Bill Nelson

Mr. NELSON of Florida

Mr. NELSON of Florida. Mr. President, I rise today to introduce a bill that will preserve a part of the history of Florida and America. My bill will allow 20 acres of untouched, undeveloped sand dune land on American Beach, Amelia Island, FL to become part of Timucuan Ecological and Historic Preserve. The history of American Beach is partly the chronicle of Africa- American achievement and economic autonomy during the Jim Crow era. American Beach was purchased in 1932 by the Afro American Life Insurance Company and its President, A.L. Lewis. This insurance company was the first insurance company owned by any Floridian, either a black or white. Mr. Lewis' granddaughter, affectionately referred to as the ``Beachlady,'' still resides on American Beach and is revered for her colorful life and her work to preserve the American Beach from development and environmental degradation. American Beach was an integrated beach when all beach communities throughout the United States were segregated. For decades, it flourished as an ocean-side paradise for blacks from all parts of the country. American Beach is still owned primarily by African Americans who are the descendants of the original owners. But, developers are slowly moving in to destroy this property that holds a chapter of American history. The sand dunes tell many stories of generations long past--writer Zora Neale Hurston, heavy-weight champion Joe Louis, entertainer Cab Calloway, and civil rights leader A. Philip Randolph vacationed on American Beach. But, most of the beach dwellers and visitors were ordinary working-class African Americans. This legislation merely seeks to expand the boundaries of a wonderful nature preserve already in place to preserve this unique and special place called American Beach. I ask unanimous consent that the text of the bill be printed in the Record.

Mr. NELSON of Florida

Mr. NELSON of Florida. Mr. President, I rise today to introduce a bill that will preserve a part of the history of Florida and America. My bill will allow 20 acres of untouched, undeveloped sand dune land on American Beach, Amelia Island, FL to become part of Timucuan Ecological and Historic Preserve. The history of American Beach is partly the chronicle of Africa- American achievement and economic autonomy during the Jim Crow era. American Beach was purchased in 1932 by the Afro American Life Insurance Company and its President, A.L. Lewis. This insurance company was the first insurance company owned by any Floridian, either a black or white. Mr. Lewis' granddaughter, affectionately referred to as the ``Beachlady,'' still resides on American Beach and is revered for her colorful life and her work to preserve the American Beach from development and environmental degradation. American Beach was an integrated beach when all beach communities throughout the United States were segregated. For decades, it flourished as an ocean-side paradise for blacks from all parts of the country. American Beach is still owned primarily by African Americans who are the descendants of the original owners. But, developers are slowly moving in to destroy this property that holds a chapter of American history. The sand dunes tell many stories of generations long past--writer Zora Neale Hurston, heavy-weight champion Joe Louis, entertainer Cab Calloway, and civil rights leader A. Philip Randolph vacationed on American Beach. But, most of the beach dwellers and visitors were ordinary working-class African Americans. This legislation merely seeks to expand the boundaries of a wonderful nature preserve already in place to preserve this unique and special place called American Beach. I ask unanimous consent that the text of the bill be printed in the Record.

Mr. NELSON of Florida

Mr. NELSON of Florida. Mr. President, on a completely different subject, as a Nation, we are recklessly careening down the road toward bankruptcy. In the fiscal year that ends in a week, September 30, we are going to be hemorrhaging in our budget to the tune of $500 billion. That is a half trillion dollars. In the new fiscal year that starts October 1, it is estimated we are going to be hemorrhaging to the tune of $600 billion, well over a half trillion dollars. Just to put it in perspective, in the decade of the 1980s, when we ran up so much of our national debt, the max in any one year in the late 1980s was a deficit of $280 billion. That means we were spending $280 billion more than we had coming in in revenue. Therefore, we had to go out and borrow it, and that added to the national debt. The next fiscal year starts in a few days. We are going to spend more than we have coming in tax revenue to the tune of $600 billion and we have to borrow it. Now, where do my colleagues think we borrow it from? We borrow it from folks like you and me, when we buy Treasury bills. We borrow it from institutional investors like pension funds. But it will shock people to know that a good bit of the debt that is being acquired, or debt that is being bought--or to put it in the vernacular of the street, the people who we are borrowing from are the Chinese and the Saudis. Does that not portend some uncomfortable things for America to have a good part of its national debt owned by folks who from time to time we have serious policy differences with? How did we get into this? September 11 clearly was part of the problem. To protect this Nation, the war in Afghanistan and the war in Iraq have caused additional spending, but that is not the only reason for the $600 billion deficit. It was because in the spring of 2001, by a one-vote margin, on a technical part of the budget bill, this Chamber of the Senate passed an instruction that by a majority vote we could pass a tax bill and that tax bill, once we passed it, diminished the revenues so much that the deficit started to swell. We are on a reckless fiscal course, headed toward bankruptcy. Is it any wonder that earlier we heard the majority leader and the Democratic leader going at it over this question of addressing the President's $87 billion request? That is going to add all the more to the budget deficit. We are going to pass the $67 billion that is going to the troops because our troops are going to be provided what they need. But for the remaining $20 billion that is for building 1,000 schools in Iraq, what do we tell our constituents at home about building schools here? For that $20 billion that is to fix water systems and roads and bridges in Iraq, what are we to tell our constituents in America about the water systems and the roads and the bridges?

Mr. NELSON of Florida. I thank the Presiding Officer for giving me the remainder of the time. I yield the floor.

