Barbara Mikulski

Ms. MIKULSKI

Ms. MIKULSKI. Mr. President, I rise today to introduce the Administration's proposal to reauthorize the Older Americans Act (OAA). The Older Americans Act is a vital program that meets the day-to-day needs of our nation's seniors. Through an aging network that involves 57 state agencies on aging, 660 area agencies on aging, and 27,000 service providers, the OAA provides countless services to our country's older Americans. The OAA was last reauthorized in 1992 and its authorization expired in 1995. The time is long overdue for Congress to reauthorize this program. That is why, as the Ranking Democrat on the Subcommittee on Aging, I am working with the Chairman of the Subcommittee to introduce a bipartisan bill in the Senate to reauthorize the OAA. That's why I am here today to introduce the Administration's plan to reauthorize the Act as a courtesy and to remind my fellow colleagues about the importance of passing an OAA reauthorization bill. Many Americans have not heard of the Older Americans Act. They've probably heard of Meals on Wheels and maybe they know about the senior center down the street. But our country's seniors who count on the services provided under the Act couldn't do without them. Whether it's congregate or home delivered meals programs, legal assistance, the long-term care ombudsman, information and assistance, or part-time community service jobs for low-income seniors. This Act covers everything from transportation to a doctor's appointment to a hot meal and companionship at a local senior center to elder abuse prevention. But we're not going to just settle for the status quo. We must make the most of this opportunity to modernize and improve the OAA to meet the needs of seniors. That's why I'm including the National Family Caregiver Support Program in this bill I'm introducing today. Through a partnership between states and area agencies on aging, this program will provide information about resources available to family caregivers; assistance to families in locating services; caregiver counseling, training, and peer support to help them deal with the emotional and physical stresses of caregiving; and respite care. We must get behind our nation's caregivers by helping those who practice self-help. Caregivers often put in a 36 hour day: taking care of the family, pursuing a career, caring for the senior who needs care, and finding the information on care and putting together a support system. We need to support those who are providing this invaluable care. I want to reauthorize the OAA this year before the new millennium when our population over age 65 will more than double. I'm pleased that our colleagues in the House are moving in this direction as well. I urge my colleagues here in the Senate to act promptly once a bill is voted out of committee and support our nation's seniors by reauthorizing the Older Americans Act.

Ms. MIKULSKI

Ms. MIKULSKI. Mr. President, I rise today to introduce the ``Seniors' Access to Continuing Care Act of 1999'', a bill to protect seniors' access to treatment in the setting of their choice and to ensure that seniors who reside in continuing care communities, and nursing and other facilities have the right to return to that facility after a hospitalization. As our population ages, more and more elderly will become residents of various long term care facilities. These include independent living, assisted living and nursing facilities, as well as continuing care retirement communities (CCRCs), which provide the entire continuum of care. In Maryland alone, there are over 12,000 residents in 32 CCRCs and 24,000 residents in over 200 licenced nursing facilities. More and more individuals and couples are choosing to enter continuing care communities because of the community environment they provide. CCRC's provide independent living, assisted living and nursing care, usually on the same campus--the Continuum of Care. Residents find safety, security and peace of mind. They often prepay for the continuum of care. Couples can stay together, and if one spouse needs additional care, it can be provided right there, where the other spouse can remain close by. Most individuals entering a nursing facility do so because it is medically necessary, because they need a high level of care that they can no longer receive in their homes or in a more independent setting, such as assisted living. But residents are still able to form relationships with other residents and staff and consider the facility their ``home''. I have visited many of these facilities and have heard from both residents and operators. They have told me about a serious and unexpected problem encountered with returning to their facility after a hospitalization. Hospitalization is traumatic for anyone, but particularly for our vulnerable seniors. We know that having comfortable surroundings and familiar faces can aid dramatically in the recovery process. So, we should do everything we can to make sure that recovery process is not hindered. Today, more and more seniors are joining managed care plans. This trend is likely to accelerate given the expansion of managed care choices under the 1997 Balanced Budget Act. As more and more decisions are made based on financial considerations, choice often gets lost. Currently, a resident of a continuing care retirement community or a nursing facility who goes to the hospital has no guarantee that he or she will be allowed by the managed care organization (MCO) to return to the CCRC or nursing facility for post acute follow up care. The MCO can dictate that the resident go to a different facility that is in the MCO network for that follow up care, even if the home facility is qualified and able to provide the needed care. Let me give you a few examples: In the fall of 1996, a resident of Applewood Estates in Freehold, New Jersey was admitted to the hospital. Upon discharge, her HMO would not permit her to return to Applewood and sent her to another facility in Jackson. The following year, the same thing happened, but after strong protest, the HMO finally relented and permitted her to return to Applewood. She should not have had to protest, and many seniors are unable to assert themselves. A Florida couple in their mid-80's were separated by a distance of 20 miles after the wife was discharged from a hospital to an HMO- participating nursing home located on the opposite side of the county. This was a hardship for the husband who had difficulty driving and for the wife who longed to return to her home, a CCRC. The CCRC had room in its skilled nursing facility on campus. Despite pleas from all those involved, the HMO would not allow the wife to recuperate in a familiar setting, close to her husband and friends. She later died at the HMO nursing facility, without the benefit of frequent visits by her husband and friends. Collington Episcopal Life Care Community, in my home state of Maryland, reports ongoing problems with its frail elderly having to obtain psychiatric services, including medication monitoring, off campus, even though the services are available at Collington--how disruptive to good patient care! On a brighter note, an Ohio woman's husband was in a nursing facility. When she was hospitalized, and then discharged, she was able to be admitted to the same nursing facility because of the Ohio law that protected that right. Seniors coming out of the hospital should not be passed around like a baton. Their care should be decided based on what is clinically appropriate, NOT what is financially mandated. Why is that important? What are the consequences? Residents consider their retirement community or long term care facility as their home. And being away from home for any reason can be very difficult. The trauma of being in unfamiliar surroundings can increase recovery time. The staff of the resident's ``home'' facility often knows best about the person's chronic care and service needs. Being away from ``home'' separates the resident from his or her emotional support system. Refusal to allow a resident to return to his or her home takes away the person's choice. All of this leads to greater recovery time and unnecessary trauma for the patient. And should a woman's husband have to hitch a ride or catch a cab in order to see his recovering spouse if the facility where they live can provide the care? NO. Retirement communities and other long term care facilities are not just health care facilities. They provide an entire living environment for their residents, in other words, a home. We need to protect the choice of our seniors to return to their ``home'' after a hospitalization. And that is what my bill does. It protects residents of CCRC's and nursing facilities by: enabling them to return to their facility after a hospitalization; and requiring the resident's insurer or MCO to cover the cost of the care, even if the insurer does not have a contract with the resident's facility. In order for the resident to return to the facility and have the services covered by the insurer or MCO: 1. The service to be provided must be a service that the insurer covers; 2. The resident must have resided at the facility before hospitalization, have a right to return, and choose to return; 3. The facility must have the capacity to provide the necessary service and meet applicable licensing and certification requirements of the state; 4. The facility must be willing to accept substantially similar payment as a facility under contract with the insurer or MCO. My bill also requires an insurer or MCO to pay for a service to one of its beneficiaries, without a prior hospital stay, if the service is necessary to prevent a hospitalization of the beneficiary and the service is provided as an additional benefit. Lastly, the bill requires an insurer or MCO to provide coverage to a beneficiary for services provided at a facility in which the beneficiary's spouse already resides, even if the facility is not under contract with the MCO, provided the other requirements are met. In conclusion, Mr. President, I am committed to providing a safety net for our seniors--this bill is part of that safety net. Seniors deserve quality, affordable health care and they deserve choice. This bill offers those residing in retirement communities and long term care facilities assurance to have their choices respected, to have where they reside recognized as their ``home'', and to be permitted to return to that ``home'' after a hospitalization. It ensures that spouses can be together as long as possible. And it ensures access to care in order to PREVENT a hospitalization. I want to thank my cosponsors Senators Dodd, Hollings, Jeffords, Kennedy, Murray and Wellstone for their support. I urge my colleagues to join me in passing this important measure to protect the rights of seniors and their access to continuing care.

