Barbara Mikulski

Ms. MIKULSKI

Ms. MIKULSKI. Mr. President, I rise today as an original cosponsor of a bill that will put an end to the half-promise the federal government has made to women screened under the National Breast and Cervical Cancer Protection Program. When Congress first passed this program as the Breast and Cervical Cancer Mortality Prevention Act in 1990, it was a breakthrough for early detection of breast and cervical cancer. And I was proud to be its chief Senate sponsor. There is still good reason to be proud of this program. By March of 1997, the program had provided mammography screening to over 500,000 women and Pap tests to over 700,000. Nearly 3,500 women have been diagnosed with breast cancer and an additional 300 women with invasive cervical cancer. In Maryland alone, by December 1996, the state had provided more than 35,000 mammograms and 21,000 Pap tests, and diagnosed nearly 300 women with breast cancer and 13 women with invasive cervical cancer. But when we passed that program we expected--and demanded--assurances that women who are found to have breast cancer be provided the necessary diagnostic services, including breast biopsies and treatment services. The program has not lived up to the promise. While a variety of innovative strategies have emerged across the country at the state and local levels to help women get treatment, the reality is that the system is overloaded. Some state programs require providers to arrange for treatment before they can participate in the program; a very few like Maryland have been able to come up with a small pool of general revenues, but generally these funds are available for breast diagnostic services, not treatment. In others, program administrators have to rely on public hospitals, donated services and charity care. In the end, thousands of women who run local screening programs are spending countless hours finding treatment services for women diagnosed with breast cancer. This is not what we had in mind. Not at all. The system for obtaining treatment services--which at its best was an ad-hoc patchwork--has broken down. 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. These women want to pay for their services, but they often simply don't have the financial resources on their own. 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. Screening alone does not prevent cancer deaths; but treatment can. A recent 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. The study also underscores the terribly labor intensive efforts that go into finding treatment for these women--often at the expense of screening. 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. It is sad that 8 years after enactment, the program serves only 12 to 15 percent of all women who are eligible nationally. And this is likely to get worse. The study 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. Breast cancer advocates from across the country are reporting that local programs are so badly strained that they have resorted to holding bake sales and community lunches to raise money for treatment services for the women they serve. Others have cobbled together the funds at great effort--when they are sickest--and most in need of taking care of their health. One woman in Massachusetts reported that she cashed in her life insurance policy to cover the costs of her treatment. 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 no 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 percent of eligible women if we can't promise treatment to those we already screen. Women shouldn't have to hold a bake sale to get treated for breast cancer--especially if the federal government has held out the promise of early detection. It is an outrage that women with cancer must go begging for treatment. That's why I'm cosponsoring this bill. It will establish a mechanism for women to be treated. It will guarantee Medicaid coverage for necessary treatment services to women who are eligible for the CDC program, and found to have breast cancer or cervical cancer. Although I wish the bill would require the States to provide the benefit, the reality is such that we have made this program for now, an optional benefit, and place the responsibility on the States to choose to participate. By doing so, states would in effect, extend the federal-state partnership that exists for the screening services in the CDC program to treatment services. 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. I urge my colleagues to join in and cosponsor this critical piece of legislation and make good on the promise of early detection.

Ms. MIKULSKI

Ms. MIKULSKI. Mr. President, today we are celebrating one of the greatest achievements of the twentieth century--the founding of the state of Israel. I rise to congratulate the people of Israel for a half century of independence--and to look forward to a future of peace and prosperity. The story of Israel is unique. A people forced into exile, who endured centuries of persecution, rebuilt their ancient homeland. They forged a nation where they could practice their ancient faith and traditions. They created an open and free democratic society. And always, they offer a home to Jewish immigrants from around the world. The founding of Israel followed the most incomprehensible and evil event of the twentieth century, when the Nazis--with the complicity of so many others--sought to exterminate a people. The survivors of the Holocaust helped to build modern Israel. Never again will the Jewish people be dependent on anyone else for their security. At first Israelis envisioned an agrarian society. But today, Israel is a center for technology and science. American scientists and engineers are working as partners with Israelis to develop the innovations of the next century. Our great federal laboratories, like the National Institutes of Health, are now working with Israeli scientists on a cure for cancer and other deadly diseases. America's relationship with Israel is also unique. We share common goals, values and interests. We stand by each other in good times and bad. Israel has had to endure five wars and live in constant readiness for battle. They live with the constant threat of terrorism. America must continue to stand by Israel--to make sure they have what they need to protect themselves. We must also stand by them in stopping their enemies from developing the weapons of mass destruction--and the missiles to deliver these deadly weapons. We all hope that the next century will bring peace to Israel and its neighbors. Five years ago, we witnessed the famous handshakes on the White House lawn. These handshakes heralded a new commitment toward peace. The peace process is now stalled. There is a crisis of confidence and a lack of trust. There has been a lot of finger-pointing about who is to blame. But let's remember how much Israel has given up for peace. Let's remember the Sinai and Hebron. No victorious power has ever given up more for peace. Mr. President: I salute the people of Israel as they celebrate fifty years of independence, and I look forward to a future of peace, prosperity and friendship.

Ms. MIKULSKI

Ms. MIKULSKI. Mr. President, I rise today as an original cosponsor of a bill that will put an end to the half-promise the federal government has made to women screened under the National Breast and Cervical Cancer Protection Program. When Congress first passed this program as the Breast and Cervical Cancer Mortality Prevention Act in 1990, it was a breakthrough for early detection of breast and cervical cancer. And I was proud to be its chief Senate sponsor. There is still good reason to be proud of this program. By March of 1997, the program had provided mammography screening to over 500,000 women and Pap tests to over 700,000. Nearly 3,500 women have been diagnosed with breast cancer and an additional 300 women with invasive cervical cancer. In Maryland alone, by December 1996, the state had provided more than 35,000 mammograms and 21,000 Pap tests, and diagnosed nearly 300 women with breast cancer and 13 women with invasive cervical cancer. But when we passed that program we expected--and demanded--assurances that women who are found to have breast cancer be provided the necessary diagnostic services, including breast biopsies and treatment services. The program has not lived up to the promise. While a variety of innovative strategies have emerged across the country at the state and local levels to help women get treatment, the reality is that the system is overloaded. Some state programs require providers to arrange for treatment before they can participate in the program; a very few like Maryland have been able to come up with a small pool of general revenues, but generally these funds are available for breast diagnostic services, not treatment. In others, program administrators have to rely on public hospitals, donated services and charity care. In the end, thousands of women who run local screening programs are spending countless hours finding treatment services for women diagnosed with breast cancer. This is not what we had in mind. Not at all. The system for obtaining treatment services--which at its best was an ad-hoc patchwork--has broken down. 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. These women want to pay for their services, but they often simply don't have the financial resources on their own. 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. Screening alone does not prevent cancer deaths; but treatment can. A recent 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. The study also underscores the terribly labor intensive efforts that go into finding treatment for these women--often at the expense of screening. 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. It is sad that 8 years after enactment, the program serves only 12 to 15 percent of all women who are eligible nationally. And this is likely to get worse. The study 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. Breast cancer advocates from across the country are reporting that local programs are so badly strained that they have resorted to holding bake sales and community lunches to raise money for treatment services for the women they serve. Others have cobbled together the funds at great effort--when they are sickest--and most in need of taking care of their health. One woman in Massachusetts reported that she cashed in her life insurance policy to cover the costs of her treatment. 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 no 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 percent of eligible women if we can't promise treatment to those we already screen. Women shouldn't have to hold a bake sale to get treated for breast cancer--especially if the federal government has held out the promise of early detection. It is an outrage that women with cancer must go begging for treatment. That's why I'm cosponsoring this bill. It will establish a mechanism for women to be treated. It will guarantee Medicaid coverage for necessary treatment services to women who are eligible for the CDC program, and found to have breast cancer or cervical cancer. Although I wish the bill would require the States to provide the benefit, the reality is such that we have made this program for now, an optional benefit, and place the responsibility on the States to choose to participate. By doing so, states would in effect, extend the federal-state partnership that exists for the screening services in the CDC program to treatment services. 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. I urge my colleagues to join in and cosponsor this critical piece of legislation and make good on the promise of early detection.

