Don Nickles

Mr. NICKLES

Mr. NICKLES. Mr. President, I think the pension change--which, I might mention, is an entitlement change--is not paid for in this bill and it costs $14 billion over the next 10 years. So it is not an insignificant provision. There are also provisions in here dealing with a thrift savings plan. I am in favor of that. I don't have a problem with that. We should encourage that for military personnel. Most provisions in here I agree with and some I disagree with. I think changing the retirement percentage is a mistake. There is another provision in the bill that Senator Cleland, I think, was talking about. I compliment him. He was able to get this in the bill in the markup. I don't believe they had cost estimates and actually knew how much it would cost during the markup, but it was a provision dealing with the GI bill, providing benefits, educational benefits for GIs. He expanded the benefit to say it could be transferred to spouses and children. What does this mean? The bill itself increases the GI benefit from $528 a month to $600 a month, a nice, generous increase. That means a GI that is in the regular service with a commitment for 3 years can sign up and receive educational benefits totaling $600 per month--a pretty nice benefit. That is $7,200 per year. This bill is used by a significant number of GIs. This bill eliminates the coshare. They have to pay, right now, $100 a month, or for the first year $1,200. This bill eliminates that. I am not arguing about that as much as I am about the transferability provision in this bill that allows the GI benefits to be transferred to spouses, and also to the kids. I am all in favor of increasing support for our military, but I question the wisdom of this provision, which is enormously expensive. Enormously. The cost of this provision over the next 10 years--just the transfer of the GI entitlement--is $9.8 billion. Also, I might mention that in the CBO study, the last part of the page, they talk about the transfer of entitlement, and they said: CBO estimates that the provision would raise costs by about $110 billion in 2000 and by $2.2 billion over the first 5 years, and $9.8 billion over the 2000 to 2009 period. In the long run, costs will rise to about $3 billion per year. This is just in the transfer of an entitlement. So this is the creation of a new entitlement, transferring this entitlement to spouses and the kids. This $600, which I believe is indexed for inflation, can get very expensive. So we are talking about a $7,200 benefit being transferred to spouses and kids, and 10 years from now how much will that be? Well, the Congressional Budget Office says it is going to cost about $3 billion a year. I know that cost wasn't known--or at least I don't think it was --when this bill was marked up. We know what the cost is now. I think we have to look at it long and hard. Is this the right thing to do? Some people have said this doesn't come out of the defense budget, this is not part of the defense bill, this is really part of Veterans Affairs budget. It comes out of the taxpayer bill. I want to take care of veterans, too, but I don't think we have an obligation to veterans' children, to be providing for their education to the tune of $7,200. I think we have to be very cautious when we go about expanding entitlements. Maybe I am alone in this, but these entitlement increases aren't paid for. So there is a real conflict. Most of us say we believe in a balanced budget. We run back to our States and say we have balanced the budget and we have done a great job. Yet, increasing entitlements to the tune of increasing the percentage from 40 to 50 percent for military retirement, and then also making the GI bill benefits apply not only for GIs, but also for GIs' spouses and for children. I think that is enormously expensive--very expensive. The cost of this bill over the first 5 years is $17.9 billion. The cost over 10 years is $54.9 billion--almost $55 billion over 10 years. About half of that is pay raise. I don't have a problem with the pay raise provision, with one exception. The pay raise provision that is put in says not only a 4.8 pay raise, which is the most generous that we have done in a long time, and it is probably overdue, but it also says for the foreseeable future we are going to add another half point over whatever the cost-of-living index will be for the military over everybody else. I am not sure we should be making that decision for 10 years from now, or for 8 years from now. The next Congress can decide that. Maybe we should say, ``Well, for the next 4 years we will give a half point incremental increase on top of the CPI.'' I don't think we should say for every military person you will get half a percent more than everybody else. And then we are going to have pressure coming from the civil service, and from all governmental employees saying we want just as much, although we have had some studies done that say they are not making as much as those in the private sector. I think that provision can be very expensive, or certainly should be sunset or limited. So I encourage the managers of this bill to look at putting the sunset on the incremental cost-of-living increase that is now provided. I urge them to take another look at raising the retirement percentage from 40 to 50 percent. I urge in the strongest language possible to be very, very cautious about expanding the GI bill of rights to spouses and to their children. If we are going to pass entitlement programs that cost $3 billion a year, we should know it. We should recognize the cost. We should also be thinking about what the spending is going to squeeze out--what area of the military is going to take a hit, or what area of Veterans Affairs. Are we not going to be able to fund veterans' health care as well because that particular provision is in there? So I think we need to think about it long and hard. I am confident that our colleagues, who will be managing this bill in conference, will look at these issues. I am very hopeful they will be addressed before we see a bill brought back to the Senate floor as a conference bill. Mr. President, I yield the floor. Exhibit 1 congressional budget office cost estimate S. 4--Soldiers', Sailors', Airmen's, and Marines' Bill of Rights Act of 1999 Summary: S. 4 would increase various elements of compensation for current and former members of the armed forces. Specifically, it would increase pay for military personnel, provide a special allowance for low-income members, increase retirement benefits for certain members, increase educational benefits, and allow members on active duty to participate in the Thrift Savings Plan. Assuming appropriation of the necessary amounts, enactment of the bill would raise discretionary spending by about $1.1 billion in 2000 and $13.8 billion over the 2000-2004 period. In 2009, those costs would total about $6.5 billion. Because the increase in retirement benefits would apply only to members who entered the service after July 1986, annual costs would continue to rise for a few years after 2009. Additional benefits earned under the proposal between August 1, 1986, and the effective date would add about $4.5 billion to the unfunded liability of the military retirement trust fund. Because the bill would affect direct spending and revenues, pay-as-you-go procedures would apply. Increased educational benefits and higher annuities for certain military retirees would increase direct spending by about $765 million a year over the 2000-2004 period. In 2009 direct spending costs would total about $2.6 billion. The annual direct spending costs for military retirement would eventually be about 11 percent higher than spending under current law. Greater use of education benefits under the bill would raise long-run costs by about $3 billion a year. By allowing servicemembers to participate in the Thrift Savings Plan, the bill would lower revenues by $311 over the 2000-2004 period and about $141 million by 2009. Section 4 of the Unfunded Mandates Reform Act excludes from the application of that act any legislative provisions that are necessary for the national security. That exclusion might apply to the provisions of this bill. In any case, the bill contains no intergovernmental or private-sector mandates. Estimated cost to the Federal Government: The estimated budgetary impact of S. 4 is shown in Table 1, assuming that the bill will be enacted by October 1, 1999. Spending from the bill would fall, under budget functions 700 (veteran's benefits and services), 050 (national defense), and 600 (income security).