Ms. MIKULSKI

Ms. MIKULSKI. Mr. President, I rise today to introduce the ``Seniors' Access to Continuing Care Act of 1999'', a bill to protect seniors' access to treatment in the setting of their choice and to ensure that seniors who reside in continuing care communities, and nursing and other facilities have the right to return to that facility after a hospitalization. As our population ages, more and more elderly will become residents of various long term care facilities. These include independent living, assisted living and nursing facilities, as well as continuing care retirement communities (CCRCs), which provide the entire continuum of care. In Maryland alone, there are over 12,000 residents in 32 CCRCs and 24,000 residents in over 200 licenced nursing facilities. More and more individuals and couples are choosing to enter continuing care communities because of the community environment they provide. CCRC's provide independent living, assisted living and nursing care, usually on the same campus--the Continuum of Care. Residents find safety, security and peace of mind. They often prepay for the continuum of care. Couples can stay together, and if one spouse needs additional care, it can be provided right there, where the other spouse can remain close by. Most individuals entering a nursing facility do so because it is medically necessary, because they need a high level of care that they can no longer receive in their homes or in a more independent setting, such as assisted living. But residents are still able to form relationships with other residents and staff and consider the facility their ``home''. I have visited many of these facilities and have heard from both residents and operators. They have told me about a serious and unexpected problem encountered with returning to their facility after a hospitalization. Hospitalization is traumatic for anyone, but particularly for our vulnerable seniors. We know that having comfortable surroundings and familiar faces can aid dramatically in the recovery process. So, we should do everything we can to make sure that recovery process is not hindered. Today, more and more seniors are joining managed care plans. This trend is likely to accelerate given the expansion of managed care choices under the 1997 Balanced Budget Act. As more and more decisions are made based on financial considerations, choice often gets lost. Currently, a resident of a continuing care retirement community or a nursing facility who goes to the hospital has no guarantee that he or she will be allowed by the managed care organization (MCO) to return to the CCRC or nursing facility for post acute follow up care. The MCO can dictate that the resident go to a different facility that is in the MCO network for that follow up care, even if the home facility is qualified and able to provide the needed care. Let me give you a few examples: In the fall of 1996, a resident of Applewood Estates in Freehold, New Jersey was admitted to the hospital. Upon discharge, her HMO would not permit her to return to Applewood and sent her to another facility in Jackson. The following year, the same thing happened, but after strong protest, the HMO finally relented and permitted her to return to Applewood. She should not have had to protest, and many seniors are unable to assert themselves. A Florida couple in their mid-80's were separated by a distance of 20 miles after the wife was discharged from a hospital to an HMO- participating nursing home located on the opposite side of the county. This was a hardship for the husband who had difficulty driving and for the wife who longed to return to her home, a CCRC. The CCRC had room in its skilled nursing facility on campus. Despite pleas from all those involved, the HMO would not allow the wife to recuperate in a familiar setting, close to her husband and friends. She later died at the HMO nursing facility, without the benefit of frequent visits by her husband and friends. Collington Episcopal Life Care Community, in my home state of Maryland, reports ongoing problems with its frail elderly having to obtain psychiatric services, including medication monitoring, off campus, even though the services are available at Collington--how disruptive to good patient care! On a brighter note, an Ohio woman's husband was in a nursing facility. When she was hospitalized, and then discharged, she was able to be admitted to the same nursing facility because of the Ohio law that protected that right. Seniors coming out of the hospital should not be passed around like a baton. Their care should be decided based on what is clinically appropriate, NOT what is financially mandated. Why is that important? What are the consequences? Residents consider their retirement community or long term care facility as their home. And being away from home for any reason can be very difficult. The trauma of being in unfamiliar surroundings can increase recovery time. The staff of the resident's ``home'' facility often knows best about the person's chronic care and service needs. Being away from ``home'' separates the resident from his or her emotional support system. Refusal to allow a resident to return to his or her home takes away the person's choice. All of this leads to greater recovery time and unnecessary trauma for the patient. And should a woman's husband have to hitch a ride or catch a cab in order to see his recovering spouse if the facility where they live can provide the care? NO. Retirement communities and other long term care facilities are not just health care facilities. They provide an entire living environment for their residents, in other words, a home. We need to protect the choice of our seniors to return to their ``home'' after a hospitalization. And that is what my bill does. It protects residents of CCRC's and nursing facilities by: enabling them to return to their facility after a hospitalization; and requiring the resident's insurer or MCO to cover the cost of the care, even if the insurer does not have a contract with the resident's facility. In order for the resident to return to the facility and have the services covered by the insurer or MCO: 1. The service to be provided must be a service that the insurer covers; 2. The resident must have resided at the facility before hospitalization, have a right to return, and choose to return; 3. The facility must have the capacity to provide the necessary service and meet applicable licensing and certification requirements of the state; 4. The facility must be willing to accept substantially similar payment as a facility under contract with the insurer or MCO. My bill also requires an insurer or MCO to pay for a service to one of its beneficiaries, without a prior hospital stay, if the service is necessary to prevent a hospitalization of the beneficiary and the service is provided as an additional benefit. Lastly, the bill requires an insurer or MCO to provide coverage to a beneficiary for services provided at a facility in which the beneficiary's spouse already resides, even if the facility is not under contract with the MCO, provided the other requirements are met. In conclusion, Mr. President, I am committed to providing a safety net for our seniors--this bill is part of that safety net. Seniors deserve quality, affordable health care and they deserve choice. This bill offers those residing in retirement communities and long term care facilities assurance to have their choices respected, to have where they reside recognized as their ``home'', and to be permitted to return to that ``home'' after a hospitalization. It ensures that spouses can be together as long as possible. And it ensures access to care in order to PREVENT a hospitalization. I want to thank my cosponsors Senators Dodd, Hollings, Jeffords, Kennedy, Murray and Wellstone for their support. I urge my colleagues to join me in passing this important measure to protect the rights of seniors and their access to continuing care.

Ms. MIKULSKI

Ms. MIKULSKI. Mr. President, I rise today to introduce the ``Imported Food Safety Act of 1999.'' I am proud to be the sponsor of this important legislation which guarantees the improved safety of imported foods. The health of Americans is not something to take chances with. It is important that we make food safety a top priority. Every person should have the confidence that their food is fit to eat. We should be confident that imported food is as safe as food produced in this country. Cars can't be imported unless they meet U.S. safety requirements. Prescription drugs can't be imported unless they meet FDA standards. You shouldn't be able to import food that isn't up to U.S. standards, either. We import increasing quantities of fresh fruits and vegetables, seafood, and many other foods. In the past seven years, the amount of food imported into the U.S. has more than doubled. Out of all the produce we eat, 40% of it is imported. Our food supply has gone global, so we need to have global food safety. The impact of unsafe food is staggering. There have been several frightening examples of food poisoning incidents in the U.S. When Michigan schoolchildren were contaminated with Hepatitis A from imported strawberries in 1997, Americans were put on alert. Thousands of cases of cyclospora infection from imported raspberries--resulting in severe, prolonged diarrhea, weight loss, vomiting, chills and fatigue were also reported that year. Imported cantaloupe eaten in Maryland sickened 25 people. As much as $663 million was spent on food borne illness in Maryland alone. Overall, as many as 33 million people per year become ill and over 9000 die as a result of food borne illness. It is our children and our seniors who suffer the most. Most of the food-related deaths occur in these two populations. These incidents have scared us and have jump-started the efforts to do more to protect our nation's food supply. Now, I believe in free trade, but I also believe in fair trade. FDA's current system of testing import samples at ports of entry does not protect Americans. It is ineffective and resource-intensive. Less than 2% of imported food is being inspected under the current system. At the same time, the quantity of the imported foods continues to increase. What this law does is simple: It improves food safety and aims at preventing food borne illness of all imported foods regulated by the FDA. This bill takes a long overdue, big first step. First, it requires that FDA make equivalence determinations on imported food. This was developed with the FDA by Senator Kennedy and myself in consultation with the consumer groups. Today, FDA has no authority to protect Americans against imported food that is unsafe until it is too late. Last year, the GAO found that FDA lacks the authority to require that food coming into the U.S. is produced, prepared, packed or held under conditions that provide the same level of food safety protection as those in the U.S. This means that currently, food offered for import to the U.S., can be imported under any conditions, even if those conditions are unsanitary. The Imported Food Safety Act of 1999, will allow FDA to look at the production at its source. This means that FDA will be able to take preventive measures. FDA will be able to be proactive, rather than just reactive. That means that when you pack your childrens' lunches for school or sit down at the dinner table, you can rest assured that your food will be safe. Whether your strawberries were grown in a foreign country or on the Eastern Shore, in Maryland, those strawberries will be held to the same standard. You won't have to worry or wonder where your food is coming from. You won't have to worry that your children or families are going to get sick. You will know that the food coming into this country will be subject to equivalent standards. Secondly, this bill contains strong enforcement measures. Last year, the Permanent Subcommittee on Investigations, under the leadership of Senator Sue Collins, held numerous hearings on the safety of imported food. These enforcement measures are largely a product of those facts uncovered during those hearings. Senator Collins developed these enforcement provisions and introduced a bill which focuses on enforcement. I refer those with special interest in enforcement to also consider her bill. Finally, this bill covers emergency situations by allowing FDA to ban imported food that has been connected to outbreaks of food borne illness. When our children, parents and communities are getting seriously sick, the Secretary of Health and Human Services can immediately issue an emergency ban. We don't have to wait till someone else gets seriously sick or dies. We no longer have to go through the current bureaucratic mechanism that is inefficient and resource intensive. We can stop the food today, to protect our citizens. My goal is to strengthen the food supply, whatever the source of the food may be. This bill won't create trade barriers. It just calls for free trade of safe food. It calls for international concern and consensus on guaranteeing standards for public health. This bill is important because it will save lives and makes for a safer world. Everyone should have security in knowing that the food they eat is fit to eat. I'd like to thank FDA for their advice and consultation in developing this legislation. I also want to thank the Consumer Federation of America for their insight and recommendations. I look forward to working on a bipartisan basis to enact this legislation. I pledge my commitment to fight for ways to make America's food supply safer. This bill is an important step in that direction. Mr. President, I ask unanimous consent that the statement of Ms. Carol Tucker Foreman, Distinguished Fellow and Director of the Food Policy Institute, be printed in the Record.

Ms. MIKULSKI

Ms. MIKULSKI. Mr. President, I rise today to introduce the ``Imported Food Safety Act of 1999.'' I am proud to be the sponsor of this important legislation which guarantees the improved safety of imported foods. The health of Americans is not something to take chances with. It is important that we make food safety a top priority. Every person should have the confidence that their food is fit to eat. We should be confident that imported food is as safe as food produced in this country. Cars can't be imported unless they meet U.S. safety requirements. Prescription drugs can't be imported unless they meet FDA standards. You shouldn't be able to import food that isn't up to U.S. standards, either. We import increasing quantities of fresh fruits and vegetables, seafood, and many other foods. In the past seven years, the amount of food imported into the U.S. has more than doubled. Out of all the produce we eat, 40% of it is imported. Our food supply has gone global, so we need to have global food safety. The impact of unsafe food is staggering. There have been several frightening examples of food poisoning incidents in the U.S. When Michigan schoolchildren were contaminated with Hepatitis A from imported strawberries in 1997, Americans were put on alert. Thousands of cases of cyclospora infection from imported raspberries--resulting in severe, prolonged diarrhea, weight loss, vomiting, chills and fatigue were also reported that year. Imported cantaloupe eaten in Maryland sickened 25 people. As much as $663 million was spent on food borne illness in Maryland alone. Overall, as many as 33 million people per year become ill and over 9000 die as a result of food borne illness. It is our children and our seniors who suffer the most. Most of the food-related deaths occur in these two populations. These incidents have scared us and have jump-started the efforts to do more to protect our nation's food supply. Now, I believe in free trade, but I also believe in fair trade. FDA's current system of testing import samples at ports of entry does not protect Americans. It is ineffective and resource-intensive. Less than 2% of imported food is being inspected under the current system. At the same time, the quantity of the imported foods continues to increase. What this law does is simple: It improves food safety and aims at preventing food borne illness of all imported foods regulated by the FDA. This bill takes a long overdue, big first step. First, it requires that FDA make equivalence determinations on imported food. This was developed with the FDA by Senator Kennedy and myself in consultation with the consumer groups. Today, FDA has no authority to protect Americans against imported food that is unsafe until it is too late. Last year, the GAO found that FDA lacks the authority to require that food coming into the U.S. is produced, prepared, packed or held under conditions that provide the same level of food safety protection as those in the U.S. This means that currently, food offered for import to the U.S., can be imported under any conditions, even if those conditions are unsanitary. The Imported Food Safety Act of 1999, will allow FDA to look at the production at its source. This means that FDA will be able to take preventive measures. FDA will be able to be proactive, rather than just reactive. That means that when you pack your childrens' lunches for school or sit down at the dinner table, you can rest assured that your food will be safe. Whether your strawberries were grown in a foreign country or on the Eastern Shore, in Maryland, those strawberries will be held to the same standard. You won't have to worry or wonder where your food is coming from. You won't have to worry that your children or families are going to get sick. You will know that the food coming into this country will be subject to equivalent standards. Secondly, this bill contains strong enforcement measures. Last year, the Permanent Subcommittee on Investigations, under the leadership of Senator Sue Collins, held numerous hearings on the safety of imported food. These enforcement measures are largely a product of those facts uncovered during those hearings. Senator Collins developed these enforcement provisions and introduced a bill which focuses on enforcement. I refer those with special interest in enforcement to also consider her bill. Finally, this bill covers emergency situations by allowing FDA to ban imported food that has been connected to outbreaks of food borne illness. When our children, parents and communities are getting seriously sick, the Secretary of Health and Human Services can immediately issue an emergency ban. We don't have to wait till someone else gets seriously sick or dies. We no longer have to go through the current bureaucratic mechanism that is inefficient and resource intensive. We can stop the food today, to protect our citizens. My goal is to strengthen the food supply, whatever the source of the food may be. This bill won't create trade barriers. It just calls for free trade of safe food. It calls for international concern and consensus on guaranteeing standards for public health. This bill is important because it will save lives and makes for a safer world. Everyone should have security in knowing that the food they eat is fit to eat. I'd like to thank FDA for their advice and consultation in developing this legislation. I also want to thank the Consumer Federation of America for their insight and recommendations. I look forward to working on a bipartisan basis to enact this legislation. I pledge my commitment to fight for ways to make America's food supply safer. This bill is an important step in that direction. Mr. President, I ask unanimous consent that the statement of Ms. Carol Tucker Foreman, Distinguished Fellow and Director of the Food Policy Institute, be printed in the Record.

