Barbara Mikulski

Ms. MIKULSKI

Ms. MIKULSKI. Mr. President, I would like to engage in a colloquy with my friend, the chairman of the subcommittee, on shoreline mapping.

Ms. MIKULSKI

Ms. MIKULSKI. Mr. President, I rise as a cosponsor of the Woodrow Wilson Bridge Financing Act of 1999. The Woodrow Wilson bridge is the only federal bridge in the country. This bridge used to be a bridge over troubled water. Now it is a troubled bridge over the Potomac River. We need a new bridge--not only because of the significant increase in the volume of commuters, interstate travelers and trucks that use the bridge, but also for public safety. The construction of this bridge must be completed in a timely way. I support this legislation for two reasons. First, it provides the funding that we need to finish constructing the Woodrow Wilson bridge. Second, it makes the project compliant with the Clean Air Act as required by the U.S. District Court for the District of Columbia. Specifically, this legislation provides the authorization for an additional $600 million for the bridge. This $600 million is in addition to the $900 million that has already been committed by the federal government. It will provide $150 million per year from 2004 to 2007. The legislation also commits the surrounding states to contribute their fair share to the construction of the bridge. Since federal funding makes up 80% of the cost of the bridge, the Capitol Region jurisdictions are committed to providing the remaining 20%. In fact, the states have to provide at least $0.67 for every $1 provided from the Highway Trust fund. Together, the federal and state governments will be able to provide what we need to build the bridge. The Woodrow Wilson Bridge Financing Act of 1999 is an innovative, creative and resourceful response to what was once a big problem for the entire metropolitan area. I urge my colleagues to join me in supporting this important legislation.

Ms. MIKULSKI

Ms. MIKULSKI. Mr. President, twenty five years ago today, Turkish troops invaded and divided the nation of Cyprus. This illegal and immoral division of Cyprus continues today--dividing a country and creating instability in the Mediterranean. During the early days of the Turkish occupation, six thousand Greek- Cypriots were killed. Over two hundred thousand were driven from their homes. Many of the missing, including some Americans, have never been accounted for. Little has changed in the past quarter century. Today, forty thousand Turkish troops remain in Cyprus. The Greek-Cypriots who remain in the northern part of the island are denied basic human rights such as the right to a free press, freedom to travel, and access to religious sites. I am disappointed that we have made no progress in ending the occupation of Cyprus. This year, as we mark this somber anniversary, I urge my colleagues to join me in recommitting ourselves to bring peace to Cyprus. First of all, we must continue to make the resolution of the Cyprus problem a priority. President Clinton and Secretary of State Albright have focused more attention on this region that any other Administration. Ambassador Richard Holbrooke and Ambassador Tom Miller have done an excellent job trying to bring both sides together. As Ambassador Holbrooke assumes his new responsibilities at the United Nations, we must encourage the Administration to replace him with an emissary of equal stature. The second priority is that we must continue to provide humanitarian assistance to the people of Cyprus. Each year, Congress provides fifteen million dollars to foster bicommunal cooperation in Cyprus. These funds are used for education, health care, and to help both communities to solve regional problems--such as to improve water and energy supplies. These funds are an investment in stability in a strategically important region of the world. I'm pleased that the Senate Foreign Operations Appropriations bill includes this funding. As a member of the Subcommittee, I will continue to fight to ensure that the final legislation includes this funding. The third priority is that Congress should pass the Enclaved People of Cyprus Act. Senator Olympia Snowe and I introduced this legislation to call for improved human rights for the Greek Cypriots living under Turkish control. I urge my colleagues to join us by cosponsoring this legislation. Mr. President, the crisis in Cyprus has brought two NATO allies to the brink of war. The occupation is also a human tragedy that should enrage all of us who care about human rights. We must continue to work toward a peaceful and unified Cyprus.

Ms. MIKULSKI

Ms. MIKULSKI. Mr. President, I rise as a cosponsor of the Woodrow Wilson Bridge Financing Act of 1999. The Woodrow Wilson bridge is the only federal bridge in the country. This bridge used to be a bridge over troubled water. Now it is a troubled bridge over the Potomac River. We need a new bridge--not only because of the significant increase in the volume of commuters, interstate travelers and trucks that use the bridge, but also for public safety. The construction of this bridge must be completed in a timely way. I support this legislation for two reasons. First, it provides the funding that we need to finish constructing the Woodrow Wilson bridge. Second, it makes the project compliant with the Clean Air Act as required by the U.S. District Court for the District of Columbia. Specifically, this legislation provides the authorization for an additional $600 million for the bridge. This $600 million is in addition to the $900 million that has already been committed by the federal government. It will provide $150 million per year from 2004 to 2007. The legislation also commits the surrounding states to contribute their fair share to the construction of the bridge. Since federal funding makes up 80% of the cost of the bridge, the Capitol Region jurisdictions are committed to providing the remaining 20%. In fact, the states have to provide at least $0.67 for every $1 provided from the Highway Trust fund. Together, the federal and state governments will be able to provide what we need to build the bridge. The Woodrow Wilson Bridge Financing Act of 1999 is an innovative, creative and resourceful response to what was once a big problem for the entire metropolitan area. I urge my colleagues to join me in supporting this important legislation.