Mr. NELSON of Florida

Mr. NELSON of Florida. Mr. President, I will address the rotation policy in Iraq of our U.S. military forces, and specifically the National Guard and the Reserves. I will also address the planning of that rotation policy. Over the weekend, I met with enumerable groups in Florida about their loved ones who are serving overseas. As members of the Senate Armed Services Committee, we addressed this issue with Deputy Secretary of Defense Wolfowitz and the Chairman of the Joint Chiefs, General Myers, in our committee meeting 2 weeks ago on the plan of rotation and the inequities that are coming out as a result of the lack of planning and how that is being implemented. Now, I am going to give some specific examples. I might say that this large stack contains all e-mails--and you know how small the type is on e-mails--from family members in my State about the inequity of the situation. These are e-mails that I have received directly from soldiers, primarily members of the Florida National Guard and the Reserves. As I tried to address what I perceive to be the inequity in this so- called plan as being implemented, as I tried to address it in committee, as I have in private meetings with the brass, and now as I try to discuss these inequities with the Senate, I, first, will say that had the executive branch of Government listened to the bipartisan voices in the Senate Armed Services Committee--and in particular the Senate Foreign Relations Committee where the chairman of that committee, Dick Lugar of Indiana, a Republican, and one of his ranking members, Senator Chuck Hagel of Nebraska, a Republican, and another of his high-ranking members, Senator Lincoln Chafee of Rhode Island, a Republican, along with a chorus of voices on the committee, including mine--had they listened about the need for a plan after the military campaign in the postwar occupation of Iraq, then I don't think we would be going through the strains and stresses on this rotation policy. Combatant Commander General Abizaid, who is supplied with Army troops through the Army Chief of Staff, of which they are having to stretch out these deployments of the National Guard and Reserves in Iraq, had they listened--had the executive branch of Government listened that there had to be a plan in place, as we had for Germany and Japan--we had a plan being worked on for 3 years prior to the end of World War II for Germany and Japan--had the plan been in place, we would see that we should not have an American face as occupiers in a Muslim country. Instead, it should be the world community participating in trying to stabilize Iraq politically and economically. Had a plan been in place, the preparation would have been there to bring in the Iraqi civilians to run the Government so that there is an Iraqi face on the running of the Government. But that plan is not in place and we are seeing the results of the near chaos from time to time and, indeed, the sabotage that is occurring, the deaths that are occurring, and so forth. But that is an issue for another day. It is a table setter for what I want to talk about--the inequity of the rotation policy and the plan that is specifically being conducted in the rotation of the troops in Iraq. First, Florida's National Guard is one of the most professional in the Nation. It is well organized, it is well trained, and it is well led. They have proven their dedication to duty in this war, and they have committed to do whatever this Nation asks, and they have done it very well. A couple of days ago, General Schoomaker, the Chief of Staff of the Army, told me that the soldiers of the Florida National Guard are as good as they come. They are also tired and fatigued. I raised this rotation policy with the Deputy Secretary of Defense and the Chairman of the Joint Chiefs in that committee meeting a couple weeks ago. I have discussed this rotation policy with the Army Chief of Staff. I will discuss this policy with the Secretary of Defense tomorrow. Florida National Guard soldiers were among the first Guard units alerted in December. They were brought into the armory the day after Christmas to start preparing all of their equipment, and they were mobilized right after New Year's Day. They were also among the first to enter the theater of operations, beginning in February and flowing quickly through March and early April. Florida's National Guard soldiers participated throughout the major combat phase of this operation and throughout the breadth and depth of the theater--a theater that we know had no safe rear area, in the traditional sense. Company C, Charlie Company, 2nd Battalion, 124th Infantry of the Florida Guard--let me tell you what they did before the war. The war started on March 19. Charlie Company dug by hand through the berm that marks the Jordanian-Iraqi border, and then they attacked into Iraq in support of the 5th Special Forces Group. They were in Iraq before the war started on March 19. Since then, Charlie Company has been passed around the theater, from command to command, about 10 times, from the 5th Special Forces Group, to Special Operations Headquarters, to the 5th Corps Headquarters, to the 3rd Infantry Division, to the 2nd Armored Cavalry Regimen, and to the 1st Armored Division. Charlie Company is still there and they have suffered two fatalities--one gunned down at the University of Baghdad the night I was coming into Baghdad in early July, another in a vehicle accident, and a third wounded in the neck. Other companies of the three battalions of the 124th Infantry, of the Florida Guard, have been passed among the headquarters all over the theater no less than 40 times since arriving in the area of operations. This is not a complaint. This is a statement of fact. Florida is justifiably proud of its contribution to the war on terror. Florida has the third highest number of Guard and Reserve soldiers mobilized and deployed globally in the war on terror, with 6,190 Florida Guard soldiers. Two States are a little higher, California and Texas, and it is only by a few hundred soldiers in each of those States. Florida has also deployed the second highest number of Guard soldiers to the Iraqi theater. Right now, in the Iraqi area of operations, there are 2,482. We are second highest to Alabama, and Alabama has 38 soldiers more. These two States, Alabama and Florida, by far have the most soldiers deployed to the Iraqi theater. No State has provided more infantry from the Guard than Florida-- 1,392 infantry soldiers, followed by Indiana's infantry at 1,286. These two States by far are contributing more to the Iraqi theater from Guard units than are infantry troops. Naturally, since they were deployed the day after Christmas, they are tired, and I believe they should be replaced by fresh troops as soon as possible. There is a new policy, and the new policy of the Defense Department is a ``12-month Boots on the Ground in Iraq'' rotation policy, and it may not be equitably implemented because Florida's Guard entered the theater in company-size elements spread out over a period of 2\1/2\ months. So it doesn't sound like it is equitable for this new policy of boots-on-the-ground for the clock to start ticking only when the last unit arrives in theater, what they call over at the Pentagon ``closed in command.'' I understand that other National Guard units are already beginning the process of coming home, and I am happy for them, and I am happy they are coming back to their loved ones. But I cannot seem to get a clear answer from the Department of Defense and the Army about who is coming home early and why. National Guard units that