Ms. MIKULSKI

Ms. MIKULSKI. Mr. President, I say thank you. I will be happy to vote when my turn comes. Thank you. Mr. LEAHY addressed the Chair.

Ms. MIKULSKI. Mr. President, we shortly will be entering into the closing hours of this debate. I want to take this opportunity to offer some observations about the ratification and also why this is so important. I would like to take a minute, though, to really congratulate the people of Israel on the 50th anniversary of the founding of that great state, and how special, unique, that we are debating NATO expansion and bringing Poland, Hungary, and the Czech Republic into NATO on the 50th anniversary of the founding of Israel. Forever and a day, I will always remember that we will have taken this vote at the same date of the anniversary of that state. It will be important because, as we commemorate, soon, the 50th anniversary of NATO and the 50th anniversary of the founding of Israel, just like the 50th anniversary of the United Nations, as this century comes to an end, we will look at what came out of the end of World War II that created the institutions that will take us, hopefully, to a new century and a new millennium, where we will not repeat the despicable and inhumane practices of the old century, or ever again have to fight another war in Europe. The Senate is about to take a historic vote and we are voting to make Europe more stable and America more secure. We are voting for a safer world. This will be one of the most important votes I will cast. Voting for a treaty is, indeed, a very special obligation, reserved only for the U.S. Senate. For those who have known me, they have known I have fought long and hard for Poland and other countries of Eastern Europe to become free and independent. I think about the dark days of martial law in Poland, when we worked to support the Solidarity movement in Poland. Since the end of the cold war, when the captive nations of Eastern Europe threw off the yoke of communism, I have yearned for this day. I have supported the aid that the American people so generously provided to help the people of Eastern Europe build free-market democracies. I have introduced legislation with former colleagues, Senator Brown of Colorado and Senator Simon of Illinois, to nudge our Government toward welcoming the newly freed countries into our Western institutions. My passion for this issue, though, is based partly on my own personal history. Each ethnic group in America brings their own history to this country. My colleagues have heard me speak about Poland's history many times in the past, because I have never believed that America was a melting pot. I always believed that America was a mosaic. We each come with our history and our culture and become part of something bigger than ourselves. So I come with thousands of years of history behind me, in terms of my heritage. The history of Poland has indeed been a melancholy one, because every king, kaiser, czar or comrade who ever wanted to have a war in Europe starts always, first, by invading Poland. It has been historically true for a thousand years, and it has certainly been true for the last 100 years. At the same time, Poland has always wanted to be part of the West in terms of its values and in terms of its orientation. It felt so passionate about democracy that when we fought our own revolution it sent two of its finest heroes, Kosciusko and Pulaski, to fight in the war for America's freedom. Pulaski came and was a brilliant soldier and led in the Battle of Savannah. Kosciusko was a brilliant tactician and led in the founding and building of West Point and, at the same time, then, fought for the democracy and became a great friend of Jefferson. He returned to Poland to help the Polish people of that time establish the first constitutional monarchy in Europe. Poland thought it would be free and have a constitutional monarchy, but that was not to happen. In the 19th century, Poland was divided into three parts, under Russia, Prussia, and the Austro-Hungarian Empire, and it remained that way. That is when my great-grandmother came to this country. She came, not because she just wanted to come and start a new life, she came on a prearranged marriage, because she wanted to forever escape that kind of occupation. This evening is not about history lessons, but Poland was occupied, partitioned, invaded in World War I, had a brief stint of democracy between World War I and World War II, only to be invaded by the Nazis in World War II and occupied. For me, growing up as a Polish American in east Baltimore, I learned about the burning of Warsaw. I knew about the occupation of Poland by the Nazis. I have seen films of the occupation, in which the great cathedral had Nazi storm troopers in there, burning the statues of the Saints and our Dear Lord himself, with their weapons. I learned about the burning of Warsaw at the end of World War II, when the Germans burned it because of the Warsaw uprising. Soviet troops stood on the other side of the Vistula River and watched it burn. Then we learned about the Katyn massacre, where Russians murdered more than 4,000 military officers and intellectuals in the Katyn Forest at the start of the Second World War, so there would not be an intellectual force in Poland, ever, to lead it to democracy. For 5 years our family hoped and prayed, hoping World War II would end, with my uncle serving in the military. And then, at end of the war only to see Potsdam and Yalta occur, where Poland was sold out. My great- grandmother had on her mantle, three pictures, one of Pius XII, one of my uncle who had become a member of the police force, and the other of Roosevelt, because she believed in the Democratic Party. After Potsdam and Yalta, she took the picture of Roosevelt and turned him face down, until the day she died. Those were the kinds of stories that I grew up with, looking at Poland as part of the captive nation. Then suddenly, in August of 1980, an obscure electrician, working in the Gdansk Shipyard, jumped over a wall proclaiming the Solidarity movement. And when he jumped over that wall, he took the whole world with him, to continue the push in this part of the century to free Poland. And then the movement, also of dissidents, spread. These are the kinds of stories. What I wear here today is a picture of the Blessed Mother of Czestochowa. She is the Patron Saint and Protectress of Poland. Members of the Solidarity movement wore exactly this emblem because they were forbidden under martial law to wear any symbol related to Solidarity. So they wore a religious symbol. I wear this symbol today because this, then, is the next step toward what we fought for in World War II, what dissidents in these countries have worked for--to create a democracy and a free-market economy, risking their lives, imprisoned, living under the boot of communism. So now those are the kinds of things that we must grasp. This is a historic moment, when three countries whose heart, soul, and political orientation is with us. So, I hope for those who worked so long and so hard, within Poland, Hungary and the Czech Republic, that we, then, understand the ratification of NATO enlargement. Despite the importance of history, my support for NATO is based on the future. My support is based on what is best for our country. NATO enlargement will make Europe more stable and America more secure. It means the future generations of Americans, I believe, will not have to fight or die in Europe. It will make NATO stronger. It will make America stronger. And it will make Western civilization stronger. Mr. President, I am only sorry my great-grandmother is not alive to see this, because when we vote to ratify this treaty, we will undo the historic tragedy that has often engulfed these nations and forever and ever, in the next century, ensure not only their protection but also ensure that despicable practices like the Holocaust will never again happen. That is what the 21st century is all about. That is why I will enthusiastically vote aye, when my name is called. I yield the floor. Mr. BIDEN addressed the Chair.