Ms. MIKULSKI

Ms. MIKULSKI. Just for a point of information and clarification back to the Senator from Pennsylvania, in a meeting yesterday with the women of the Senate--a bipartisan meeting, I might add--I believe we were told there is a hold on this among our colleagues. Perhaps we can work together to lift that hold to ensure that the bureaucracy concerns are dealt with so we can go on with the mutual humanitarian concerns that I know we share on both sides of the aisle. Again, I thank the Senator for his leadership on this in the most sincere, kind way.

Ms. MIKULSKI. First, I congratulate the Senator from Pennsylvania on his leadership in this area. As he knows, we have worked together, but he has certainly been in the forefront on the war crimes issue in particular, the issue of rape as a war crime. We thank him for that. Does the Senator from Pennsylvania know why the money is not being released?

Ms. MIKULSKI. Will the Senator from Pennsylvania yield for a question?

Ms. MIKULSKI

Ms. MIKULSKI. Mr. President, it has been interesting to me that during the two hours I have been here, in the time allocated to this amendment, no one from the other side has debated the merits of the Kerrey-Mikulski amendment. We have heard about the health care plan, we heard about Mrs. Clinton's health plan, but no one challenged the fact that the American people should have continuity of care. Just because a business changes their insurance company, you should not have to change your doctor. Also, we heard a great deal about the States--let the States do it. I bring to the attention of my colleagues, only 22 States have a continuity-of-care provision; 28 States do not. So, 28 States are vulnerable to the lack of a continuity-of-care provision. Also, all 50 States have a Constitution. So why should we have one ourselves? Why should we have one? The reason we have a Federal Constitution is that we are one nation under a law that should protect all American people and we also have a Federal Constitution that we love and cherish because we have a Bill of Rights. Imagine if we were still waiting for the 14th amendment, if we were doing it one State at a time. Imagine if we women had gotten the right to vote, if we had done it one State at a time. Do you think the railroads would have let us have the direct vote by the people of the Senate? No; I think we would still be choo-choo-ing along under the old system. Let's talk about the cost. I think that is a fallacy in the argument. This Congress is going to debate in the next week or two a tax bill that could plunge us into a deficit. Sure, we think we have a surplus, but it is a promissory note surplus; it is not a guaranteed surplus. So while we are going to talk about cost, just wait until we start talking about that tax bill. The other thing is, we did not hesitate to pass the national ballistic missile system. I will tell you something. My constituents in Maryland are more at risk for their lives and safety from insurance gatekeepers preventing them from having access to the medical care they need than they are of some missile striking us in Baltimore, Crisfield, Hagerstown, or all around the State, or this country. So let's not talk about cost. And let's not invent phony arguments. Let's go back to what we are debating, the Kerrey-Mikulski amendment that says let's provide continuity of care. It is very straightforward. It would allow for a transition that, when a doctor is no longer included as a provider under a plan, or employers change plans, it would provide 90-day transitional care for any patient undergoing an active course of treatment with a doctor. That means if you have diabetes, it means if you have high blood pressure, it means if you have glaucoma, that you can at least have a transition plan to have someone meet your needs. Then we make three exceptions. We make them for pregnancy, we make them for terminal illness, and we make them for someone who is institutionalized. A patient who is dying should not have to change a doctor in the last days of his or her life. If you are pregnant, I think you ought to have the doctor through post-partum care that is directly related to delivery. That's what we are fighting for today, and I hope we pass this amendment. I yield the floor.

Ms. MIKULSKI. I thank the Democratic whip for yielding me this time. Mr. President, I am troubled about the pending amendment because one of its components my colleagues might not be aware of is that it strips the Democratic provision to provide continuity of care. This is pretty serious because what continuity of care means. What does continuity of care mean? Under our proposal, continuity of care means just because your company changes HMOs, you should not have to change your doctor, or if your doctor is put out of the network, you shouldn't have to leave your doctor. I hope we can make sure that we keep continuity of care in. If we lose it, we are going to have our own amendment. Senator Bob Kerrey and I are going to offer our own amendment on continuity of care. I will tell you why we feel so strongly about it. We think the most important thing in getting well is the doctor- patient relationship. You need to have a doctor who knows you, and you need to keep your doctor who has prescribed a course of treatment and who knows you as a person, not as a lab test, not as a chart. We do not believe doctors are interchangeable. We believe you should be able to keep your own doctor. Let me tell you what the Democratic provision does. Under the Democratic proposal, if your company changes HMOs, you get to keep your physician through at least a 90-day transition period. So if you are a diabetic or if you are engaged in a particular course of treatment, you get to keep your doctor. Then we have three provisions that make sure you keep your doctor when you are facing significant medical circumstances. What would be a significant medical circumstance? It means, for instance, when you are pregnant. We think that when you are having your baby and you have an OB/GYN and a course of treatment, you should be able to keep that same doctor all the way through your pregnancy and through your postpartum recovery. Why is that important? Suppose you are a diabetic, or suppose you have kidney problems, or suppose you have a whole variety of other medically indicated symptoms that require very special monitoring; you can't just change your doctor. We certainly don't want to change doctors in late-term pregnancies. We have talked a lot on this floor about late-term pregnancies. Well, let's make sure you get to keep the same doctor during late-term pregnancies. Let's take another issue. If you are terminally ill, under the Republican school of thought you would lose your physician--if you are terminally ill and your company changes providers. We think if you are dying of cancer, if you are in the last stages of any illness, or if your child is in the last stages of illness, you shouldn't have to change your doctor. We truly believe that when a little boy or girl is dying of leukemia and the family is facing the heartbreak of that, they should at least be able to keep the same doctor through the course of treatment. The other exception we provide is if you are in an institution or a facility. So if you are in a mental facility and you are getting well, you are working hard to get well, let's keep the doctor while you are keeping up the fight to get well. If you are also recovering from a stroke and you are in a rehab center, we say you should be able to keep your doctor and the same set of providers throughout that course of treatment. We are being bashed on this floor about how we are for lawyers. Well, I am not for or against lawyers, but I am for doctors. I am really for the doctors and the other appropriate health care providers. I think that if you are pregnant, or terminally ill, or if you are in an institution trying to get better, you ought to be able to keep your doctors, and maybe we would not have to turn to the lawyers. I yield the floor. Mr. FRIST addressed the Chair.

