Barbara Mikulski

Ms. MIKULSKI

Ms. MIKULSKI. Mr. President, I rise today to introduce the ``Clinical Social Work Medicare Equity Act of 2003.'' I am proud to sponsor this legislation that will include clinical social workers among other mental health providers that are exempted from the Medicare Part B Prospective Payment System. This bill will ensure that clinical social workers can receive Medicare reimbursements for the mental health services they provide in skilled nursing facilities. Since my first days in Congress, I have been fighting to protect and strengthen the safety for our Nation's seniors. Making sure that seniors have access to quality, affordable mental health care is an important part of this fight. I know that millions of seniors do not have access to, or are not receiving, the mental health services they need. For example, depression affects nearly 6 million seniors, but only one-tenth ever get treated. This is unacceptable. Clinical social workers may also be the only mental health providers in some rural areas. Protecting seniors' access to clinical social workers can help make sure that our most vulnerable citizens get the quality, affordable mental health care they need. Clinical social workers, much like psychologists and psychiatrists, treat and diagnose mental illnesses. In fact, clinical social workers are the primary mental health providers for nursing home residents. But unlike other mental health providers, clinical social workers cannot bill directly for the important services they provide to their patients. This bill will correct this inequity and make sure clinical social workers get the payments and respect they deserve. Before the Balanced Budget Act of 1997, clinical social workers billed Medicare Part B directly for mental health services provided in nursing facilities to each patient they served. Under the Prospective Payment System, services provided by clinical social workers are lumped, or ``bundled,'' along with the services of other health care providers for the purposes of billing and payments. Psychologists and psychiatrists, who provide similar counseling, were exempted from this system and continue to bill Medicare directly. This bill would exempt clinical social workers, like their mental health colleagues, from the Prospective Payment System, and would make sure that clinical social workers are paid for the services they provide to patients in skilled nursing facilities. The Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act addressed some of these concerns, but this legislation would remove the final barrier to ensuring that clinical social workers are treated fairly and equitably for the care they provide. This bill is about more than paperwork and payment procedures. This bill is about equal access to Medicare payments for the equal and important work done by clinical social workers. It is also about making sure our Nation's most vulnerable citizens have access to quality, affordable mental health care. Without clinical social workers, many nursing home residents may never get the counseling they need when faced with a life threatening illness or the loss of a loved one. I think we can do better by our nation's seniors, and I'm fighting to make sure we do. The Clinical Social Work Medicare Equity Act of 2003 is strongly supported by the National Association of Social Workers. I ask unanimous consent that a letter of endorsement from the National Association of Social Workers be printed in the Record. I also want to thank Senators Johnson, Murray, Stabenow, Corzine, Inouye, and Bingaman for their cosponsorship of this bill. I look forward to working with my colleagues to enact this important legislation.