Mr. NICKLES. Mr. President, I became concerned about the cost not just of the pay increases, which are handled by appropriation committees every year--in other words, this bill can authorize pay increases of whatever percent, but the appropriators have to come up with the money to do it. They will do that within the budget cycle, and we are going to pass a budget this year. So I am optimistic that will be funded. It will be within the budget and it will be responsible. So, again, I don't have a problem with that portion of the bill, the pay raise. That portion of the bill, I might mention, is $26 billion over the next 10 years. It is about half of this bill. The total cost of this bill is about $55 billion over the next 10 years. So I don't have a problem with the pay raise provision. I do have a problem with two of the entitlement increases in this bill. I think, with all due respect, they are mistakes. I think increasing the military retirement percentage from 40 to 50 percent is a mistake. Some colleagues say don't raise that. I was in the Congress when we reduced it from 50 to 40. We did that with an overwhelming vote of 92-1. In 1986, we reduced the military retirement schedule from 50 to 40 percent as part of an overall package for entitlement reform in the military. It was overwhelming, 92-1. Now we are getting ready to do the opposite, increasing it probably from 40 percent to 50 percent. That means that an individual can join at age 18 or 20, serve 20 years, receive retirement pay beginning at age 40 for life, and receive cost-of-living adjustments. That is very expensive. Also, when they are 41 years old, they can seek other employment; I expect that they would do that in most cases. So they would have other employment in addition to the military retirement. It is a very expensive provision. In 1986, changes were made with a lot of work; I think it was work that was well thought out. I might note that there is a letter from the Concord Coalition, signed by our former colleagues, Senator Rudman and Senator Nunn, which urges us not to do this, saying they worked hard and they were with many of us in the Senate at that time. I will read part of it: We understand that it has been tentatively decided to include in the year-end omnibus spending bill a provision substantially repealing the 1986 military pension reforms. We urge you in the strongest possible terms to reject this unwise, expensive, and untimely provision. They also said: Several commissions reported that the old pension system was so generous to personnel in their early 40s with 20 years of service that the pensions worked as incentives to highly skilled personnel to leave the military. One of the objectives of this bill is to get people to stay in the military. They also say: Rolling back the 1986 reforms means returning to a system that encourages military personnel to retire prematurely from the service in their early 40s at half pay, augmented by full COLAs. Mr. President, I ask unanimous consent to have this entire letter printed in the Record.

Mr. NICKLES. Mr. President, I know my colleague, the Senator from Florida, has an amendment. I want to make a few comments on the bill if that accommodates his schedule. I won't be very long. Mr. President, I wish to compliment my friend and colleague, Senator Warner, for his stewardship of this bill, for his chairmanship of the Armed Services Committee, and for his dedication to improving our national defense. He has a proven record in national defense, both as a Secretary of the Navy and his service in the Senate. I understand the support that this bill has by colleagues, and certainly I feel supportive of our military and national defense as well. I have always believed that for the Federal Government our No. 1 priority should be the protection of our people, protection of our country, and the protection of our freedom. This bill will help do this in some ways. So I support those efforts. I support a lot of what is in this bill, but I don't support everything in this bill. I think it would be less than forthcoming if I didn't express my displeasure with at least two provisions in this bill. Maybe by expressing that displeasure we can remedy that before this bill becomes law. I say that in all sincerity. I want a lot of this bill to become law. Frankly, when my staff asked me earlier, ``Do you want to sponsor S.4, one of our first bills? It improves national defense, increases pay.'' Well, I have 35,000 to 40,000 troops in my State, and I definitely want to increase their pay. So I support that provision of the bill. When I started reading the summaries of it--and I have a copy of a summary and cost estimate from the Congressional Budget Office, dated February 12, 1999. I ask unanimous consent that this CBO summary be printed at the conclusion of my statement.

Mr. NICKLES. I will speak for 5 minutes on the bill, not on the amendment.

Mr. NICKLES. Would the Senator withhold?

Mr. NICKLES

Mr. NICKLES. I announce that the Senator from Alabama (Mr. Shelby) is necessarily absent.