Ms. MIKULSKI. Mr. President, we are in the closing hours of this debate now. I want to thank the distinguished Senator from Massachusetts for his steadfast advocacy not only this week, but his whole life has been devoted to making sure that people have access to health care, and to believing that in the United States of America there is an opportunity structure where we give help to those people who try to practice self-help--we have done that in education and in our legal framework--and also to be sure that if you have something happen to you in terms of your physical, emotional, or mental well- being, you should have access to health care in the greatest country in the world. I thank Senator Kerrey for offering this amendment. I think it is an outstanding amendment and I am pleased to be a cosponsor. I lend my voice to this amendment that the Senator has offered, and I hope that at least once this week we can pass an amendment 100-0, and that we put the profits of an insurance company aside, put the politics of party aside, and that we take a moment to think what is in the best interest of the American people. I hope that on this amendment we can come together. Senator Kerrey's amendment is one that I offered in the committee. It was defeated along party lines. But I understand committees. That is the way it goes. But I don't understand how we are doing this on the floor of the Senate because, first of all, we are advocating continuity of care. What does that mean? It means just because your boss changes insurance companies, you don't have to change your doctor. It also means if your physician is pushed out of a network, you are not pushed aside from seeing that physician. Why is this important? It is important because doctors are not interchangeable. The hallmark of getting well and staying well is the relationship between a doctor and a patient. We have known this throughout history. This is nothing new. This goes back to Hippocrates and the earliest basis of medicine. Your doctor knows you as a person-- not as a chart or a lab test. Your doctor knows you, your history, your family's history. Your doctor knows what is best for you and how to act in the most prudent way in regard to what is medically necessary or medically appropriate or medically indicated. Why is this important? There are those who will say this will cost too much. I say, if we don't have it, it will be penny-wise and pound-foolish. If you are dumped from seeing the doctor you currently have and you have to start all over again, that doctor is going to have to take a complete physical. The doctor is going to have to take complete tests and in many instances start all over with you. Diabetes is treatable and diabetes is manageable, but if you are a diabetic and go to a new doctor, that doctor has to know you and your history and your family history, and start again with complicated tests and complicated evaluations. That is penny-wise and pound-foolish. You should stick with your own doctor, or at least come up with a transition plan. What about the terminally ill? This amendment Senator Kerrey has offered says if you are terminally ill, or your family member, or your child, is terminally ill, you get to keep your doctor. What happens if your child has a terminal illness? You are struggling with this illness. Imagine being a father wanting to be at the bedside of a child who is terminally ill. Instead he is in the other room calling an insurance company finding out if his son's doctor is in his new plan's network because the company he works for has changed HMOs. So he is up there not talking to the doctor about his son, or not even talking to his son, but trying to figure this out. I think that is cruel. I think it is cruel and unusual punishment. What happens if you are recovering from a stroke and you are in a rehabilitation hospital? Under the Kerrey-Mikulski amendment, you will get to keep your doctor during that rehabilitation, so you can return and not be having to try to find out who your physician is going to be. What happens if you have been admitted to a mental hospital for an acute psychiatric episode and you have chronic schizophrenia, but you also have a physician who has been treating you, who knows you, and in those 90 days you have to change doctors just when you are trying to get your mental health back again? This is what we are talking about--continuity of care, so for those undergoing an active course of treatment and for all Americans who have insurance you would get at least 90 days to come up with a transition plan. But in three categories--if you are terminally ill; also if you are within an institution or facility; or if you are pregnant--you get to keep your doctor for a longer period. We think this is what should happen. This isn't just Barbara Mikulski making this up. I will submit a letter from the Consortium of Citizens with Disabilities. These are people who strongly support the Kerrey-Mikulski amendment. This is what they say: Protecting continuity of care is not some wonky technicality. It will have a real impact on the quality of care for many people with disabilities and anyone who is undergoing active treatment. Consider for a moment what could happen to a child with cerebral palsy if their parent's employer changed health plans and there was no opportunity to adequately plan a transition to new plan and new providers. It can be assumed this child would be receiving ongoing physical therapy. This could be potentially expensive and exhausting for the family. There may be a variety of other reasons for this. I ask unanimous consent that this letter be printed in the Record.

Ms. MIKULSKI. Mr. President, we have letters from parents. We have letters from advocacy groups that say in the United States of America when you get health care it shouldn't have term limits on it. I yield the floor.

