they cover prescription drugs and other outpatient medical services. By making contraception affordable for working women and families, this provision takes a positive step forward in the effort to reduce abortions in our country. Second, this amendment seeks to make women and health care providers more aware of emergency contraception, which is really just a specified dose of standard birth control pills that can be taken up to 72 hours after unprotected sex. Despite the potential for emergency contraception to drastically reduce unintended pregnancies and the need for abortion, it is underutilized and misunderstood. This amendment seeks to correct that. Emergency contraception is FDA-approved to be a safe and effective form of contraception, and it is often the only contraception option for women who have been raped. Of the 300,000 women in our country who report rapes every year, 25,000 of them become pregnant. Women who have been raped deserve to be given information about emergency contraception when they seek medical help following their sexual assault. Rapes can happen at any time, day or night. Oftentimes, women are treated in hospital emergency rooms. This amendment also ensures that hospitals counsel raped women about their risk of pregnancy and offer them emergency contraception as an option. This policy is in line with emergency care standards established by the American Medical Association and could significantly reduce future abortions. Lastly, I am glad that this amendment gives States the option of covering pregnant women in their Children's Health Insurance Programs. Based on bipartisan legislation we passed unanimously in the Finance Committee last summer, this bill allows coverage for prenatal care, delivery, and postpartum care. This provision could drastically improve the lives and health of thousands of women and children throughout our Nation. The infant and maternal mortality statistics in this great country of ours are shocking. According to the Centers for Disease Control and Prevention, the United States ranks 28th in the world in infant mortality. We rank behind countries like Cuba and the Czech Republic. It is amazing to me that the United States lags far behind these nations in this area. Another shocking statistic from the CDC is that the United States ranks 21st in the world in maternal mortality. The World Health Organization estimates that the U.S. maternal mortality rate is double that of Canada. When we are ahead of every other nation in almost every other arena, I am deeply saddened that we have not taken a course of action that would prove to the rest of the world that we truly do value life in this country, and that we want to do all we possibly can to ensure the healthy delivery of children, as well as the health of their mothers. The fact is, we know how to address this problem. The solution lies in prenatal and postpartum care. Studies have shown that this care significantly reduces infant mortality, maternal mortality, and the number of low-birthweight babies. Prenatal care is also cost-effective. For every dollar we spend on prenatal care, we save more than 6 dollars in neonatal intensive care costs. Pre-term births are one of the most expensive reasons for a hospital stay in the United States. I cannot emphasize enough the great opportunity we have here in the Senate to drastically improve the lives and health of women and babies in our country. We must allow States to cover pregnant women under SCHIP--the States want to do it, and the Federal government should give them the option. I do not understand why anyone would stand in the way of common sense, practical solutions like the ones offered in this amendment. If my colleagues are serious in their quest to reduce abortions, they will support this amendment. Instead of debating the same bill we did 5 years ago--a bill that will ultimately be decided by the courts--let's do something proactive for our Nation's most vulnerable women and families. I urge all my colleagues to support this amendment today.