Mr. NICKLES

Mr. NICKLES. Mr. Chief Justice, the United States Senate has nearly concluded only the second impeachment trial of a President in history. We fulfilled our promise to conclude the process in an expeditious and responsible manner in accordance to the Constitution. Americans understand there is really only one person to blame for this ordeal: Bill Clinton. He could have prevented the entire impeachment process if he had chosen the truth instead of lies and obstruction and the well-being of the nation instead of his own personal and political needs. He squandered his opportunity to provide trustworthy leadership on the important issues facing America. The President's actions left the Attorney General with no choice but to ask the Independent Counsel to investigate. They left the Independent Counsel with no choice but to refer charges to the House of Representatives. They left the House with no choice but to impeach him. The day Senators took that impeachment oath was one of the most serious, solemn times that I have experienced during my 18 years in the Senate. Our oath was to do impartial justice, and that oath was in my mind as I weighed the facts, the law, and the Constitution. The President took an oath too. He took an oath to tell the truth, the whole truth, and nothing but the truth. I believe that clear and convincing evidence presented to the Senate demonstrates that President Clinton did indeed commit multiple acts of perjury, as alleged in Article I, and multiple acts of obstruction of justice, as alleged in Article II, and deserves to be found guilty on both articles of impeachment. The President made a serious, serious mistake when he went to his Paula Jones deposition, raised his right hand and swore to tell the truth, the whole truth, and nothing but the truth, and then lied repeatedly. Following that, he committed more acts of obstruction and more lies, culminating in his testimony before the grand jury where he lied time and time again. He had obstructed justice and he had perjured himself in the Jones case, and he wanted to be consistent, so he perjured himself again. One of many specifics, concerning his ``conversations'' with Betty Currie: ``I was trying to get the facts down. I was trying to understand what the facts were.'' He wasn't trying to understand the facts. He knew what the facts were. He was trying to mislead a witness, and then he lied under oath after being begged, ``Don't do it again, Mr. President.'' I believe the public deserves, and the Constitution permits, that the Senate demand a high standard of conduct in its President. Rather than find a loophole to excuse the President's behavior, the Senate ought to find him guilty. The President's counsel have attempted to frame the question before the Senate as ``[a]re we at that horrific moment in our history when our Union could be preserved only by taking the step that the framers saw as the last resort?'' \1\ His lawyers are asking the wrong question. In fact, as Manager Canady pointed out, under this standard even the deeds of Richard Nixon may not have been worthy of impeachment.\2\ The proper question is not whether America would survive President Clinton remaining in office: that answer is yes. The proper question before the Senate is whether, knowing what we now know about his conduct, America should have to do so. --------------------------------------------------------------------------- Footnotes at end of speech. --------------------------------------------------------------------------- Another of the President's lawyers argued that ``[i]f you convict and remove President Clinton on the basis of these allegations, no President will ever be safe from impeachment again[.]'' \3\ I, for one, have a little more confidence that our future leaders will not commit felonies, but if a future President commits the same crimes as President Clinton, I hope that President will face the same constitutional response. In fact, one familiar lawyer recognized that there is ``no question that an admission of making false statements to government officials and interfering with the FBI is an impeachable offense.'' \4\ That lawyer was William Clinton, speaking in 1974.

Mr. NICKLES

Mr. NICKLES. Objection.

Mr. NICKLES. Regular order.

Mr. NICKLES

Mr. NICKLES. Mr. President, I rise today to join in offering the U.S. Energy and Economic Growth Act. This legislation is an effort to help revive our domestic oil and gas industry which plays such a vital role in our national security. If our domestic industry is to survive, then Congress needs to act now to provide tax incentives to encourage energy production in America. Since the early 1980's, oil and gas extraction employment has been cut in half. Employment in the oil and gas industry has declined by almost 500,000 since 1984. Imports of crude oil products were $71 billion in 1977, and the import dependency ratio now exceeds fifty percent. From 1973 to 1998, crude oil production dropped 43% in the lower 48 states. We must take action now to save domestic production not only for the sake of the oil and gas industry but for the sake of the national security of this nation. To date, the Clinton Administration has done nothing to encourage domestic production. In the President's State of the Union address, he named no initiatives to aid this troubled industry and recently, his Administration has conspired with the U.N. to almost double the amount of oil Iraq can export under the so-called food-for-oil program. The U.S. Energy and Economic Growth Act is intended to do just what its name implies--preserve and revitalize the domestic oil and gas industry through economic incentives to production. This bill would accomplish these goals through specific tax proposals. Marginal wells are those which produce less than 15 barrels per day or gas wells which produce less than 90 thousand cubic feet per day. The United States has over 500,000 marginal wells producing nearly 700 million barrels of oil each year and contributing 80,000 jobs and $14 billion to the annual economy. This legislation provides incentives to keep these valuable wells in production through a $3 per barrel tax credit on the first three barrels of daily production, or $0.50 per mcf for the first 18 mcf of daily natural gas production. These credits would only apply when low market prices necessitated them for the survival of the industry, and are phased out when prices increase. In an effort to reclaim oil lost to closed wells, this bill allows producers to exclude income attributable to oil and natural gas from a recovered inactive well. The provision only applies to wells which have been inactive for at least two years prior to the date of enactment, and which are recovered within five years from the date of enactment. The U.S. Energy and Economic Growth Act would also allow current expensing of geological and geophysical costs incurred domestically including the Outer Continental Shelf. These costs are an important and integral part of exploration and production for oil and natural gas, and should be expensed. Furthermore, this bill clarifies that delay rental payments are deductible, at the election of the taxpayer, as ordinary and necessary business expenses. This clarifies an otherwise gray area in Treasury regulations and eliminates costly administrative and compliance burdens on both taxpayers and the IRS. Lastly, the legislation includes hydro injection and horizontal drilling as tertiary recovery methods for purposes of the Enhanced Oil Recovery Credit. Although the Treasury Department is tasked with continued evaluations and editions to the list of recovery methods covered under this credit, they have proven notably lax in pursuing this objective. By legislating this outcome, this bill keeps domestic production of our endangered marginal wells on the cutting edge of available technology. Collectively, the provisions of this bill provide much needed incentives to an industry that is vital to our national security. The sooner the Administration and Congress acknowledge the critical importance of the domestic oil and gas industry and stop burdening this industry with high taxes and regulatory obstacles, the sooner we can take the necessary actions to preserve and revitalize this important sector of our economy. Passage of the U.S. Energy and Economic Growth Act would be a significant step in that direction. I urge my colleagues to support this legislation which will positively impact the domestic oil and gas industry by helping to bridge the gap in these lean economic times.