Ms. MIKULSKI

Ms. MIKULSKI. Mr. President, I say to my colleagues in the Senate and to those listening everywhere, I rise to congratulate the U.S. Air Force on their gallantry and their bravery in risking their lives to take much-needed medicine to a woman who is now a scientist working in Antarctica on a National Science Foundation expedition. This woman recently discovered a lump in her breast and needs medical treatment. She cannot leave Antarctica until the middle of October because of the horrendous weather conditions. She can't get out and nobody can get to her. But God bless the U.S. Air Force. They were willing to step forward at great risk to themselves to take the much- needed medicine, and at a very specific moment, drop the six packages that will be able to provide her with treatment, through the genius of telemedicine. Imagine the terror of a woman who discovers a lump in her breast. Imagine if this lump is discovered while you are serving at a remote research station on the South Pole, which is completely inaccessible during many months of the year. A plane has never landed on the South Pole during the winter. So how could she hope to get the medical supplies she needed for treatment? This is the situation faced by a woman serving at the National Science Foundation's Amundsen-Scott research station at the South Pole. She could neither leave the station nor expect outside help until October. We all know when a lump is discovered, immediate treatment is essential. That is part of what we have been arguing about. But guess what. This is when our U.S. Air Force became involved. We are all so proud of what they do to protect America's values and interests around the world. Most recently, they were successful in ending genocide and ethnic cleansing in Kosovo. But on this mission to the South Pole, they were called on to act as humanitarians. Flying from New Zealand, the 23-person crew had to fly their aircraft for nearly a 7,000-mile round trip. They had limited visibility. They had to make their drop with great precision--since the medicine and equipment could not be exposed to the harsh conditions for more than a few minutes. Personnel on the ground also showed great skill and courage. They came outside in 70-below degree weather to plot the drop site with a great big letter ``C'' so the supplies could be dropped in the right spot, and they could be there at the right time to get it. All Americans were awed by their skill and bravery. It was led by Major Greg Pike and his crew. They made their drop successfully, returned safely, and the supplies are now being used. For those of us who saw the news, we know the U.S. Air Force risked themselves because if that plane ran into difficulty, they were at a point of no return. When they opened up the plane to be able to drop this much-needed medicine, they had to put special gear on because they themselves were facing temperatures at 150 degrees below zero. But they did it because they had the ``right stuff'' to make sure she had the right medicine. I tell you, it was quite a moment to see. Those great guys also sent her a bouquet of flowers and pictures of themselves and their families. Mr. President, this also reminds us of the bravery of our National Science Foundation staff who have also worked in very difficult conditions to conduct the important scientific research. We say to her, to the lady in the Antarctic, if she can watch us on C-SPAN: God bless you. We are pulling for you, and we say here in the Senate, God bless the U.S. Air Force. I yield the floor.

Ms. MIKULSKI

Ms. MIKULSKI. Mr. President, we are at a fork in the road today. We are at a fork in the road to show whether we really are engaged in a debate over partisan politics or whether we are engaged in a debate over how we can best help patients in the United States of America. I urge my colleagues, in the situation we now find ourselves, to put partisan politics aside and reach out to what is in the best interests of patients, what is in the best interests of the people of the United States of America. That is why I think the suggestion of taking the Snowe amendment and attaching it to the Dodd amendment would show the American people that in this debate, at this time, at this moment, we are willing to put patients above politics. That is what I hope we can do. There is much to be commended in the Snowe amendment. It is a very good amendment. I congratulate the Senator from Maine on this amendment. I would so like to support it. Unfortunately, it knocks out the Dodd amendment providing patients with access to clinical trials. The Senator from Maine has had a longstanding reputation of really being an advocate for providing access to clinical trials. I recall with great fondness our battles, going back to the days in the House of Representatives, when she and Congresswoman Schroeder cochaired the women's caucus. We fought to get women included in the clinical trials at NIH. The Senator from Maine and all others will recall when we were systematically excluded. We worked together on a bipartisan basis when she came to the Senate. Working with her, Congresswoman Morella, and Congresswoman Schroeder, we were able to literally call NIH's bluff on their shallow and unscientific reasons for not including women in clinical trials. When President Bush appointed Bernadine Healy as head of NIH, Senator Kennedy and I worked to establish the Office of Women's Health at NIH, and now women are included in the clinical trials. What a hollow victory it will be today if we deny them the access to the very clinical trials we fought so hard to open up for women. I am sorry we have come to this. At this fork in the road, let's not make another fork in the road over partisan politics. We can show the American people that we really want to be concerned about patients. We have done it before. We have done it with the people in this room. Some of the greatest pleasures and joys of my life have been working on a bipartisan basis, opening up clinical trials and establishing quality standards for mammograms. So I am going to offer one more opportunity, and I plead with my colleagues to allow this to happen. I want to have the Snowe amendment attached to the Dodd amendment. Therefore, I ask unanimous consent that S. 1344, the Daschle substitute amendment, be modified with language from the Snowe amendment, No. 1241, prohibiting drive-through mastectomies and requiring coverage for second opinions.