Mrs. LINCOLN

Mrs. LINCOLN. Mr. President, I rise today to introduce the ``Access to Diabetes Screening Services Act of 2003'' with my friends Senators Collins and Bingaman. This bill will help to bring the epidemic of diabetes under control by providing Medicare coverage for laboratory diagnostic tests and other services which are used to screen for diabetes. Medicare cannot currently provide these screening services because they are prohibited to do so by Federal law. Diabetes has reached epidemic proportions among adults in the United States. The latest figures published by the Centers for Disease Control, CDC, in the January 1, 2003, edition of the ``Journal of the American Medical Association'' show that 7.9 percent of the American population has diabetes. The CDC believes that if trends continue, more than 10 percent of all Americans will have diabetes by the year 2010. Even today our Nation is feeling the effects of this disease--diabetes is the Nation's sixth leading cause of death. Diabetes strikes even harder in our nation's minority and emerging majority populations. Today, the CDC estimates that 11.9 percent of the African American population and nine percent of the Hispanic population has diabetes. Without a doubt, diabetes is now truly the epidemic of our time. These rising rates are especially evident among our Nation's aging population. Currently almost seven million Americans age 65 and older, or over 20 percent of seniors, have diabetes. Roughly 20 percent of seniors age 65 and older have a newly identified condition called pre- diabetes, which if left untreated will develop into diabetes. An additional 40,000 people living with diabetes and end-stage renal disease under the age of 65 participate in the Medicare program. Even more distressing is the fact that approximately one third of the 7 million seniors with diabetes, or 2.3 million people, are undiagnosed. They simply do not know that they have this very serious condition--a condition whose complications include heart disease, stroke, vision loss and blindness, amputations, and kidney disease. My own home State of Arkansas has had first-hand experience with the rising diabetes rates. Arkansas ranks fifth in the Nation for diabetes incidence. Recent studies show that 8.9 percent of all Arkansas adults had diagnosed diabetes, and over one million Arkansans are at risk for undiagnosed diabetes. Our Nation is not yet doing enough to manage this preventable and controllable disease. Last week, the National Institutes of Health, the CDC and the American Diabetes Association announced that the direct costs of treating diabetes grew by more than 50 percent between 1997 and 2002, from $44 billion to $91.8 billion. One of every ten dollars spent on healthcare in America is now spent on diabetes, and the average per capita cost of healthcare for a person living with diabetes is $13,243 versus $2,560 for a typical American without diabetes. Those in the medical community and the federal government are only too aware of the rising prevalence and serious nature of diabetes. The Centers for Disease Control, National Institutes of Health, and the Department of Health and Human Services recently joined together in a national education campaign to inform people about diabetes and encourage people age 45 and older to get screened for diabetes. Unfortunately, current law does not allow Medicare to reimburse for diabetes testing, even if a patient presents serious risk factors for diabetes such as obesity, high blood pressure, or high cholesterol. Most shockingly, even if a patient is experiencing early evidence of diabetes complications, such as blindness or kidney disease, Medicare still cannot reimburse a physician for diabetes testing. This nonsensical omission of diabetes screening coverage is even more shocking in light of the fact that about 25 percent of the Medicare budget currently is devoted to providing medical care to seniors living with diabetes. In 1999, Arkansas spent $1.6 billion on direct and indirect costs of diabetes. The amount Arkansas spent on diabetes in 2002 is undoubtedly higher in light of the cost data available. Why are we continuing to react to diabetes and its complications instead of proactively screening our Medicare beneficiaries for this common and costly disease? This screening can identify the disease, even before any symptoms have appeared, and has the potential to save and improve thousands of lives. In addition, this screening will potentially help prevent countless cases of end-stage renal disease, blindness and amputations--preventable complications of the diabetes that are draining Medicare of vital resources. The American Association of Clinical Endocrinologists strongly believes that patients with diabetes should be identified as early as possible in their illness. We have the technology to do this through screening. I cannot overstate the need for this legislation. When faced with the rising prevalence of diabetes, the high percentage of seniors who already have the disease, the alarmingly high number of seniors who have diabetes but do not know it yet, the growing number of seniors living with preventable diabetes complications, and the high cost associated with diabetes treatment, it is obvious that Medicare should provide coverage for diabetes screening. Our Nation must do more to battle the epidemic of diabetes through prevention, detection and treatment. This legislation will make detection of a deadly disease available to all Medicare enrollees. The American Diabetes Association has identified Medicare screening coverage as a top legislative priority, and I have worked closely with them to craft this legislation. I urge all of my colleagues to give serious consideration to cosponsoring and actively supporting the Diabetes Screening Act of 2003.