Ms. MIKULSKI. Mr. President, I ask unanimous consent that the order for the quorum call be rescinded that I may speak on the ratification of NATO enlargement.

Ms. MIKULSKI

Ms. MIKULSKI. Mr. President, I rise in opposition to the Warner amendment to freeze NATO membership and, if time permits, to also comment on the Moynihan amendment regarding the necessity for EU membership for these countries before being included in NATO. It is very difficult--like you when you spoke earlier and said you had great admiration for both the Senator from New York and the Senator from Virginia as I do, we have such constructive relationships, and I admire their grasp on policy and their desire to move ahead on constructive foreign policy. As well-intentioned as the Warner proposal is, its acceptance would be inconsistent with the NATO treaty itself. It would unnecessarily limit U.S. flexibility in pursuing further enlargement should the United States of America determine that such enlargement would be in its national interest. It would also undercut the tremendous gains for peace accomplished over the last decade in Central Europe, including the historic reconciliation now underway between Russia and the West. Article X of the Washington treaty, which was the alliance's founding charter nearly 50 years ago, states that membership is open to ``any other European state in a position to further the principles of this treaty and to contribute to the security of the North Atlantic area.'' NATO has been an unprecedented success in deterring conflict and promoting peace and stability. Toward these ends, NATO has been expanded three times in the past. To remain relevant and successful in the future, NATO must keep its doors open to those European democracies ready to bear the responsibilities, as well as the burdens, of membership. NATO enlargement is a policy deeply rooted in this principle, often driven by moral imperatives, but equally important strategic self- interest and objective criteria concerning military readiness and political and economic reform. It is not easy to become a NATO member. This is not like signing up for an American Express card. New NATO members must meet stringent military base criteria. They must also demonstrate a commitment to resolve ethnic disputes and territorial disputes by peaceful means. In fact, the prospect of NATO membership has led newly free countries in Europe to settle border disputes. Potential NATO members must also show a commitment to promote stability and well-being by promoting economic liberty, social justice and environmental responsibility. They must establish democratic and civilian control of their military, a transparent military budget and be fit for duty, as well as using diplomacy as its first tool of dispute resolution. You have to do that in order to even be considered. So, therefore, I oppose the Warner amendment because it would freeze or reduce U.S. flexibility within the alliance and, at the same time, close the door that article X gave as a message of optimism and hope. The Warner amendment would repudiate article X and its message of optimism and hope, which is what a freeze on enlargement would do. It would be seen by reformist countries of Central Europe as a door being shut. Do we really want to send such a disillusioning message to those other countries that are working for democracy, economic reform and civilian control of their military? Article X of the Washington treaty was a source of hope to Central Europe during Soviet oppression. The prospect of NATO membership remains an important incentive for democratic and economic reform. It has already motivated the reconciliations between Germany and the Czech Republic, Germany and Poland, Romania and Hungary, Romania and Ukraine, and Italy and Slovenia, among others. The civil and military agreements between these countries have helped to consolidate peace and stability in Central Europe, and these things must be protected and not undercut. Third, a mandated pause would create a new dividing line in Europe. If Central European countries not invited into NATO conclude that the process of enlargement has not only been stalled but stopped, a key incentive behind their current participation in NATO's Partnership for Peace Program, a military partnership, would be eliminated. A key achievement of this program is the coordination that it now fosters between their defense planning and force structure development. Thus, a freeze on enlargement would impede, if not reverse, this remarkable development of European security around an alliance-determined agenda. This is what NATO is all about. Fourth, an arbitrary freeze on NATO enlargement would harm Russia's historic reconciliation with NATO and the United States. A freeze would appear to give Moscow a veto over NATO enlargement. It certainly would be interpreted as a victory for the hard-liners by those who still advocate a Russian sphere of influence over its neighbors, those who wish to see that Russia could deny the entry into NATO of these three democracies. Worse, it could lead others to draw the conclusion that they will never ever have a chance to join NATO and never ever get out of the Russian sphere of influence. A freeze would undercut the basic principles that all of Europe's states have a right to choose their own security arrangements--a principle that must be one of the cornerstones of Russia's relationships with the United States and NATO membership. Mr. President, the resolution of ratification passed the Senate Committee on Foreign Relations 16 to 2, and on that day that it voted, March 3, 1998, it explicitly addressed the concerns of those accusing the alliance of moving too fast on enlargement. It states: The United States will not support the admission of, or the invitation for admission of, any new NATO member, unless . . . (I) the President consults with the Senate consistent with article II, section 2, clause 2 of the Constitution of the United States . . . and (II) the prospective members can fulfill the obligations and responsibilities of membership, and its inclusion would serve the overall political and strategic interests of NATO and the United States. That is what the committee voted on, that we just would not have an open door but it would be an open door according to article X of the treaty we already adopted. Mr. President, I encourage my colleagues, no matter how well- intentioned--no matter how well-intentioned the Warner amendment is, I think it would absolutely undercut peace and stability. Mr. President, also in terms of the Moynihan amendment, I want to associate myself with your remarks in which you said we could not be part of NATO under that, Canada could not, Turkey could not. And if we then would adopt the Moynihan amendment, should we then consider an amendment that would remove from NATO any members that are now part of EU? What would that mean? It would take us out. It would take Canada out. It would take Turkey out. I do not think it is logical. I know there are many concerns about Russia. I know my time is limited and others wish to speak on this amendment. Later on this afternoon I will give my thoughts on Russia. I wish to maintain a constructive relationship with Russia, but I do not think this is the time nor the place to then give in to the Russian hard-liners but to focus on the new Russia, which I believe is not an imperial Russia. Mr. President, I yield the floor.

Ms. MIKULSKI. Seven minutes.

Ms. MIKULSKI. Mr. President, I seek recognition.