Ms. MIKULSKI

Ms. MIKULSKI. Mr. President, I rise today to introduce the Federal Employees Health Benefits Improvement Act of 2003 along with my colleague from Maryland, Senator Sarbanes. This bill would reduce the employee portion of premiums costs under the Federal Employee Health Benefits Plan. Our Federal employees work hard for the American people and they deserve quality benefits. Why is this legislation important? Health insurance premiums for Federal employees and retirees rose an average of 11.2 percent this year. In contrast, Federal worker's wages are expected to rise by 4.1 percent in the Washington-Baltimore area once the fiscal year 2003 Omnibus Appropriations bill is approved. This follows a 13.3 percent increase last year, and an increase of 10.5 percent for 2001. As a result, premiums are nearly 50 percent greater than they were just 5 years ago. The Federal program provides health insurance coverage to about 9 million government workers, retirees and family members. More than 800,000 of these workers live in the DC metro area. Health insurance costs are skyrocketing, and Federal employees are paying a greater share of their take home pay for health care each year. Currently, Federal employees pay anywhere between 28 percent to 30 percent of premiums. In the private sector, other large employers pay at least 80 percent of premiums and employees pay 20 percent, according to recent data published by the Bureau of Labor Statistics and the Kaiser Family Foundation. How would this bill help solve this problem? This bill would change the financing formula for Federal Employees Health Benefits Program, FEHBP. Under this approach, the federal agencies would pay 80 percent of the weighted average for premiums. This would help reduce the out-of-pocket health care costs for federal employees and improve the affordability of FEHBP immensely. What would this mean to Federal employees? My bill would help improve the affordability of health care insurance for all 9 million. Currently, about 250,000 federal employees do not have health insurance. Many of them cannot afford health care insurance at the current rates. My proposal would improve the affordability of health care insurance so that many of these workers would be able to afford coverage. For example, under Blue Cross Blue Shield's Standard Option Plan, an individual would save almost $400, and a family would save about $925 this year. Providing quality benefits for federal employees is also an important tool in helping recruit and retain a high quality workforce and compete with the private sector and other State and local governments. This bill would have an enormous impact in my State, Maryland, but would also benefit Federal workers nationally. Under this proposal, the percent that a Federal employee pays in health insurance premiums would decline, putting more money into Federal employees pockets each pay period. This bill improves benefits for our hardworking Federal Employees. I urge my colleagues to join me in expressing support for this bill.

Ms. MIKULSKI

Ms. MIKULSKI. Mr President, I rise to speak today on the Columbia tragedy. On Saturday, February 1, our Nation suffered a tragic loss. The seven astronauts of the Space Shuttle Columbia gave their lives in service of their country and all mankind. These brave men and women displayed a dedication to duty and scientific exploration that is an inspiration to all of us. India and Israel share in our shock and grief. Israel lost a national hero, their nation's first astronaut, Colonel Ilan Ramon. My thoughts and prayers are with all the families. They should know that the United States Senate shares their sorrow and will remember and honor the lives of their loved ones. The best way to honor these seven brave men and women is to move forward with the space program. But first, there needs to be a thorough, rigorous and candid investigation of what went wrong. The issues confronting us are immediate and severe. Three American astronauts remain in space. The two investigative committees must gather the evidence, conduct their analysis and report to the Congress and to the American people with candor so the shuttle program can move forward in the safest way possible. In my years as chair of the Appropriations Subcommittee, and now as its ranking member, shuttle safety has been my top priority. But, shuttle safety and astronaut safety have also been the priority of the committee--on a bipartisan basis. When I first joined the committee, Senator Jake Garn of Utah--himself a former astronaut--was my mentor. We worked together using the findings of the Challenger and Augustine Commissions as blueprints for NASA's future. The Augustine report gave us guiding principles for a balanced space program. The Challenger report told us what we needed to do on safety. Now, with my friend and colleague, Senator Kit Bond, I share the same bipartisan spirit. We have common goals and common values. He believes, as I do, that safety must come first. Over the last few years, no matter which of us was chair and which was ranking, safety was the number one priority. There has never been any question that we would fully fund the shuttle program and shuttle safety initiatives. Year after year, Senator Bond and I worked together to make sure everything that NASA asked for was put in the Federal checkbook. But, we went even farther than that. For the last two years, while I was chair, I wrote into the report language that NASA must make the safety of the shuttle program and the safety of our astronauts its highest priority. Last year, I said in the committee's report that NASA's budget must reflect its long-term challenges. I asked for a detailed assessment of the agency's needs and an accounting of what funding was needed. The immediate need facing NASA is the Columbia investigation. This report addresses an immediate problem for which there are immediate and severe consequences. Then the long range issues must be addressed. What does NASA do about its aging infrastructure and aging workforce? How are we going to have a balanced 21st century space program that includes human flight, space science and aeronautics? To conclude, I salute the men and women of Texas and Louisiana. The local law enforcement, national guard, regular men and women who live in these small towns--everyone is pitching in to find fragments of the Columbia, to guard them, to make sure every piece gets to the NASA investigators. People are opening their homes to volunteers, cooking and delivering meals. Thank you for everything you are doing. You represent the best of the American spirit. Like we have seen after other tragedies--the rescue workers and volunteers at ground zero--in the face of tragedy, America stands united.