Mrs. LINCOLN

Mrs. LINCOLN. Mr. President, the sacrifices that these men and women are making to protect our freedoms, depend our libraries, and ensure regional and global stability. We are very proud of each and every one of them, and we owe all of them a tremendous debt of gratitude for their service and for their dedication to their country. We look forward to welcoming them home safely. Exhibit No. 1 arkansas troops currently activated Amry National Guard (947 Arkansas): N. Little Rock: State Area Command, 4. Ft. Smith: 2nd Battalion, 142nd Field Artillery, HQ, 42. Lincoln: 2nd Battalion, 142nd Field Artillery, SVC Battery, 20. Van Buren: 2nd Battalion, 142nd Field Artillery, Battery A, 72. Siloam Springs: 2nd Battalion, 142nd Field Artillery, Battery B, 73. Ozark: 2nd Battalion, 142nd Field Artillery, Battery C, 73. West Memphis: 216th Military Police Company, 124. Little Rock: 149th Medical Company, 2. Little Rock: 343rd Mobile Public Affairs Detachment, 7. Ft. Smith: 935th Support Battalion, 99. N. Little Rock: 935th Support Battalion, 32. Charleston: 296th Medical Company, 117. Marked Tree: 1123rd Transportation Company, 167. N. Little Rock: 25th Support Detachment, 49. N. Little Rock: 114th Aviation Air Traffic Control Battalion, 64. N. Little Rock: 223rd Regiment (Regional Training Institute, 2. Army Reserve (794 Arkansans): Fayetteville: 362nd Psychological Operations Company, 67. Little Rock: 431st Civil Affairs Battalion, 140. Little Rock: 460th Chemical Brigade, 1. Pine Bluff: 92nd Chemical Battalion, 1. Charleston: 38th Ordnance Group, 56. Little Rock: 468th Chemical Battalion, 45. N. Little Rock: 489th Engineer Battalion, 452. Little Rock: 90th Reserve Support Command, 22. Little Rock: 112th Chaplain Detachment, 2. Little Rock: U.S. Army Engineering Facility Group, 8. Air National Guard (145 Arkansans): Little Rock: 189th Airlift Wing, 99. Fort Smith: 188th Airlift Wing, 46. Naval Reserves (7 Arkansans): Little Rock: Naval Support Activity Bahrain, Detachment C, 7.

Mrs. LINCOLN. Mr. President, I rise today to pay tribute to the American troops in the National Guard and Reserves who are placing themselves in harm's way to defend our Nation against the threats of terrorism and global instability. As of Wednesday, March 5, there are 176,553 Reservists and Guardsmen nationwide activated in the war on terrorism and in preparation for a potential war against Iraq. Currently, there are 1,875 Arkansans activated in the Guard and Reserves. I ask unanimous consent that the attached list be printed in the Record following my remarks.

Mrs. LINCOLN

Mrs. LINCOLN. Mr. President, I am pleased to introduce the Medicare Patient Access to Physical Therapists Act of 2003, which allows Medicare beneficiaries direct access to qualified physical therapists without a physician referral, as allowed by State law. I am proud to be joined in this effort today by my friends Senators Specter, Landrieu, and Ensign. Currently, 35 States, including my home State of Arkansas, allow for direct access to physical therapists without the added cost of a physician referral. Direct access is an important change that physical therapists and their patients are seeking to the Medicare program. The National Rural Health Association, Easter Seals, and the Brain Injury Association of America join with us today in expressing their support for this important legislation. Currently, seniors and disabled Medicare beneficiaries must first visit a physician before being allowed to visit a physical therapist. This burdensome requirement in Medicare is simply no longer necessary and limits access to timely and medically necessary physical therapists' services. Providing Medicare beneficiaries with direct access to physical therapists should be a critical component of any Medicare reform. Congress must consistently balance patient safety, accessibility of services from qualified providers, and costs to the Medicare program when evaluating services. State boards that regulate physical therapy confirm that patient safety is not compromised by the elimination of the referral requirement because malpractice incidents and costs are not markedly higher in States that allow direct access. Second, direct access to physical therapists would allow for improved access to quality health care services, particularly in rural and urban underserved communities. It is a burden for elderly and disabled patients with chronic conditions to drive back and forth to a physician's office simply to obtain another referral for physical therapy. This not only disrupts patient access to timely therapy treatment but creates a needless administrative expense for the Medicare program. Finally, a study of BlueCross/BlueShield insurance claims in Maryland indicates that services are not over-utilized when a patient has direct access to physical therapists. In fact, the study indicates significantly lower costs when care is initiated without a physician referral. With this in mind, a policy that improves access to physical therapists is a positive reform for the Medicare program and its beneficiaries. The Medicare program should not impose arbitrary administrative barriers to patients who need physical therapy services, especially when States have an entirely different standard for access. I encourage my colleagues to support this Medicare modernization plan to ensure the best access to physical therapy for America's most vulnerable population--senior and disabled patients.