Ms. MIKULSKI

Ms. MIKULSKI. Mr. President, I rise today to introduce the ``Seniors' Access to Continuing Care Act of 1998'', 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, which provide the entire continuum of care. In Maryland alone, there are over 12,000 residents in 32 continuing care retirement communities and 24,000 residents in over 200 licenced nursing facilities. 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. Many individuals have little choice when entering a nursing facility. They 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''. 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. But hospitalization presents other challenges. 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 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. An elderly couple in Riverside, California encountered the same problem when the husband was discharged from the hospital and retained against her will at the HMO skilled nursing facility instead of the couple's community. At 25 miles apart, it was impossible for his wife and friends to visit at a time when he needed the tenderness and compassion of loved ones. Another Florida woman, a resident of a CCRC fractured her hip. Her HMO wanted her to move into a nursing home for treatment. She refused to abandon her home and received the treatment at the CCRC. Her HMO refused to pay for the treatment, so she had to pay out of her pocket. 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 managed care organization (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 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 to speak in favor of the expansion of NATO. And how appropriate that our friends, colleagues, and allies from the United Kingdom have joined us on the Senate floor just as they have joined us in battle and just as they have joined us in keeping the peace, and we welcome them with affection, admiration, and gratitude. Mr. President, I am pleased that the Senate has returned to consideration of the ratification of NATO enlargement. I hope we will now have an uninterrupted debate. NATO enlargement deserves the dignity of serious consideration of this matter and to take such time as the Senate deems necessary. Mr. President, I support NATO enlargement because it will make Europe more stable and America more secure. It means that the new democracies of Central and Eastern Europe will share the burden of European security. It means that future generations might not have to fight and die in a European theater. If NATO doesn't enlarge, the Iron Curtain remains permanent and the unnatural division of Europe will live on longer than the Communist empire did in the Soviet Union. NATO will remain, as President Havel has said, an alumni club for cold war victors. It will have little relevance to the realities of the 21st century. Mr. President, as a Polish American, I know that the Polish people did not choose to live behind the Iron Curtain. They were forced there by the Yalta agreement and by Potsdam and because they and the Baltic States and the other captive nations were sold out by the West. Many Members of the U.S. Senate have stood long for the freeing of the captive nations. Many of our colleagues have been strong supporters of Solidarity. I, as both a Congresswoman and then as a U.S. Senator, supported the Solidarity movement. I was a strong supporter of the Solidarity movement. I was with President Ronald Reagan in a wonderful evening he held at the White House where he hosted the Polish Ambassador to the United States who had defected when Poland had imposed martial law on its own people, there sitting with President Reagan and the Ambassador from Poland who chose to defect rather than uphold where the Polish Army had been forced to go against its own people. We pledged that we would make Poland free. And now Poland is free, but we have to make sure that Poland, Hungary, and the Czech Republic are not only free but that they are secure. That is why my support is for the expansion of NATO. My support for NATO is not based on ethnic American politics nor is it even based on the past, but it is based on the future. What will the new world order look like? I support NATO enlargement because it will make America and Europe more stable and secure. NATO enlargement means a future in which the newly independent countries will take their rightful place as a member of Western Europe. NATO played an important part in securing this freedom. It has been the most successful alliance in history. It is an alliance that helped us win the cold war. It deterred war between the superpowers and helped prevent confrontation between member states. But if NATO is to survive, it must adapt to the needs of a post-cold- war world, or it will become irrelevant. NATO has evolved since it was created in 1949. We have enlarged NATO on three different occasions. Each new member strengthened NATO and increased security in Europe. No expansion of NATO is easy. No expansion of NATO is done without thought. No expansion of NATO is ever without controversy. We can only reflect what the bitter debate must have been when we voted to include Germany because of their provocative role in World War I and World War II. Today, we are facing difficult and different threats to security. We have civil wars, as in Bosnia; we have hot spots caused by ethnic and regional tensions, as in Kosovo; we have international crimes, drugs, and terrorism; and we have the spread of weapons of mass destruction. NATO must change in order to meet these new threats. Europe's new democracies will help us meet those challenges. The countries of Central and Eastern Europe want to help us address these new threats. How many times has the Senate discussed burdensharing in Europe--and we want others to share the burden, not only in the financial cost, but of the risk to be borne in defending democracy. How often have we in the United States complained that European countries were not willing to pay their fair share for their own defense? Now, we have countries that are asking to share the burden. They are asking to pledge their troops and equipment for a common defense. They are asking to share the burden of peacekeeping. In fact, they are doing it right now in Bosnia, where thousands of troops from Poland, Hungary, and the Czech Republic are helping to secure the peace. Hungary has made itself available, so it is our base camp to go into Bosnia. They have even committed to joining us and ending Iraq's chemical and biological weapon programs, which is more than can be said of some of our allies. These countries are not asking for a handout, nor are they asking for our protection without their own ability to maintain their own defense. They are asking to be full partners in the new Europe. By transforming their countries into free-market democracies, countries that have a democracy, a free-market economy, with civilian control of the military, transparent military budgets, wow, these new democracies are ready to join NATO. These new democracies will contribute to America's security by making NATO stronger. They are adding troops and equipment. They will provide additional strategic depth to NATO. They will also provide the will to fight for democratic values. Their history and geography make them passionate defenders of peace and democracy. They know what it means to be occupied and oppressed by tyrants, occupied and oppressed against their own will. They will put our common values into action. They will join with us in defending our national security and our values, whether it means peacekeeping in Europe or preventing the spread of weapons of mass destruction anywhere in the world. Opponents of NATO enlargement have valid concerns, and I think we need to discuss them. First of all, opponents of enlargement point to cost. They say that NATO enlargement has a cost, and they are right. The new NATO members must modernize their military and make them compatible with NATO systems. The new NATO members have committed to pay this price. There will also be a cost to the United States. Our funding of NATO's common budget will increase. NATO estimates that the total common budget will increase $1.5 billion over 10 years. The American share of that will be $400 million, or $40 million a year. But what is the cost of not enlarging NATO? I believe it will be far higher. What will be the cost to European security, the cost to the new democracies of Eastern Europe, the long-term cost to America? And, most important, will the benefits of NATO enlargement outweigh the costs? As a member of the Senate NATO Observer Group, working on a bipartisan basis, I met recently with the Foreign Ministers of Poland, Hungary, and the Czech Republic. I asked them those very questions. The Polish Foreign Minister, Bronislaw Geremek, is a hero of the Solidarity movement. He said that Poland would feel abandoned once again by the West. He said that Poland will still pay to modernize their military. In fact, he said that the failure to include these three nations in NATO will cause them to spend more on their military budget. They also said they would form their own military alliance, which would be decidedly more anti-Russian than NATO. He went on to say that by refusing to enlarge NATO, we would give the hardliners in Russia a great victory. The antidemocratic forces in Russia would feel vindicated and proud. We would be handing them a victory that they could build on. What would be the long-range costs to America of failing to prepare NATO for the 21st century? The cost would be instability in Europe and the increased chance of being pulled into yet another European war. And the cost of preventive security is always less than the cost of war. I would like to discuss the benefits of enlargement, which I believe outweigh the costs. The strategic benefits of enlargement are most important. NATO enlargement will create a zone of peace and stability that does include Eastern Europe. It will extend NATO's stabilizing influence to more of Europe and reduce the chances of aggression or conflict in Eastern Europe. Enlargement will bring peace and security to Eastern Europe, just as it did for the West. There are also economic benefits. Europe is America's largest trading partner, with $250 billion in two-way trade each year. Our new NATO partners will increase trading opportunities. They are building vibrant free-market economies. Poland's economy is growing at 6 percent, which is more rapidly than many of the others. NATO brings stability, and stability brings prosperity. We are creating a prosperity zone across Europe. Mr. President, in the best tradition of the Senate, I could expand, but I know my colleague from Texas is waiting to speak as well. We are both involved in the supplemental. What I want to say is that the treaty ratification is one of the Senate's most fundamental duties. We are extending our Nation's commitment to collective defense. I certainly don't take this responsibility lightly. In the very best tradition of the Senate, we are addressing NATO enlargement as a national security issue, not a political issue. NATO enlargement is bipartisan, and it should be. It must be fully supported by members of both parties and the leadership of the Senate. We have worked closely with the President and Secretary Albright. The Senate has been fully consulted at every step of the process, as has been required by our Constitution. Senator Lott and Senator Daschle, our Republican and Democratic leaders, appointed a NATO observer group, chaired by Senator Roth, which has engaged in all aspects of discussing NATO enlargement, as well as the appropriate committees. So now we have had discussion at the committee level. Now it is time to debate this on the Senate floor. I am proud to support NATO enlargement. By ratifying this resolution, we are marking the end of the cold war and the beginning of a new century. We are building an undivided, peaceful, and democratic Europe for the new millennium. We are laying the groundwork for a new era of peace and stability. Mr. President, a new century is coming, a new millennium is about to be born, and I do not want the repugnant and despicable wars that characterized the 20th century to be carried into and repeated in the 21st century. That is why I believe in the expansion of NATO with these three countries. I look forward to a full and ample debate with my colleagues, Mr. President. This is a moment that I think is a long time waiting. We appreciate the leadership of President Ronald Reagan, who brought the end of the cold war, and Mr. George Bush, who was willing to defend and fight against the weapons of mass destruction. And now, under President Bill Clinton, we look forward to expanding NATO and to keeping that momentum going. I yield the floor. Mrs. HUTCHISON addressed the Chair.