Ms. MIKULSKI

Ms. MIKULSKI. No. We didn't.

Ms. MIKULSKI. Mr. President, I wish to speak about an amendment that I have offered to get behind the nurses and patients in this country. My amendment would provide $20 million in this bill to fund programs created by last year's bipartisan Nurse Reinvestment Act to recruit and retain nurses. I'm pleased that my amendment has been accepted by the managers of this appropriations bill. I thank Senators Stevens, Byrd, Specter, and Harkin for working with me to include my amendment in the Senate fiscal year 2003 appropriations bill. My amendment is a down payment. It has the support of 17 bipartisan cosponsors. The Nurse Reinvestment Act is an important bipartisan accomplishment from the last Congress. Republicans and Democrats came together to make this down payment to address the nursing shortage, a crisis that impacts patient care across the country. Now Congress must provide the funds to make these nurse recruitment and retention efforts a reality. America is facing a nursing shortage and it will only get worse. Today, there are about 126,000 nurse vacancies in hospitals alone nationwide. This number does not even include the nurses needed in nursing homes, home health agencies, schools and other sites. In my home state of Maryland, about 15.6 percent of the nursing jobs are vacant in hospitals. More than 2,000 full-time nurses are desperately needed. In 2000, there was a shortage of 110,000 registered nurses in this country. According to the Department of Health and Human Services, this number will: more than double by 2010 to 275,000; more than quadruple in 2015 to 507,000; and reach 808,000 in 2020. The demand for nurses will increase as the 78 million baby boomers get older and start to need more health care. The nursing shortage comes at a time when nurses are being asked to do more: hospitals caring for more critically ill patients; nurses receiving small pox vaccinations and giving small pox vaccinations to patients; and the nurses in military reserves called into active duty. Most importantly, this nursing shortage affects patient care. Nurses are on the front lines of health care everyday in hospitals, nursing homes, and home health agencies. A study published last year in the New England Journal of Medicine found that nursing shortages in hospitals are associated with a higher risk of complications and even death for patients. Last year, Congress passed the bipartisan Nurse Reinvestment Act as a down payment to help recruit and retain nurses, a first step to help address the nursing shortage. This bill alone will not solve the nursing shortage. It does not address the fact that nurses are underpaid, overworked, and undervalued. The Nurse Reinvestment Act does three things. First, it helps bring men and women into the nursing profession by making nursing education more affordable. It provides scholarships and loan repayments in exchange for two years of service in areas that need nurses the most. Second, the Nurse Reinvestment Act helps keep nurses in the profession by providing additional education and training opportunities and programs to empower nurses. It provides financial assistance to pursue advanced degrees and training such as fostering mentoring programs, internships and residencies, as well as specialized geriatric care training. It also supports programs to encourage collaboration with other health care professionals and promote nurse involvement in decision-making. Finally, it increases the number of faculty in nursing education programs by forgiving loans in exchange for a commitment to teach in a nursing school. Last year, Congress put nursing recruitment and retention as a priority in our federal lawbooks. But this will be a hollow opportunity if Congress does not fund the Nurse Reinvestment Act this year. Congress must now put the Nurse Reinvestment Act as a priority in the federal checkbook. Funding the Nurse Reinvestment Act in 2003 has bipartisan support from 37 Senators. I also want to thank Senators Kennedy, Kerry, Jeffords, Clinton, Murray, Rockefeller, Corzine, Lieberman, Collins, Sarbanes, Lautenberg, Johnson, Biden, Cantwell, Smith, Roberts, and Landrieu for cosponsoring my amendment. My amendment is endorsed by the American Nurses Association, American Association of Colleges of Nursing, National League for Nursing, Emergency Nurses Association, American Association of Community Colleges, American College of Nurse Practitioners, National Association of Pediatric Nurse Practitioners, Oncology Nursing Society, and the Maryland Nurses Association. Numerous other groups support funding the Nurse Reinvestment Act in 2003 including the American Hospital Association, American Health Care Association, and the Federation of American Hospitals. But most importantly, this amendment has the support of patients who want to have nurses when they need them. Patients across the country are depending on the Congress to help them. This is my third nursing shortage as a United States Senator. I want to help find solutions so that it is the last nursing shortage. I thank my colleagues for their support. I strongly urge the House and Senate conferees on this bill to keep this $20 million to fund the Nurse Reinvestment Act in the conference report. Patients, nurses, and health care facilities across the country are depending on your support.