have spent the entire major combat phase outside of Iraq appear to be on the way home. I will give an example. I had several from the highest echelons of the Department of the Army tell me that another State's National Guard is rotating back--that State's Guard has, in fact, never been in Iraq. In fact, if that information is correct that the other State's Guard is returning in October, then they will have served there 11 months. I am happy for them, but I am questioning the equity of a case where because of a ``closed in command'' policy, the last unit arriving in the theater starting the clock ticking for 12 months ``boots on the ground,'' that, in effect, is going to extend some of the Florida National Guard a year and a half since they were mobilized and when they went to that headquarters to start packing their gear on December 26. Then I was told last night by another general in the Pentagon that, no, that particular State was not going home until next January or February. The Department of Defense cannot get the information correct. I have been told three different things about those units. I have been told four different things about the Florida units. So I have had to dig it out for myself by talking to our own Guard members through e- mail and talking with them directly by telephone. The rotation policy for our Guard and Reserve forces should be simple: Return them to their civilian lives as soon as is militarily practical. This requires detailed and timely planning which does not appear to have been adequate or to have been based on realistic assumptions for operations after the major combat phase. Of course, the major combat phase was brilliant. General Franks will go down in military history as one of the great military leaders of the United States. Now we are in the phase of the occupation, and our soldiers of the Florida National Guard are proud to soldier on in Iraq, Afghanistan, Kuwait, and Bosnia, as well as at home securing Air Force bases in Florida. But we are on the threshold of a serious problem for our Guard and Reserve servicemembers. Their sacrifices began the moment they were mobilized and left their civilian lives behind. They leave their families, they leave their employers, their livelihoods. Their families' well-being is at risk throughout the deployment regardless of their location or tactical conditions. Guard families in Florida and across the Nation have endured the separation, uncertainty, financial hardship, and fear that goes along with any deployment into harm's way, and that is what they signed up for. They are willing to accept it. When I talked with these family members, as I did in Orlando last Thursday, in Tampa on Friday, and in Miami on Monday, they were almost apologetic to me. They said: For me to say anything sounds like I don't want to be patriotic. I am most patriotic, they tell me, and we are so proud of our Guard who are serving. They are pointing out, if others are coming back in less than a year, why are our Florida Guard and Reserves going to be mobilized for up to a year and a half? That is an excellent question. Let me give some of these family stories. In central Florida in Daytona Beach at the Halifax Medical Center, Kaitlyn Rose Long was born on February 25. Her father was not there. He did not expect to be there because he is a soldier deployed since January. At the time of her birth, he was 7,600 miles away in Qatar. Kaitlyn's mother thought her husband was coming home soon, particularly because he had suffered a collapsed lung while working guard duty in Balad, an Iraqi city about 50 miles north of Baghdad. He was sent to a hospital in Germany where doctors initially told him he was going to have to go home. They changed their minds, and he is expected back in Balad next week. To family members that is heartbreaking, but they will accept that. What they will not accept is the inequity of treating some one way and others another way. The husband of another 25-year-old mother of three from Brandon is a specialist in Charlie Company of the 2nd Battalion. As I said earlier, they have shifted to over a half a dozen units during their deployment. In mid-May, the company was told, because they were fatigued from the fog of war, that they were heading home. Instead, they were sent to Baghdad. Another lady, Ada Dominquez, came from Miami all the way to the Orlando meeting to tell me of her concern about this inequity. Florida's military families are tough, they are dedicated, and they are loyal Americans, proud of their service. They are willing to continue to make sacrifices to keep this Nation strong and free. They are an inspiration to me. They are an inspiration to all of us. They know this is very tough and complex, and it is still a very dangerous mission. One soldier's mother from central Florida said to me: Just tell them when they are going to be coming home. Do not keep jerking them around, getting this information; it stops, then it starts, and then it stops. She said that is when the morale sinks to the lowest. Members of the Guard and the Reserve are also volunteers. As we so often say, we recruit individuals but we re-enlist families. The rotation challenges the Army struggles with now are going to be the result of too few troops for the missions we ask them to do. We need to look seriously at adding more troops to the Active Force. There have been a number of us who have been trying to urge the Secretary of Defense to open that issue, and thus far it has not been addressed. We must, as a Nation, figure out how we are going to deal with this challenge, or we are going to risk losing the numbers we need in the finest Guard and Reserve system in world history. If the demands on our military continue at their current pace and more than 12-month overseas deployments become routine--as some of the Florida troops are facing, up to a year and a half--then our National Guard and Reserve troops are not going to re-enlist when the time comes. Our military force of the Army, which is roughly a half million plus Active, 400,000 plus Reserves, and 300,000 plus Guard; we can see that the Guard and the Reserves are so integrally important to the military force structure. If we do not have what is perceived to be an equitable rotation policy, then when it comes time for them to re-up, many of them will not. That will be devastating from the standpoint of providing for the force structure this Nation is going to need as we face the multitude of places around the world where we will have to go and battle the terrorists. If those ranks are depleted, then we will not have them when we need them the most. I commend the Guard and the Reserves. They have been one of the finest military fighting outfits that has ever been produced to supplement the regular Active-Duty Army. We can talk about the Air Guard as well, performing services all over this country, including air defense. It is those Guard units, under the command of the general from Tyndall Air Force Base, that if we ever have another airliner hijacked, he has the command responsibility of ordering the shoot-down of that airliner that is taken over by terrorists. The Air Guard is performing that. The issue in front of us now is the equity of the Guard and the Reserves in the rotation policy. I hope General Schumacher, the Secretary of Defense, the Deputy Secretary of Defense, the Chairman and Vice Chairman of the Joint Chiefs will listen to these words and will enact a policy of rotation that will be perceived to be equitable for all the Guard units. Parliamentary inquiry, Mr. President. What is the status of the morning business?