Mr. NICKLES

Mr. NICKLES. Mr. President, I rise today to join in offering the U.S. Energy and Economic Growth Act. This legislation is an effort to help revive our domestic oil and gas industry which plays such a vital role in our national security. If our domestic industry is to survive, then Congress needs to act now to provide tax incentives to encourage energy production in America. Since the early 1980's, oil and gas extraction employment has been cut in half. Employment in the oil and gas industry has declined by almost 500,000 since 1984. Imports of crude oil products were $71 billion in 1977, and the import dependency ratio now exceeds fifty percent. From 1973 to 1998, crude oil production dropped 43% in the lower 48 states. We must take action now to save domestic production not only for the sake of the oil and gas industry but for the sake of the national security of this nation. To date, the Clinton Administration has done nothing to encourage domestic production. In the President's State of the Union address, he named no initiatives to aid this troubled industry and recently, his Administration has conspired with the U.N. to almost double the amount of oil Iraq can export under the so-called food-for-oil program. The U.S. Energy and Economic Growth Act is intended to do just what its name implies--preserve and revitalize the domestic oil and gas industry through economic incentives to production. This bill would accomplish these goals through specific tax proposals. Marginal wells are those which produce less than 15 barrels per day or gas wells which produce less than 90 thousand cubic feet per day. The United States has over 500,000 marginal wells producing nearly 700 million barrels of oil each year and contributing 80,000 jobs and $14 billion to the annual economy. This legislation provides incentives to keep these valuable wells in production through a $3 per barrel tax credit on the first three barrels of daily production, or $0.50 per mcf for the first 18 mcf of daily natural gas production. These credits would only apply when low market prices necessitated them for the survival of the industry, and are phased out when prices increase. In an effort to reclaim oil lost to closed wells, this bill allows producers to exclude income attributable to oil and natural gas from a recovered inactive well. The provision only applies to wells which have been inactive for at least two years prior to the date of enactment, and which are recovered within five years from the date of enactment. The U.S. Energy and Economic Growth Act would also allow current expensing of geological and geophysical costs incurred domestically including the Outer Continental Shelf. These costs are an important and integral part of exploration and production for oil and natural gas, and should be expensed. Furthermore, this bill clarifies that delay rental payments are deductible, at the election of the taxpayer, as ordinary and necessary business expenses. This clarifies an otherwise gray area in Treasury regulations and eliminates costly administrative and compliance burdens on both taxpayers and the IRS. Lastly, the legislation includes hydro injection and horizontal drilling as tertiary recovery methods for purposes of the Enhanced Oil Recovery Credit. Although the Treasury Department is tasked with continued evaluations and editions to the list of recovery methods covered under this credit, they have proven notably lax in pursuing this objective. By legislating this outcome, this bill keeps domestic production of our endangered marginal wells on the cutting edge of available technology. Collectively, the provisions of this bill provide much needed incentives to an industry that is vital to our national security. The sooner the Administration and Congress acknowledge the critical importance of the domestic oil and gas industry and stop burdening this industry with high taxes and regulatory obstacles, the sooner we can take the necessary actions to preserve and revitalize this important sector of our economy. Passage of the U.S. Energy and Economic Growth Act would be a significant step in that direction. I urge my colleagues to support this legislation which will positively impact the domestic oil and gas industry by helping to bridge the gap in these lean economic times.

Mr. NICKLES

Mr. NICKLES. I announce that the Senator from Colorado [Mr. Allard] is necessarily absent.

Mr. NICKLES. I announce that the Senator from Colorado [Mr. Allard] is necessarily absent.

Mr. NICKLES. I announce that the Senator from Colorado [Mr. Allard] is necessarily absent.

Mr. NICKLES

Mr. NICKLES. I ask that the Senate stand in adjournment as under the previous order.

Mr. NICKLES

Mr. NICKLES. Mr. Chief Justice, for the information of all colleagues, tomorrow we will begin the debate at 12 noon instead of 1 o'clock.

Mr. NICKLES. On tomorrow, we will resume and begin debate on the motion to subpoena. I now ask unanimous consent that the time for argument be reduced to 4 hours, equally divided, as provided for under Senate resolution 16.

Mr. NICKLES. I ask unanimous consent that when the Senate adjourns, it stand in adjournment until the hour of 12 noon on Tuesday, and I further ask consent that during the remainder of the trial it be in order for Members to submit unanswered questions to the Chair.

Mr. NICKLES. I ask unanimous consent that the Senate now return to open session.