Ms. MIKULSKI

Ms. MIKULSKI. Mr. President, I rise today to introduce the ``Seniors' Access to Continuing Care Act of 1998'', 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, which provide the entire continuum of care. In Maryland alone, there are over 12,000 residents in 32 continuing care retirement communities and 24,000 residents in over 200 licenced nursing facilities. 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. Many individuals have little choice when entering a nursing facility. They 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''. 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. But hospitalization presents other challenges. 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 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. An elderly couple in Riverside, California encountered the same problem when the husband was discharged from the hospital and retained against her will at the HMO skilled nursing facility instead of the couple's community. At 25 miles apart, it was impossible for his wife and friends to visit at a time when he needed the tenderness and compassion of loved ones. Another Florida woman, a resident of a CCRC fractured her hip. Her HMO wanted her to move into a nursing home for treatment. She refused to abandon her home and received the treatment at the CCRC. Her HMO refused to pay for the treatment, so she had to pay out of her pocket. 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 managed care organization (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 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 in opposition to H.R. 2646, the Education IRA Tax Bill. I oppose this bill for three reasons. First of all, it is does not meet the education needs of America's children. Second, it does not support the mission of either public or private education. Third, it does not meet its stated goal of providing economic relief to America's families. Mr. President, this bill is ineffective in serving the education needs of our children. One of my priorities as a Senator for Maryland is standing behind our kids. I believe this priority should also be at the heart of the Senate's agenda. The bill before us does not reflect what America's priorities in education should be. Let me state clearly that I believe that education should be a non- partisan issue about what is good for our kids and the future of our country. Fighting for education does not mean pitting our schools or our people against one another. It should not be about private schools vs. public schools, or wealthier people vs. people with more modest means of educating their children. This is not what education is about. This is not what the business of the Senate is about. We are here to do the very best we can for ALL of the people of America, not just a select few. We have a duty to help ALL of the children of America to prepare themselves for the 21st century. We need to be able to look toward a future that promotes a sustainable, robust economy. A key element to our future is educating those who will be governing our future. We need to invest in our children's education so that they can skillfully navigate our country into the ever expanding world markets. They need the skills to become productive members of our workforce. Our children need the educational tools that allow them to understand the complicated economic mechanisms that govern our modern world. While the Coverdell IRA bill purports to be a pro-education bill, it does nothing to improve the education of the majority of our students. Coverdell does nothing to ensure our kids have the tools they need to cope with these important issues as future leaders and hardworking adult citizens of our country. Support for public education must be the priority for federal investment. Coverdell represents an actual divestment in public schools. The Coverdell bill costs $1.6 billion dollars over the next ten years and gives the majority of the benefits to only 7% of the families with children in school. Even those benefits are meager ones. For example, the average family with children in private schools stands to benefit only $37 a year in tax exclusions. This $1.6 billion can be much better spent following an agenda that truly gets behind our kids. The Senate should support and pass legislation that offers real solutions to address the problems faced by our schools. Students cannot learn in overcrowded schools that are falling down around them. Schools in every state in this country are in desperate need of repair. This year, K-12 enrollments reached an all-time high of 52 million children and they will continue to rise. It is estimated that we will need to build 6,000 new schools by 2006 to maintain current class sizes. Leaky roofs and overcrowded classrooms are the real problems that need to be addressed, not whether an average $37 per year tax benefit is what is best for Americans and education. We should target scarce federal resources to finance the construction and modernization of our public schools. These are the schools that 93% of our children attend. These schools will help many communities provide modern, well-equipped schools that can be wired for computers and technology so the children can get the education they need to succeed in the 21st century. These are also the same schools that may house after-school education and safety programs which our children need. We need to place our priorities on hiring new teachers. I supported Senator Kennedy's amendment to hire 100,000 new teachers and to make certain that they are well qualified in the areas we need them most. Under the 1994 Crime bill, we agreed to add 100,000 cops to police forces throughout the country. My own state of Maryland has added over 1,200 cops--who are out in the community fighting crime. I know what a difference they've made in preventing crime, and in ensuring that those who commit crimes are apprehended. Our streets are safer because of this program. Think what a difference 100,000 new teachers could have made. I am disappointed that this amendment was not approved. The Coverdell bill does not meet any of these dire education needs-- for school repair, for school construction, for more teachers and smaller class sizes. It is silent on these critical needs. The Coverdell bill is ineffective in supporting the mission of either public or private education. I believe that public education--the choice of 93% of America's families--must not be shortchanged by the federal government. But let me be clear that I support our private schools as well. I am a proud product of parochial schools. What I am today I owe in large measure to the sisters who educated me in Baltimore's parochial schools. They nourished my intellect, and they nourished my spirit. So I know about the value of private schools and I support private schools. But I believe there are better ways to support private school education. The federal government already provides substantial assistance in support of private education. There are a range of federal programs that private schools can take advantage of which are designed to serve a variety of school student and teacher needs. For example, there are 366 private schools in Maryland that take advantage of ``Innovative Programs,'' a federal program available to both private and public schools. Innovative Programs supports a broad range of local activities in eight primary areas including technology, reform implementation, disadvantaged children, literacy programs, gifted programs and some Title I and Goals 2000 activities or programs. I believe that better use of the resources tied up by this bill--some $760 million over the next five years--could be better used through supporting existing programs that benefit both public and private schools. Finally, Mr. President, this legislation is ineffective in providing economic relief to America's families. I know how hard many families of modest means struggle to give their children the best education possible. The Coverdell bill has been presented as a tool to give these families some financial relief. But, that is a hollow promise. The average family with children in private schools would receive tax relief of only $37.00 a year. $37.00, Mr. President. I know that every dollar counts, but $37.00 a year is not going to make much of a difference in the average family's budget. The bottom line is that the education IRA will not fix our crumbling schools or help us bring qualified teachers into our classrooms. The education IRA will not bring the information superhighway to public schools. In fact, it will bring very little benefit to the majority of Americans and no benefit at all for Americans who cannot afford to contribute money to these savings accounts. For these reasons, I must oppose this legislation.