Ms. MIKULSKI. Vote yes on Mikulski.

Ms. MIKULSKI. Mr. President, I want to make a few quick points. First, my amendment, word for word, was voted for in the House of Representatives. I say to my friends on the other side of the aisle and to my very good friend, the Senator from Virginia, that this amendment was offered by two Congressmen from Virginia, Moran and Wolf. This amendment passed the House 261 to 166. Tom Davis, Jo Ann Davis, and Frank Wolf voted for this. I might also note that the Presiding Officer voted for it when he was in the House. So it had bipartisan support. I wish we had that bipartisan support. I wish the people who voted for it in the House would vote for it now that they are in the Senate. That is No. 1. No. 2, who would be contracted out? OMB has told the agencies, 127,500 people by the end of 2003. They are going to go for the largest numbers in the quickest way. It is going to be clerical. It is going to be support. It is going to be the mail. It is going to have a tremendous impact on people of color who have worked their way into Federal civil service. If one reads the Federal Managers Magazine, they have said the VA has said it is going to have a tremendous impact, they fear, on their diversity. The same has also been said by other agencies. Again, I am not looking for quotas in diversity anymore than I am looking for quotas in contracting out, but I want us to know who is going to be affected. It is not going to be that high-tech software engineer. I believe that just as the Northern Virginia High Tech Council has offered great ideas and ingenuity through their members, so has Maryland. We understand that. Let's look at NIH. Let's look at FDA. Who is going to be contracted out there? Is it really going to be the Nobel prize winner? No. It is going to be a lot of folks who do the thankless day to day work who are going to be contracted out. Now, my colleagues also need to know, I fear for national security. In many of these agencies, it is going to be the blue-collar jobs, such as the electricians, the people who are the facility managers, and others.

Ms. MIKULSKI. Excuse me?

Ms. MIKULSKI. Is the Senator yielding back all his time?

Ms. MIKULSKI. I thank the Senator from Nevada for asking to be a cosponsor. I reserve such time as I may have.