Mr. NICKLES

Mr. NICKLES. Mr. President, today I am introducing the Senate Republican Patients' Bill of Rights Plus. Joining me in this effort are 49 of my colleagues who recognize the importance of ensuring that all Americans are able to not only receive the care they have been promised, but also the highest quality of care available. The foundation of this proposal is to address some of the very real concerns that patients have about their health care needs and to provide significant opportunities for all consumers in choosing their doctors and health plans. We know that many Americans have believed they were denied coverage that their plans were supposed to cover. We recognize that some individuals fear that their health care plans will not give them access to specialists when they need them. We know that some Americans think their health care plans care more about cost than they do about quality. Last January, the Majority Leader asked me to put together a group of colleagues to address the issue of health care quality. For over eight months, Senators Frist, Collins, Hagel, Roth, Jeffords, Coats, Santorum, and Gramm worked tirelessly to put together a responsible, credible package that would preserve what is best about our nation's health care while at the same time determine ways to improve upon-- without stifling--the quality of care our nation delivers. We set out to rationally examine the issues and develop reasonable solutions without injuring patient access to affordable, high quality care. This was no easy task. We spent month after month talking to experts who understand the difficulty and complexity of our system. We met with representatives from all aspects of the industry including the Mayo Clinic, the Henry Ford Health Systems, the American Medical Association, the American Hospital Association, the National Committee for Quality Assurance, the Joint Commission on the Accreditation of Healthcare Organizations, Corporate Medical Directors, Commissioners from the President's Quality Commission, Purchasers, Families USA, the Employee Benefit Research Institute, and many others. After many, many months of dissecting serious questions about our system, we determined that there were indeed some areas in which we could improve patient access and quality. Together, we have written an innovative plan that will answer the problems that exist in the industry, while at the same time preserving affordability, which is of utmost importance. After all, Mr. President, I think you agree that if someone loses their health insurance because a politician playing doctor drives prices to an unaffordable level, you have hardly given them more rights or better quality health care. We are proud of what we have been able to accomplish. For the first time, patients can choose to be unencum- bered in their relationship with their doctor. They will be able to choose their own doctor and get the middle man out of the way. There will be no corporate bureaucrat, no government bureaucrat and no lawyer standing between a patient and their doctor. In addition our legislation does what no other bill has done. It provides the patient with more choice in their health plans. Mr. President the bill we introduce today: Protects consumers in employer-sponsored plans that are exempt from state regulation. People enrolled in such plans will have the right to: Choose their doctors. Our bill contains both ``point-of-service'' and ``continuity of care'' requirements that will enhance consumer choice. See their ob-gyns and pediatricians without referral. Guarantees parents and families peace of mind by giving patients direct access to pediatricians and ob-gyns without prior referral from a ``gatekeeper.'' Have a ``prudent layperson'' standard applied to their claims for emergency care. Our bill will require health plans to cover--without prior authorization--emergency care that a ``prudent layperson'' would consider medically necessary. Communicate openly with their doctors without ``gag'' clauses. Holds health plans accountable for their decisions. Extends to enrollees in ERISA health plans and their doctors the right to appeal adverse coverage decisions to a physician who was not involved in the initial coverage determination. Allows enrollees to appeal adverse coverage determinations to independent medical experts who have no affiliation with the health plan. Determinations by these experts will be binding on the health plan. Requires health plans to disclose to enrollees consumer information, including what's covered, what's not, how much they'll have to pay in deductibles and coinsurance, and how to appeal adverse coverage decisions to independent medical experts. Guarantees consumers access to their medical records. Requires health care providers, health plans, employers, health and life insurers, and schools and universities to permit an individual to inspect, copy and amend his or her own medical information. Requires health care providers, health plans, health oversight agencies, public health authorities, employers, health and life insurers, health researchers, law enforcement officials, and schools and universities to establish appropriate safeguards to protect the confidentiality, security, accuracy and integrity of protected health information and notify enrollees of these safeguards. Protects patients from genetic discrimination in health insurance. Prohibits health plans from collecting or using predictive genetic information about a patient to deny health insurance coverage or set premium rates. Promotes quality improvement by supporting research to give patients and physicians better information regarding quality. Establishes the Agency for Health- care Quality Research (AHQR), whose purpose is to foster overall improvement in healthcare quality and bridge the gap between what we know and what we do in healthcare today. The Agency is built on the platform of the current Agency for Health Care Policy and Research, but is refocused and enhanced to become the hub and driving force of federal efforts to improve the quality of healthcare in all practice environments--not just managed care. The role of the Agency is not to mandate a national definition of quality, but to support the science necessary to provide information to patients regarding the quality of the care they receive, to allow physicians to compare their quality outcomes with their peers, and to enable employers and individuals to be prudent purchasers based on quality. Makes health insurance more accessible and affordable by: Allowing self-employed people to deduct the full amount of their health care premiums. Making medical savings accounts available to everyone. Reforming flexibility spending accounts to let consumers save for future health care costs. Mr. President, this bill is a comprehensive bill of rights that will benefit all Americans, and I am proud to join with so many of my colleagues in introducing it. This legislation is built around several basic principles which distinguishes it from other proposals. First and foremost, it recognizes that regulation adds costs and not value. The legislation places a priority on ensuring that we will not increase the number of uninsured or make health care unaffordable through excessive regulation. Second, our legislation rightly places patients ahead of trial lawyers. The inclusion of a strong, internal and external appeals provision holds HMOs accountable, while guaranteeing that patients get the care they need when they need it. Third, our legislation protects the historic and traditional role of states to regulate private health insurance. States are best equipped to determine the needs of their citizens. Our legislation ensures that the Federal Government and HCFA will not be empowered to expand their reach into the private market. The creation of new federal bureaucracies will only serve to stagnate and destroy what is best about our health care system. Finally, our legislation places a high priority on choice. Unlike every other proposal our bill will give every American the right to fire their HMO. Every patient will have their choice of doctor and health plan. Our bill empowers an independent medical expert to order an insurance company to pay for medically necessary care so that patients suffer no harm. Theirs allows professional trial lawyers to sue health plans after harm is done. Mr. President, when my insurance company tells me that they won't cover a service for my family, I want the ability to appeal that decision to a doctor who doesn't work for my insurance company. And I want that appeal handled promptly, so that my family receives the benefit. That is what our bill requires. Other bills create new ways for trial lawyers to make money. According to a June 1998 study by Multinational Business Services, the Democrats' bill would create 56 new Federal causes of action--56 new reasons to sue people in Federal court. That's fine for trial lawyers, but it doesn't do much for patients. Patients want their claim disputes handled promptly and fairly. According to a study by the General Accounting Office, it takes an average 25 months--more than two years--to resolve a malpractice suit. One case that the GAO studied took 11 years to resolve! I'm sure the lawyers who handled that case did quite well for themselves. But what about the patient? Under our bill, patients can appeal directly to an outside medical expert for a prompt review of their claim--without having to incur any legal expenses. In medical malpractice litigation, patients receive an average of only 43 cents of every dollar awarded. The rest goes to lawyers and court fees. Our bill assures that health care dollars are used to serve patients. It does not divert dollars away from patients and into the pockets of trial lawyers. Mr. President, another big difference between our bill and others proposed is that their bill takes a ``big government'' approach to health reform. Our bill relies on State Insurance Commissioners to protect those Americans who are enrolled in state-regulated plans. We protect the unprotected by providing new federal safeguards to the 48 million Americans who are enrolled in plans that the states are not permitted to regulate. Another problem: Some bills impose a risky and complicated scheme that relies on federal bureaucrats at the Health Care Financing Administration (HCFA) to enforce patients' rights in states that do not conform to the federal mandates in their bill. HCFA is the agency that oversees the federal Medicare and Medicaid programs. Last year, in the Balanced Budget Act, Congress created new consumer protections for Medicare beneficiaries--a ``Patients' Bill of Rights'' for the 38.5 million senior citizens and disabled Americans who rely on Medicare for their health care. We asked HCFA to protect those rights. How have they done? I regret to say, Mr. President, that they have not done very well at all. On July 16, 1998, a GAO witness testified before the Ways and Means Committee on how well HCFA was doing in implementing the Balanced Budget Act and enforcing the Medicare patients' bill of rights. According to GAO, HCFA has ``missed 25 percent of the implementation deadlines, including the quality-of-care medical review process for skilled nursing facilities. It is clear that HCFA will continue to miss implementation deadlines as it attempts to balance the resource demands generated by the Balanced Budget Act with other competing objectives.'' Mr. President, I won't detail all of the ways that HCFA has failed-- the fact that it is delaying implementation of a prostate screening program to which Medicare beneficiaries are entitled, the fact that it has failed to establish a quality-of-care medical review process for skilled nursing facilities, the fact that it is far behind schedule in developing a new payment system for home health services. The list goes on and on. But let me focus on one failure that is especially relevant. All of us agree that people have the right to information about their health plans. When they have the choice of more than one plan, accurate information that compares the plans is critical. Last year, Congress allocated $95 million to HCFA to develop an information and education program for Medicare beneficiaries. This money was to be used for publishing and mailing handbooks containing comparative plan information to seniors, establishing a tool-free number and Internet website, and sponsoring health information fairs. Well, there haven't been any information fairs and the toll-free number isn't operational. They do have a website, but they've decided to mail comparative information handbooks only to seniors in 5 states: Washington, Oregon, Ohio, Florida and Arizona. So for the pricey sum of $95 million, only about 5.5 million seniors will receive important information about their health plans, leaving 32.5 million seniors without these handbooks. At that rate, HCFA would need more than $1 billion each year just for handbooks. Mr. President, if this agency is struggling to protect the rights of 38.5 million Medicare beneficiaries, how can we ask it to protect the rights of up to as many as 100 million people enrolled in private health plans? We believe that consumer protections are too important to entrust to a cumbersome and inefficient federal government. State governments have long been in the business of insurance regulation and the federal government should not usurp their role. One just has to look at HCFAs record on the Health Insurance and Portability and Accountability Act (HIPAA). This Act gave HCFA enforcement authority in states that do not meet federal health standards. But how has HCFA done in the enforcement of HIPAA? A GAO report analyzing HCFA's success states that HCFA has done very little in this area. HCFA's activities, to date, have been ``limited primarily to responding to consumer queries and complaints and providing guidance'' to carriers in 4 of the 5 states that are not in compliance. The GAO report goes on to say that even HCFA admits ``the agency has thus far pursued a ``Band Aid'' or minimalist approach to regulating HIPAA. The failure to fully address this regulatory responsibility is due to the fact that HCFA lacks the ``appropriate experience'' in the regulating of the private health insurance market. The federal government should protect those who are enrolled in plans that are exempt from state regulation and those enrolled in the programs it runs, like Medicare and Medicaid. The federal government should start protecting the rights of senior citizens under Medicare, instead of meddling in areas where it doesn't belong. Mr. President, our bill is a truly comprehensive bill of rights for patients, providing new consumer protections for the 48 million Americans who are unprotected by state law, giving the 124 million Americans enrolled in employer-sponsored plans new rights to appeal adverse coverage decisions, protecting the civil rights of consumers to gain access to their medical records, protecting consumers against discrimination based on genetic tests, promoting quality improvement, establishing a new women's health initiative, and giving millions of Americans access to affordable health insurance through medical savings accounts. The doctor-patient relationship is one of the most important in people's lives. Our legislation preserves and protects that relationship, while taking many common-sense steps forward to affirm and expand quality and access. I look forward to a deliberative, thoughtful process this year on examining the complex issues addressed in our Patients Bill of Rights PLUS. Last year, the debate surrounding this legislation was extremely politicized and resulted in a partisan standoff. That was unfortunate. I am hopeful that the Committees will work this year to examine these issues completely and substantively. Health care costs are rising everyday, Mr. President. We must balance the need to protect patients with the need to make health care accessible. The Committees will need to examine the current trends in the market place and evaluate any legislation on all fronts, not just political rhetoric. Health care is just too important to politicize. Mr. President, I ask unanimous consent that the text of the bill and a summary be printed in the Record.