Ms. MIKULSKI

Ms. MIKULSKI. Mr. President, I rise today to continue the discussion of the Patients' Bill of Rights and lend my voice to the Graham amendment for access to emergency care without penalty by an HMO when any prudent person presents their symptoms. Before I do that, I congratulate the Senator from Rhode Island for his most eloquent and insightful remarks. For my colleagues, the Senator from Rhode Island has devoted his life to protecting the lives of Americans. As a West Point graduate serving in the U.S. military, he did that abroad, and now he does it in the Senate Chamber standing up for America's children. I thank him for his devotion and his gallantry. I am happy to be an able member of the Reed platoon. I am pleased today to join with Senator Bob Graham and other colleagues in speaking out about the people who go to an emergency room and want to be treated for their symptoms without fear of not having their visit covered by their HMO. When it comes to emergency care, people are afraid of both the symptoms they face as well as being denied coverage by their insurance company. ``ER'' is not just a TV show; it is a real-life situation which thousands of Americans face every day. Yet I hear countless stories from friends and neighbors and constituents, as well as from talking to ER docs in my own State, who tell me they are afraid to see their doctor or take their child or parent to the emergency room because they will not be reimbursed and will be saddled with debt. Patients must be covered for emergency visits that any prudent person would make. That means if they have symptoms that any prudent person says could constitute a threat to their life and safety, they should be reimbursed. The prudent layperson standard is at the heart of this amendment. It is supported by the American College of Emergency Physicians which has stated that the way the Republican bill is written, it ``must be interpreted as constraints on a patient's use of the `prudent layperson' standard.'' The Republican bill only goes part way. We need to restore common sense to our health care system. Let me give an example, the case of Jackie, a resident of Bethesda, MD. She went hiking in the Shenandoah mountains. She lost her footing and fell off a 40-foot cliff. She had to be airlifted to a hospital. Thanks to our American medical system, she survived. After she regained consciousness and was being treated at the hospital for these severe injuries, Jackie learned that her HMO refused to pay her hospital bill because she did not get prior authorization. This is outrageous. Imagine falling off of a 40-foot cliff, waking up in a hospital and being told that your HMO will not cover your bills because you did not call while you were unconscious. In America, we think if you need emergency care, you should be able to call 911, not your HMO's 800 number. Incredibly, some of my colleagues in the Senate say that all these stories are anecdotes and they are horror stories. These are not anecdotes. We are talking about people's lives. If you would come with me to the emergency rooms at Johns Hopkins Hospital, the University of Maryland, Salisbury General on a major highway on the Eastern Shore, all over the State, you would learn that many people come to the ER because of not only accidents but they are experiencing symptoms where they wonder if their life could be threatened or the life of their child. The child is having acute breathing, and you do not know if that child is having an undetected asthma attack; or a man sitting at Oriole Park suddenly has shortness of breath, pains in his left side and leaves to go to the ER at the University of Maryland next to Camden Yards. Should they call 911 or should they call 800 HMO? I think they should call 911, and they should worry about themselves and their family and not about reimbursement. So when we come to a vote, I really hope that we will pass the Graham amendment. The Republicans say they have an alternative. But it does not guarantee that a patient can go to the closest emergency room without financial penalty. Do not forget, it covers only 48 million Americans; it leaves out 113 million other Americans. Let's do the right thing. Let's make sure that patients with insurance cannot be saddled with huge bills after emergency treatment. I thank the Senate and yield the floor.

Ms. MIKULSKI

Ms. MIKULSKI. I thank the Chair. Mr. President, I thank Senator Robb and Senator Kennedy for their support of this very crucial legislation. We, the women of the Senate, really turn to men we call the ``Galahads,'' who have stood with us and been advocates on very important issues concerning women's health. Often we have had bipartisan support. I ask today that the good men on the other side of the aisle come together and support the Robb amendment. We have raced for the cure together. We have done it on a bipartisan basis. Certainly, today we could pass this amendment. I challenge the other party to vote for this amendment because what it will do is absolutely save lives and save misery. There are many things that a woman faces in her life, but one of the most terrible things that she fears is that she will go to visit her doctor and find out from her mammogram and her physician that she has breast cancer. The worst thing after that is that she needs a mastectomy. Make no mistake, a mastectomy is an amputation, and it has all of the horrible, terrible consequences of having an amputation. Therefore, when the woman is told she can come in and only stay a few hours--after this significant surgery that changes her body, changes the relationships in her family, she is told she is supposed to call a cab and go back home; it only adds to the trauma for her. Well, the Robb amendment, which many of us support, really says that it is the doctor and the patient that decides how long a woman should stay in the hospital after she has had the surgery. Certainly, we should leave this to the doctor and to the patient. An 80 year old is different than a 38 year old. This legislation parallels the D'Amato legislation that had such tremendous support on both sides of the aisle. I say to my colleagues, if we are going to race for the cure, let's race to support this amendment. Mr. REID addressed the Chair.