Ms. MIKULSKI. I thank the Chair. Mr. President, my amendment is the original amendment that I had pending this morning. It seeks to maintain the integrity of the civil service system by making sure that civil service is never subjected to bounty hunters looking to get rid of their jobs through arbitrary and capricious targets and quotas. It makes sure that the civil service never lapses into cronyism or political patronage. My amendment prevents Federal agencies from establishing or applying arbitrary targets or quotas for the contracting out of Federal jobs. I want to be clear that my amendment does not prohibit privatization. Privatization can continue to go forth as established by Congress in the FAIR Act of 1998. It allows contracting out. I don't object to that. What I object to is targets, quotas, and bounty hunters. Firstly, this is the smallest Federal workforce since the 1960s. Next, we are at war. We are fighting a war against terrorism. We also created a new agency called Homeland Security. Lastly, we are facing the largest number of potential retirees from civil service in over 30 years. Don't we want a civil service? I am proud of the civil service. Members of my family have been part of the Federal civil service. My brother-in-law was a librarian, I have a sister who was a secretary, and I am a Senator. I believe if we are going to recruit and retain the people we need, we need to make sure we do not embark upon this arbitrary, capricious, hostile, and predatory behavior. That is not the way to govern. That is not the way to inspire. That is not the way to recruit, and it is certainly not the way to retain. It is not that Barbara Mikulski is opposed to this; Federal managers are opposed to this amendment. They are concerned that they are going to be writing lots of justifications on how to retain jobs. They want to fight for America. They want to fight for or perform the missions of their agencies. We went from an era of patronage politics. Now we are embroiled in an atmosphere of partisan politics. I wish we could get back to performance-based politics, sound civil service, good reform, some of the ideas being proposed by the other side of the aisle, looking at what should be contracted out, which would maintain the mission of the agency, give value to the taxpayer but dignity to the Federal employee. So what is wrong with that? I will tell you why the amendment is being opposed. What we want to be able to do is allow the privatization to occur under the laws that now exist. The FAIR Act of 1998 and the 76-OMB circular that was established in the 1960s in the Kennedy-Johnson era is what I want. My amendment simply prohibits the arbitrary and capricious contracting out by saying: None of the funds made available in this act may be used by an executive agency to establish, apply, or enforce numerical targets or quotas. That is all it says. If you are for quotas, vote for this. If you are for targets, vote for this. If you are for arbitrary and capricious decisionmaking, go ahead and do it. Who is going to hire these people? Are we going to create new corporations? What about all those guys who worked for Enron? Maybe they could get into ``let's hire a public employee and privatize.'' And all the guys from WorldCom, maybe when they get out on parole they could start a new agency to pick up these Federal employees. I do not know for the life of me why we are so hostile to Federal employees. We have less of a workforce now, and we are asking them to fight for America; we are asking them to work for missions, the agencies. We took away their privileges in homeland security, and now we are going to take away their jobs.

Ms. MIKULSKI. Mr. President, I believe we can move expeditiously along on this debate. Might I inquire from the Presiding Officer the amount of time we have to debate this amendment?

Ms. MIKULSKI. Mr. President, I ask unanimous consent that further reading of the amendment be dispensed with.

Ms. MIKULSKI. Mr. President, I send an amendment to the desk, which is provided for under the unanimous consent agreement.

Ms. MIKULSKI. Mr. President, I hope when we do another process such as this and enter into negotiations and when the negotiation is over we don't come back and offer something that had been rejected as an amendment. I am disappointed that this amendment is being offered. That is politics. Everyone has a right to offer their amendments. I accept the offer of the Senator from Maine and the Senator from Ohio for the long haul and for discussion. This is very serious. We do know we need a modernized civil service. We do know we need to reform. But we do not need targets and quotas where OMB has said itself, get rid of 127,000, 500,000 jobs this year. So 127,000 people? Who are we going to get rid of? Let's start with the Nobel prize winners at NIH. Who needs them? They can go off to the private sector. Good-bye. Who needs a Nobel prize winner for finding the cure for Alzheimer's? Maybe we could contract out Customs officers. Maybe we could go to rent-a-cop agencies. Or what about those secretaries who keep the agencies going--like the one who went to my high school who has worked for the FBI for nearly 50 years in Baltimore, who has helped keep the FBI going, such as when the FBI was out trying to find the sniper who killed several Marylanders and people from Northern Virginia. I don't know what is so hostile about Federal employees. If we want to save money in pensions, and if we want to save money in health care, that is another issue. But bounty hunters? No. Maybe bounty hunters are OK when you go after predators, but I don't think the Federal employees should be subjected to bounty hunters. Guess who else is opposed to this amendment. Federal managers, because they say all they are going to be doing is paperwork to be able to justify this. I could elaborate. Everybody knows I am opposed to the Thomas amendment because it is just a dressed-up version of going after quotas, which I tried to stop in the first place. Mr. President, I know that it is getting late. I think we ought to have a vote on this. If I prevail, by defeating the Thomas amendment, we are done. If not, I am going to come back and have another say. Mr. President, I yield all of my time back.

