Patty Murray

Mrs. MURRAY

Mrs. MURRAY. Mr. President, I ask unanimous consent that the pending amendment be set aside so that I may offer an amendment.

Mrs. MURRAY

Mrs. MURRAY. Mr. President, there is a health care crisis in this country. Millions of Americans have no health insurance. Insurance companies continue to increase their premiums and doctors and patients are the ones who are paying. In my home State of Washington, our health care system is in trouble. Some doctors are closing their practices, retiring early, or moving to other States. We have a shortage of nurses and other medical professionals. And one in nine Washington State residents do not even have health insurance. Doctors in my State are seeing their malpractice insurance premiums increase by 100 and even 200 percent. At the same time, Medicare, Medicaid, and private insurance companies are reducing their reimbursement amounts. These multiple forces have created a perfect storm for doctors and patients. In some specialties, like OB GYN, the malpractice insurance market is out of control. Insurance companies keep jacking up their premiums. These insurance company increases are simply not sustainable. I strongly support legislation to correct these problems and to get skyrocketing insurance premiums back under control. We must help to stabilize our health care system by making sure that doctors are not forced out of business by rising insurance rates. Unfortunately, the proposal before us is not the answer. There are major flaws with both the process and the substance of the proposal. First, this bill would preempt State patient rights laws, and give more protection to HMOs and insurance companies at the expense of real people who are hurt. Second, caps on noneconomic malpractice awards have not been effective at reducing insurance rates in States where they have been tried; and Third, this bill is being used as a political club, instead of a real attempt to find a meaningful solution. I am deeply disappointed that some Senators would rather play political games with our Nation's health care instead of trying to find a real solution. One problem is that this proposal preempts State patients' right laws and protects HMOs and insurance companies rather than doctors and patients. For the past 3 days Senators have talked about the impact of the medical malpractice crisis on doctors and patients across the country. And those who have been following this debate might assume that this legislation would only provide protection to doctors and hospitals. But this bill goes much further. S. 11 also extends additional protections to nursing homes, HMOs, drug and medical device manufacturers. Not only does S. 11 provide liability relief for these groups. In some cases it preempts State patient bills of rights laws and protections--protections that patients and doctors have fought hard to achieve. Since 1997, I have worked to secure passage of a Federal Patient's Bill of rights to protect patients and to ensure that insurance companies make decisions based on sound medicine, not profit margins. Working with doctors and hospitals we have twice tried in the U.S. Senate to enact a comprehensive Patients' Bill of Rights, but were defeated by special interests. The foundation of any patients' bill of rights legislation is holding HMOs accountable for making medical decisions. Unfortunately, S. 11 would take us in the opposite direction. Many States, like my home State of Washington, did not wait for Federal action to protect patients and doctors. In March 2000, Washington state enacted a strong Patients' Bill of Rights law that held HMOs and insurance companies accountable and liable for harm caused when insurance plans denied or delayed access to recommended health care services. The State law also provides a 3-year statute of limitation from the completion of the independent external review process. But, S. 11 would preempt this law. It would impose a Federal noneconomic limitation of $250,000 and would reduce the state of limitation to 1 year. This is the wrong approach. The Senate leadership is proposing to substitute the judgment of the Federal Government in Washington, DC for the judgment of the State legislature in Washing State. As insurance has historically been a State, not a Federal, issue, Congress must be careful about this Federal expansion. The second problem with this proposal is that caps on malpractice awards do not necessarily reduce insurance rates. I have heard my colleagues refer to California's experience as a model for Federal action, since California has enacted caps. However, recent data shows that average actual premium rates in California are actually higher than States that have no such caps, according to the Medical Liability Monitor. Across the country, States that have imposed caps on noneconomic damages, are now seeing similar increases in insurance premiums as those States without caps. If the goal is to help insurance companies with their profit margins, then this bill might help. But if the goal is to help doctors afford to pay for insurance, then this bill will not help. Even if caps did force insurance companies to reduce their rates, are caps fair to patients who were harmed? We know that as many as 90,000 people a year die from medical errors. Not all of these errors constitute malpractice, but limiting fair and just compensation for even a fraction of these individuals and their families is a major change in our judicial system--and a huge price to pay in the name of reform. If this legislation had gone through the appropriate committee process, Congress might have gotten some answers to these questions, and the legislation before us might have been helped doctors and patients. Unfortunately, this bill was brought forward for purely political reasons. This is the greatest tragedy of all for doctors and patients. Some colleagues would use this bill to help their follow partisans rather than the physicians who need it. This bill did not go through the standard committee process. There were no public hearings to get expert testimony to help shape the legislation. There was no committee markup for the legislation for Senators to weigh in on the issue. In fact, there are a number of reports indicating that malpractice claims are not necessarily responsible for higher insurance premiums. These reports suggest that it is not the growing number of cases or even the size awards that are driving premium increases, but rather the decline in the value of investments for insurance companies. Without the opportunity to fully understand the problem--with hearings and markups-Congress cannot develop a real, workable solution. Instead, some Republicans are exploiting this legislation, according to the Washington Post, ``as an issue for next year's election.'' In fact, even Republicans have acknowledged that this is not a serious proposal, but instead is a ``political document.'' A Republican Senator was quoted in the New York Times this morning discussing this bill. He said the Senate leadership is ``bringing this bill up to get most of my Democratic friends to vote against it, a handful of Republicans to vote against it, and they're going to take it on the campaign trail.'' This is outrageous. Patients are losing their doctors. Doctors are going out of business. And rather than address a critical problem, the Senate leadership is playing political games. So what is the answer? Clearly, the medical malpractice insurance rates doctors are facing are untenable. They are a real problem for doctors, for patients, and for our entire health care community. Every week, I hear from doctors throughout Washington State about the challenges that soaring malpractice insurance premiums are causing. That is why I support the Durbin-Graham proposal to provide immediate relief to doctors. When insurance markets are dysfunctional--as they certainly are in malpractice--the Federal Government has a tradition of providing needed support. We did that with flood insurance a few years ago, and we did it again with terrorism insurance in 2001. When an insurance market fails, there is certainly precedent for Federal corrective actions. If we can provide relief for terrorism and flood insurance, we should be able to provide relief for high-risk, critical practices like trauma and OB GYN services. While we need to examine every way that we might address this crisis, as I look at this idea, I am also realistic. Noneconomic damages are not the only factor impacting insurance premiums. It is not clear to me that capping just noneconomic damages will really solve the problem. In addition, malpractice insurance is traditionally a state issue. If the Federal Government is going to insert itself so dramatically in a State matter, we need to be sure this approach is going to work. There are still too many unanswered questions to proceed with this bill. We know that the status quo is not sustainable, but we need to recognize that this is a complicated problem and there can be no quick fixes. It is time to stop playing politics and start working together to find solutions and heal our ailing system.