Mr. NELSON of Florida. How many minutes remain?

Mr. NELSON of Florida. Is the time equally divided?

Mr. NELSON of Florida. Mr. President, I will make a couple of other comments.

Mr. NELSON of Florida. The Senator from Florida would ask, does that mean the entire first 30 minutes is set aside for this side of the aisle?

Mr. NELSON of Florida

Mr. NELSON of Florida. Will the Senator yield for a question?

Mr. NELSON of Florida. I appreciate the Senator offering this amendment and I just want to underscore with a question that the Senator's amendment will allow the research to go on as we intended in the Defense authorization bill but would not allow the development and the engineering where these weapons would be actually designed until such time as the executive branch would come back to the Congress to get approval to do that. Is that correct?

Mr. NELSON of Florida. I thank the Senator.

Mr. NELSON of Florida

Mr. NELSON of Florida. Mr. President, I wish to speak about this day 2 years ago and what it signifies to our country. There is not a soul in this country who does not remember exactly where they were and what they were doing on that fateful day that was so much of a watershed point in our country. I will tell you where I was. I was with the Senator from North Dakota and a number of others in a leadership meeting about 30 yards from here on the west front of the Capitol. We had broken up our meeting and were watching the television, watching the World Trade Center, when someone burst in the door and said, ``The Pentagon has been hit.'' We immediately looked to the window looking out across The Mall and saw the black smoke rising. In times such as that, it is interesting how you react. Since my wife and I had just moved into an apartment overlooking the southwest corner of the Pentagon, my instinctive reaction was to leap to a telephone and to try to get word to her to get out of the apartment and get to the basement garage. Of course, I did not know what was happening on that side of the Potomac River. I went back to the meeting room, and it was vacant. I walked into the hallway and saw everyone pouring down the stairs. I will never forget what I heard at the bottom of the stairs. I heard the Capitol Police shouting at the top of their lungs: ``Get out of the building. Get out of the building.'' The memories of that day are seared in the minds of so many of us. And here we are 2 years later still confronting the terrorists and still conducting the war against terrorism. I am going to close with this because still people come up to me in my State of Florida, as they did so frequently in the aftermath of that fateful day 2 years ago, and they say: ``Bill, what can we do?'' Let me tell you what my advice is, and it is the same now as it was then. Loyal, hard-working Americans, what can you do? You can go on about your lives being faithful and hard-working and productive citizens of this country because in defense of this country and our values and our way of life, it is not only that we need military strength for that, we need to continue our moral strength, and we need to continue our economic strength. It is the strength of that and many other values, if we continue in our normal everyday productive selves that we will overcome. I particularly use that word ``overcome'' because that is what America is. Our character as a people is that we are overcomers to the obstacles that are put in front of us, to the setbacks with which we are faced. We are overcomers, and our history shows that time and time again. Likewise, this time it will be also. I thank the Chair. I yield the floor.