Ms. MIKULSKI

Ms. MIKULSKI. Mr. President, what does a woman do in a few days before she is scheduled to have a mastectomy? How should she spend her time? What should she be doing? Should she be on the phone calling her HMO, trying to figure out what will happen to her after surgery? Who will take care of her, how long will she be in the hospital? Should she be on the phone, dealing with bureaucracy? Should she be dealing with paperwork? Should she be on the phone, dealing with an insurance gatekeeper? No, I do not think that is what she should be doing and I think the Senate will agree with me. I think she should be with her family. I think she should be talking with her husband, because he is as scared as she is. He is terrified that she might die. He is wondering how can he support her when she comes home. She needs to talk to her children so that they understand that even though she is going in for an operation, they know their mother will be there when she comes back home but she might not be quite the same. She needs to be with her family. She needs to be with her clergyman. She needs to be with those who love her and support her. This is what we are voting on here today. Who should be in charge of this decision? When a woman has a mastectomy she needs to recover where she can recover best. That should be decided by the doctor and the patient. We hear about these drive through mastectomies, where women are in and out in outpatient therapy. They are dumped back home, often sent home still groggy with anesthesia, sometimes with drainage tubes still in place or even at great risk for infection. Make no mistake, we cannot practice cookbook medicine and insurance gatekeepers cannot give cookbook answers. An 80-year-old woman who needs a mastectomy needs a different type of care than a 38-year-old woman. And a 70-year-old woman whose spouse himself may be 80 might have different family resources than a 40-year-old woman. Even the board of directors of the American Association of Health Plans states this: ``. . . the decision about whether outpatient or inpatient care meets the needs of a woman undergoing removal of a breast should be made by the woman's physician after consultation with the patient.'' As I said earlier, we go out there and we Race for the Cure. Now we have to race to support this amendment. Let's look at what we have done with our discoveries. We in America have discovered more medical and scientific breakthroughs than any other country in world history. It is America who knew how to handle infectious diseases. It is America who comes up with lifesaving pharmaceuticals. We have been working together on a bipartisan basis to double the NIH budget. We have joined together on a bipartisan basis to have mammogram quality standards for women. Now we have to join together on a bipartisan basis and pass this amendment. We must continue our discovery, we must continue our research, and we must continue to make sure that we have access to the discoveries we have made. This is what this amendment is all about. It allows a woman and her physician to make this decision. Some time ago very similar legislation was offered by the former Senator of New York, Mr. D'Amato. People on the other side of the aisle had cosponsored this bill. What we are saying here is, if you cosponsored it under Senator D'Amato, vote for it under the Robb- Mikulski-Boxer-Murray amendment. This should not be about partisan politics. Let's put patients first. Let's understand what is going to happen to a woman. Let's understand what is going to happen to her family. And let the doctors decide. I told my colleagues a few weeks ago--I recalled a few months ago I had gall bladder surgery. I could stay overnight because it was medically necessary and medically appropriate. Surely if I can stay overnight for gall bladder surgery a woman should be able to stay overnight when she has had a mastectomy. I yield the floor.

Ms. MIKULSKI

Ms. MIKULSKI. Mr. President, I rise today to reflect on the passing of a truly remarkable woman: Washington Post Editorial Page Editor Meg Greenfield. A tough, tenacious and trailblazing woman, Ms. Greenfield had a sharp intellect, a vibrant sense of humor, and a keen political instinct. Meg Greenfield was at the center of many of Washington's intellectual, cultural and political developments in the past three decades. Her fiercely independent eye for news gave her the ability to cultivate relationships with individuals from every political, cultural and economic background. Her insightful portraits of life in our nation's capital were profound and memorable. Ms. Greenfield forever changed the access and acceptance women have in the field of journalism. She astutely examined tough issues such as global disarmament and international affairs which were traditionally seen as ``male'' issues. She commanded respect and demanded fairness and impartiality from her staff. In 1978, Ms. Greenfield moved the world with her commentary on issues of international affairs, civil rights and the press. For her efforts she claimed the much coveted Pulitzer Prize for editorial writing. One year later, she moved into the post of Editor for the Washington Post editorial page. A responsibility she undertook with dignity, grace, a keen wit and what she would call ``the sensibility of 1950s liberals-- conservative on foreign policy and national defense, but liberal on social issues'' for over 20 years. For these and many other reasons I admired Meg Greenfield and her vastly important work. She also played a critical role in my own career. When I ran for the United States Senate, I met with the Washington Post editorial board, and I had heard about the tough, no- nonsense Meg Greenfield. I was very impressed with her, and she believed in me and my ideas for Maryland. The endorsement I received from the Washington Post in the 1986 Democratic primary was a turning point in the campaign. I was running against two very good friends of mine: the terrific Congressman from Montgomery County, Mike Barnes, and Maryland's Governor Harry Hughes. The confidence and support I received from Meg Greenfield and the Post editorial board gave me pride and momentum, and helped lead me to victory. Meg Greenfield's colleagues at the editorial page wrote the day after her death, ``The anonymity typical of editorial pages could not disguise the hand of Meg Greenfield. As a writer her work was often instantly recognizable . . . for its felicity and stateliness and not least for its wry and mischievous humor. As an editor she imprinted her special blend of a wise skepticism and a reach for the public good on a long generation of Post editorials.'' In this tribute, they describe not only her as the consummate professional, but as the wonderful and caring woman that she was. Meg Greenfield will be dearly missed in the many circles of Washington life. Her spirit and legacy will inspire us for years to come.

Ms. MIKULSKI

Ms. MIKULSKI. I thank the Chair.