Mrs. MURRAY

Mrs. MURRAY. Mr. President, I rise today to recognize a great American and a true military heroine who has honorably served our country for over 20 years in the Army Medical Service Corps: MAJ Roberta Kearney Chang. As a resident of Bellevue, WA, MAJ Chang began her career at Fort Benning, GA, home of the Army's infantry, as a medical platoon leader. There, she earned the coveted Parachutist Wings and Expert Field Medical Badge. Following in her father's footsteps, the late First Lieutenant Robert M. Kearney, United States Army, Retired, she quickly rose through the ranks and served at Army bases throughout the world. MAJ Chang had two overseas tours, one in Honduras, Central America, and one in the Republic of Korea. In Honduras, she participated in humanitarian missions to provide aid and medical care to the people of this country. In Korea, she successfully completed two consecutive company commands for the 121st Evacuation Hospital and Headquarters, 18th Medical Command. MAJ Chang was handpicked to become an instructor at the U.S. Army Academy of Health Sciences, Fort Sam Houston, TX. In this capacity she taught health care administration subjects to over 5,000 officers annually. MAJ Chang also served as the senior patient administrator for the Command Surgeon, United States Army Reserve Personnel Command. She counseled and assisted hundreds of reservists that were injured as a result of service in Operation Desert Storm. Her knowledge of the intricacies of the physical disability system for both the active duty and reserve component soldiers is unsurpassed, and she is considered an expert trainer in these areas. She served as a health care operations officer and the head of communications and customer service at the TRICARE Mid-Atlantic, Lead Agent Office Norfolk, VA for final assignment TRICARE Mid-Atlantic serves over 1 million military beneficiaries. In each assignment, MAJ Chang excelled and met every challenge, and was rewarded with greater responsibilities and opportunities. Her talent for teaching and mentoring personnel, as well as her creativity and skill in management, were instrumental in providing army medicine the fine cadre of hospital administrators serving today. Above all, she is a stellar officer and leader who always put the welfare of her staff and patients first. MAJ Chang is a committed health care professional, and is an active member of the American College of Healthcare Executives and the American Health Information Management Association. MAJ Chang always went the extra mile to serve her country and her fellow man. Her performance reflects greatly on herself, the United States Army, the Department of Defense, and the United States of America. I extend my deepest appreciation to MAJ Roberta Kearney Chang on behalf a grateful Nation for her over 20 years of dedicated military service. Congratulations, MAJ Chang, and let me be the one of the first to welcome you home to Washington State.