Mrs. LINCOLN

Mrs. LINCOLN. Mr. President, I rise today to pay tribute to Victor Baird, who is retiring from his position as acting staff director and chief counsel to the U.S. Senate Select Committee on Ethics after more than 15 years of service. For the last 2 years, I have had the privilege to serve on the U.S. Senate Select Committee on Ethics, an assignment that has provided me valuable insights into the workings and the ethical guidelines of this body. When I joined the committee, I was a relatively junior member, having served only 2 years in the Senate. I consider myself extremely fortunate that during this time, I have been able to draw on the wisdom and expertise of Victor Baird. Following a distinguished legal career in Georgia, Victor came to Washington in 1987 to serve as counsel to the Ethics Committee. Over the ensuing 15 years, Victor has brought to the committee a sense of nonpartisan balance, careful legal judgment, historical perspective, and good humor--a collection of qualities that have served the committee well during some challenging times. His advice to committee members and his leadership of the committee staff have been invaluable during the last 15 years, and we owe him a debt of gratitude for his service. I should note that, although the committee is losing a valuable asset in Victor Baird, we are fortunate in the choice of his successor--Rob Walker. Mr. Walker has served the past 4 years as chief counsel and staff director of the U.S. House of Representatives Committee on Standards of Official Conduct. But prior to that, he served as counsel to the Senate Ethics Committee, where he worked closely with Victor Baird. The Senate Ethics Committee is fortunate to have Rob back. I look forward to working with him, as I am sure that he will continue the tradition of fairness and excellence that his predecessor has established. So as we say goodbye to Victor Baird, let's also thank him for his steady and dependable service in the committee for these last 15 years, and let's wish him well in his ventures in the years to come.

Mrs. LINCOLN

Mrs. LINCOLN. Mr. President, I certainly thank my colleague from West Virginia for his courtesy and kindness in letting me go forward. I appreciate it. Mr. President, I come to the floor today to express my frustration with the nomination of Miguel Estrada to the Court of Appeals for the DC Circuit. I have never before opposed a judicial nominee, but after much prayer and reflection I cannot support this nominee until he is able and willing to cooperate with the Senate in its Constitutional responsibility to advise and consent. I believe all executive and judicial nominations that come before the U.S. Senate are entitled to courtesy and respect. I also believe the U.S. Senate's role of advise and consent is an important check and balance that our forefathers instituted, and it is an obligation that I do not take lightly. I know our forefathers put it there for a good reason. Each nominee is entitled to a thorough and fair hearing, and I have fully evaluated each of President Bush's nominees as the Constitution mandates. In every case before us, I have supported President Bush's nominees. Yet I can not in good conscience support this nominee at this time based on the lack of information that has been made available and the manner in which this nomination has been presented. Is it too much to ask of a person who is being offered a lifetime position to simply answer a few questions? As a nominee seeking Senate confirmation, Mr. Estrada has the burden of proof to demonstrate his fitness for the high office he seeks. During the confirmation process, a nominee can meet this burden in many ways depending in part on the background and experience of an individual at the time of appointment. Another consideration is the level of scrutiny warranted for a life-time appointment to an important judgeship. Finally, one critical element I look for in all nominees is a willingness to cooperate with the Senate and show deference and respect for the process we engage in here in the Senate. As many of my colleagues have already established, Mr. Estrada comes to the Senate with a very limited written record upon which to make an informed judgment. To make our job even more difficult, the administration has refused to release relevant information that would shed much needed light on this nominee's judicial philosophy and reasoning. Moreover, Mr. Estrada seemed determined to be evasive and unresponsive to questions put to him during his confirmation hearing. After weighing these factors, reviewing the committee