Ms. MIKULSKI

Ms. MIKULSKI. Mr. President, I rise in firm opposition to S. Con. Res. 86, the Budget Resolution for fiscal year 1999. I do so with great disappointment. Mr. President, last year the Congress produced an historic budget agreement. We produced a plan to finish the job we started in 1993 of eliminating the budget deficit. We worked together--across party lines--to balance the budget, to protect our seniors by ensuring the solvency of Medicare, and to provide for key investments in education and health care. We also provided real tax relief for working families. I had hoped we would be able to continue to build off the framework of the 1997 Balanced Budget Act and Taxpayer Relief Act. Unfortunately, this budget resolution ignores the priorities that were at the core of those agreements. I will oppose this resolution because it does not reflect the principles and priorities that I believe must be part of the budget. I want a budget that preserves the safety net for seniors, gets behind our kids, provides for safe streets and a safer world, and provides for investments in science and technology. I believe this budget is defective in each of these areas. The Democratic budget alternative that was offered during our debate was strong where this resolution is deficient. It would have allowed for enactment of a comprehensive child care initiative to improve and expand the availability of quality, affordable child care and after school programs for school age children. No working parent should have to worry about finding suitable care for their child--a safe place with well-trained staff. The lack of adequate safe and affordable child care is a major concern of America's families. Our alternative would have gone a long way to meet that critical need. The Democratic alternative was strong on education. It would have enabled us to improve the education of our children through initiatives to reduce classroom size, hire 100,000 more teachers, and to ensure that children attend school in safe and well-maintained facilities. Our Democratic alternative was strong on Social Security. It made clear that before we spend one penny of any projected budget surplus, we should save Social Security first. Social Security is a sacred compact with America's seniors. We owe it to every senior citizen to ensure that Social Security is there for them, and that it will be there for today's workers when they retire. Our Democratic alternative was strong on health care. It would have provided for vital new investments in health care research. It would have ensured that the funds generated by a comprehensive tobacco bill-- a priority for the American people--could be used to fight teen smoking, to conduct tobacco-related health research, to provide programs for people who want to quit smoking, and to help tobacco farmers move to new crops. I believe we produced a budget that should have had the support of a bipartisan majority. It was a common sense budget--that kept our commitment to a balanced budget, while providing for the sorts of investments in key priorities that are critical for getting our country ready for the next century. I am deeply disappointed that our alternative was rejected. The Budget Resolution before us now does not meet America's needs. I cannot support it. focus on teacher quality

Ms. MIKULSKI

Ms. MIKULSKI. Mr. President, I wanted to rise very briefly and share with my colleagues the fact that a colleague who served in the House has passed on to God's glory. I knew her as a very dear friend. Congresswoman Bella Abzug died yesterday of complications of heart disease. I knew Mrs. Abzug as friend. I knew her as a wonderful Congresswoman. I want to state on the Senate floor how much she will be missed. Congresswoman Abzug fought for the rights of women. She fought for civil rights. She fought for human rights. She was known as ``Battling Bella.'' She had a very big heart and a very large agenda. I cannot believe that she died of heart disease, because if there was one fault that Bella did not have, it was heart problems. In fact, it was her very big heart that wanted to be sure that women were fully included in our society and enjoyed equal protection under the law in the Constitution. She wanted to be sure that she spoke out for the women of this country and that we also included everyone else who was left out and left behind. Also, when she left the Congress, she spoke very eloquently and added to her agenda the human rights of women and children all around the world. She will be deeply missed. Her hat stood there. You could always find Bella in a crowd. But when the history books are searched, we will find that Congresswoman Abzug is the indelible mark on the history of the United States of America for those who worked with her. She will be greatly missed. But, most of all, she will be missed by the people she fought for and championed all of her life.