Mr. NICKLES

Mr. NICKLES. Mr. President, today I am introducing the Senate Republican Patients' Bill of Rights Plus. Joining me in this effort are 49 of my colleagues who recognize the importance of ensuring that all Americans are able to not only receive the care they have been promised, but also the highest quality of care available. The foundation of this proposal is to address some of the very real concerns that patients have about their health care needs and to provide significant opportunities for all consumers in choosing their doctors and health plans. We know that many Americans have believed they were denied coverage that their plans were supposed to cover. We recognize that some individuals fear that their health care plans will not give them access to specialists when they need them. We know that some Americans think their health care plans care more about cost than they do about quality. Last January, the Majority Leader asked me to put together a group of colleagues to address the issue of health care quality. For over eight months, Senators Frist, Collins, Hagel, Roth, Jeffords, Coats, Santorum, and Gramm worked tirelessly to put together a responsible, credible package that would preserve what is best about our nation's health care while at the same time determine ways to improve upon-- without stifling--the quality of care our nation delivers. We set out to rationally examine the issues and develop reasonable solutions without injuring patient access to affordable, high quality care. This was no easy task. We spent month after month talking to experts who understand the difficulty and complexity of our system. We met with representatives from all aspects of the industry including the Mayo Clinic, the Henry Ford Health Systems, the American Medical Association, the American Hospital Association, the National Committee for Quality Assurance, the Joint Commission on the Accreditation of Healthcare Organizations, Corporate Medical Directors, Commissioners from the President's Quality Commission, Purchasers, Families USA, the Employee Benefit Research Institute, and many others. After many, many months of dissecting serious questions about our system, we determined that there were indeed some areas in which we could improve patient access and quality. Together, we have written an innovative plan that will answer the problems that exist in the industry, while at the same time preserving affordability, which is of utmost importance. After all, Mr. President, I think you agree that if someone loses their health insurance because a politician playing doctor drives prices to an unaffordable level, you have hardly given them more rights or better quality health care. We are proud of what we have been able to accomplish. For the first time, patients can choose to be unencum- bered in their relationship with their doctor. They will be able to choose their own doctor and get the middle man out of the way. There will be no corporate bureaucrat, no government bureaucrat and no lawyer standing between a patient and their doctor. In addition our legislation does what no other bill has done. It provides the patient with more choice in their health plans. Mr. President the bill we introduce today: Protects consumers in employer-sponsored plans that are exempt from state regulation. People enrolled in such plans will have the right to: Choose their doctors. Our bill contains both ``point-of-service'' and ``continuity of care'' requirements that will enhance consumer choice. See their ob-gyns and pediatricians without referral. Guarantees parents and families peace of mind by giving patients direct access to pediatricians and ob-gyns without prior referral from a ``gatekeeper.'' Have a ``prudent layperson'' standard applied to their claims for emergency care. Our bill will require health plans to cover--without prior authorization--emergency care that a ``prudent layperson'' would consider medically necessary. Communicate openly with their doctors without ``gag'' clauses. Holds health plans accountable for their decisions. Extends to enrollees in ERISA health plans and their doctors the right to appeal adverse coverage decisions to a physician who was not involved in the initial coverage determination. Allows enrollees to appeal adverse coverage determinations to independent medical experts who have no affiliation with the health plan. Determinations by these experts will be binding on the health plan. Requires health plans to disclose to enrollees consumer information, including what's covered, what's not, how much they'll have to pay in deductibles and coinsurance, and how to appeal adverse coverage decisions to independent medical experts. Guarantees consumers access to their medical records. Requires health care providers, health plans, employers, health and life insurers, and schools and universities to permit an individual to inspect, copy and amend his or her own medical information. Requires health care providers, health plans, health oversight agencies, public health authorities, employers, health and life insurers, health researchers, law enforcement officials, and schools and universities to establish appropriate safeguards to protect the confidentiality, security, accuracy and integrity of protected health information and notify enrollees of these safeguards. Protects patients from genetic discrimination in health insurance. Prohibits health plans from collecting or using predictive genetic information about a patient to deny health insurance coverage or set premium rates. Promotes quality improvement by supporting research to give patients and physicians better information regarding quality. Establishes the Agency for Health- care Quality Research (AHQR), whose purpose is to foster overall improvement in healthcare quality and bridge the gap between what we know and what we do in healthcare today. The Agency is built on the platform of the current Agency for Health Care Policy and Research, but is refocused and enhanced to become the hub and driving force of federal efforts to improve the quality of healthcare in all practice environments--not just managed care. The role of the Agency is not to mandate a national definition of quality, but to support the science necessary to provide information to patients regarding the quality of the care they receive, to allow physicians to compare their quality outcomes with their peers, and to enable employers and individuals to be prudent purchasers based on quality. Makes health insurance more accessible and affordable by: Allowing self-employed people to deduct the full amount of their health care premiums. Making medical savings accounts available to everyone. Reforming flexibility spending accounts to let consumers save for future health care costs. Mr. President, this bill is a comprehensive bill of rights that will benefit all Americans, and I am proud to join with so many of my colleagues in introducing it. This legislation is built around several basic principles which distinguishes it from other proposals. First and foremost, it recognizes that regulation adds costs and not value. The legislation places a priority on ensuring that we will not increase the number of uninsured or make health care unaffordable through excessive regulation. Second, our legislation rightly places patients ahead of trial lawyers. The inclusion of a strong, internal and external appeals provision holds HMOs accountable, while guaranteeing that patients get the care they need when they need it. Third, our legislation protects the historic and traditional role of states to regulate private health insurance. States are best equipped to determine the needs of their citizens. Our legislation ensures that the Federal Government and HCFA will not be empowered to expand their reach into the private market. The creation of new federal bureaucracies will only serve to stagnate and destroy what is best about our health care system. Finally, our legislation places a high priority on choice. Unlike every other proposal our bill will give every American the right to fire their HMO. Every patient will have their choice of doctor and health plan. Our