Mr. NELSON of Florida

Mr. NELSON of Florida. Mr. President, I wish to talk about cancer as well as finalize details of this appropriations bill which includes more than $5 billion for the Cancer Institute. I am reminded of a related issue that threatens cancer care in this country. I am extremely concerned with several provisions in the Medicare prescription drug coverage bill already passed by the Senate and the House. As we know, when the Medicare Program was first enacted, much of the care provided to patients was delivered in the hospital inpatient setting. That was 1965 when Medicare was enacted. Over the course of the next 37 years, as science and medicine has progressed, patient care has shifted dramatically to the physician's office. Perhaps nowhere has this shift been more prevalent than in cancer care. Today, over 80 percent of all care is delivered in physicians' offices, and that is cancer care. This is due in large part to the introduction of the new outpatient drugs which have significantly reduced the need for inpatient hospital care for cancer patients. If Congress was designing the Medicare Program today, in 2003, instead of in 1965, there is little doubt that outpatient prescription drug coverage would be a central part of that program. That is a lot of the argument we made when we passed the prescription drug benefit, a bill that passed earlier in the summer. The current Medicare system, however, only provides limited coverage for outpatient drugs. Clearly, that needs to change, especially for cancer care. Medicare does provide coverage for many cancer drugs, such as chemotherapeutic agents and supportive drugs. In addition, Medicare provides reimbursement to physician practices for professional services associated with the administration of those covered drugs under Medicare. As has been noted by the General Accounting Office and the HHS inspector general, the current system for reimbursement of cancer care is seriously flawed. Medicare payments for cancer drugs frequently exceed the cost to the providers, and at the same time, however, Medicare reimbursement for drug administration covers only a small fraction of the actual cost of providing quality cancer care. It is estimated that the current Medicare reimbursement only covers about 20 percent of the actual practice expenses. I have heard from many of Florida's 775 oncologists, and they have told me that the overpayment for covered drugs has helped make up for the significant underpayment in practice expenses incurred by physicians' offices. This includes expenses for oncology nurses, pharmacists, case managers, medical equipment, and other services and supplies involved in providing cancer patients with the highest quality of care. The goal for reform ought to be simple. Medicare should neither overpay nor underpay for drugs and related expenses. Unfortunately, the legislation passed by both Houses does not achieve the balanced reform that I think all of us agree is needed. Instead, the legislation passed by the Senate on prescription drugs calls for a cut of $16 billion over the next 10 years. The House-passed bill is no better, and it includes a cut of over $13 billion from the current Medicare reimbursement levels. The consequences from cuts of this magnitude are going to be dramatic, including the closure of satellite clinics in rural areas, forcing cancer patients to drive hundreds of miles for treatments. Oncology nurses, pharmacists, social workers, and the like will lose their jobs. Clinical research in community-based clinics, where approximately 60 percent of all cancer clinical trials are conducted today, are going to be brought to a halt. Many doctors will be forced to significantly reduce the number of Medicare cancer patients they treat, while others will stop accepting new cancer patients altogether. Patients are going to be forced to seek treatment elsewhere, but hospitals have indicated they have neither the physical capacity nor the nursing staff to treat a large volume of new cancer patients. In fact, a recent survey conducted by the American Society of Clinical Oncology found that if the proposed cuts in Medicare reimbursement are enacted into law, 73 percent of physicians surveyed would send chemotherapy patients to a hospital instead of treating them in the office. Fifty-three percent would limit the number of Medicare patients they treat, and nearly one in five indicated they would stop treating Medicare patients entirely. If that happens, it is exactly the opposite of what we ought to be doing, because a person can keep their costs a lot lower if they are doing this treatment in a doctor's office instead of doing it in the hospital. I am sure all of us unanimously would agree that we cannot let this happen, especially at a time when such tremendous progress is being made in cancer research and treatment. Yet it is happening under our eyes. It happened in this bill that we passed. According to the statistics from the American Cancer Society, approximately 1.3 million new cancer cases will be diagnosed this year, and 60 percent of those cases will be among Medicare beneficiaries. In my home State, more than a million people will be told over the next decade that they have been diagnosed with cancer. If the $16 billion of cuts in cancer care that have been proposed are enacted into law, this would mean a $1.6 billion reduction in Medicare cancer care reimbursement in my State of Florida alone. This cut is second only to the cut in California, which would be hit with a $1.7 billion cut. Let's face it, cuts of this magnitude are not sustainable. This is just Medicare reimbursement that we are talking about because private payers frequently follow the Medicare payment formulas. In the private sector, those cuts will be even more dramatic. The cumulative effect of all of these proposed Medicare cuts, combined with the private payer cuts that will undoubtedly follow, will have a very serious impact on the ability of cancer patients to receive the care they need in order to survive. I remind everybody that there is not one among us who has not been touched by cancer in some way, if not among ourselves, among our loved ones and our friends. We have the greatest system of cancer care in the world. Patients are living longer. They are living productive lives thanks to the scientific advances and the dedicated men and women who provide the high-quality care in convenient and cost-effective community clinics throughout this country. People from around the world travel to America for cancer care. My colleagues ought to see the Latin American market, how it comes to Florida for that care, because they know we have the latest technologies, the best doctors, the most compassionate nurses, and the best trained medical workforce in the world. That is why people come to the United States for their health care, especially cancer care. Advances in cancer research have led to the development of new therapies that are more targeted, and those therapies are less toxic. As a result, cancer mortality rates in the U.S. have been declining. We are winning this war on cancer. Now is not the time to call for a retreat, a surrender, by slashing Medicare payments. The conference committee on the Medicare prescription drug bill is meeting right now, and all across this land people who care about what I am trying to articulate ought to be sending their ideas, their requests, and their pleas, along with their prayers, to that conference committee and let them know what they think. We have a saying in the South: Let them have an earful. While many issues still have to be ironed out in that conference committee, it is putting the Congress one step closer to enacting the most sweeping reform of the Medicare Program since its inception. In closing, I urge my colleagues to continue the discussions with the cancer care community to develop a proposal that will preserve patient access to community-based cancer care. Cancer patients and their families are counting on Congress to preserve high-quality community- based cancer care. This is one of the most serious issues we are facing, and when we make tradeoffs because of budgetary limitations, as we did on the floor of this Senate in the consideration of the Medicare prescription drug benefit, where we traded cuts in cancer care for increases in rural health care, that is a tradeoff that we should not have to make. We ought to be able to do both. The consequences, if we allow it to stand, are going to be extremely great. I yield the floor.

Mr. NELSON of Florida

Mr. NELSON of Florida. Mr. President, I rise to state my support for Senator Schumer's amendment to increase funding for the Ryan White Comprehensive AIDS Resources Emergency (CARE) Act. The Ryan White CARE Act is the largest single source of Federal funding dedicated to the care and treatment of people living with HIV/ AIDS in our Nation. This exceptional program provides funding for primary health care and support services for people with HIV/AIDS who lack health insurance and the financial resources to pay for their care. Each year, CARE Act programs nationwide reach over half a million individuals with or at risk for HIV. The Centers for Disease Control and Prevention (CDC) estimate that 850,000 to 950,000 people are living with HIV and/or AIDS in the U.S., and of those people approximately one-third are not accessing proper care and treatment. CARE Act programs are essential to extending care to all those living with HIV/AIDS. Recent reports indicate that the number of patients with HIV/AIDS is increasing faster than the Federal funding. In my own State of Florida that has meant that patients in need have had to delay getting care. The number of people on the waiting lists has never been so widespread or long-lasting. According to a recent article in the Sun Sentinel, AIDS Project Florida, Broward County's largest agency serving these individuals, exhausted its July funds for medical care before the end of the month and had to put newly diagnosed HIV patients on a waiting list to see a doctor. The same article tells us the situation is in Palm Beach County is no better. The Comprehensive AIDS Program of Palm Beach County has had up to three-dozen HIV patients waiting to see counselors at each of three offices because of a rush of new clients--including some from Broward. Ryan White CARE Act programs grant vital resources to communities affected by this epidemic. This program's comprehensive scope not only addresses a patient's health care needs, but also food supplies, alternative medicine options, as well as transportation. We cannot expect our communities to meet this growing need without increased funds. I urge my colleagues to join me in supporting Senator Schumer's efforts to increase funding to this critical program.