record, meeting personally with Mr. Estrada, and considering the views of hundreds of constituents and interested organizations, I am not satisfied that Mr. Estrada has met the burden required for confirmation to such an important position. Even though Mr. Estrada is reluctant or unwilling to say so, I assume Mr. Estrada has a conservative ideology and that he and I would disagree on many issues. But after voting for every judicial nominee to come before the Senate since I took office, I can say with credibility that Mr. Estrada's ideology doesn't prevent me from supporting his nomination. A nominee's particular views or political beliefs don't bother me, so long as I am confident that nominee can separate his personal beliefs and opinions from his duty as a Federal judge to follow established precedent and interpret the law and Constitution fairly and without political bias. What concerns me a good deal, however, is the unwillingness of the administration and Mr. Estrada to respond directly to reasonable requests for legitimate information. How hard is it to answer questions about Supreme Court cases that have been on the books for years? Why is the administration so unwilling to allow U.S. Senators to review written material that would help us discharge our duty under the Constitution? I believe having judges from different backgrounds is important, and I salute President Bush for nominating an Hispanic to serve on this court. I fully support efforts to diversity the Federal judiciary so that it is more representative of our society. But I cannot support Mr. Estrada simply because he is Hispanic. Charges of racial insensitivity have no place in this debate. This Senate has already confirmed unanimously seven of President Bush's Hispanic judicial nominees. Like all nominees that come before the Senate, Mr. Estrada must answer questions put before him. I want to make clear that the questions Democrats asked of Mr. Estrada are no different than the questions Republicans have asked of nominees. In fact, when the current Attorney General served on the Senate Judiciary Committee, he asked a judicial nominee the same question that Mr. Estrada refused to answer. The question was: ``Which judge has served as a model for the way you would conduct yourself as a judge and why?'' Mr. Estrada was asked and refused to answer a similar question. When I let my boys off at school this morning--they are 6 years old and in the first grade--they were having problems with a buddy at school, in their class. They were saying: What do we do with this, Mom? How do we handle it? Do you know what I said to them? I said: Work with him. Figure it out. Work with him. That is simple, and it is simply what Democrats have told Mr. Estrada: Work with us. We are trying to do our job, to satisfy our constitutional responsibility, in good conscience, to meet the job we are sent here to do by the constituents who believe in us. If that means reviewing oral arguments and briefs of a few cases so that Mr. Estrada can state an opinion on at least one case decided by the Supreme Court in the last 40 years, why not do it? No one disagrees that Mr. Estrada has a distinguished academic and professional background. He is a very nice man. I met with him. My responsibility is not just to put nice people into judgeships. He graduated magna cum laude from Columbia and magna cum laude from Harvard Law School, served as editor for Harvard Law Review, and clerked for a Supreme Court Justice. It should not take him more than an afternoon, or less, to do a little research so that he could answer the questions that members of the Judiciary Committee have put before him. I call on the administration to let Mr. Estrada answer the questions the Senate has put before him, in good faith, so that the Senate can vote on Mr. Estrada. Is it really too much to ask, to simply say we need more information to make an important judgment on a very important, lifetime nomination? Please, give us the ability to execute our responsibilities under the Constitution. Is it too much to ask of one man, who is before us, who has the burden of proof, to show us his capabilities? Is it too much to ask, to simply say let's spend a couple of more hours, answer a few questions, and move forward? Because this Nation has a great deal to deal with. We have many issues on our plates and many things we need to address immediately. I simply say to my colleagues, is it too much to ask, to simply answer a few questions? Mr. President, I especially thank my colleague from West Virginia for his yielding to me and allowing me to move forward.