bill empowers an independent medical expert to order an insurance company to pay for medically necessary care so that patients suffer no harm. Theirs allows professional trial lawyers to sue health plans after harm is done. Mr. President, when my insurance company tells me that they won't cover a service for my family, I want the ability to appeal that decision to a doctor who doesn't work for my insurance company. And I want that appeal handled promptly, so that my family receives the benefit. That is what our bill requires. Other bills create new ways for trial lawyers to make money. According to a June 1998 study by Multinational Business Services, the Democrats' bill would create 56 new Federal causes of action--56 new reasons to sue people in Federal court. That's fine for trial lawyers, but it doesn't do much for patients. Patients want their claim disputes handled promptly and fairly. According to a study by the General Accounting Office, it takes an average 25 months--more than two years--to resolve a malpractice suit. One case that the GAO studied took 11 years to resolve! I'm sure the lawyers who handled that case did quite well for themselves. But what about the patient? Under our bill, patients can appeal directly to an outside medical expert for a prompt review of their claim--without having to incur any legal expenses. In medical malpractice litigation, patients receive an average of only 43 cents of every dollar awarded. The rest goes to lawyers and court fees. Our bill assures that health care dollars are used to serve patients. It does not divert dollars away from patients and into the pockets of trial lawyers. Mr. President, another big difference between our bill and others proposed is that their bill takes a ``big government'' approach to health reform. Our bill relies on State Insurance Commissioners to protect those Americans who are enrolled in state-regulated plans. We protect the unprotected by providing new federal safeguards to the 48 million Americans who are enrolled in plans that the states are not permitted to regulate. Another problem: Some bills impose a risky and complicated scheme that relies on federal bureaucrats at the Health Care Financing Administration (HCFA) to enforce patients' rights in states that do not conform to the federal mandates in their bill. HCFA is the agency that oversees the federal Medicare and Medicaid programs. Last year, in the Balanced Budget Act, Congress created new consumer protections for Medicare beneficiaries--a ``Patients' Bill of Rights'' for the 38.5 million senior citizens and disabled Americans who rely on Medicare for their health care. We asked HCFA to protect those rights. How have they done? I regret to say, Mr. President, that they have not done very well at all. On July 16, 1998, a GAO witness testified before the Ways and Means Committee on how well HCFA was doing in implementing the Balanced Budget Act and enforcing the Medicare patients' bill of rights. According to GAO, HCFA has ``missed 25 percent of the implementation deadlines, including the quality-of-care medical review process for skilled nursing facilities. It is clear that HCFA will continue to miss implementation deadlines as it attempts to balance the resource demands generated by the Balanced Budget Act with other competing objectives.'' Mr. President, I won't detail all of the ways that HCFA has failed-- the fact that it is delaying implementation of a prostate screening program to which Medicare beneficiaries are entitled, the fact that it has failed to establish a quality-of-care medical review process for skilled nursing facilities, the fact that it is far behind schedule in developing a new payment system for home health services. The list goes on and on. But let me focus on one failure that is especially relevant. All of us agree that people have the right to information about their health plans. When they have the choice of more than one plan, accurate information that compares the plans is critical. Last year, Congress allocated $95 million to HCFA to develop an information and education program for Medicare beneficiaries. This money was to be used for publishing and mailing handbooks containing comparative plan information to seniors, establishing a tool-free number and Internet website, and sponsoring health information fairs. Well, there haven't been any information fairs and the toll-free number isn't operational. They do have a website, but they've decided to mail comparative information handbooks only to seniors in 5 states: Washington, Oregon, Ohio, Florida and Arizona. So for the pricey sum of $95 million, only about 5.5 million seniors will receive important information about their health plans, leaving 32.5 million seniors without these handbooks. At that rate, HCFA would need more than $1 billion each year just for handbooks. Mr. President, if this agency is struggling to protect the rights of 38.5 million Medicare beneficiaries, how can we ask it to protect the rights of up to as many as 100 million people enrolled in private health plans? We believe that consumer protections are too important to entrust to a cumbersome and inefficient federal government. State governments have long been in the business of insurance regulation and the federal government should not usurp their role. One just has to look at HCFAs record on the Health Insurance and Portability and Accountability Act (HIPAA). This Act gave HCFA enforcement authority in states that do not meet federal health standards. But how has HCFA done in the enforcement of HIPAA? A GAO report analyzing HCFA's success states that HCFA has done very little in this area. HCFA's activities, to date, have been ``limited primarily to responding to consumer queries and complaints and providing guidance'' to carriers in 4 of the 5 states that are not in compliance. The GAO report goes on to say that even HCFA admits ``the agency has thus far pursued a ``Band Aid'' or minimalist approach to regulating HIPAA. The failure to fully address this regulatory responsibility is due to the fact that HCFA lacks the ``appropriate experience'' in the regulating of the private health insurance market. The federal government should protect those who are enrolled in plans that are exempt from state regulation and those enrolled in the programs it runs, like Medicare and Medicaid. The federal government should start protecting the rights of senior citizens under Medicare, instead of meddling in areas where it doesn't belong. Mr. President, our bill is a truly comprehensive bill of rights for patients, providing new consumer protections for the 48 million Americans who are unprotected by state law, giving the 124 million Americans enrolled in employer-sponsored plans new rights to appeal adverse coverage decisions, protecting the civil rights of consumers to gain access to their medical records, protecting consumers against discrimination based on genetic tests, promoting quality improvement, establishing a new women's health initiative, and giving millions of Americans access to affordable health insurance through medical savings accounts. The doctor-patient relationship is one of the most important in people's lives. Our legislation preserves and protects that relationship, while taking many common-sense steps forward to affirm and expand quality and access. I look forward to a deliberative, thoughtful process this year on examining the complex issues addressed in our Patients Bill of Rights PLUS. Last year, the debate surrounding this legislation was extremely politicized and resulted in a partisan standoff. That was unfortunate. I am hopeful that the Committees will work this year to examine these issues completely and substantively. Health care costs are rising everyday, Mr. President. We must balance the need to protect patients with the need to make health care accessible. The Committees will need to examine the current trends in the market place and evaluate any legislation on all fronts, not just political rhetoric. Health care is just too important to politicize. Mr. President, I ask unanimous consent that the text of the bill and a summary be printed in the Record.