Ms. MIKULSKI

Ms. MIKULSKI. Mr. President, I rise today in strong support of the amendment offered by Senators Murray and Snowe. I am proud to be a cosponsor of this amendment. This amendment would repeal the current ban on privately funded abortions at US military facilities overseas. I strongly support this amendment for three reasons. First of all, safe and legal access to abortion is the law. Second, women serving overseas should have access to the same range of medical services they would have if they were stationed here at home. Third, this amendment would protect the health and well-being of military women. It would ensure that they are not forced to seek alternative medical care in foreign countries without regard to the quality and safety of those health care services. We should not treat US servicewomen as second- class citizens when it comes to receiving safe and legal medical care. It is a matter of simple fairness that our servicewomen, as well as the spouses and dependents of servicemen, be able to exercise their right to make health care decisions when they are stationed abroad. Women who are stationed overseas are often totally dependent on their base hospitals for medical care. Most of the time, the only access to safe, quality medical care is in a military facility. We should not discriminate against female military personnel by denying safe abortion services just because they are stationed overseas. They should be able exercise the same freedoms they would enjoy at home. It is reprehensible to suggest that a woman should not be able use her own funds to pay for access to safe and quality medical care. Without this amendment, military women will continue to be treated like second-class citizens. The current ban on access to reproductive services is yet another attempt to cut away at the constitutionally protected right of women to choose. It strips military women of the very rights they were recruited to protect. Abortion is a fundamental right for women in this country. It has been upheld repeatedly by the Supreme Court. Let's be very clear. What we're talking about here today is the right of women to obtain a safe and legal abortion paid for with their own funds. We are not talking about using any taxpayer or federal money--we are talking about privately funded medical care. We are not talking about reversing the conscience clause--no military medical personnel would be compelled to perform an abortion against their wishes. This is an issue of fairness and equality for the women who sacrifice every day to serve our nation. They deserve access to the same quality care that servicewomen stationed here at home--and every woman in America--has each day. I urge my colleagues to support this important amendment to the 2000 Department of Defense Appropriations Bill.

Ms. MIKULSKI

Ms. MIKULSKI. Mr. President, I rise today to talk about an issue that is critical to saving children's lives. That issue is guns in the hands of our children. The events of Columbine have been a wake up call for the American people. Guns don't belong in the hands of kids. We must do everything we can to see to it that children cannot buy guns. We also need tougher penalties for illegal possession and crimes committed with guns. This is about America's children and getting behind our kids. This is about keeping our kids safer in their schools and safer on our streets. I respect the Constitution and the right of law-abiding citizens to own guns. I understand that many people own a gun for self-protection. The fear of crime is a real issue for many Americans. I believe people should be able to protect themselves. I also know people enjoy using guns for sport. Many Americans enjoy hunting, and I do not want to interfere with lawful sport. My support for reasonable steps to protect kids does not go against my support for people's right to protect themselves or their right to hunt. We can take measures to save lives without infringing on the Constitution. One of my biggest concerns is the safe storage of guns in the home. I think it makes sense to require trigger locks for guns while children are in the home. There have been too many tragic accidents with children that could have been prevented. Guns are too easily available to our young people. We must require gun show participants to comply with the same laws as gun shop owners. This would cut off a deadly supply of firearms to our Nation's children and dangerous criminals. The guns used in the Columbine massacre were purchased from gun shows. I was very disappointed that the Lautenberg amendment did not pass. This amendment would have closed the gun show loophole. What passed instead was an amendment giving a gun show participant the option of conducting a background check. Now, what gun show participant is going to choose to take the time and effort when the gun seller in the next booth is willing to sell a gun with no questions asked? I was happy to support an amendment which would toughen the penalties for possession of semiautomatic assault weapons. The presence of semiautomatic weapons on our streets is a deplorable situation. Assault weapons have one purpose--to kill the largest number of people as quickly and efficiently as possible. They have no legitimate hunting or sporting use. I want to see them taken off our streets. We must get behind our kids and teach them that character counts. We have to teach them respect for guns and respect for human life. We must listen carefully to them and help them when they are in trouble. We need to give them constructive goals to work toward. We must give them opportunities to live a rewarding life. Then they can respect themselves and others and not resort to guns and violence to demand the attention they need. We want kids to turn toward each other--not against each other.

Ms. MIKULSKI

Ms. MIKULSKI. Mr. President, I know we have been discussing the juvenile justice bill now for several days. I would like to compliment the leadership on both sides of the aisle for trying to move this bill. But this is not about a bill. It is not about an amendment. It is not about money. It is about America's children and how are we going to get behind our children so they are safer in their schools and safer on their streets. There are two aspects of this bill where I have had a longstanding passion. Number one is making sure we have the support services in our schools to back up our teachers and help our children. And number two is after school so we can provide meaningful, structured activities for kids so they will not only have a place to go but a place to benefit from both learning and character building. This is why in this legislation I support the Democratic initiative to put more mental health counselors into the schools and also to put school social workers and school nurses into the schools. Our teachers are very busy. I hope we pass the 100,000 new teachers initiative, so we have smaller class sizes so our teachers can give more attention to our children. But, while our teachers are in the classroom, there are other support services that help those children while they are in school. I want to see more school nurses in our schools to help our kids. Mr. President, a school nurse often provides the early detection and warning for other problems the children have. They know whether our children need eyeglasses or a hearing aid. Sometimes a child who doesn't have needed eyeglasses is a child headed for trouble out of frustration. It is often the school nurse who begins identifying the early warning signals of emotional problems. Or if a child is under treatment, it is that school nurse who is supervising that the child is taking his or her medication and staying on the medication. This is what helps our kids. Let me talk about the school social worker. This is not about Freud, this is not about Jung, this is not about in-depth counseling. This is making sure we know where these children are in terms of some aspects of the problems they are having. If a child is referred to a school social worker, that means the child is teeter-tottering and could go one way or the other. Often a child comes to school troubled because of problems at home. It could be a mother who has a substance abuse problem. It could be a father who is without a job. A school social worker first and foremost listens to the child and helps the family. Often it is the school social worker who takes the child in a teeter- totter situation and makes sure they do not go off on the wrong track. It is the school social worker that can get them back on the right track. These are the kinds of things we want to have in our juvenile justice bill. Yes, we need more security. But I tell you, while we are looking for more cops in the schools, let's also get more counselors into the schools to be able to help our kids and our teachers. Our children are lonely. Our children are very lonely. Listen to them. They often turn to each other and, as we saw in some communities, they turn on each other. We have to reach out to our children so they have a significant adult they can relate to in their lives. Hopefully, it is their parents. That puts you on first base. Hopefully, they can relate to a good teacher. That can put you on second base. But often what puts you on the third base and brings you home is structured, afterschool activities. Our most famous general, Colin Powell, is devoted to these afterschool activities. It is the single most important prevention program for children. Afterschool can help kids avoid trouble. Or help them to move on, exercising the great talents they have. I visited the afterschool programs in my community. I even had townhall meetings with children in these communities. It was fantastic. You say: What do you like about the afterschool program? They say: At 3 o'clock we leave school and we walk in here and we are greeted with a snack and we are greeted with a smile. Often it could be a police officer in a PAL Program, a Police Athletic League, or it could be part of the Boys and Girls program. Then they learn. Often they do their homework. They even have computer classes. They are learning. They have activities. Then they move to sports or other programs. For the kids who go into sports, it is not only about playing basketball, it is about learning sportsmanship. This is about character building, confidence building, and so on. We can do no more important things than getting behind our teachers, supporting our families, and having these services. I hope we do not think our children should be taught in a prison-like atmosphere. We need to make sure they are safe. Let's have enough teachers, enough counselors, and enough support so the schools are not only safe, but our children's learning is sound. I yield the floor.

Ms. MIKULSKI. Mr. President, I ask I be allowed to speak for 5 minutes on the pending bill.