Mrs. MURRAY

Mrs. MURRAY. Mr. President, I rise today to introduce legislation that will greatly enhance Federal participation in financing and improving our Nation's ferry transportation system. Today I am introducing the Ferry Transportation Enhancement Act. I am proud to have Senators Boxer, Cantwell, Corzine, Clinton, Edwards, Feinstein, Hollings, Kennedy, Lautenberg, and Schumer as original cosponsors. This bill will provide significantly more resources to state governments, public ferry systems, and public entities responsible for developing facilities for ferries. Specifically, the bill would: provide $150 million a year for the Federal Highway Administration's Ferry Boat Discretionary Program for fiscal years 2004 through 2009. This is approximately four times the $38 million a year that is currently being provided under this program; add ``ferry maintenance facilities'' to the list of allowable use of funds under this program; add ``ferries'' to the Clean Fuels Program; establish a Ferry Joint Program Office to coordinate Federal programs affecting ferry boat and ferry facility construction, maintenance, and operations and to promote ferry service as a component of the Nation's transportation system; establish an information database on ferry systems, routes, vessels, passengers and vehicles carried; and establish an institute for ferries to conduct R&D, conduct training programs, encourage collaborative efforts to promote ferry service, and preserve historical information. This will parallel institutes that now exist for highways, transit, and rail. Currently, the Federal investment in ferries is only one-tenth of one percent of the total Surface Transportation Program. There is virtually no coordination at the Federal level to encourage and promote ferries as there are for other modes of transportation. We need better coordinated ferry services because it's the sole means of surface transportation in many areas of the country, including Hawaii, Alaska and my home State of Washington. Ferries are also the preferred, and the only feasible, method of commuting from home to work in places like Washington State, New York/ New Jersey, North Carolina, Hawaii and Alaska. Finally, in many States--like my home State of Washington--they are an important part of the tourism industry and represent a part of our cultural identity. The symbol of ferries moving people and vehicles on the waterways of the Puget Sound is as much a part of our cultural identity as computers, coffee, commercial aircraft and the Washington Apple. Ferry use is growing. In Washington State our ferry system--the Nation's largest--currently transports 26 million passengers each year and carries 11 million vehicles. Other systems that serve New York/New Jersey, North Carolina, San Francisco, and Alaska also have significant numbers of passengers using the ferries. The Nation's six largest ferry systems carried 73 million people and 13 million vehicles last year. The growth projection for ferry use is very high. For these larger systems, it is projected that by 2009 there will be a 14-percent increase in passengers and a 17-percent increase in vehicles being carried by ferries compared to 2002. In San Francisco, that projection is a 46-percent increase. It is clear that many people are using ferries and more will be using them in the future. This is all with very little help from the Federal Government. Our investment in ferries pails in comparison to the Federal investments in highways and other forms of mass transit. Our bill would provide the needed funding for these growing systems for new ferry boat construction, for ferry facilities and terminals, and for maintenance facilities. The bill also would make ferries eligible under the Clean Fuels Program. Like busses, ferries are a form of mass transit that is environmentally cleaner than mass use of cars and trucks. Making them eligible for the Clean Fuels Program will encourage boat makers to design cleaner and more efficient vessels in the future. This will make ferry travel an even more environmentally friendly means of transportation than it already is today. Finally, setting up a Ferry Joint Program Office, keeping track of ferry statistics, and establishing a National Ferry Institute will increase the profile of ferries as part of our Nation's infrastructure and provide a method to analyze and research ways to improve their use. In the end, I hope this proposal can be included in the TEA-21 Reauthorization. Ferries are an important part of our Nation's transportation infrastructure. This bill recognizes their importance by providing the resources and support they need to grow and serve passengers. I urge the Senate support this bill, and I look forward to working with my colleagues to see it passed.

Mrs. MURRAY

Mrs. MURRAY. Mr. President, I rise today to introduce legislation that will greatly enhance Federal participation in financing and improving our Nation's ferry transportation system. Today I am introducing the Ferry Transportation Enhancement Act. I am proud to have Senators Boxer, Cantwell, Corzine, Clinton, Edwards, Feinstein, Hollings, Kennedy, Lautenberg, and Schumer as original cosponsors. This bill will provide significantly more resources to state governments, public ferry systems, and public entities responsible for developing facilities for ferries. Specifically, the bill would: provide $150 million a year for the Federal Highway Administration's Ferry Boat Discretionary Program for fiscal years 2004 through 2009. This is approximately four times the $38 million a year that is currently being provided under this program; add ``ferry maintenance facilities'' to the list of allowable use of funds under this program; add ``ferries'' to the Clean Fuels Program; establish a Ferry Joint Program Office to coordinate Federal programs affecting ferry boat and ferry facility construction, maintenance, and operations and to promote ferry service as a component of the Nation's transportation system; establish an information database on ferry systems, routes, vessels, passengers and vehicles carried; and establish an institute for ferries to conduct R&D, conduct training programs, encourage collaborative efforts to promote ferry service, and preserve historical information. This will parallel institutes that now exist for highways, transit, and rail. Currently, the Federal investment in ferries is only one-tenth of one percent of the total Surface Transportation Program. There is virtually no coordination at the Federal level to encourage and promote ferries as there are for other modes of transportation. We need better coordinated ferry services because it's the sole means of surface transportation in many areas of the country, including Hawaii, Alaska and my home State of Washington. Ferries are also the preferred, and the only feasible, method of commuting from home to work in places like Washington State, New York/ New Jersey, North Carolina, Hawaii and Alaska. Finally, in many States--like my home State of Washington--they are an important part of the tourism industry and represent a part of our cultural identity. The symbol of ferries moving people and vehicles on the waterways of the Puget Sound is as much a part of our cultural identity as computers, coffee, commercial aircraft and the Washington Apple. Ferry use is growing. In Washington State our ferry system--the Nation's largest--currently transports 26 million passengers each year and carries 11 million vehicles. Other systems that serve New York/New Jersey, North Carolina, San Francisco, and Alaska also have significant numbers of passengers using the ferries. The Nation's six largest ferry systems carried 73 million people and 13 million vehicles last year. The growth projection for ferry use is very high. For these larger systems, it is projected that by 2009 there will be a 14-percent increase in passengers and a 17-percent increase in vehicles being carried by ferries compared to 2002. In San Francisco, that projection is a 46-percent increase. It is clear that many people are using ferries and more will be using them in the future. This is all with very little help from the Federal Government. Our investment in ferries pails in comparison to the Federal investments in highways and other forms of mass transit. Our bill would provide the needed funding for these growing systems for new ferry boat construction, for ferry facilities and terminals, and for maintenance facilities. The bill also would make ferries eligible under the Clean Fuels Program. Like busses, ferries are a form of mass transit that is environmentally cleaner than mass use of cars and trucks. Making them eligible for the Clean Fuels Program will encourage boat makers to design cleaner and more efficient vessels in the future. This will make ferry travel an even more environmentally friendly means of transportation than it already is today. Finally, setting up a Ferry Joint Program Office, keeping track of ferry statistics, and establishing a National Ferry Institute will increase the profile of ferries as part of our Nation's infrastructure and provide a method to analyze and research ways to improve their use. In the end, I hope this proposal can be included in the TEA-21 Reauthorization. Ferries are an important part of our Nation's transportation infrastructure. This bill recognizes their importance by providing the resources and support they need to grow and serve passengers. I urge the Senate support this bill, and I look forward to working with my colleagues to see it passed.