Ms. MIKULSKI

Ms. MIKULSKI. Mr. President, I rise in strong opposition to the amendment offered by Senator DeWine. The bill reported by the Senate Appropriations Committee would enable federal employees, whose health insurance is provided under the Federal Employees Health Benefits Plan, to receive coverage for abortion services. The DeWine amendment would prohibit coverage for abortion, except in cases of life endangerment, rape or incest. It would continue a ban which has prevented federal employees from receiving a health care service which is widely available for private sector employees. I oppose this Amendment for two reasons. First of all, it is an assault on the earned benefits of federal employees. Secondly, it is part of a continuing assault on women's reproductive rights and would endanger women's health. We have seen vote after vote designed to roll back the clock on women's reproductive rights. Every year, on this Appropriations measure and on many others, the assault on a woman's constitutional right to decide for herself whether or not to have a child continues. This amendment continues that assault. Well, I support the right to choose. And I support federal employees. And that is why I strenuously oppose this amendment. Let me speak first about our federal employees. Some 280,000 federal employees live in the State of Maryland. I am proud to represent them. They are the people who make sure that the Social Security checks go out on time. They make sure that our nation's veterans receive their disability checks. At NIH, they are doing vital research on finding cures and better treatments for diseases like cancer, Parkinson's and Alzheimers. There is no American whose life is not touched in some way by the hard work of a federal employee. They deserve our thanks and our support. Instead, federal employees have suffered one assault after another in recent years. They have faced tremendous employment insecurity, as government has downsized, and eliminated over 200,000 federal jobs. Their COLAs and their retirement benefits have been threatened. They have faced the indignity and economic hardship of three government shutdowns. Federal employees have been vilified as what is wrong with government, when they should be thanked and valued for the tremendous service they provide to our country and to all Americans. I view this amendment as yet another assault on these faithful public servants. It goes directly after the earned benefits of federal employees. Health insurance is part of the compensation package to which all federal employees are entitled. The costs of insurance coverage are shared by the federal government and the employee. I know that proponents of continuing the ban on abortion coverage for federal employees say that they are only trying to prevent taxpayer funding of abortion. But that is not what this debate is about. If we were to extend the logic of the argument of those who favor the ban, we would prohibit federal employees from obtaining abortions using their own paychecks. After all, those funds also come from the taxpayers. But no one is seriously suggesting that federal employees ought not to have the right to do whatever they want with their own paychecks. And we should not be placing unfair restrictions on the type of health insurance federal employees can purchase under the Federal Employee Health Benefit Plan. About 1.2 million women of reproductive age depend on the FEHBP for their medical care. We know that access to reproductive health services is essential to women's health. We know that restrictions that make it more difficult for women to obtain early abortions increase the likelihood that women will put their health at risk by being forced to continue a high-risk pregnancy. If we continue the ban on abortion services, and provide exemptions only in cases of life endangerment, rape or incest, the 1.2 million women of reproductive health age who depend on the FEHBP will not have access to abortion even when their health is seriously threatened. We will be replacing the informed judgement of medical care givers with that of politicians. Decisions on abortion should be made by the woman in close consultation with her physician. These decisions should be made on the basis of medical judgement, not on the basis of political judgements. Only a woman and her physician can weigh her unique circumstances and make the decision that is right for that particular woman's life and health. It is wrong for the Congress to try to issue a blanket prohibition on insuring a legal medical procedure with no allowance for the particular set of circumstances that an individual woman may face. I deeply believe that women's health will suffer if we do so. I believe it is time to quit attacking federal employees and their benefits. I believe we need to quit treating federal employees as second class citizens. I believe federal employees should be able to receive the same quality and range of health care services as their private sector counterparts. Because I believe in the right to choose and because I support federal employees, I urge my colleagues to join me in defeating the DeWine Amendment.

Ms. MIKULSKI

Ms. MIKULSKI. Mr. President, our foreign policy must reflect our values. That's why I oppose the Silk Roads Strategy Act amendment. The sponsors of this legislation say that we should build stronger ties with the nations of the South Caucasus and Central Asia. I agree. We must promote peace, democracy and economic growth in this important region. But to do this, we can't ignore basic human rights or fundamental American values. The Silk Roads Strategy Act would enable the President to waive Section 907 of the Freedom Support Act. Section 907 prohibits most direct American aid to Azerbaijan until it takes demonstrable steps to cease all blockades against Armenia and Nagorno-Karabakh. Section 907 has been modified in recent years to enable humanitarian aid and aid provided by the Overseas Private Investment Corporation, the Trade Development Agency and the Export Import Bank. Yet Azerbaijan has done nothing to end the embargo and has been recalcitrant in the OSCE peace process. American foreign aid is not an entitlement. We have a right to place conditions on our assistance. We have a right to demand that countries receiving US aid live up to certain basic humanitarian standards. For almost ten years, Azerbaijan has maintained a blockade of Armenia. This blockade prevents the delivery of basic human needs-- including food, medicine and fuel. What does this mean for the people of Armenia and Nagorno-Karabakh? It means terrible human suffering. It means a high infant mortality rate and poor maternal health. It means hunger. It means shortages of the basic needs of life--food, medicine and energy. Senator McConnell has offered a second degree amendment that would maintain Section 907. This is a reasonable approach. The McConnell amendment would enable us to strengthen relations with the Caucasus-- without compromising our values. I urge my colleagues to join me in supporting the McConnell amendment--and in opposing the Silk Roads Strategy Act. silk road strategy act of 1999

Ms. MIKULSKI

Ms. MIKULSKI. Mr. President, I ask unanimous consent that I be allowed to speak in morning business for no more than 5 minutes.

Ms. MIKULSKI. I ask unanimous consent that I be allowed to speak as if in morning business for no more than 5 minutes.

Ms. MIKULSKI

Ms. MIKULSKI. I thank the whip from the Democratic side, and I also thank the Senator from Oklahoma for his graciousness.