Mr. NELSON of Florida

Mr. NELSON of Florida. Mr. President, I support the Senator and his amendment. There are certain things in life, if we apply our efforts, our research, our development, our technology, we can ultimately lick. One of them that, of course, we are working real hard on is cancer. One of them, another big killer, is heart disease. And clearly the plague of AIDS is one of them. I support the Senator and thank him for bringing this amendment to the floor. At the appropriate time I would like to address another amendment with the manager. I yield the floor.

Mr. NELSON of Florida. Mr. President, I request of the manager of the bill I be given some opportunity to speak on another amendment, but at his pleasure. I will speak whenever he would prefer.

Mr. NELSON of Florida. Mr. President, I have been to Head Start facilities all over my State. What a wonderful little academic atmosphere for these 3-, 4-, and 5-year-olds who are starting the program, as well as those who are younger than 3. It is this little academic atmosphere where they start to learn their letters, the alphabet, and their numbers. They start to learn respect for their fellow little citizens, respect for property. In addition to that academic environment, we are looking at their health, their physical health, their mental health, their dental health. Back in July, the House of Representatives by a 1-vote margin, 217 to 216, started to sound the death knell on this fantastically successful and wildly popular program by saying, instead of funding it directly to the Head Start centers, they were going to put it in a nice little block grant and send it to eight State legislatures and Governors. You know the fiscal distress the States are in. You know the temptation it is going to be for those States if we ever entertain anything like that. To the contrary, here we have an opportunity to take a stand with the amendment of Senator Dodd, to say responsibly we are going to increase the Head Start Program that gets these little fellows, these little children, prepared to enter prekindergarten and the first grade. I support the Senator's amendment.

Mr. NELSON of Florida. I thank the Senator.

Mr. NELSON of Florida

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

Mr. NELSON of Florida. Mr. President, I send to the desk an amendment.

Mr. NELSON of Florida. Mr. President, this is an amendment that I think is noncontroversial, that I am led to believe will be accepted by both sides. It calls for a study by the GAO of a practice that is going on in health care today that I have considerable concerns with, which could cause the beginning of the demise of a major part of Medicare, which is our health insurance system provided by the Federal Government for senior citizens. The practice, interestingly, started in my State of Florida. It has spread to other States. We do not know the extent of this practice. That is one of the reasons for the GAO study that would take place over the next year and a half. But here is what happens: Let's say a doctor has a patient list of some 3,000 patients, and the doctor wants to constrict his or her practice. So the doctor writes all of the patients--and what I am recounting right now is in fact what has happened in Florida--the doctor writes all of the patients and says: Henceforth, I am going to limit my practice. If you want to continue with me, you must pay an entrance fee of $1,800 per year. In some cases it has been noted in articles that have appeared in periodicals such as the Los Angeles Times, the Washington Post, and the New York Times that that entrance fee is as high as $20,000 per patient. So what happens is, patients who have enjoyed the services of that physician in the physician-patient relationship, and who cannot afford the entrance fee, suddenly have to go elsewhere to seek their health care services. You may say: Well, that sounds reasonable because we ought to have the opportunity for individuals to charge what they want for the services they provide as a physician. And, of course, that is our free market system way of doing things. But when part of the equation is a health insurance system funded by the Federal Government for senior citizens, and the doctor wants to continue to receive reimbursement by that health insurance system called Medicare, and the doctor is limiting the access of patients with an entrance fee which that patient must pay, then what we start to create under Medicare is a two-tier system of those who can afford it and those who cannot. It was never contemplated that is what Medicare would be. Let me give you an example in the private sector. If Blue Cross/Blue Shield has a panel of doctors, and those doctors on that panel are entitled to receive reimbursement from the health insurance company--in this case in the private sector my example is Blue Cross/Blue Shield-- if those doctors say, ``Well, I will be glad to see you, enrollee of Blue Cross/Blue Shield, insured by Blue Cross/Blue Shield, but you have to pay me $1,800 a year before I will see you,'' do you think Blue Cross/Blue Shield is going to keep that doctor on its panel of physicians who are going to handle those insureds of that insurance company? The answer to that is, of course not. If that will not occur in the private sector, then why, in the public sector, in a health insurance system funded by the Federal Government for senior citizens, should the Federal Government close its eyes and look the other way while the physicians limit their practice with that entrance fee? We have already addressed this. The Senate took its first step in opposing the use of these access fees by doctors who treat Medicare patients by including a provision in last year's budget resolution that expressed the Senate's preference that Federal funds should not reimburse doctors who charge their Medicare patients any unnecessary fees. What has happened in the meantime is the doctors who practice this, of course, want these entrance fees because they can now limit their practice. But, oh, by the way, they still want to continue to receive the insurance benefits from Medicare, so naturally they are going to fight this. And they have engaged all kinds of lobbyists to fight it. So what I am asking for is a study. It is my understanding that both sides of the aisle have agreed to have this provision. This is a study by the GAO over the next year and a half that will look at how extensive this is and whether there is any diminution in the service through Medicare to the Medicare recipients we are trying to help. I maintain there is. What the doctors will tell you is: No, no, no; what we are doing is we are adding all kinds of different services. We are adding an annual health checkup, a physical exam. We are going to give them hot towels. There won't be any waits in a waiting room. They will have a special private waiting room. I do not have any problem with that if that is what the patient wants to pay. But to say no patient can come to that doctor who is receiving Medicare reimbursement unless that patient is, at the same time, paying them that entrance fee--which ranges across America from $1,800 per patient in Florida to $20,000 per patient that was noted by the New York Times and the Los Angeles Times in a case out in California--then I think it is beginning to establish a dangerous precedent that in effect could impose a means test to access Medicare providers. That would further increase the gap between those who can afford health care and those who cannot. That is not the purpose of Medicare. The purpose of Medicare is to assist all seniors, not just some seniors. The purpose of Medicare is a health insurance system funded by the Federal Government for all senior citizens, not just some. I think the logical extension of this practice is, as you go down the line, with access limited, we are going to create a two-tier system, and that is not what Congress had in mind. So what I am offering is an amendment that would get at the heart of this. Let's be fair. If the doctors can make their case to GAO, then so be it. I personally believe strongly that it is the beginning of the disintegration of the main principle of Medicare, which is to have access to health care for all senior citizens. Mr. President, that is the essence of the amendment. I will abide by the leaders of the bill as to how they want to dispose of it. If the leader of the committee, the chairman, would like me to call for a vote, I would be happy to do so. It is whatever is the pleasure of the distinguished chairman of the committee, the Senator from Pennsylvania.