Mrs. LINCOLN

Mrs. LINCOLN. Madam President, today I am pleased to introduce the Geriatric Care Act of 2003, a bill to increase the number of geriatricians in our country through training incentives and Medicare reimbursement for geriatric care. I am proud to be joined in this effort today by Senators Reid, Snowe, Breaux, Graham, Bingaman, Landrieu, Murray, Mikulski, Sarbanes, Reed, Kennedy, and Collins. Our country teeters on the brink of revolutionary demographic change as baby boomers begin to retire and Medicare begins to care for them. As a member of the Finance Committee and the Special Committee on Aging, I have a special interest in preparing health care providers and Medicare for the inevitable ``aging of America.'' By improving access to geriatric care, the Geriatric Care Act of 2003 takes an important first step in modernizing Medicare for the 21st century. By the year 2030, 70 million Americans will be 65 and older. The elderly will soon represent one-fifth of the United States population, the largest proportion of older persons in our Nation's history. Our Nation's health care system will face an unprecedented strain as our population grows older. Our Nation is simply ill-prepared for what lies ahead. Demand for quality care will increase, and we will need physicians who understand the complex health problems that aging inevitably brings. As seniors live longer, they face much greater risks of disease and disability. Conditions such as heart disease, cancer, stroke, diabetes and Alzheimer's disease occur more frequently as people age. The complex problems associated with aging require a supply of physicians with special training in geriatrics. Geriatricians are physicians who are first board certified in family practice or internal medicine and then complete additional training in geriatrics. Geriatric medicine provides the most comprehensive health care for our most vulnerable seniors. Geriatrics promotes wellness and preventive care, helping to improve patients' overall quality of life by allowing them greater independence and preventing unnecessary and costly trips to the hospital or other institutions. Geriatricians also have a heightened awareness of the effects of prescription drugs. Given our seniors' growing dependence on prescriptions, it is increasingly important that physicians know how, when, and in what dosages to prescribe medicines for seniors. That's because frequently, older patients respond to medications in different ways than younger patients. In fact, 35 percent of Americans 65 years and older experience adverse drug reactions each year. According to the National Center for Health Statistics, medication problems may be involved in as many as 17 percent of all hospitalizations of seniors annually. Care management provided by a geriatrician will not only provide better health care for our seniors, but will also save costs to Medicare in the long term by eliminating more costly medical care in hospitals and nursing homes. Quite clearly, geriatrics is a vital thread in the fabric of our health care system, especially in light of our looming demographic changes. Yet today, there are fewer than 9,000 certified geriatricians in the United States. Of the approximately 98,000 medical residency and fellowship positions supported by Medicare in 1998, only 324 were in geriatric medicine and geriatric psychiatry. Only three medical schools in the country, the University of Arkansas for Medical Sciences, UAMS, being one of them, has a Department of Geriatrics. This is incredible considering that all 125 medical schools in our country have departments of pediatrics. As if that weren't alarming enough, the number of geriatricians is expected to decline dramatically in the next several years. In fact, most of these doctors will retire just as the Baby Boomer generation becomes eligible for Medicare. We must reverse this trend and provide incentives to increase the number of geriatricians in our country. Unfortunately, there are barriers preventing physicians from entering geriatrics. These include insufficient Medicare reimbursements for the provision of geriatric care, inadequate training dollars, and too few positions for geriatricians. Many practicing geriatricians find it increasingly difficult to focus their practice exclusively on older patients because of insufficient Medicare reimbursement. Unlike most other medical specialties, geriatricians depend almost entirely on Medicare revenues. A recent MedPAC report identified low Medicare reimbursement levels as a major stumbling block to recruiting new geriatricians. Currently, the reimbursement rate for geriatricians is the same as it is for regular physicians. But the services geriatricians provide are fundamentally different. Physicians who assess younger patients simply don't have to invest the same time that geriatricians must invest assessing the complex needs of elderly patients. Moreover, chronic illness and multiple medications make medical decision-making more complex and time consuming. Additionally, planning for health care needs becomes more complicated as geriatricians seek to include both patients and caregivers in the process. We must modernize the Medicare fee schedule to acknowledge the importance of geriatric assessment and care coordination in providing health care for seniors. Geriatric practices cannot flourish and these trends will not improve until we adjust the system to reflect the realities of senior health care. The Geriatric Care Act I am introducing today addresses these shortfalls. This bill provides Medicare coverage for the twin foundations of geriatric practice--geriatric assessment and care coordination. The bill authorizes Medicare to cover these essential services for seniors, thereby allowing geriatricians to manage medications effectively, to work with other health care providers as a team, and to provide necessary support for caregivers. The Geriatric Care Act also will remove the disincentive caused by the Graduate Medical Education cap established by the 1997 Balanced Budget Act. As a result of this cap, many hospitals have eliminated or reduced their geriatric training programs. The Geriatric Care Act corrects this problem by allowing for additional geriatric training slots in hospitals. By allowing hospitals to exceed the cap placed on their training slots, this bill will help increase the number of residents in geriatric training programs. Finally, the Geriatric Care Act contains a new provision that ensures Graduate Medical Education payments for the second year of geriatric fellowship training. A one-year fellowship may be adequate for training clinical geriatricans but a two-year fellowship is essential for training academic geriatricans who will teach geriatrics to primary care and specialty physicians-in-training. Academic geriatricians are critical in preparing the next generation of doctors to care for our growing elderly population. My home State of Arkansas ranks sixth in the Nation in percentage of population 65 years and older. In a decade, we will rank third. In many ways, our population in Arkansas is a snapshot of what the rest of the United States will look like in the near future. We are blessed in Arkansas to have the Donald W. Reynolds Department of Geriatrics and the Center on Aging at the University of Arkansas for Medical Sciences. It is my hope that the Geriatric Care Act will make it easier for our medical school and others across the country to train more physicians in geriatrics. As our parents, grandparents, friends, and loved ones cope with the challenges that aging brings, we must ensure that physicians skilled in caring for their special needs are there to help them. I ask my colleagues to join me in support of this effort to modernize Medicare to support crucial geriatric services for our Nation's seniors. I ask unanimous consent that following my statement there be a printed list of organizations that support the Geriatric Care Act of 2003.