Ms. MIKULSKI

Ms. MIKULSKI. Mr. President, I rise in support of the Sarbanes substitute amendment to the Financial Services Modernization Act. I salute him for his leadership in seeking financial services reform that prepares us for the new century. I agree that we should reform our financial services. There is no doubt that changes in law have lagged behind changes in our banking and financial services industries. This amendment is a great improvement over the underlying bill. It would provide greater protections for consumers. It would also maintain the Community Reinvestment Act--which is so important in enabling low income communities to help themselves. However, I would like to raise a number of what I call ``flashing yellow lights'' or warning signals that we should be aware of before enacting financial services modernization. We should proceed with caution to avoid irrevocable changes when the savings of hard working families and the viability of our communities could be put in jeopardy. For example, financial services reform would make it easier for banks, securities firms and insurance companies to merge into oligopolies. The savings of many would be controlled by a few. Americans will know less about where their deposits are kept and how they are used. What would be the effect of these mergers on consumers? I am concerned that these mega institutions could lead to higher fees and fewer choices for consumers. Marylanders used to have savings accounts with local banks where the teller knew their name and their family. We have already seen the trend toward mega-mergers, accompanied by higher fees, a decline in service, and the loss of neighborhood financial institutions. This legislation accelerates that trend. In addition, what would be the affect of this legislation on the alarming increase in foreign takeovers of US banks? I support increased globalization, but what will happen when home town banks are taken over by companies that have no roots or commitments to the community? With a globalization of financial resources, the local bank could be bought by a holding company based outside the United States. Instead of the friendly neighborhood teller, consumers would be contacting a computer operator in a country half-way around the globe through an 800 number. Their account could be subject to risks that have nothing to do with their job, their community or even the economy of the United States. I know that impersonalized globalization is not what banking customers want when they talk about modernization of financial services. So I will support the Sarbanes amendment. It goes further in answering my concerns. But I hope we will be able to address these concerns more fully as we move forward with this legislation. they generally do not have a city to serve, much less an inner city. Third, in the last 9 years, Federal regulators have performed 16,380 CRA evaluations of these banks--evaluating them annually. These banks report that it costs them between $60,000 and $80,000 a year to comply with CRA. Yet, at the end of 9 years and 16,380 evaluations, just three small rural banks have been found to be substantially out of compliance. One million--excuse me, one trillion. Excuse me, let me be sure I have my figure here. At the end of this process, with small banks having spent perhaps $1,310,400,000,000 complying with paperwork in the name of evaluating community lending, we have found just three banks out of compliance. Not only does the substitute eliminate this provision that ends this senseless wasting of small bank resources that cost local communities and deny them access to credit, but it imposes confiscatory penalties that would make a bank, if it fell out of compliance with CRA, potentially subject to a $1 million fine, not just on the bank but on the bank officer or on the bank director. We have two letters here, one from the Independent Bankers and one from the ABA, raising the point that one of the toughest things to do now in this period of massive lawsuit liability is to get good people to serve on a bank board. Both the Independent Bankers of America and the ABA have written urging us not to adopt a provision that would make it virtually impossible for small banks, especially, to get qualified officers and board members because of the liability costs. I urge my colleagues to reject this substitute.

Ms. MIKULSKI

Ms. MIKULSKI. Mr. President, I rise today to congratulate the Association of Mapping Seniors (AMS) on the 25th Anniversary of their founding. The AMS is a distinguished organization of former employees at mapping and imagery agencies like the National Imagery and Mapping Agency (NIMA). Their important work has been invaluable to both our national policy makers, and our national security. Mr. President, the data produced by these dedicated Americans has been key to understanding our world and making it safer. Mapping and imagery not only help us support our men and women in uniform, but also help us develop our cultural understanding of ourselves in terms of population, growth, religious and economic clusters, and more. I want to commend each and every member of the AMS for their indispensable service to our country, our community, and our culture. I am also proud to note that Maryland has been home to many devoted members of this important organization. As many of my colleagues know, I am a strong and unyielding supporter of federal employees, and these men and women are no exception. I want to thank them, Mr. President, for their outstanding service to our country, and to honor them in celebration of the 25th Anniversary of the Association of Mapping Seniors.

Ms. MIKULSKI

Ms. MIKULSKI. Mr. President, I rise today to introduce the Medicare Social Work Equity Act of 1999. I am proud to sponsor this legislation which will amend section 4432 in the Balanced Budget Act of 1997 which prevents social workers from directly billing Medicare for mental health services provided in skilled nursing facilities (SNF's). This bill will also ensure that clinical social workers (CSW's) can receive Medicare reimbursement for mental health services they provide in skilled nursing facilities. I am honored to be joined by my good friends Senators Murray, Inouye, Hollings, Wyden, Johnson, Reid, and Bingaman who care equally about correcting these inequities for social workers and about ensuring quality mental health services for nursing home residents. The Balanced Budget Act of 1997 (BBA) changed the payment method for skilled nursing facility care. Before BBA, reimbursement was made after services had been delivered for the reasonable costs incurred. However this ``cost-based system'' was blamed for inordinate growth in Medicare spending at skilled nursing facilities. The Balanced Budget Act of 1997 phased in a prospective payment system for skilled nursing facilities that was fully implemented on January 1, 1999, for Medicare part A services. Payments for part B services for skilled nursing facility residents are to be consolidated. This means that the provider of the services must bill the facility instead of directly billing Medicare. The consolidated billing provision has been delayed indefinitely by the Health Care Financing Administration (HCFA) while it addresses Year 2000 (Y2K) compliance issues. However, Congress was careful to not include psychologists and psychiatrists in this consolidated billing provision. Social workers were included, I think by mistake. Clinical social workers are the primary providers of mental health services to residents of nursing homes, particularly in underserved urban and rural areas. CSW's are also the most cost effective mental health providers. This legislation is important for three reasons: First, I am concerned that section 4432 inadvertently reduces mental health services to nursing home residents. Second, I believe that the consolidated billing requirement will result in a shift from using social workers to other mental health professionals who are reimbursed at a higher cost to Medicare. Finally, I am concerned that clinical social workers will lose their jobs in nursing homes or will be inadequately reimbursed. In addition, this bill ensures that clinical social workers can receive Medicare reimbursement for mental health services they provide in skilled nursing facilities. An April 1998, HCFA rule would have effectively eliminated Medicare reimbursement for clinical social worker services provided to residents of SNF's, whether or not their stay was being paid by Medicare, Medicaid, or a private payer. It would have deemed all mental health services provided to nursing home residents ``required'' services, not distinguishing between the mental health diagnosis and treatment services provided by CSW's and the required medically-related social services provided at the SNF. Facilities would likely bring in a psychiatrist or psychologist (if available) because services provided by them could still be billed separately This would affect seniors in many rural and underserved areas where CSW's are often the only available mental health provider and have developed relationships over time with these SNF patients. HCFA delayed this rule for two years. However, clarification is needed in the law to ensure that CSW's can be reimbursed by Medicare for the mental health services they provide to inpatients in SNF's. This bill makes that necessary change. I like this bill because it will correct inequities for America's social workers, it will assure quality of care for nursing home residents, and will assure cost efficiency for Medicare. This bill is strongly supported by the National Association of Social Workers, Clinical Social Work Federation, American Psychological Association, American Group Psychotherapy Association, Bazelon Center for Mental Health Law, National Mental Health Association, National Council for Community Behavioral Health Care, National Association of Protection and Advocacy Systems, Anxiety Disorders Association of America, and the Mental Health and Aging Network of the American Society on Aging. I now look forward to the Senate's support of this important legislation.

Ms. MIKULSKI

Ms. MIKULSKI. Mr. President, I rise today to introduce the Medicare Social Work Equity Act of 1999. I am proud to sponsor this legislation which will amend section 4432 in the Balanced Budget Act of 1997 which prevents social workers from directly billing Medicare for mental health services provided in skilled nursing facilities (SNF's). This bill will also ensure that clinical social workers (CSW's) can receive Medicare reimbursement for mental health services they provide in skilled nursing facilities. I am honored to be joined by my good friends Senators Murray, Inouye, Hollings, Wyden, Johnson, Reid, and Bingaman who care equally about correcting these inequities for social workers and about ensuring quality mental health services for nursing home residents. The Balanced Budget Act of 1997 (BBA) changed the payment method for skilled nursing facility care. Before BBA, reimbursement was made after services had been delivered for the reasonable costs incurred. However this ``cost-based system'' was blamed for inordinate growth in Medicare spending at skilled nursing facilities. The Balanced Budget Act of 1997 phased in a prospective payment system for skilled nursing facilities that was fully implemented on January 1, 1999, for Medicare part A services. Payments for part B services for skilled nursing facility residents are to be consolidated. This means that the provider of the services must bill the facility instead of directly billing Medicare. The consolidated billing provision has been delayed indefinitely by the Health Care Financing Administration (HCFA) while it addresses Year 2000 (Y2K) compliance issues. However, Congress was careful to not include psychologists and psychiatrists in this consolidated billing provision. Social workers were included, I think by mistake. Clinical social workers are the primary providers of mental health services to residents of nursing homes, particularly in underserved urban and rural areas. CSW's are also the most cost effective mental health providers. This legislation is important for three reasons: First, I am concerned that section 4432 inadvertently reduces mental health services to nursing home residents. Second, I believe that the consolidated billing requirement will result in a shift from using social workers to other mental health professionals who are reimbursed at a higher cost to Medicare. Finally, I am concerned that clinical social workers will lose their jobs in nursing homes or will be inadequately reimbursed. In addition, this bill ensures that clinical social workers can receive Medicare reimbursement for mental health services they provide in skilled nursing facilities. An April 1998, HCFA rule would have effectively eliminated Medicare reimbursement for clinical social worker services provided to residents of SNF's, whether or not their stay was being paid by Medicare, Medicaid, or a private payer. It would have deemed all mental health services provided to nursing home residents ``required'' services, not distinguishing between the mental health diagnosis and treatment services provided by CSW's and the required medically-related social services provided at the SNF. Facilities would likely bring in a psychiatrist or psychologist (if available) because services provided by them could still be billed separately This would affect seniors in many rural and underserved areas where CSW's are often the only available mental health provider and have developed relationships over time with these SNF patients. HCFA delayed this rule for two years. However, clarification is needed in the law to ensure that CSW's can be reimbursed by Medicare for the mental health services they provide to inpatients in SNF's. This bill makes that necessary change. I like this bill because it will correct inequities for America's social workers, it will assure quality of care for nursing home residents, and will assure cost efficiency for Medicare. This bill is strongly supported by the National Association of Social Workers, Clinical Social Work Federation, American Psychological Association, American Group Psychotherapy Association, Bazelon Center for Mental Health Law, National Mental Health Association, National Council for Community Behavioral Health Care, National Association of Protection and Advocacy Systems, Anxiety Disorders Association of America, and the Mental Health and Aging Network of the American Society on Aging. I now look forward to the Senate's support of this important legislation.