Ms. MIKULSKI. Mr. President, I rise with vigor to unabashedly oppose the amendment of the Senator from Wyoming. The reason I do is that he reintroduces the words ``quota'' and ``target.'' The amendment of the Senator from Wyoming essentially says that a ``target'' or a ``goal'' is to be considered--``target, target, quota, quota.'' I thought we didn't like targets and quotas. I am surprised that the Senator from Wyoming is so enthusiastic about them. Under the Thomas amendment, Federal managers will still be forced to meet arbitrary quotas for privatization without real criteria, rationales, or consideration. Under the Thomas amendment, the goal is to get a quota or a target--not better government. Let us be very clear. My original amendment never did seek the end to privatization. Privatization must be based on thoughtful criteria as established by the Congress in the FAIR Act. Let us privatize Federal jobs where appropriate, but let us keep a strong, independent Federal workforce. I want to deal with the very valid issues raised by the Senator from Maine. I agree. I wanted to modify my amendment. I wanted to modify my amendment by adding what is now in the first paragraph in the Thomas amendment, which I agree to--that nothing in this section would prevent any agency of the executive branch from subjecting work performed by the Federal Government employees to be contracted out to public or private competition. I wanted to do that this morning. The Senator from Wyoming would not agree to that modification. We went into a dialog. In the dialog, the Senator from Maine, again, offered a very constructive recommendation-- that nothing in this section would limit the use of such funds under the Government Performance Act. I was willing to go with that. If we had agreed to that, we could have agreed to that modification this morning and Senators could be heading home tonight. But, no, OMB had to get into the act. They insisted that this paragraph say, unless there has to be a target or quota. Sure. They say based on research and sound analysis. Let me tell you. When the fox is guarding the hen house, I don't care what accounting system they have. They are still going after targets and they are still going after quotas. That is why I object to the amendment of the Senator from Wyoming. I would love to have agreed to the original two paragraphs that I think would have met the very valid concern of the other side. I salute those on the other side who are reformers. But, no, we didn't go that route. I am still opposing it. Anything with the word ``target'' in it and anything with the word ``quota'' in it. I am fighting today. I am fighting all night, if I have to. I will fight tomorrow, and I will fight on until the end of the 108th Congress. I am not going to destroy the integrity of the civil service system with arbitrary quotas and with arbitrary and capricious targets. We are going to do this right. We are going to do it under the law. We are not going to turn Federal managers into bounty hunters. How much time do I have?

Ms. MIKULSKI. When do I get my time? There are 15 minutes on each amendment?

Ms. MIKULSKI. Mr. President, the Senator from Ohio has the right to speak, but it was not part of the agreement. I was just referring to the usual and customary behavior in the Senate.

Ms. MIKULSKI. This discussion will be on my time. But usually when we have a time allocation we go back and forth. Is the Senator from Wyoming going to take all of his 15 minutes and then give me all of mine? Is that the way we are going to do it?

Ms. MIKULSKI. Mr. President, parliamentary inquiry: First, I recognize that the Senator has time. But I didn't know if we were going to alternate speakers. Does the Senator from Wyoming intend to use all of his 15 minutes and then turn it over to me? I am sorry. I don't want to in any way deny the Senator from Ohio his right to speak. Usually one side makes an argument, and then the other replies, and then go back. Are we not doing that?

Ms. MIKULSKI. Parliamentary inquiry.

Ms. MIKULSKI

Ms. MIKULSKI. Yes.

Ms. MIKULSKI. I didn't hear the Senator.

Ms. MIKULSKI. I believe there is a unanimous consent.

Ms. MIKULSKI. Mr. President, I say to the very cooperative Senator from Alaska, we have not been able to work out our amendment because of a disagreement with OMB. Our colleagues have been most collegial, but we have not been able to work it out. We have been able to work out the nurses amendment, but I do not believe we have been able to work out the civil service quota amendment.