Ms. MIKULSKI

Ms. MIKULSKI. Mr. President, I come here today to talk about something that is very compelling to the women of this country; that is, the Patients' Bill of Rights. The Patients' Bill of Rights is a women's issue, because it is the women of America's families who often make the decisions that are very important in terms of the health care of their family. They are the ones who often read the fine print of insurance documents. They fill out the paperwork in order to make sure their children have access to the health care they need. They are often the ones on the front line either trying to get health insurance for their families or also ensuring they have the best benefit package. But, guess what. When it comes down to them getting the health care they need, they are often denied it. They are often denied having access to an OB/GYN who is the primary care provider for most American women, because they are called ``a specialist.'' Also, when they face a tremendous problem in their lives, such as a mastectomy, they are often denied the time they need to get the care they need because of the insurance gatekeepers. We call this the drive- by mastectomy situation. We call it a drive-by mastectomy, because a procedure is performed on a woman, she is driven to the hospital, and she is driven out of the hospital--sometimes within hours. What is a mastectomy? Make no mistake, the term ``mastectomy'' is a technical term. But what it really means to a woman is that it is a breast amputation with all of the horror, terror, and trauma that an amputation brings out. When one faces such a horrific procedure, certainly you should have the kind of care you need. And that should be decided by the doctor and the patient--not by an insurance gatekeeper. What does a mastectomy mean? For every woman in the United States of America, the one phrase that she is terrified to hear is: You have breast cancer. The next phrase that she is terrified to hear is: It has gone so far that we have to do a mastectomy. It is traumatic for her, because it is not only body altering, but it is family altering, and it is relationship altering. When one looks at one woman facing a mastectomy, she needs to discuss this with her spouse. He is as scared as she is. He is terrified that she is going to die. He is terrified about how he can support her when she comes home from the hospital. And then they know they have to sort out a relationship under such difficult situations. When a woman has a mastectomy, they need to recover where they recover best. That is decided by the doctor and the patient. Women are sent home still groggy from anesthesia and sometimes with drainage tubes still in place, with infection, and are not sure if that is the right place. Make no mistake. We can't practice cookbook medicine. Insurance gatekeepers can't give cookbook answers. An 80-year-old who needs a mastectomy needs a different kind of care than a 38-year-old woman. We go out there, and we race for the cure. I think it is wonderful. We do it on a bipartisan basis. But if we find the cures, we need access to the clinical trials. It is being denied in the Republican Patients' Bill of Rights. We need to be able to talk to our own OB/GYN. That is called ``a specialist''; we can't do that. We need to have access to the care. This is the United States of America. We have discovered in this century more medical and scientific breakthroughs than any other century in American history. It is in America where we found how to handle infectious diseases. It is in America where we have come up with lifesaving pharmaceuticals. It is in America where we have had lifesaving new surgical techniques only to find that in America, though we invented something to save your life, we also invented insurance gatekeepers that prevent you from having access to those lifesaving mastectomies. This can't be so. If we are going to really take America into the 21st century, we must continue our discovery. We must continue our research, and we have to have access to our discoveries. The Republicans, through Senator D'Amato, offered legislation on drive-by mastectomies. When the Republicans offered their bill in the committee, it was strikingly absent. Senator Murray and other Members offered the D'Amato amendment. However, along party lines it was rejected, 10-8. Certainly what was good for D'Amato a year ago should be good now, at least to have the opportunity to debate this year. The Democratic alternative Senator Murray and other Members want to offer simply says that decisions should be made by the doctor in consultation with the patient. A few months ago I had gallbladder surgery. I could stay overnight for my gallbladder surgery because it was medically necessary and medically appropriate. Surely if I can stay overnight for gallbladder surgery, a woman should be able to stay overnight if she has had a mastectomy. I yield the floor.

Ms. MIKULSKI

Ms. MIKULSKI. Mr. President, I rise today in support of General Eric K. Shinseki's appointment as the Army's thirty-fourth Chief of Staff. As a highly decorated officer and a dedicated member of our nation's Armed Forces, I know that General Shinseki will prove to be a valuable member of the Joint Chiefs of Staff. In his thirty-three years of service, General Shinseki has served the Armed Forces in both the continental United States and overseas. He served in the United States Army Hawaii, as well as at Fort Shafter with Headquarters, United States Army-Pacific. From March 1994 to July 1995, General Shinseki was the Executive Officer of the 1st Squadron of the 3rd Armored Cavalry Regiment at Fort Bliss, Texas. From August 1997 until November 1998, Shinseki was the Commanding General of the United States Army-Europe and 7th army. He concurrently led NATO soldiers as the Commander of the Allied Land Forces Central Europe in Germany. Additionally, General Shinseki has served as Commander of the Stabilization Force in Bosnia-Herzegovina, and as the Army's Vice Chief of Staff. As my colleagues know, I am a strong supporter of our men and women in uniform. I understand the difficult sacrifices they make every day in defense of our country--and our ideals. I honor the hard work and commitment that sacrifice demands. Just as they fight for us, I fight for them and federal policies that support them. As a result of General Shinseki's military service, he has earned the Defense Distinguished Service Medal, a Legion of Merit with oak leaf cluster, a Bronze Star Medal with ``V'' Device and two oak leaf clusters, a Purple Heart Award with oak leaf cluster, and a Meritorious Service Medal with two oak leaf clusters. Mr. President, I know that General Eric K. Shinseki will be an instrumental contributor to the Joint Chiefs of Staff. Throughout his career he has shown his capability as a leader. His leadership and his military successes will help him to succeed as the new Army Chief of Staff. I look forward to working with him on the restructuring of TECOM to ensure that Aberdeen remains the home of Army testing. I am happy to know that General Shinseki shares the Maryland delegation's view of how important Aberdeen Proving Ground is to the Army, Maryland, and the United States. I wish General Shinseki the best in his new position.