Mrs. MURRAY

Mrs. MURRAY. Mr. President, I thank my colleague from New York. Amendment No. 1019 Mr. President, I have a statement I will give for the Record, but I also want to thank Senator Conrad for his work on the self-injected biologics and the offering of this amendment tonight. I am delighted to be a cosponsor on this amendment. It is something I have worked on for over 2 years. And as Senator Conrad said, we have patients today with MS, with rheumatoid arthritis, who are forced to go to a doctor, a medical clinic in order to get the drugs they need. This will save us money in the long run because people will be able to stay home. But, most importantly, it will allow people quality of life in the care they need. I thank Senator Conrad and Senator Smith and the other cosponsors of this amendment. Mr. President, I am pleased to join with Senator Conrad and Senator Smith in offering this amendment to give those on Medicare access to a new, exciting group of drugs known as self-injected biologics. Senator Conrad offered a similar amendment during the Senate Finance Committee markup and received a commitment from the chair to work with us on this effort. As a result of this commitment, Senator Conrad withdrew the amendment. We have been working with CBO and Senator Baucus' staff to address any concerns. Currently, Medicare will only cover biologics if they are administered in a physician's office or clinical setting. That means patients must travel to the physician's office to receive treatment. This is not easy for many patients who have rheumatoid arthritis or MS--two diseases that can severely limit a person's mobility. Fortunately, there are versions of these drugs that a patient can take in their own home. It is a great innovation that will improve a patient's access. Unfortunately, Medicare won't cover biologics that are administered in the home. That just doesn't make sense. I have been working to correct this inequity for the past 2 Congresses. The Murray-Conrad-Smith amendment would provide 2 years of coverage, under Part B, for those self-injected biologics that replace treatments currently available only in a physician's office. We allow for 2-year coverage to bridge the gap to implementation of a Medicare prescription drug benefit. We have received a CBO score for the 2 years and believe that we can find room in 2004 and 2005 to provide this important coverage for MS and RA patients. This legislation is strongly endorsed by the Arthritis Foundation and will provide additional coverage to all four MS self-injected or self- administered treatments. For MS, only one treatment is covered under Medicare, provided in a physician's office. I am hopeful that the managers of this legislation will be able to accept our amendment and end this discriminatory practice in Medicare. Mr. President, I thank the Senator from New York.