Mrs. LINCOLN

Mrs. LINCOLN. Madam President, today I am pleased to introduce the Geriatric Care Act of 2003, a bill to increase the number of geriatricians in our country through training incentives and Medicare reimbursement for geriatric care. I am proud to be joined in this effort today by Senators Reid, Snowe, Breaux, Graham, Bingaman, Landrieu, Murray, Mikulski, Sarbanes, Reed, Kennedy, and Collins. Our country teeters on the brink of revolutionary demographic change as baby boomers begin to retire and Medicare begins to care for them. As a member of the Finance Committee and the Special Committee on Aging, I have a special interest in preparing health care providers and Medicare for the inevitable ``aging of America.'' By improving access to geriatric care, the Geriatric Care Act of 2003 takes an important first step in modernizing Medicare for the 21st century. By the year 2030, 70 million Americans will be 65 and older. The elderly will soon represent one-fifth of the United States population, the largest proportion of older persons in our Nation's history. Our Nation's health care system will face an unprecedented strain as our population grows older. Our Nation is simply ill-prepared for what lies ahead. Demand for quality care will increase, and we will need physicians who understand the complex health problems that aging inevitably brings. As seniors live longer, they face much greater risks of disease and disability. Conditions such as heart disease, cancer, stroke, diabetes and Alzheimer's disease occur more frequently as people age. The complex problems associated with aging require a supply of physicians with special training in geriatrics. Geriatricians are physicians who are first board certified in family practice or internal medicine and then complete additional training in geriatrics. Geriatric medicine provides the most comprehensive health care for our most vulnerable seniors. Geriatrics promotes wellness and preventive care, helping to improve patients' overall quality of life by allowing them greater independence and preventing unnecessary and costly trips to the hospital or other institutions. Geriatricians also have a heightened awareness of the effects of prescription drugs. Given our seniors' growing dependence on prescriptions, it is increasingly important that physicians know how, when, and in what dosages to prescribe medicines for seniors. That's because frequently, older patients respond to medications in different ways than younger patients. In fact, 35 percent of Americans 65 years and older experience adverse drug reactions each year. According to the National Center for Health Statistics, medication problems may be involved in as many as 17 percent of all hospitalizations of seniors annually. Care management provided by a geriatrician will not only provide better health care for our seniors, but will also save costs to Medicare in the long term by eliminating more costly medical care in hospitals and nursing homes. Quite clearly, geriatrics is a vital thread in the fabric of our health care system, especially in light of our looming demographic changes. Yet today, there are fewer than 9,000 certified geriatricians in the United States. Of the approximately 98,000 medical residency and fellowship positions supported by Medicare in 1998, only 324 were in geriatric medicine and geriatric psychiatry. Only three medical schools in the country, the University of Arkansas for Medical Sciences, UAMS, being one of them, has a Department of Geriatrics. This is incredible considering that all 125 medical schools in our country have departments of pediatrics. As if that weren't alarming enough, the number of geriatricians is expected to decline dramatically in the next several years. In fact, most of these doctors will retire just as the Baby Boomer generation becomes eligible for Medicare. We must reverse this trend and provide incentives to increase the number of geriatricians in our country. Unfortunately, there are barriers preventing physicians from entering geriatrics. These include insufficient Medicare reimbursements for the provision of geriatric care, inadequate training dollars, and too few positions for geriatricians. Many practicing geriatricians find it increasingly difficult to focus their practice exclusively on older patients because of insufficient Medicare reimbursement. Unlike most other medical specialties, geriatricians depend almost entirely on Medicare revenues. A recent MedPAC report identified low Medicare reimbursement levels as a major stumbling block to recruiting new geriatricians. Currently, the reimbursement rate for geriatricians is the same as it is for regular physicians. But the services geriatricians provide are fundamentally different. Physicians who assess younger patients simply don't have to invest the same time that geriatricians must invest assessing the complex needs of elderly patients. Moreover, chronic illness and multiple medications make medical decision-making more complex and time consuming. Additionally, planning for health care needs becomes more complicated as geriatricians seek to include both patients and caregivers in the process. We must modernize the Medicare fee schedule to acknowledge the importance of geriatric assessment and care coordination in providing health care for seniors. Geriatric practices cannot flourish and these trends will not improve until we adjust the system to reflect the realities of senior health care. The Geriatric Care Act I am introducing today addresses these shortfalls. This bill provides Medicare coverage for the twin foundations of geriatric practice--geriatric assessment and care coordination. The bill authorizes Medicare to cover these essential services for seniors, thereby allowing geriatricians to manage medications effectively, to work with other health care providers as a team, and to provide necessary support for caregivers. The Geriatric Care Act also will remove the disincentive caused by the Graduate Medical Education cap established by the 1997 Balanced Budget Act. As a result of this cap, many hospitals have eliminated or reduced their geriatric training programs. The Geriatric Care Act corrects this problem by allowing for additional geriatric training slots in hospitals. By allowing hospitals to exceed the cap placed on their training slots, this bill will help increase the number of residents in geriatric training programs. Finally, the Geriatric Care Act contains a new provision that ensures Graduate Medical Education payments for the second year of geriatric fellowship training. A one-year fellowship may be adequate for training clinical geriatricans but a two-year fellowship is essential for training academic geriatricans who will teach geriatrics to primary care and specialty physicians-in-training. Academic geriatricians are critical in preparing the next generation of doctors to care for our growing elderly population. My home State of Arkansas ranks sixth in the Nation in percentage of population 65 years and older. In a decade, we will rank third. In many ways, our population in Arkansas is a snapshot of what the rest of the United States will look like in the near future. We are blessed in Arkansas to have the Donald W. Reynolds Department of Geriatrics and the Center on Aging at the University of Arkansas for Medical Sciences. It is my hope that the Geriatric Care Act will make it easier for our medical school and others across the country to train more physicians in geriatrics. As our parents, grandparents, friends, and loved ones cope with the challenges that aging brings, we must ensure that physicians skilled in caring for their special needs are there to help them. I ask my colleagues to join me in support of this effort to modernize Medicare to support crucial geriatric services for our Nation's seniors. I ask unanimous consent that following my statement there be a printed list of organizations that support the Geriatric Care Act of 2003.