Mr. NELSON of Florida. Mr. President, I am grateful to the Senator from Pennsylvania.

Mr. NELSON of Florida. Madam President, with the permission of the two leaders, I would like to speak to another amendment that is pending. That is Senator Byrd's amendment. Since we have no one else in the Chamber ready to offer an amendment, I would like to do so at this time. Senator Byrd's amendment, on which we will be voting probably later today, will allow us to fulfill the promises we made when we passed 2 years ago the No Child Left Behind Act which was the additional educational assistance from the Federal Government to the States and local governments in order to help children by increasing title I for disadvantaged children. Let me go back and cite a little of the history. The Federal Government has had a very limited role in education. Today, of all the expenditures for education--be it at the university level all the way down to the beginning of school, pre-K and K--the Federal Government only engages in 7 percent of those expenses. Ninety- three percent is borne by the governments you would expect to carry the load in education--the State and the local governments, mainly through the school boards. Along about 20 years ago or so, when we set up the Department of Education--and I don't remember the exact time title I was set up--it was believed that there was a particular role for the Federal Government to play in assisting State and local government on educational expenses by helping the children who had disadvantaged backgrounds, and thus was born title I which sends money to help children who come from disadvantaged backgrounds. Indeed, an example is the School Lunch Program. It is clearly an acknowledgment that a child cannot learn if the child is hungry--and a whole host of other kinds of moneys that flow from the Federal Government to try to reach that principle that every child should have an equal opportunity to an education. In the Senate 2 years ago--fortunately, then, we were looking at a surplus in our Federal budget--we crafted, in a give and take, not only with the other body, the House of Representatives, but also with the White House--especially with the White House--this act that is referred to as No Child Left Behind. It had additional provisions of accountability, testing so that you could measure the progress of children in those school districts in those States. It was authorized at a specific level. It was authorized at approximately $18 billion, whereas at the time the funding was about $11 billion. That was the clear intent when we passed it. But when we got around to appropriating the moneys, for whatever reason, the White House decided it was not going to support the increased funding to the level authorized in the bill, the No Child Left Behind Act, of $18 billion, but instead was only going to support an increase of roughly $1 billion, to the tune of somewhere around $12 billion, from $11 billion. As a result, I had about 25 townhall meetings when I was home in August. When those school board members came, when that superintendent of the schools came to that townhall meeting or when I met, in one case, in Volusia County, with the entire school board, they were crying the blues that they have all kinds of requirements under this new law we enacted but the money did not flow with it. Senator Byrd has offered an amendment to take that level of funding up to what was worked out with the President and the Senate in our negotiations in a bipartisan way in the Senate as well as between the leadership of the Senate--at that time it was under the leadership of Senator Daschle, as majority leader--and the White House. That is what Senator Byrd's amendment does. It increases it roughly about $6 billion to the level authorized. Folks back home--and I believe it is this way all over America, not just in Florida--are crying the blues about how the No Child Left Behind Act was not funded as promised. Title I schools provide education to the most disadvantaged children in our country. These are the very children we pledged not to leave behind. Typically they use those funds to buy educational material, to provide afterschool programs, to provide professional development to teachers, all of these things aimed at that special category of children, the disadvantaged children. This is separate and apart from the disabled children. We had an amendment yesterday, which unfortunately did not pass, to bring up the level of funding on the program known as IDEA which is special funding from the Federal Government for disabled children. Think of all the problems that a school board, that a school, that a classroom teacher has to confront these days--disabilities, as well as children coming from disadvantaged backgrounds. We were not able to pass that amendment yesterday on disabled kids. I hope we will be able to pass this one for disadvantaged children. Why we would deny the most needy schools, providing education in the most difficult circumstances, the resources they need to make a difference in the lives of those disadvantaged kids is, to use a southern expression, beyond me. Why would we pass a law that claims to leave no child behind and then underfund the very reforms that were included in the bill to reach all of those students? In order to ensure that every child, no matter where that child comes from, has the opportunity to achieve, we simply have to stop paying lipservice to educational reform and we have to start funding it. That is what I promised my people back home in Florida that I was going to come back up here and try to articulate to this Senate. It doesn't make any sense, given all the budgets we have, that our education budget is any lesser priority, especially given that this is the future of America. So with Senator Byrd's amendment, we have the opportunity to reach a little over 2 million more disadvantaged students. I simply don't want us to pass up this opportunity. Head Start Madam President, as long as I don't see any other Senators seeking recognition, I want to bring something else to the attention of the Senate. It came home to me loudly and clearly when I was home. The last week before the August recess, the House of Representatives passed a bill by a one-vote margin that is starting the demise of another one of the most successful and tremendously popular programs, the Head Start Program. What the House of Representatives passed in late July before they left--and most people around the country don't know this. There was a simple one-line mention in the newspapers that the House of Representatives had passed, by a vote of 217 to 216, a bill to take the funding formula for Head Start and change it in eight States, to be determined, instead of in those eight States sending the funding directly to those Head Start centers--instead, to package it in a block and send it to the Governor and the legislatures of eight States, yet to be determined. Now, let me tell you why I think this is the beginning of the demise of Head Start. Head Start is a wildly popular program because it has been so successful over three decades of doing what? Of bringing 3- year-olds, 4-year-olds, and 5-year-olds who come from disadvantaged and poor backgrounds up to the level that, by the time they enter school at prekindergarten and the first grade, they are not so far left behind that they have a chance to compete and they don't become discarded in the system and then, of course, so much more expensive in the long run because of the cost to society of the dropout, and so forth. I visited a Head Start center and you should have seen it. It was down in Boynton Beach in Florida. It has this happy little classroom environment where these 3, 4, and 5-year-olds are beginning to learn their numbers, beginning to learn the alphabet, beginning to interact in a classroom setting, beginning to learn self-discipline, respect for property, respect for others, and respect for themselves--a wildly successful and, therefore, enormously popular program. There are 19,000 Head Start centers all over America, and the funding formula--since this was a program that was set up by the Federal Government over three decades ago, again, with that principle that we are trying to achieve that of giving each child an equal opportunity for an education--the funding was set up by the Federal Government to try to assist the States. Now, let me tell you--well, I don't have to; just go talk to your school board members, talk to the principals and the teachers in those elementary schools. Ask them whether they think it is of extremely high value--the Head Start Program--when those kids are in pre-K and the first grade and they see their progress throughout the elementary school system. They will give you an earful of just how important it is to keep it. But that is not what the House of Representatives did. The House of Representatives, by that one-vote margin, decided they were going to fund it in a different way. Instead of the money, as it has for over 30 years, going straight to the Head Start center based on a formula of how many children and what kind of background, instead, they are going to ball up all that money for all of the Head Start centers in eight States, yet to be chosen--by the way, you can pick eight States that have well over half of the population of the entire country--and they are going to give that in a block grant to the Governor and legislature of those States. Well, have we missed reading all of the chronicling on the front pages of the newspapers of how 48 of the 50 States are in fiscal cardiac arrest, how they are hurting so much they don't have enough funds? Can you imagine the temptation, even though we might try to put requirements on it, to find ways around it to siphon off some of those funds from Head Start into other educational programs? I am telling you, if we did that, in this Senator's judgment, that would be the beginning of the demise of one of the most successful and popular programs in America, the Head Start Program. I have enough confidence in the common sense of this Senate and in the sensitivity of the Members of this body in listening to their people back home--even though what the House did didn't get a lot of press attention--that this Senate would not even consider the change of that funding formula. But we have to speak out on it because it hasn't gotten a lot of attention. It is appropriate that while we are debating the question of funding on education, particularly with Senator Byrd's amendment that goes to title I, which is getting at those disadvantaged kids, we also ought to talk about Head Start, which is getting at the very beginning of the educational process of those disadvantaged kids before they ever get to the elementary level of education. So I wanted to share with the Senate--to again use a southern expression--that I had received an earful back home. I am glad I did and I am glad I could share this with the Senate. When that bill comes over from the House they passed in the last week of their session, I hope we will tell them nothing doing, we are not messing with an extremely popular program. Instead, what we are going to do with that popular and successful program is expand it because today it only, as successful as it is, reaches 60 percent of the eligible children. Even of the earlier ones that we can start working on below age 3, we are only reaching about 3 percent of that eligible population. We have a lot of room to help these little folks as they get ready to compete so they don't get so far behind once they enter school. Madam President, I yield the floor.