Mrs. MURRAY

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

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

Mrs. MURRAY. Mr. President, Congress is about to update Medicare to finally help seniors with prescription drugs, and while I have some real concerns about the way this bill would provide drug coverage, I am convinced that after 5 years of stalemate, it is time to pass a drug benefit now to begin to get seniors the help they need. Mr. President, I have been working to improve this bill by providing additional funding in the Budget Committee, by supporting various amendments, and by offering my own amendment. I want to make sure that the drug benefit we create will help as many seniors as possible. Before we add a new benefit to Medicare, we have to remember that there's a serious problem with Medicare today that penalizes seniors based on where they live. The problem is in the payment formula that Medicare uses, and it hurts many seniors. Today under Medicare, some seniors can get fewer services--and pay higher premiums--just based on where they live. Every senior pays the same amount into Medicare, but some seniors get much fewer benefits based on geography. That's not fair to seniors in my State and in other States. For the past few years, I've been working to fix that problem. Last year, I introduced the MediFair Act to bring all States up to the national average in Medicare payments. We are still working to fix this disparity in Medicare today. The problem is that this new drug benefit would follow that same old, unfair formula. It means that seniors in States such as Washington will have few choices and pay higher premiums. That's why I'm offering my amendment today--to give seniors more choices and lower premiums as they get healthcare and prescription drugs. As we improve Medicare, we shouldn't build on the unfair polices of the past. While I am still working to fix the underlying formula that's hurting seniors in my State, we can at least avoid perpetuating an unfair system in this new benefit. I am proud to report that we have made some progress recently to fix the regional disparity that penalizes many Medicare patients. I am pleased to have joined with Senators Grassley and Baucus in closing the rural versus urban gap in reimbursements. And, earlier this year, the Budget Committee unanimously adopted the Feingold-Murray-Johnson amendment, which modified the Medicare reserve fund to allow legislation to promote geographic equity in Medicare payments. Back in 1997, when we expanded Medicare+Choice, we took some steps to make it fairer. Since the Medicare+Choice rate was based on the fee- for-service rate, it was important to provide some guaranteed level for states with low reimbursements. We did two things. First, we set a minimum payment--known as a floor--so that no county would fall below a certain level. Second, we tweaked the funding formula to provide greater equity across the country for everyone on Medicare. That approach is known as a ``blend'' because it takes the regional formula and blends it with the national average. Those were both good steps. There was only one problem: Congress never provided the funding to revise the formula. So we put a fix in the law, but we never funded it. We have not been able to fund it until now because it has to be budget neutral. Today, my amendment would finally fund that technical correction and give seniors better access to care. Specifically, my amendment fully funds the Medicare+Choice blend formula starting in 2006 for determining the Medicare Advantage benchmark. If we don't fix this problem, we will deny many seniors access to coordinated care. PPO's and HMO's will only go into those regions already at the higher end of per beneficiary reimbursement. We should--at the very least--try to create a level playing field for all regions of the country. It is unfair to talk about competition when some regions will receive hundreds of dollars more per beneficiary than others. During this debate, I have listened to my colleagues talk about the benefits of PPO's and HMO's as part of their new Medicare Advantage. Senator Frist has spoken several times on the benefit of a coordinated care approach for improving disease management and keeping seniors healthier longer. While I still have some concerns about how these new plans will operate, I want to be sure that seniors in Washington State and other States with low Medicare reimbursement can take advantage of Medicare Advantage. I also want to point out that is not about increasing payments to insurance plans. It's about ensuring that seniors in all regions of the country have access to competitive Medicare Advantage plans. My amendment is similar to language adopted in the House Ways & Means Committee mark. However, I do not fully fund the blend in my amendment until 2006. The House proposes the change starting in 2004. I also point out that my amendment doesn't force plans in any State or region to do anything. If they want to base Medicare Advantage on either the current fee-for-service rate--or the Medicare +Choice rate--they are free to do so. My amendment gives plans a third option that could be more fair and could help more seniors. Finally--in an effort to truly measure the cost of providing care to all seniors--my amendment directs the Department of Health and Human Services to determine the costs of care provided to Medicare beneficiaries at DoD or VA facilities. Since Medicare assumes the reimbursement, these beneficiaries should be counted in the equation. Failing to account for the cost of this care has resulted in lower fee for service per beneficiary costs. Those lower fee-for-service rates means significant inequities in Medicare reimbursement. We should correct this existing flaw before we build a new drug benefit around it. I have been trying to get HHS to take this step since 1997 and supported language in BIP A2000 directing HHS to report to Congress on recommendations for correcting this inequity. Unfortunately, HHS remains unwilling or unable to properly determine the actual cost of care in any given region or State. self-injectables Mr. President, I want to take just a moment to update my colleagues on another amendment that I will be offering soon with Senator Conrad and Senator Smith. It relates to a new, exciting group of drugs known as self-injected biologics, and it's a chance to give Medicare patients access to the benefits these new drugs offer. Senator Conrad offered a similar amendment during the Senate Finance Committee mark up and received a commitment from the Chair to work with us on this effort. As a result of this commitment, Senator Conrad withdrew the amendment. We have been working with CBO and Senator Baucus' staff to address any concerns. Currently, Medicare will only cover biologics if they are administered in a physician's office or clinical setting. That means patients must travel to the physician's office to receive treatment. That's not easy for many patients who have Rheumatoid Arthritis or MS-- two diseases that can severely limit a person's mobility. Fortunately, there are versions of these drugs that a patient can take in their own home. It's a great innovation that will improve a patient's access. Unfortunately, Medicare won't cover biologics that are administered in the home. That just doesn't make sense. I have been working to correct this inequity for the past two Congresses. The Murray-Conrad-Smith amendment would provide two years of coverage, under Part B, for those self injected biologics that replace treatments currently available only in a physician's office. We allow for two-year coverage to bridge the gap to implementation of a Medicare prescription drug benefit. We have received a CBO score for the two years and believe that we can find room in 2004 and 2005 to provide this important coverage for MS and RA patients. This legislation is strongly endorsed by the Arthritis Foundation and will provide additional coverage to all four MS self-injected or self-administered treatments. For MS, only one treatment is covered under Medicare, provided in a physician's office. I am hopeful that the managers of this legislation will be able to accept our amendment and end this discriminatory practice in Medicare. Let me close by returning to the amendment currently before the Senate. For those Senators concerned about the inequities in the current Medicare reimbursement rates, I urge you to support this amendment. Fully funding the blend--as a third option in determining the Medicare Advantage benchmark--will provide greater equity and ensure that all seniors in all regions have access to a competitive, managed and coordinated care approach. Let's finally stop an unfair system and give seniors the access they deserve. It's the right thing to do, and I urge its immediate passage. I yield the floor.