Ms. MIKULSKI

Ms. MIKULSKI. Mr. President, on March 25, the game of baseball experienced a tremendous loss when former Baltimore Orioles' manager, coach and minor-league player Cal Ripken, Sr., passed away at the age of 63. Cal Ripken, Sr. was a monumental figure in Baltimore's baseball heritage. For nearly four decades, Cal Sr. was the heart of the Baltimore Orioles' organization. He exemplified everything that is good about baseball and about America--hard work, dedication and integrity. He taught his sons, Cal Ripken, Jr. and Bill Ripken, to play baseball when they were young and inspired in them his own legendary love of our national pastime. In 1987, Cal Sr. was named manager of the Orioles, and became the first father to manage two sons simultaneously at the major league level. Ripken Sr. retired in 1992, having spent 36 years with the Orioles' organization. I will never forget going to the ball park, year after year, and seeing the competitive fire Cal Ripken Sr. brought to the Orioles. He knew how to bring out the best in the players he coached and managed. Cal Ripken, Sr. will be remembered for what he instilled in his family, in Baltimore and in all of us: work hard, show up every day, and always give it everything you've got. His spirit will live forever in the hearts of every Baltimore Oriole and every Oriole fan.

Ms. MIKULSKI

Ms. MIKULSKI. Mr. President, I rise to congratulate a group of young constituents and journalists at Rockville High School's newspaper, The Rampage. This year, the students on the staff of The Rampage and their journalism teacher, Kevin Keegan, won recognition as the best student newspaper in Maryland for the seventh year in a row. I am proud of these students for putting their minds and their hearts into creating a first-rate newspaper for the Rockville community. More than 200 years ago, when the Framers of the United States Constitution created the First Amendment, they recognized and enshrined the importance of a free press in a democratic society. With its declaration that no law could abridge the freedom of the press, the First Amendment also bestowed on our Nation's journalists a unique and special role. The Nation has given reporters the awesome responsibility to help communicate the needs of the Nation, report on and analyze the functioning of government, and chronicle the day-to-day events that affect our communities. In return, we hope those journalists recognize the importance of their responsibility and carefully tend their role as stewards of public information. To maintain this profoundly important and delicate relationship, it is essential that journalists have strong training in writing, investigation, and ethics. That is why I am so proud of The Rampage, its staff, and its advisor. Mr. Keegan is teaching the important fundamentals of journalism, instilling in these young people the power and obligation of a free press, and encouraging them to grow personally and professionally in the process. Along the way, their hard work and commitment has earned these young journalists great respect and renown. I would like to say a special word of thanks to The Rampage advisor, Mr. Keegan. He is well-known in Rockville and across the state for his commitment to teaching and to his students. As a journalism teacher and advisor for 20 years and coach of Team Maryland, a state all-star academic team, Mr. Keegan embodies all that is great and good about education in America. He inspires students personally, challenges them academically, and donates enormous amounts of energy and time to give kids the extra attention and encouragement they need to succeed. In 1997, he was recognized statewide when Hood College in Frederick honored him with its Maryland Distinguished Teacher award. Mr. President, I have worked with quite a few journalists in my years of public service. I have been proud that many Maryland reporters and news outlets have earned national reputations and honors. But I am uniquely proud of The Rampage today because they represent great hope for maintaining a strong free press and a strong democratic society. In their ranks we may well find some of the next generation's Pulitzer Prize winners. I congratulate them today on their tremendous accomplishments and wish them all the best for their future endeavors. Maryland is very proud of them.

Ms. MIKULSKI

Ms. MIKULSKI. Mr. President, today, I rise to talk about an issue that is very important to me, very important to my constituents in Maryland and very important to the people of the United States of America. For the third Congress in a row, I am joining in a bipartisan effort with my friend and colleague, Senator Olympia Snowe, to end an unfair policy of the Social Security System. Senator Snowe and I are introducing the Social Security Family Protection Act. This bill addresses retirement security and family security. We want the middle class of this Nation to know that we are going to give help to those who practice self-help. What is it I am talking about? We have found that Social Security does not pay benefits for the last month of life. If a Social Security retiree dies on the 18th of the month or even on the 30th of the month, the surviving spouse or family members must send back the Social Security check for that month. I think that is a harsh and heartless rule. That individual worked for Social Security benefits, earned those benefits, and paid into the Social Security trust fund. The system should allow the surviving spouse or the estate of the family to use that Social Security check for the last month of life. This legislation has an urgency, Mr. President. When a loved one dies, there are expenses that the family must take care of. People have called my office in tears. Very often it is a son or a daughter that is grieving the death of a parent. They are clearing up the paperwork for their mom or dad, and there is the Social Security check. And they say, ``Senator, the check says for the month of May. Mom died on May 28. Why do we have to send the Social Security check back? We have bills to pay. We have utility coverage that we need to wrap up, mom's rent, or her mortgage, or health expenses. Why is Social Security telling me, `Send the check back or we're going to come and get you'?'' With all the problems in our country today, we ought to be going after drug dealers and tax dodgers, not honest people who have paid into Social Security, and not the surviving spouse or the family who have been left with the bills for the last month of their loved one's life. They are absolutely right when they call me and say that Social Security was supposed to be there for them. That is what our bill is going to do. That is why Senator Snowe and I are introducing the Family Social Security Protection Act. When we talk about retirement security, the most important part of that is income security. And the safety net for most Americans is Social Security. We know that as Senators we have to make sure that Social Security remains solvent, and we are working to do that. We also don't want to create an undue administrative burden at the Social Security Administration--a burden that might affect today's retirees. But it is absolutely crucial that we provide a Social Security check for the last month of life. How do we propose to do that? We have a very simple, straightforward way of dealing with this problem. Our legislation says that if you die before the 15th of the month, you will get a check for half the month. If you die after the 15th of the month, your surviving spouse or the family estate would get a check for the full month. We think this bill is fundamentally fair. Senator Snowe and I are old-fashioned in our belief in family values. We believe you honor your father and your mother. We believe that it is not only a good religious and moral principle, but it is good public policy as well. The way to honor your father and mother is to have a strong Social Security System and to make sure the system is fair in every way. That means fair for the retiree and fair for the spouse and family. That is why we support making sure that the surviving spouse or family can keep the Social Security check for the last month of life. Mr. President, we urge our colleagues to join us in this effort and support the Social Security Family Protection Act.

Ms. MIKULSKI

Ms. MIKULSKI. Mr. President, today, I am introducing a bill to modify a harsh and heartless rule of government that is unfair and prevents current workers from enjoying the benefits of their hard work in their retirement. This legislation is very important to me, very important to my constituents in Maryland, and very important to government workers and retirees across the nation. I want the middle class of this Nation to know that if you worked hard to become middle class you should stay middle class when you retire. Under current law, there is something called the Pension Offset law. This is a harsh and unfair policy. Let me tell you why. If you are a retired government worker, and you qualify for a spousal Social Security benefit based on your spouse's employment record, you may not receive what you qualify for. Because the Pension Offset law reduces or entirely eliminates a Social Security spousal benefit when the surviving spouse is eligible for a pension from a local, state or federal government job that was not covered by Social Security. This policy only applies to government workers, not private sector workers. Let me give you an example of two women, Helen and her sister Phyllis. Helen is a retired Social Security benefits counselor who lives in Woodlawn, Maryland. Helen currently earns $600 a month from her federal government pension. She's also entitled to a $645 a month spousal benefit from Social Security based on her deceased husband's hard work as an auto mechanic. That's a combined monthly benefit of $1,245. Phyllis is a retired bank teller also in Woodlawn, Maryland. She currently earns a pension of $600 a month from the bank. Like Helen, Phyllis is also entitled to a $645 a month spousal benefit from Social Security based on her husband's employment. He was an auto-mechanic, too. In fact, he worked at the same shop as Helen's husband. So, Phyllis is entitled to a total of $1,245 a month, the same as Helen. But, because of the Pension Offset law, Helen's spousal benefit is reduced by \2/3\ of her government pension, or $400. So instead of $1,245 per month, she will only receive $845 per month. This reduction in benefits only happens to Helen because she worked for the government. Phyllis will receive her full benefits because her pension is a private sector pension. I don't think that's right, and that's why I'm introducing this legislation. The crucial thing about the Mikulski Modification is that it guarantees a minimum benefit of $1,200. So, with the Mikulski Modification to the Pension Offset, Helen is guaranteed at least $1,200 per month. Let me tell you how it works. Helen's spousal benefit will be reduced only by 2/3 of the amount her combined monthly benefit exceeds $1,200. In her case, the amount of the offset would be 2/3 of $45, or $30. That's a big difference from $400, and I think people like our federal workers, teachers and our firefighters deserve that big difference. Why should earning a government pension penalize the surviving spouse? If a deceased spouse had a job covered by Social Security and paid into the Social Security system, that spouse expected his earned Social Security benefits would be there for his surviving spouse. Most working men believe this and many working women are counting on their spousal benefits. But because of this harsh and heartless policy, the spousal benefits will not be there, your spouse will not benefit from your hard work, and, chances are, you won't find out about it until your loved one is gone and you really need the money. The Mikulski modification guarantees that the spouse will at least receive $1,200 in combined benefits. That Helen will receive the same amount as Phyllis. I'm introducing this legislation, because these survivors deserve better than the reduced monthly benefits that the Pension Offset currently allows. They deserve to be rewarded for their hard work, not penalized for it. Many workers affected by this Offset policy are women, or clerical workers and bus drivers who are currently working and looking forward to a deserved retirement. These are people who worked hard as federal employees, school teachers, or firefighters. Frankly, I would repeal this policy all together. But, I realize that budget considerations make that unlikely. As a compromise, I hope we can agree that retirees who work hard should not have this offset applied until their combined monthly benefit exceeds $1,200. In the few cases where retirees might have their benefits reduced by this policy change, my legislation will calculate their pension offset by the current method. I also have a provision in this legislation to index the minimum amount of $1,200 to inflation so retirees will see their minimum benefits increase as the cost of living increases. I believe that people who work hard and play by the rules should not be penalized by arcane, legislative technicalities. That's why I'm introducing this bill today. Representative William Jefferson of Louisiana has introduced similar legislation in the House. I look forward to working with him to modify the harsh Pension Offset rule. If the federal government is going to force government workers and retirees in Maryland and across the country to give up a portion of their spousal benefits, the retirees should at least receive a fair portion of their benefits. I want to urge my Senate colleagues to join me in this effort and support my legislation to modify the Government Pension Offset.