Mr. NELSON of Florida

Mr. NELSON of Florida. Mr. President, I was looking forward to going right now to a classified briefing on Liberia as part of our Senate Armed Services Committee. It is my understanding that briefing has been canceled because they feel too many of the Senators have already gone back to their States. I am going to still see if we can get that information for those of us on the Armed Services Committee who are still here. But as we look at Liberia, we cannot keep delaying decisionmaking. I think putting the marines on the boats offshore is clearly a step in the right direction, but this should have been done a couple of weeks ago. Although it wasn't, the marines are in transit, and that is a step in the right direction. What do we need to do? I think it is clearly in the interest of the United States that we diplomatically--in addition to the military action--make sure the cease-fire we are trying to get in place stays, and to reach out to all sides, including the rebel side. I think they have an interest in having the cease-fire. We need to make sure that cease-fire sticks. Then we need to work out an arrangement whereby the African troops come into place. At that point, once there is a military presence stabilizing the country, I think we should have a simultaneous evacuation of Taylor with our U.S. Marines coming in with a presence for a short period of time, with mainly the peacekeeping burden being put on the ECOWAS or African troops. Clearly, we, the United States, need to be directly involved in order to stabilize that region, with a minimum of involvement of U.S. troops. It is clearly in our interest that part of Africa be stabilized. We are going to have to help with it. I think the movement of the marines into that region, albeit on the ships offshore, is a step in the right direction. I hope something akin to what I have laid out here will, in fact, be put into place. So thank you, Mr. President, for the opportunity to share these thoughts. I yield the floor.