Mrs. MURRAY

Mrs. MURRAY. Mr. President, I rise today to introduce legislation to help rural and underserved communities across the country get connected to the information economy. Today I am introducing the Community Telecommunication Planning Act of 2003. I am proud to have Senators Boxer, Cantwell, Kennedy, Leahy, and Pryor as original cosponsors. This bill will give small and rural communities a new tool to attract high speed services and economic development. Representative Inslee from my home State, along with several other members, will soon introduce a companion bill in the House. I appreciate him working with me to meet this challenge. I am especially proud of how this legislation came about. For the last four years, I've been working with a group of community leaders in Washington State to find ways to help communities get connected to advanced telecommunications services. I want to take a moment to thank the members of my Rural Telecommunication Working Group for their hard work on this bill. The members include: Brent Bahrenburg, Gregg Caudell, Dee Christensen, Dave Danner, Louis Fox, Tami Garrow, Larry Hall, Rod Fleck, Ray King, Dale King, Terry Lawhead, Dick Llarman, Jim Lowery, Jim Miller, Joe Poire, Skye Richendrfer, Ted Sprague, Jim Schmit, and Ron Yenney. We met as a working group, and we held forums around the State that attracted hundreds of people. We've tapped the ideas of experts, service providers and people from across the State who are working to get their communities connected. The result is this legislation, which I am proud to say is part of Washington State's contribution to our national effort to connect all parts of our country to the Internet. The bill was originally introduced in the 107th Congress. I was able to attach a version of it to the Farm Bill. Unfortunately, the provision was removed during Conference. This bill addresses a real need in many communities. While urban and suburban areas have strong competition between telecommunications providers, many small and rural communities are far removed from the services they need. We must ensure that all communities have access to advanced telecommunications like high speed internet access and the wireless Internet. Just as yesterday's infrastructure was built of roads and bridges, today our infrastructure includes advanced telecom services. Advanced telecommunications can enrich our lives through activities like distance-learning, and they can even save lives through efforts like telemedicine. The key is access. Access to these services is already turning some small companies in rural communities into international marketers of goods and services. Unfortunately, many small and rural communities are having trouble getting the access they need. Before communities can take advantage of some of the help and incentives that are out there, they need to work together and got through a community planning process. Community plans identify the needs and level of demand, create a vision for the future, and show what all the players must do to meet the telecom needs of their community for today and tomorrow. These plans take resources to develop, and my bill would provide those funds. Providers say they're more likely to invest in an area if it has a plan that makes a business case for the costly infrastructure investment. Communities want to provide them with that plan, but they need help developing it. Unfortunately, many communities get struck on that first step. They don't have the resources to do the studies and planning required to attract service. So the members of my Working Group came up with a solution: have the Federal Government provide competitive grants that local communities can use to develop their plans. I took that idea and put it into this bill. After determining what services they need, communities must then go out and make a market case to providers. That is why I've added ``market development'' to the list of allowable uses of grant funding. While this bill deals with new technology, it's really just an extension of the infrastructure support the federal government traditionally provides to communities. The Federal Government already provides money to help communities plan other infrastructure improvements--everything from roads and bridges to wastewater facilities. Because today's economic infrastructure includes advanced telecom services, I believe the Federal Government should provide similar support for local technology infrastructure. In summary, this bill would provide rural and underserved communities with grant money for creating community plans, technical assessments and other analytical work, and it would allow these communities to use the funding to market these plans to providers. With these grants, communities will be able to turn their desire for access into real access that can improve their communities and strengthen their economies. This bill can open the door for thousands of small and rural areas across our country to tap the potential of the information economy. I urge the Senate to support this bill, and I look forward to working with my colleagues to see it passed. I ask unanimous consent that the text of the bill be printed in the Record.