Ms. MIKULSKI. Mr. President, today I introduce the Hazardous Occupations Retirement Benefits Act of 1999. This legislation will grant an early retirement package for revenue officers of the Internal Revenue Service, customs inspectors of the U.S. Customs Service, and immigration inspectors of the Immigration and Naturalization Service. Under current law, most Federal law enforcement officers and firefighters are eligible to retire at age 50 with 20 years of Federal service. Most people would be surprised to learn that current law does not treat revenue officers, customs inspectors and immigration inspectors as federal law enforcement personnel. This legislation will amend the current law and finally grant the same 20-year retirement to these members of the Internal Revenue Service, Customs Service, and Immigration and Naturalization Service. The employees under this bill have very hazardous, physically taxing occupations, and it is in the public's interest to have a young and competent work force in these jobs. The need for a 20-year retirement benefit for inspectors of the Customs Service is very clear. These employees are the country's first line of defense against terrorism and the smuggling of illegal drugs at our borders. They have the authority to apprehend those engaged in these crimes. These officers carry a firearm on the job. They are responsible for the most arrests performed by Customs Service employees. The Customs Service interdicts more narcotics than any other law enforcement agency--over a million pounds a year. In 1996, they seized 180,946 pounds of cocaine, 2,895 pounds of heroin, and 775,225 pounds of marijuana. They are required to have the same law enforcement training as all other law enforcement personnel. These employees face so many challenges. They confront criminals in the drug war, organized crime figures, and increasingly sophisticated white-collar criminals. Revenue officers struggle with heavy workloads and a high rate of job stress. Some IRS employees must even employ pseudonyms to hide their identity because of the great threat to their personal safety. The Internal Revenue Service currently provides it's employees with a manual entitled: `Assaults and Threats: A Guide to Your Personal Safety' to help employees respond to hostile situations. The document advises IRS employees how to handle on-the-job assaults, abuse, threatening telephone calls, and other menacing situations. Mr. President, this legislation is cost effective. Any cost that is created by this act is more than offset by savings in training costs and increased revenue collection. A 20-year retirement bill for these critical employees will reduce turnover, increase productivity, decrease employee recruitment and development costs, and enhance the retention of a well-trained and experienced work force. I urge my colleagues to join me again in this Congress in expressing support for this bill and finally getting it enacted. This bill will improve the effectiveness of our inspector and revenue officer work force to ensure the integrity of our borders and proper collection of the taxes and duties owed to the Federal Government.

Ms. MIKULSKI

Ms. MIKULSKI. Mr. President, today, I am introducing a bill to modify a harsh and heartless rule of government that is unfair and prevents current workers from enjoying the benefits of their hard work in their retirement. This legislation is very important to me, very important to my constituents in Maryland, and very important to government workers and retirees across the nation. I want the middle class of this Nation to know that if you worked hard to become middle class you should stay middle class when you retire. Under current law, there is something called the Pension Offset law. This is a harsh and unfair policy. Let me tell you why. If you are a retired government worker, and you qualify for a spousal Social Security benefit based on your spouse's employment record, you may not receive what you qualify for. Because the Pension Offset law reduces or entirely eliminates a Social Security spousal benefit when the surviving spouse is eligible for a pension from a local, state or federal government job that was not covered by Social Security. This policy only applies to government workers, not private sector workers. Let me give you an example of two women, Helen and her sister Phyllis. Helen is a retired Social Security benefits counselor who lives in Woodlawn, Maryland. Helen currently earns $600 a month from her federal government pension. She's also entitled to a $645 a month spousal benefit from Social Security based on her deceased husband's hard work as an auto mechanic. That's a combined monthly benefit of $1,245. Phyllis is a retired bank teller also in Woodlawn, Maryland. She currently earns a pension of $600 a month from the bank. Like Helen, Phyllis is also entitled to a $645 a month spousal benefit from Social Security based on her husband's employment. He was an auto-mechanic, too. In fact, he worked at the same shop as Helen's husband. So, Phyllis is entitled to a total of $1,245 a month, the same as Helen. But, because of the Pension Offset law, Helen's spousal benefit is reduced by \2/3\ of her government pension, or $400. So instead of $1,245 per month, she will only receive $845 per month. This reduction in benefits only happens to Helen because she worked for the government. Phyllis will receive her full benefits because her pension is a private sector pension. I don't think that's right, and that's why I'm introducing this legislation. The crucial thing about the Mikulski Modification is that it guarantees a minimum benefit of $1,200. So, with the Mikulski Modification to the Pension Offset, Helen is guaranteed at least $1,200 per month. Let me tell you how it works. Helen's spousal benefit will be reduced only by 2/3 of the amount her combined monthly benefit exceeds $1,200. In her case, the amount of the offset would be 2/3 of $45, or $30. That's a big difference from $400, and I think people like our federal workers, teachers and our firefighters deserve that big difference. Why should earning a government pension penalize the surviving spouse? If a deceased spouse had a job covered by Social Security and paid into the Social Security system, that spouse expected his earned Social Security benefits would be there for his surviving spouse. Most working men believe this and many working women are counting on their spousal benefits. But because of this harsh and heartless policy, the spousal benefits will not be there, your spouse will not benefit from your hard work, and, chances are, you won't find out about it until your loved one is gone and you really need the money. The Mikulski modification guarantees that the spouse will at least receive $1,200 in combined benefits. That Helen will receive the same amount as Phyllis. I'm introducing this legislation, because these survivors deserve better than the reduced monthly benefits that the Pension Offset currently allows. They deserve to be rewarded for their hard work, not penalized for it. Many workers affected by this Offset policy are women, or clerical workers and bus drivers who are currently working and looking forward to a deserved retirement. These are people who worked hard as federal employees, school teachers, or firefighters. Frankly, I would repeal this policy all together. But, I realize that budget considerations make that unlikely. As a compromise, I hope we can agree that retirees who work hard should not have this offset applied until their combined monthly benefit exceeds $1,200. In the few cases where retirees might have their benefits reduced by this policy change, my legislation will calculate their pension offset by the current method. I also have a provision in this legislation to index the minimum amount of $1,200 to inflation so retirees will see their minimum benefits increase as the cost of living increases. I believe that people who work hard and play by the rules should not be penalized by arcane, legislative technicalities. That's why I'm introducing this bill today. Representative William Jefferson of Louisiana has introduced similar legislation in the House. I look forward to working with him to modify the harsh Pension Offset rule. If the federal government is going to force government workers and retirees in Maryland and across the country to give up a portion of their spousal benefits, the retirees should at least receive a fair portion of their benefits. I want to urge my Senate colleagues to join me in this effort and support my legislation to modify the Government Pension Offset.

Ms. MIKULSKI

Ms. MIKULSKI. Mr. President, today I introduce the Hazardous Occupations Retirement Benefits Act of 1999. This legislation will grant an early retirement package for revenue officers of the Internal Revenue Service, customs inspectors of the U.S. Customs Service, and immigration inspectors of the Immigration and Naturalization Service. Under current law, most Federal law enforcement officers and firefighters are eligible to retire at age 50 with 20 years of Federal service. Most people would be surprised to learn that current law does not treat revenue officers, customs inspectors and immigration inspectors as federal law enforcement personnel. This legislation will amend the current law and finally grant the same 20-year retirement to these members of the Internal Revenue Service, Customs Service, and Immigration and Naturalization Service. The employees under this bill have very hazardous, physically taxing occupations, and it is in the public's interest to have a young and competent work force in these jobs. The need for a 20-year retirement benefit for inspectors of the Customs Service is very clear. These employees are the country's first line of defense against terrorism and the smuggling of illegal drugs at our borders. They have the authority to apprehend those engaged in these crimes. These officers carry a firearm on the job. They are responsible for the most arrests performed by Customs Service employees. The Customs Service interdicts more narcotics than any other law enforcement agency--over a million pounds a year. In 1996, they seized 180,946 pounds of cocaine, 2,895 pounds of heroin, and 775,225 pounds of marijuana. They are required to have the same law enforcement training as all other law enforcement personnel. These employees face so many challenges. They confront criminals in the drug war, organized crime figures, and increasingly sophisticated white-collar criminals. Revenue officers struggle with heavy workloads and a high rate of job stress. Some IRS employees must even employ pseudonyms to hide their identity because of the great threat to their personal safety. The Internal Revenue Service currently provides it's employees with a manual entitled: `Assaults and Threats: A Guide to Your Personal Safety' to help employees respond to hostile situations. The document advises IRS employees how to handle on-the-job assaults, abuse, threatening telephone calls, and other menacing situations. Mr. President, this legislation is cost effective. Any cost that is created by this act is more than offset by savings in training costs and increased revenue collection. A 20-year retirement bill for these critical employees will reduce turnover, increase productivity, decrease employee recruitment and development costs, and enhance the retention of a well-trained and experienced work force. I urge my colleagues to join me again in this Congress in expressing support for this bill and finally getting it enacted. This bill will improve the effectiveness of our inspector and revenue officer work force to ensure the integrity of our borders and proper collection of the taxes and duties owed to the Federal Government.