Ms. MIKULSKI

Ms. MIKULSKI. Mr. President, I am proud to stand today with my colleague from Missouri and the chairman of the VA-HUD Subcommittee, Senator Bond, to offer a sense-of-the-Senate amendment to the fiscal year 1999 budget. This amendment is designed to state the Senate's view that it is absolutely critical that HUD's section 202 program, which is its elderly housing program, absolutely be fully funded. That is what the resolution states. That is what I encourage the Members on both sides of the aisle to support. For years, I have been an advocate for an affordable and available supply of safe and decent housing for our elderly. For years, I have worked with Senator Bond to ensure adequate funding. In 1992, as the chair of the VA-HUD Subcommittee, I worked to successfully change the section 202 program from a very expensive loan program to a grant program. Do you know what? It allowed us to build more housing for less cost. I am concerned, though, that there is in the budget resolution a proposed cut of nearly $500 million in housing for the elderly. I am also concerned about the desire to move to more of a voucher approach to elderly housing instead of new construction, forcing the senior citizens of this country who need a modest subsidy to go out and kind of forage on their own to find housing that meets their needs. Mr. President, our Nation has many responsibilities, but its most important one is to protect and help all its citizens, but it has a particular moral obligation to look out for senior citizens. Promises made should be promises kept. This generation, which is now the frail elderly, organized to save this country and to save Western civilization during World War II. Many fought on the battlefront and many were the ``Rosie the Riveters'' who helped this country on the homefront. This is why we need to now look out for them as the frail elderly. The amendment I offer today with Senator Bond seeks to do this. They are our mothers and fathers, who raised and nurtured us; our aunts and uncles, who gave advice; and the neighbors who kept an eye on us; they are the people who we grew up with, who looked out for us in our communities; they are the people, in many cases who, with their blood, sweat and tears, helped build this country into what it is today. Mr. President, we have the moral obligation to ensure that we do what we can to ensure that those elderly citizens who need our help get our help. The AARP estimates that there are eight people on the waiting list for every one HUD section 202 unit that becomes available. Senator Bond has put that into the Record. Our subcommittee has done extensive research on this. What do we find? First of all, that the secton 202 program is the most popular HUD housing program we fund. Why is it popular? It meets compelling needs. It often stabilizes neighborhoods where people are ``aging in place.'' It also enables groups that are nonprofit and faith based to participate in providing housing. The section 202 Elderly Housing Program is important because it meets those needs. Since 1959, when this program was created under a whole other different type of HUD, we have funded 5,004 elderly housing projects, with over 330,000 housing units. They are primarily lived in by frail, older women in their seventies living with an income of less than $10,000. I think that is a good way to spend taxpayer dollars. The combination of affordable housing and supportive services under the section 202 program has been absolutely critical in meeting not only the housing needs but in promoting independent living, self- sufficiency, and dignity for the elderly, while delaying more costly institution. There are 1.4 million elderly Americans who currently have worst-case housing needs. There are 33 million Americans aged 65, over some 13 percent of all Americans, and this number is growing. That is why I have asked HUD to come up with new ideas on how we are going to meet, No. 1, the expanding elderly population, and, No. 2, the expanding frail elderly population. I believe that if we focus our attention and our resources, we will meet our needs. This is why I support the Bond amendment. It is the Mikulski-Bond amendment. My colleague, Senator Sarbanes from Maryland, who is the ranking member on the Housing and Banking Committee, also wants to be a cosponsor. I will conclude my remarks by talking about the voucher program. This Senator is never going to support a voucher program for the elderly. I will tell you why. When you are old, when you are sick, when you have a pain, when you have a walker, when you have a wheelchair, when you can barely read a newspaper without a magnifying glass, we are not going to give you a voucher, and say, ``OK, kiddo, you are out there on your own.'' We are not going to do that. Senior citizens should not have to go into the marketplace to forage with a voucher to find housing that would meet their needs. Mr. President, I know you have been in housing for the elderly in your own State. They have special architectural needs--low steps and special kinds of grips in the bathroom--all those kinds of things that, if they fall, they don't fail. You just can't put them in any kind of apartment in the United States of America; they have specialized needs. We can meet those needs. What is so fantastic--I cannot underestimate nor overstate the fact that faith-based organizations are involved in this. In my home State, the role of Catholic Charities, Associated Jewish Charities, and other organizations from the United Way step forward to make wise use of Federal funds and, at the same time, often value add to what the Federal Government is doing. I really encourage my colleagues to support the Bond-Mikulski amendment. It is cosponsored by Senator Sarbanes. I know that many others will join us. This is one of many budget amendments stating sense-of-the-Senate resolutions. This, I think, is not only the sense of the Senate, Mr. President, it is the sense of the American people. Senator John Kerry also wants to cosponsor it. Colleagues will be able to cosponsor it as we go forward. I yield the floor on this amendment. I really encourage my colleagues to support it. Mr. BOND addressed the Chair.

Ms. MIKULSKI

Ms. MIKULSKI. Mr. President, I want to go on record today in support of the amendment to the Fiscal Year 1999 Budget Resolution offered by the Ranking Member of the Veterans Affairs Committee, Senator Rockefeller. Mr. President, since the VA was founded, we have fought a World War, a Cold War and a Gulf War. From the World Wars to Korea, Vietnam to the Persian Gulf, each conflict produced a new generation of veterans with unique needs. The particular needs may vary somewhat for veterans of different eras, but one thing should never change - the commitment that we make to our veterans. Our veterans entered into a covenant with this nation when they agreed to risk their lives for our freedom. We must ensure that promises made must be promises kept. Our veterans must receive quality medical care, effective services and timely processing of benefits. I have fought for many years, and continue to fight, to ensure that our veterans receive the medical care and benefits that they have earned. Mr. President, our veterans didn't waiver when they put their lives on the line. When they were fighting to defend our liberty, risking death to ensure that we could sleep easy at night, they didn't waiver. Mr. President, we should not waiver on our veterans. The VA General Counsel issued a ruling in 1997 that veterans who develop illnesses linked to nicotine dependence developed while in service were entitled to compensation benefits. The Department of Veterans Affairs, beginning in Fiscal Year 1998, is due to begin paying those benefits. There is now a proposal before us to eliminate the VA's obligation to pay those benefits. The Congressional Budget Office estimates that by eliminating the benefits, the government would save $10 billion. Well, apparently that money was too attractive to resist, and is included in the Budget Resolution to offset ISTEA spending. Mr. President, let me be clear. I support the much needed money that is going to provide critical infrastructure work throughout the country. And like many Senators, I am pleased to see federal support of transportation spending in my home state of Maryland. But Mr. President, our benefits for our veterans should not be traded and bartered. The funds that are due for our veterans must be protected. It is wrong to take money that is targeted for the benefits that our veterans have earned and use it for anything else - no matter how noble it may be. Mr. President, I urge my colleagues to support the Rockefeller amendment and prevent the raiding of these veterans benefits.

Ms. MIKULSKI

Ms. MIKULSKI. Mr. President, I rise today to introduce the ``Medicare Social Work Equity Act of 1998''. 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. I am honored to be joined by my good friends Senator Murray and Senator Wyden who care equally about correcting this inequity for social workers. Last year's Balanced Budget Act changed the payment method for skilled nursing facility care. Under current law, reimbursement is made after services have 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 phases in a prospective payment system for skilled nursing facilities beginning July 1, 1998. Payments for Part B services for skilled nursing facility residents will be consolidated. This means that the provider of the services must bill the facility instead of directly billing Medicare. Congress was careful to not include psychologists and psychiatrists in this new 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. Clinical social workers are also the most cost effective mental health providers. This legislation is important for three reasons: First, I am concerned that section 4432 will inadvertently reduce mental health services to nursing home residents. Second, I believe that the new consolidated billing requirement will result in a shift from using social workers to other mental health professionals who are reimbursed at a higher cost. This will result in higher costs to Medicare. Finally, I am concerned that clinical social workers will lose their jobs in nursing homes or will be inadequately reimbursed. I like this bill because it will correct an inequity for America's social workers, it will assure quality of care for nursing home residents, and will assure cost efficiency for Medicare. I look forward to the Senate's support of this worthy legislation.