Mrs. MURRAY

Mrs. MURRAY. Mr. President, I rise today to introduce legislation to help rural and underserved communities across the country get connected to the information economy. Today I am introducing the Community Telecommunication Planning Act of 2003. I am proud to have Senators Boxer, Cantwell, Kennedy, Leahy, and Pryor as original cosponsors. This bill will give small and rural communities a new tool to attract high speed services and economic development. Representative Inslee from my home State, along with several other members, will soon introduce a companion bill in the House. I appreciate him working with me to meet this challenge. I am especially proud of how this legislation came about. For the last four years, I've been working with a group of community leaders in Washington State to find ways to help communities get connected to advanced telecommunications services. I want to take a moment to thank the members of my Rural Telecommunication Working Group for their hard work on this bill. The members include: Brent Bahrenburg, Gregg Caudell, Dee Christensen, Dave Danner, Louis Fox, Tami Garrow, Larry Hall, Rod Fleck, Ray King, Dale King, Terry Lawhead, Dick Llarman, Jim Lowery, Jim Miller, Joe Poire, Skye Richendrfer, Ted Sprague, Jim Schmit, and Ron Yenney. We met as a working group, and we held forums around the State that attracted hundreds of people. We've tapped the ideas of experts, service providers and people from across the State who are working to get their communities connected. The result is this legislation, which I am proud to say is part of Washington State's contribution to our national effort to connect all parts of our country to the Internet. The bill was originally introduced in the 107th Congress. I was able to attach a version of it to the Farm Bill. Unfortunately, the provision was removed during Conference. This bill addresses a real need in many communities. While urban and suburban areas have strong competition between telecommunications providers, many small and rural communities are far removed from the services they need. We must ensure that all communities have access to advanced telecommunications like high speed internet access and the wireless Internet. Just as yesterday's infrastructure was built of roads and bridges, today our infrastructure includes advanced telecom services. Advanced telecommunications can enrich our lives through activities like distance-learning, and they can even save lives through efforts like telemedicine. The key is access. Access to these services is already turning some small companies in rural communities into international marketers of goods and services. Unfortunately, many small and rural communities are having trouble getting the access they need. Before communities can take advantage of some of the help and incentives that are out there, they need to work together and got through a community planning process. Community plans identify the needs and level of demand, create a vision for the future, and show what all the players must do to meet the telecom needs of their community for today and tomorrow. These plans take resources to develop, and my bill would provide those funds. Providers say they're more likely to invest in an area if it has a plan that makes a business case for the costly infrastructure investment. Communities want to provide them with that plan, but they need help developing it. Unfortunately, many communities get struck on that first step. They don't have the resources to do the studies and planning required to attract service. So the members of my Working Group came up with a solution: have the Federal Government provide competitive grants that local communities can use to develop their plans. I took that idea and put it into this bill. After determining what services they need, communities must then go out and make a market case to providers. That is why I've added ``market development'' to the list of allowable uses of grant funding. While this bill deals with new technology, it's really just an extension of the infrastructure support the federal government traditionally provides to communities. The Federal Government already provides money to help communities plan other infrastructure improvements--everything from roads and bridges to wastewater facilities. Because today's economic infrastructure includes advanced telecom services, I believe the Federal Government should provide similar support for local technology infrastructure. In summary, this bill would provide rural and underserved communities with grant money for creating community plans, technical assessments and other analytical work, and it would allow these communities to use the funding to market these plans to providers. With these grants, communities will be able to turn their desire for access into real access that can improve their communities and strengthen their economies. This bill can open the door for thousands of small and rural areas across our country to tap the potential of the information economy. I urge the Senate to support this bill, and I look forward to working with my colleagues to see it passed. I ask unanimous consent that the text of the bill be printed in the Record.

Mrs. MURRAY

Mrs. MURRAY. Mr. President, I say to my colleague from Florida, thank you on behalf of all who care about this issue for your longtime battle and diligence. Every time you are right, they keep coming back at you, but you keep winning. I agree, there are a number of Senators on this floor who are not from coastal States but they should be joining because certainly they all come to our States to see the beautiful coastlines, whether it is Florida, Washington State, California, or Maine. They want to preserve that, too. They want to take their grandchildren and great- grandchildren, some day, to your State. I certainly hope they want to come to ours, too. If we devastate the environment, the tourism will not be there. I thank my colleague for working on this issue.

Mrs. MURRAY. As the Senator from Florida knows well, for all who live on coastal States, our economies are struggling today; the high-tech industry is struggling; Boeing has lost thousands of jobs. There is still the beautiful environment that people come to visit. The last thing anyone wants in our rain forests, whether in Oregon or Washington, or the beaches of California, the last thing they want to see is an oil rig or, worse, an oilspill in the areas we care so much about.

Mrs. MURRAY. Mr. President, I say to my colleague from Florida, I have listened to his battles for many years as he has fought to protect the beautiful shores of Florida. I have seen the shores of Florida, and they are gorgeous. He is right, tourism is a critical part of the economy of his State of Florida, as it is to mine. People come to Washington State to see our beautiful mountains, our beautiful forests, and to fish. The last thing they want to see is oil drilling off our coasts. This underlying bill that allows an inventory is simply a step for the oil companies to then get in and drill. My State would be absolutely appalled to see that happen.