Ms. MIKULSKI

Ms. MIKULSKI. Mr. President, I rise not to rebut the amendment by the Senator from Michigan but to make an opening statement about this budget and certain very crucial items in it. I compliment Senator Lautenberg for his strong advocacy as the ranking member of the Budget Committee and his longstanding championship for those people who have been left out and left behind. Sir, I thank you for your role not only in this budget but what you do every day in the Senate. Through the best efforts, I am very concerned that the fiscal year 2000 budget resolution really does not adequately address the solvency of Social Security, nor does it address adequately the solvency of Medicare--the two most important programs that the United States has, domestically, and the ones that Americans universally rely upon and plan their life around having in a reliable way, that has reliability and continuity, and that the entire private sector assumes will be there as they plan private sector products. Now, preserving Social Security and Medicare must be our Nation's top priority, and I believe the original efforts by the Lautenberg group were there. What we have before us today, I believe, does not protect Social Security. Now, we say a lot in the Senate about family values. Well, I believe there is a value that comes out of the Judeo-Christian ethic I believe in, and it is called honor your father and honor your mother. I believe it is not only a good commandment to live by, I think it is a good commandment to govern by. We should not only have it in our prayer books. We should have it in the Federal checkbook. This is why I am so adamant that we must save Social Security first and preserve the solvency of Medicare. When we look at Social Security, we want to make sure that we protect those who have the least resources with them--those without pensions, those without IRAs, those without 401(k)s. These are the people who we know represent, as we speak, now, over 40 million people. If there are 40 million Americans without health insurance, you had better believe they are going to be the same 40 million who do not have 401(k)s. To them ``K'' means Kellogg, and it is a cereal. It is not a life security system. I am particularly concerned about women. And I am particularly concerned about both men and women who, at the end of the day and near the end of their lives, will have no reliable pension program to look out for them. This is what the Social Security issue is all about. I want to be sure that in any debate we have--whether it is on the budget, or whether it is the Social Security bills--I want to ensure that Social Security is universal and portable, that it is a guaranteed benefit, that it is inflation proof, and looks out, as I said, for those who do not have anything else going for them. I have a particular interest in this as it affects women. That is because I truly believe that Social Security is a woman's issue. Without it, over half of all elderly women would now be living in dire poverty. Yes. Women today are working more outside the home, yes, and earning more than past generations. But in reality, their lifetime earnings, access to pensions, and ability to save continues to be less than men. That is why Social Security is a woman's issue. Let me elaborate. First of all, women live longer. The life expectancy rate for women is 65, 4 years longer than for men. That means they will need income security for a longer period of time. Also, the equity that we placed in Social Security is absolutely crucial. Why? Because right now women do not get equal pay for equal work, making 70 percent of what men make for similar jobs. They will get less Social Security because their benefits are based in part on wages. That means the hard-working female x ray technician who puts in 40 hours a week might take home $28,000 a year instead of the financial worth that her male counterpart has. We need a Social Security system, too, that women can count on, that respects values of work inside the home and acknowledges it in retirement. This is why the spousal benefit is so crucial and why we need to preserve it. Women move in and out of the paid marketplace to do some of the most important work--raising children and caring for elderly parents and their relatives. Take, for instance, someone who works in an office as an executive assistant. She got her high school diploma, didn't go to college, worked full time for 5 years, but leaves the workforce to raise her children. She might do that for 7 years and then return part time. Notice that she lost 7 years in her contribution, and then is a part-time wage earner, and then often has to go back at an entry wage. This woman needs to know that Social Security is there for her, and that she is not penalized for what she did, which was the unpaid work for providing the most invaluable service to America; that is, raising America's children. Certain ideas have been proposed to reforming Social Security which would have a devastating impact on women. Having reliance on private retirement accounts would hurt women disproportionately. Again, women earn less money, unequal pay, leave the paid workforce to raise children, or care-give, and would have less to ``invest.'' Reducing the Social Security COLA would hurt women. And there are other reforms. But the point that I make is that Social Security as it now stands is the best deal for women. Sure, we need to make reforms. Sure, we need to look at the other ideas. That is why we should not cut or dramatically alter Social Security. Sure, it can pay benefits into 2032. But we have to look ahead to be sure that there is solvency of Social Security. That is why we support the Lautenberg effort. We want to be sure that for women who have worked all of their lives, in the home or outside the home, there will be a guaranteed benefit with a full cost of living, that it will have a progressive benefit formula that helps the low-income wage earners, and that there is a spousal and survivor benefit for married women, divorced and widowed. The only way we can do that is if we take the surplus and put 62 percent aside, and also 15 percent for Medicare. Otherwise, this is a hollow budget full of promise and hollow on opportunity. Mr. President, I salute the efforts of Senator Lautenberg. I am deeply disturbed that we are not setting aside 62 percent as we talked about. I do not believe the other party adequately protects Social Security, adequately protects Medicare, and I believe that ultimately the American people will wake up to this. As it stands now, I will vote no for this budget.

Ms. MIKULSKI

Ms. MIKULSKI. Mr. President, the Senate is now considering the gravest decision we are ever called upon to make. Do we send our troops into harm's way to defend America's values and interests? Do we use our military to seek to end the brutal repression in a faraway country? After careful thought and serious discussions with our Secretary of State, the Chairman of the Joint Chiefs of Staff, and the Secretary of Defense, I will support U.S. participation in strategic NATO air strikes against Serbian military targets. Our objective is to stop the killing and to weaken Yugoslav President Milosevic's ability to further hurt the people of Kosovo. These objectives are crucial to achieving durable peace and security in Europe. There are two primary reasons that I support the limited use of force. First of all, we must prevent further Serbian acts of genocide and ethnic cleansing. Serbian actions have resulted in terrible human suffering. The Serbs abolished the Parliament and government of Kosovo in 1990. In response, the Kosovar Albanians maintained a policy of nonviolent resistance for seven years. During this time, Milosevic ethnically cleansed Kosovo--driving over 400,000 people out of their homes and destroying hundreds of villages. For those who wouldn't flee, Milosevic sought to starve them out--destroying farm land and blockading the shipment of food. Reports from last night indicate that further humanitarian catastrophes are imminent. Serbia is moving aggressively to overrun and drive thousands more ethnic Albanians from their homes. The Serbs have deployed 40,000 army and police units in Kosovo. Over the past weekend, over 10,000 Kosovars were forced to flee their homes fearing for their lives. And for good reason: a brutal Serbian attack on the village of Racak in January resulted in the death of 45 civilians. Some of my colleagues have argued that we should consider military action only if further humanitarian atrocities occur. We cannot wait for genocide to occur before we act. Our second goal must be to stop this war from spreading and from threatening stability and our national interests throughout central Europe. The ethnic tensions in Kosovo could spread to Albania, Macedonia and even to our NATO allies, Greece and Turkey. Serb actions threaten the stability of the entire region. I would not support the use of military force unless we had first exhausted all other options. There are three ways that America can best exert our leadership. First, through diplomacy. There is no question that we have done everything possible to resolve the Kosovo crisis peacefully through diplomacy. Second, we can apply sanctions or rewards. We have applied sanctions to Serbia for many years with little tangible result. And third, we can use our military to fight for our interests and our values. That is the decision we face today. After exhausting diplomatic and economic options, do we now use our military to force the Serbs to end their intransigence and repression? The military action proposed by President Clinton meets three principles I consider before supporting military action. First of all, whenever possible, military action should be multilateral. In Kosovo, we will be acting as part of NATO--with the nineteen allies sharing the burden. Second, the military actions should be strategic and proportional. We are authorizing air strikes against military targets--like bases, military storage depots, and command and control centers--and against key infrastructure--like roads and bridges that Serbs use to reinforce Kosovo. And third, military actions must be intended to achieve a specific goal. In this case, we are seeking to prevent further atrocities and to weaken Milosevic's ability to hurt the people of Kosovo. Mr. President, I am disturbed by the process that was initially established for this vote. The Senate should vote on whether or not to authorize the use of force. Plain and simple. Instead, we are asked to cast a cloture vote on a second degree amendment to an appropriations bill. That is not the way to conduct foreign policy in the Senate. That is why I voted against cloture on this matter--and I will vote for a bipartisan resolution to authorize U.S. participation in NATO air strikes against Serbia. Mr. President, I still hope that the Serbs will back down. But if they don't, the Senate must show that we back our troops one hundred percent. Our airmen have excellent training and the best equipment in the world. They will have the participation of our NATO allies. And they will have the prayers and support of the American people--who recognize their heroism.

Ms. MIKULSKI

Ms. MIKULSKI. Mr. President, I rise to join my distinguished colleagues Senators Chafee, Moynihan, Snowe, and to introduce legislation providing breast and cervical cancer treatment services to women who were diagnosed with these cancers through the National Breast and Cervical Cancer Early Detection Program (NBCCEDP). This bill would give states the option to provide Medicaid coverage for the duration of breast and cervical cancer treatment to eligible women who were screened through the CDC program and found to have these cancers. This is a bill whose time has come. In 1990, I was proud to be the chief Senate sponsor of the Breast and Cervical Cancer Mortality Prevention Act which created the National Breast and Cervical Cancer Early Detection Program (NBCCEDP) at the CDC. The time was right for us to create that program. Since its inception, the CDC screening program has provided more than 721,000 mammograms and 851,000 Pap tests to more than 1.2 million women. Among the women screened, over 3,600 cases of breast cancer and over 400 cases of invasive cervical cancer have been diagnosed since the beginning of the program. In Maryland alone, the state had provided more than 54,000 mammograms and 35,000 Pap tests, and diagnosed over 450 women with breast cancer and 15 women with invasive cervical cancer. Now as we prepare to enter the 21st century, it is time for us to finish what we started and provide treatment services for breast and cervical cancer for women who are screened through this program. We made the down payment in 1990 and we've been making payments ever since, but it's time for the final payment. It is time to do the right thing. We screen the women in this program for breast and cervical cancer. But we don't provide the federal follow-up to ensure that these women are treated. The CDC screening program does not pay for breast and cervical cancer treatment services, but it does require participating states to provide treatment services. A study of the program done for the Centers for Disease Control and Prevention found that while treatment was eventually found for almost all of the women screened, some women did not get treated at all, some refused treatment, and some experienced delays. While states and localities have been diligent and creative in finding treatment services for these women, the reality is that the system is overloaded. The CDC study found that when it came to treatment services, state efforts to obtain these services were short- term, labor-intensive solutions that diverted resources away from screening activities. Of those women diagnosed with cancer in the United States, nearly 3,000 women have no way to afford treatment--they have no health care insurance coverage or are underinsured. One woman in Massachusetts reported that she cashed in her life insurance policy to cover the costs of her treatment. These women depend on the time of staff and volunteers who help them find free or more affordable treatment; they depend on the generosity of doctors, nurses, hospitals and clinics who provide them with free or reduced-cost treatment. In the end, thousands of women who run local screening programs are spending countless hours finding treatment services for women diagnosed with breast cancer. I salute the efforts of these individuals who spend their time and resources to help these women. But we must not force these women to rely on the goodwill of others. These treatment efforts will become even more difficult as more women are screened by the NBCCEDP, which currently services only 12-15% of all women who are eligible nationally. The lack of coverage for diagnostic and treatment services has also had a very negative impact on the program's ability to recruit providers, further restricting the number of women screened. The CDC study also shows there are already additional stresses on the program as increasing numbers of physicians do not have the autonomy in today's ever increasing managed care system to offer free or reduced-fee services. While CDC has expanded its case management services to help more women get treatment, even CDC admits that ``more formalized and sustained mechanisms need to be instituted to ensure that all women screened have ready access to appropriate treatment and follow-up.'' It is an outrage that women with cancer must go begging for treatment, especially if the federal government has held out the promise of early detection. We should follow through on our responsibility to treat the cancer that these women were diagnosed with through the CDC program. That's why I've introduced this important legislation with my colleagues. This bill gives states the option to provide Medicaid coverage for the duration of breast and cervical cancer treatment to eligible women who were screened through the CDC program and found to have these cancers. This is not a mandate for states; it is the federal government saying to the states ``we will help you provide treatment services to these women, if you decide to do so.'' By choosing this option, states would in effect, extend the federal-state partnership that exists for the screening services in the CDC program to treatment services. I'm proud that my own state of Maryland realized the importance of providing treatment services to women who were screened through the CDC screening program. Maryland appropriated over $6 million in state funds to establish a Breast and Cervical Cancer Diagnostic and Treatment Program for uninsured, low income women. The breast cancer mortality rate in Maryland has started to decline, in part because of programs like the CDC program. But not all states have the resources to do what Maryland has done. That's why this bill is needed. It provides a long- term solution. Screening alone does not prevent cancer deaths; but treatment can. It's a cruel and heart-breaking irony for the federal government to promise to screen low-income women for breast and cervical cancer, but not to establish a program to treat those women who have been diagnosed with cancer through a federal program. It is clear that the short-term, ad-hoc strategies of providing treatment have broken down: for the women who are screened; for the local programs that fund the screening program; and for the states that face increasing burdens. Because there is not coverage for treatment, state programs are having a hard time recruiting providers, volunteers are spending a disproportionate amount of time finding treatment for women, and fewer women are receiving treatment. We can't grow the program to serve the other 78% of eligible women if we can't promise treatment to those we already screen. This bill is the best long-term solution. It is strongly supported by the National Breast Cancer Coalition representing over 400 organizations and 100,000's of women across the nation; the American Cancer Society, the National Association of Public Hospitals and Health Systems, the National Partnership for Women and Families, YWCA, National Women's Health Network, Oncology Nursing Society, Association of Women's Health, Obstetric, and Neonatal Nurses, the Rhode Island Breast Cancer Coalition, Y-ME, and Arm in Arm. I urge my colleagues to cosponsor and support this critical piece of legislation and make good on the promise of early detection.