Mrs. LINCOLN

Mrs. LINCOLN. Mr. President, I am pleased to join my colleague Senator Pete Domenici today in introducing the ``Medicare Access Equity Act of 2003.'' This important legislation will significantly help rural physicians in Arkansas and across the country keep their doors open to Medicare beneficiaries. By correcting a disparity in the Medicare physician fee schedule, Medicare will pay rural physicians more fairly for their individual effort in treating Medicare patients. In my home State of Arkansas, 60 percent of seniors live in rural areas. Consequently, Medicare patients make up a large percentage of a rural physician's practice. It is simply unfair that current Federal policy doesn't value physician work in all areas, urban and rural, in the same way. Because the component of the fee schedule that relates to physician work is multiplied by a geographic indicator adjusting for variants in cost, Medicare payment policy devalues the amount of time and skill that rural physicians spend in providing medical services. I believe that work is work, regardless of where it is performed. It takes the same amount of time and skill for a physician in Pea Ridge, AR to treat a wound or diagnose a patient as a physician in Los Angeles, CA. It is time to correct this inequity. The Medicare Access Equity Act does this by revising the geographic practice cost indices GPCI, to establish a minimum index of 1 for the ``physician work'' component. The bill applies the current formula to determine physician work GPCIs, but if a GPCI is calculated to be less than 1, the Secretary of Health and Human Services will increase it to 1. This is critical to my home State of Arkansas, where the physician work GPCI is currently 0.953, the sixth lowest GPCI in the country. Increasing Arkansas' work GPCI to 1 will automatically pump more money to rural physicians in Arkansas, where many may begin to close their doors due to the rising costs of providing health care. It is my hope that Senator Domenici and I, with help from the Senate Rural Health Caucus, can pass this important legislation as part of any Medicare reform we consider this year. Fair reimbursement is key to ensuring that rural Americans retain the quality health care they receive from their doctors.