Mrs. MURRAY. Mr. President, I rise this evening to support the amendment offered by the Senator from Florida and commend him on his leadership on this issue. The amendment that is before us tonight will prevent exploration in offshore areas that are currently protected under law. The truth is, we should not need a special amendment to protect sensitive offshore areas that are currently off limits to energy drilling and exploration, but today we find this amendment is needed because the underlying Energy Bill would essentially roll back a longstanding ban on exploration that protects our coastal areas. This Energy Bill calls for the Department of Interior to inventory oil and gas resources. It does not rule out exploration or drilling in any part of the Outer Continental Shelf and it does not prevent exploration or drilling in areas that are currently protected. Some may say they just want to allow an inventory of oil and gas off our coasts, but taking an inventory of what lies beneath the sea floor is not like taking an inventory of what is in the kitchen pantry. Looking for oil and gas off our coasts is an invasive process. It carries risks. It harms marine life and it can create serious environmental damage. If it was just taking an inventory, it would be one set of environmental concerns, but I think we all know what is really going on and it is much more than inventory. This is not just about seeing what is out there. It is really about preparing to drill for oil and gas in areas that have been protected for years, for decades actually, by law. Let's be clear. Oil companies are not going to spend millions of dollars to inventory our coasts just for the fun of it. They want to begin drilling in areas that are protected, and this Energy Bill would give them the start they want. I am reminded of that analogy about how if a camel gets its nose under the tent, pretty soon the whole camel will follow. Well, if we do not want the camel in our tent, stop it when it tries to poke its nose in. Once those oil companies get their equipment down there, they will be steps away from setting up oil rigs and creating a host of dangers on our shores. If we do not want oil companies drilling off our shores, then we cannot let them get started with these so-called inventory projects. There are good reasons why over the years Congress and past Presidents have agreed to protect parts of our Outer Continental Shelf. In fact, that moratorium that today protects the coast of my State of Washington was passed by Congress in 1990 and protected by an executive order by the first President Bush. Today, the current Bush administration wants to repeal that protection and pave the way for drilling off our coasts. Those who want to explore for energy off our coasts would like us to believe it is harmless, but it is not. When we consider offshore oil and gas development, we have to be concerned about oil spills and the release of other toxic materials. There are other environmental effects that pose dangers to marine mammal populations, fish populations, and air quality. Seismic testing techniques used by the offshore oil and gas industry can kill marine animals. This is not harmless. If this administration had a better record on the environment, I might be inclined to give them more leeway, but this administration has shown an eagerness to roll back environmental protections on so many issues that they do not have much credibility when they say they want to just look for oil off our coasts. Last month, the Bush administration took another disturbing step to undermine our environmental protection related to oil and gas drilling. In fact, on May 26, 2003, the New York Times reported that the administration proposed to defer for 2 years requirements for permits under the Clean Water Act for certain activities of oil and gas producers to prevent contaminated runoff. This is a bad precedent and a step in the wrong direction for protecting our environment. There is no good reason for oil and gas developers to be exempt from requirements that are imposed on other developers to prevent contaminated runoff. So not only do they want to let the big oil and gas companies start looking for oil in areas that have been protected for decades, this Bush administration is going to free those oil and gas companies from the rules everyone else has to follow to protect contaminated runoff. Not on my watch. We know there is a better way. Congress should be seeking long-term solutions that make sense for energy development and that balance environmental protection and economic growth. The proposal to drill in areas of the OCS that are currently under moratoria falls far short of the balanced approach we need. I urge my colleagues to support this amendment to stop an attack on decades of protection for our sensitive coastal areas. I yield the floor.

Mrs. MURRAY. The Senator from Florida makes an excellent point. Our military needs to be ready for whatever conflicts come to them on the war on terror. They need to be out there training. Certainly at Makah Air Force Base and the other bases we have, they need to know they have a place they can train and not be interfered with. I add, as the Senator from Florida knows, there are other economies that we count on as well. Fishing is a tremendous economy and part of our economy base in the State of Washington. They would not be excited about having oil rigs out there where people are fishing, as well as tourism, but certainly the military is an important part of my State. We want to make sure they have the space they need for training. The Senator makes an excellent point.

Mrs. MURRAY

Mrs. MURRAY. Mr. President, I ask unanimous consent that Andrea Lee, a legislative fellow in my office, be granted the privilege of the floor for the remainder of the debate on S. 14, the Energy Bill.

Mrs. MURRAY

Mrs. MURRAY. Mr. President, the Senate now has before it a very important amendment. I think all of us know that women have played a critical role in all of our country's recent military actions. In Afghanistan, in Iraq, and in missions throughout the world, women have demonstrated their skill, their sacrifice, and their courage. We can all be very proud of the women who have served in our military. They are our mothers, our daughters, they are our sisters, and they are our neighbors. They put themselves in harm's way to protect our freedom. They live and work in hostile combat zones under very dangerous conditions. They make sacrifices every day to defend our Nation. But today, military women are forced to sacrifice their own constitutional rights, as they risk their lives to protect our freedom. No woman----

Mrs. MURRAY. Under current law, all medical providers in the Department of Defense have a conscience clause.

Mrs. MURRAY. Yes, and she would have to pay for it out of her own money.

Mrs. MURRAY. The Senator is correct. I remind the Senator that domestically in the service, a woman has the right to receive health care services at a hospital. So where this affects a woman is when they are serving overseas and they don't have the same access.

Mrs. MURRAY. The Senator is correct only in that it would strike the language in the bill which would put us back to the previous language that is in the statute today, which I am happy to provide him, which I accurately described in my statement.

Mrs. MURRAY. If the Senator will hold a second, I will check and then respond.

Mrs. MURRAY. Yes, the Senator is correct.

Mrs. MURRAY. The Senator is correct. In all military facilities, women who are victims of rape or incest do have the opportunity to receive abortions.