Ms. MIKULSKI

Ms. MIKULSKI. Mr. President, I rise to join my distinguished colleagues Senators Chafee, Moynihan, Snowe, and to introduce legislation providing breast and cervical cancer treatment services to women who were diagnosed with these cancers through the National Breast and Cervical Cancer Early Detection Program (NBCCEDP). This bill would give states the option to provide Medicaid coverage for the duration of breast and cervical cancer treatment to eligible women who were screened through the CDC program and found to have these cancers. This is a bill whose time has come. In 1990, I was proud to be the chief Senate sponsor of the Breast and Cervical Cancer Mortality Prevention Act which created the National Breast and Cervical Cancer Early Detection Program (NBCCEDP) at the CDC. The time was right for us to create that program. Since its inception, the CDC screening program has provided more than 721,000 mammograms and 851,000 Pap tests to more than 1.2 million women. Among the women screened, over 3,600 cases of breast cancer and over 400 cases of invasive cervical cancer have been diagnosed since the beginning of the program. In Maryland alone, the state had provided more than 54,000 mammograms and 35,000 Pap tests, and diagnosed over 450 women with breast cancer and 15 women with invasive cervical cancer. Now as we prepare to enter the 21st century, it is time for us to finish what we started and provide treatment services for breast and cervical cancer for women who are screened through this program. We made the down payment in 1990 and we've been making payments ever since, but it's time for the final payment. It is time to do the right thing. We screen the women in this program for breast and cervical cancer. But we don't provide the federal follow-up to ensure that these women are treated. The CDC screening program does not pay for breast and cervical cancer treatment services, but it does require participating states to provide treatment services. A study of the program done for the Centers for Disease Control and Prevention found that while treatment was eventually found for almost all of the women screened, some women did not get treated at all, some refused treatment, and some experienced delays. While states and localities have been diligent and creative in finding treatment services for these women, the reality is that the system is overloaded. The CDC study found that when it came to treatment services, state efforts to obtain these services were short- term, labor-intensive solutions that diverted resources away from screening activities. Of those women diagnosed with cancer in the United States, nearly 3,000 women have no way to afford treatment--they have no health care insurance coverage or are underinsured. One woman in Massachusetts reported that she cashed in her life insurance policy to cover the costs of her treatment. These women depend on the time of staff and volunteers who help them find free or more affordable treatment; they depend on the generosity of doctors, nurses, hospitals and clinics who provide them with free or reduced-cost treatment. In the end, thousands of women who run local screening programs are spending countless hours finding treatment services for women diagnosed with breast cancer. I salute the efforts of these individuals who spend their time and resources to help these women. But we must not force these women to rely on the goodwill of others. These treatment efforts will become even more difficult as more women are screened by the NBCCEDP, which currently services only 12-15% of all women who are eligible nationally. The lack of coverage for diagnostic and treatment services has also had a very negative impact on the program's ability to recruit providers, further restricting the number of women screened. The CDC study also shows there are already additional stresses on the program as increasing numbers of physicians do not have the autonomy in today's ever increasing managed care system to offer free or reduced-fee services. While CDC has expanded its case management services to help more women get treatment, even CDC admits that ``more formalized and sustained mechanisms need to be instituted to ensure that all women screened have ready access to appropriate treatment and follow-up.'' It is an outrage that women with cancer must go begging for treatment, especially if the federal government has held out the promise of early detection. We should follow through on our responsibility to treat the cancer that these women were diagnosed with through the CDC program. That's why I've introduced this important legislation with my colleagues. This bill gives states the option to provide Medicaid coverage for the duration of breast and cervical cancer treatment to eligible women who were screened through the CDC program and found to have these cancers. This is not a mandate for states; it is the federal government saying to the states ``we will help you provide treatment services to these women, if you decide to do so.'' By choosing this option, states would in effect, extend the federal-state partnership that exists for the screening services in the CDC program to treatment services. I'm proud that my own state of Maryland realized the importance of providing treatment services to women who were screened through the CDC screening program. Maryland appropriated over $6 million in state funds to establish a Breast and Cervical Cancer Diagnostic and Treatment Program for uninsured, low income women. The breast cancer mortality rate in Maryland has started to decline, in part because of programs like the CDC program. But not all states have the resources to do what Maryland has done. That's why this bill is needed. It provides a long- term solution. Screening alone does not prevent cancer deaths; but treatment can. It's a cruel and heart-breaking irony for the federal government to promise to screen low-income women for breast and cervical cancer, but not to establish a program to treat those women who have been diagnosed with cancer through a federal program. It is clear that the short-term, ad-hoc strategies of providing treatment have broken down: for the women who are screened; for the local programs that fund the screening program; and for the states that face increasing burdens. Because there is not coverage for treatment, state programs are having a hard time recruiting providers, volunteers are spending a disproportionate amount of time finding treatment for women, and fewer women are receiving treatment. We can't grow the program to serve the other 78% of eligible women if we can't promise treatment to those we already screen. This bill is the best long-term solution. It is strongly supported by the National Breast Cancer Coalition representing over 400 organizations and 100,000's of women across the nation; the American Cancer Society, the National Association of Public Hospitals and Health Systems, the National Partnership for Women and Families, YWCA, National Women's Health Network, Oncology Nursing Society, Association of Women's Health, Obstetric, and Neonatal Nurses, the Rhode Island Breast Cancer Coalition, Y-ME, and Arm in Arm. I urge my colleagues to cosponsor and support this critical piece of legislation and make good on the promise of early detection.

Ms. MIKULSKI

Ms. MIKULSKI. Mr. President, I am proud to be an original cosponsor of the Murray/Kennedy Class Size Amendment. This amendment continues a major six year effort to help local school districts hire 100,000 teachers nationally. It is one the most important pieces of legislation the Senate will consider this year. This amendment will strengthen our schools today and build a framework for the future. Last year we made a down payment by including $1.2 billion in the budget for class size. This year, we must continue the fight for our schools and the fight for our kids. We must give our schools the support they need to lower class size. We must get behind our kids by passing this critical legislation. Last year, we worked together in a bipartisan fashion to reduce class size in the FY99 Omnibus Appropriations Act. Last year we got $1.2 billion in the Omnibus to reduce class size using highly qualified teachers. Nationally, this allowed us to hire some 30,000 new teachers this year. My state of Maryland alone received $17.5 million and will get about 425 new teachers this summer. Mr. President, I have visited these classrooms and I have talked to these kids. These children have told me over and over again that they want to learn. They have told me they need more individualized attention. I have received letters from kids in school who are begging for our help. They tell me their schools are overcrowded and the teachers can't control the large classrooms. They tell me they are scared to go to school and that they can't learn because the teachers are too busy trying to manage the overcrowded classes. Mr. President, this is a sad time for our students. A child should never fear going to school. We need to work and work hard to ensure that our efforts are not short circuited because of politics. I have told many teachers and students about the important strides we made last year to make sure they will have smaller and more effective classrooms. These children are excited about having more opportunities to learn. They are eager to learn to read and learn about science and technology. They are excited about all the wonderful possibilities that lie ahead for them with a proper education. But we need to do more. By passing this amendment today, we in the Senate have an opportunity to prove our commitment to education. Efforts are already underway in my state of Maryland to reduce class size. I have heard from at least five counties in my state that they have class reduction programs already in place or in development. The schools in Montgomery County, Maryland, for example, are reducing class size for reading at the primary grade level. In the primary grades, they have started a program where there are only 15 students per teacher for a 90 minute reading block. They are also reducing class size in math at the middle and high school levels and have added an extra math teacher to each school to ensure success in algebra. I applaud these efforts, but they need federal help to do more. These programs started this school year and are being phased in over the next three years focusing initially on low-performing schools. And do you know what these programs will do? They will prepare Maryland kids for the new millennium. They will prepare our children to go onto college and gain the important skills they will need in the future. These class reduction programs are the building blocks that will help prepare our kids to be our future leaders. The American people are counting on us to help fix an education system which failed so many children. Our education system has been ignored for far too long. If we don't pass this amendment today, we are sending the wrong message to the American public. Because of our efforts last year, our schools will be able to hire new teachers this summer. If we don't pass this amendment, we are telling those school that we are not committed to improving America's education system. We need to continue this effort to provide 100,000 new teachers for America. Let's get behind our kids and pass this amendment.