Ms. MIKULSKI

Ms. MIKULSKI. Mr. President, I rise today to introduce the ``Medicare Social Work Equity Act of 1998''. 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. I am honored to be joined by my good friends Senator Murray and Senator Wyden who care equally about correcting this inequity for social workers. Last year's Balanced Budget Act changed the payment method for skilled nursing facility care. Under current law, reimbursement is made after services have 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 phases in a prospective payment system for skilled nursing facilities beginning July 1, 1998. Payments for Part B services for skilled nursing facility residents will be consolidated. This means that the provider of the services must bill the facility instead of directly billing Medicare. Congress was careful to not include psychologists and psychiatrists in this new 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. Clinical social workers are also the most cost effective mental health providers. This legislation is important for three reasons: First, I am concerned that section 4432 will inadvertently reduce mental health services to nursing home residents. Second, I believe that the new consolidated billing requirement will result in a shift from using social workers to other mental health professionals who are reimbursed at a higher cost. This will result in higher costs to Medicare. Finally, I am concerned that clinical social workers will lose their jobs in nursing homes or will be inadequately reimbursed. I like this bill because it will correct an inequity for America's social workers, it will assure quality of care for nursing home residents, and will assure cost efficiency for Medicare. I look forward to the Senate's support of this worthy legislation.

Ms. MIKULSKI

Ms. MIKULSKI. Which means it has to come from another agency.

Ms. MIKULSKI. Mr. President, I rise to support the Bond-Mikulski amendment and also to oppose the second-degree amendment offered by our colleague from Oklahoma. Mr. President, I want to support my colleague from Missouri, the chairman of the subcommittee on appropriations for FEMA, Senator Bond, in his remarks about the need for the reform on the funding of FEMA. Now, Mr. President, let me take a few minutes to say that during the last 5 years FEMA has reformed itself. Prior to James Lee Witt becoming the Administrator, FEMA itself in the way it responded to disasters was a disaster. Each President--Mr. Reagan and then Mr. Bush--often had to send in a trusted aide to oversee whenever disaster affected a community because FEMA itself was so obsessed with a bunker, cold war, civil defense, hide-under-your-desk mentality for nuclear warfare, that it had not gone to a risk-based strategy to be able to respond to the disasters that America faced. When Hurricane Andrew so devastated Florida that the response of FEMA itself was a disaster, President Bush sent the very able and talented Secretary of Transportation, Mr. Card, to Florida because FEMA could not get it together to do the job. I think we are all agreed that now FEMA has moved into being an appropriate agency for the post-cold war era. It has focused on the domestic needs of the American people. It has gone to being an all- hazards response agency for not only natural disasters but any of the other kinds of disasters that it has faced. It has worked with Governors and State agencies on three things: readiness and preparedness, response, and then rehabilitation after that response-- the three R's of disaster response. Now, when we have responded, the need has spoken for itself. And that is what is in this year's appropriation--an urgent supplemental. This is the need. It is not a made-up need; just like it was not a made-up disaster. We are living in the year of El Nino. And El Nino is the weather event of the century and has really triggered a variety of natural disasters throughout the United States. As has been indicated in Senator Bond's testimony, there have been 17 Presidential disaster declarations this year in both States and territories. This $1.6 billion will address current needs and the total cost which will be generated from the current disasters. These needs are certainly emergency needs, just like over the last 5 years FEMA has incurred an average of $2.3 billion in obligations each year; and each year the VA Subcommittee absorbs the cost; and each year we take it out of other Federal agencies within our subcommittee. Now, we do not take it out of agriculture. We do not take it out of defense. We take it out of the 25 different agencies that are within the VA Subcommittee. We have already given, and we have given over a number of years. We cannot continue to do it this way. I support in the most enthusiastic and the most firm way the call of the chairman, Senator Bond, for a new authorizing framework on how we are going to fund FEMA. Lots of times, because of compassion or empathy, we then often repair things that might raise eyebrows. But in the midst of a disaster, no one wants to say no to community need. When it comes to disaster funding, we cannot have it both ways. When the Clinton administration has asked for a contingency fund to handle these disasters and emergencies, it has been dismissed as a slush fund. ``Well, you can't have a slush fund. We'll do it as pay as you go. Let's see what the disasters are and make it up in the urgent supplemental.'' Well, now we are making it up in the urgent supplemental and at the same time we know that this isn't the most desirable way to do it and therefore need the authorizers to set that policy. But I must say, the authorizers and the authorizing committees have not given this the attention it deserves nor have they had the same sense of urgency that is required when we meet disaster funding. So, therefore, for this year, please pass the Bond-Mikulski amendment; and also for this year's legislative session, give us a new authorizing framework, invite our participation, as well as the National Governors' Association, as well as the Director of FEMA, and have a bipartisan approach to how we are going to fund disasters in the future. But do not penalize the other agencies within this subcommittee because of the fact that El Nino and many other terrible situations have affected the American people. Our heart goes out to the people who have been hit by the ice storms in New England, and the horrendous tornadoes that devastated Georgia and Florida. There are these disasters. And if we are going to be in this, we have to have, No. 1, a new authorizing framework; No. 2, adequate funds, and, No. 3, maybe we have to also come up with new mechanisms where perhaps residents and businesses have a new insurance framework to be able to practice self-help. But we cannot do this today on the urgent supplemental. What we can do is meet obligations made which need to be obligations met. So I urge the defeat of the Nickles amendment, the support of the Bond-Mikulski amendment, and then let us have a new authorizing framework. I want to thank the chairman of the subcommittee for the way he has worked hard on this. We look forward to moving this legislation and meeting the obligations that have been made, at the request, I might add, of Governors. President Clinton doesn't make these up. For it to be a FEMA-declared disaster grant it has to come at the request of a Governor. I might add, when disaster hits, you don't know if it is a Democratic Governor, you don't know if it is a Republican Governor. We just know for all Americans it requires the response of the Federal Government.

Ms. MIKULSKI. We can't hear you.

Ms. MIKULSKI. Will the Senator yield?

Ms. MIKULSKI. Let me understand the consequences of what the Senator from Oklahoma is recommending. If the emergency designation is removed, the phrase ``emergency designation,'' then what are the consequences to that? Does that mean we have to find offsets? What would be the consequences of following the Senator's suggestion?

Ms. MIKULSKI. Where does the money come from? Is the Senator saying this would require us to identify offsets?