Mr. NICKLES

Mr. NICKLES. I object.

Mr. NICKLES

Mr. NICKLES. Mr. President, this morning the Senate will be in a period of morning business until 11:30 a.m. Following morning business the Senate will recess in order to accommodate the weekly party luncheons. The Senate will then reconvene at 1 p.m. this afternoon and immediately resume consideration of the articles of impeachment. Under the provisions of Senate Resolution 16 the White House will begin its opening arguments. At the conclusion of today's consideration of the articles of impeachment, the Senate will recess until 8:35 p.m. this evening and upon reconvening will proceed as a body to the House of Representatives for a joint session to receive a message from the President. I thank my colleagues for their attention. I yield the floor.

Mr. NICKLES

Mr. NICKLES. Thank you, Mr. President.

Mr. NICKLES

Mr. NICKLES. Mr. President, in my floor remarks preceding the passage of the International Religious Freedom Act of 1998 on October 9, 1998, I recognized three persons for their many hours of work and their important leadership roles in guiding this legislation to passage-- Steve Moffitt of my staff, John Hanford on the staff of Senator Richard Lugar, and Cecile Shea with Senator Joseph Leiberman. I would like to take this opportunity to add to this honor roll the names of several additional congressional staff whose efforts were essential to the crafting and historic passage of this legislation. Often when legislation is passed into law, we, who work in Congress, never have the full benefit of seeing the aid and blessing which our efforts bring to others. This will assuredly be the case for this small group of staff who worked with such dedication and excellence for the passage of the International Religious Freedom Act. Their work has now received the unanimous acclaim of both Houses of Congress, as the Senate voted 98-0 in favor of this bill, followed the next day by a unanimous voice vote in the House. But, more importantly, I hope that these individuals will rest in the satisfaction that their selfless efforts will, for decades to come, redound to the benefit of countless persons around the world imprisoned, tortured, or otherwise persecuted or restricted in the practice of their religious beliefs. This is an extraordinary and noble service which they have rendered to persons of faith throughout the world, and I believe that it is important that we, as a congressional body, recognize their role in this historic achievement. First, I wish to recognize two House staff members for their brilliant and tireless work, beginning at the very inception of the International Religious Freedom Act and carrying all the way through to its final passage. Laura Bryant of the office of Congressman Bob Clement and William Inboden, formerly with Congressman Tom DeLay, were two of the original ``visionaries'' for this bill, and their compassion for suffering believers as well as their expertise on issues of religious persecution are reflected on every page of the bill. I am deeply grateful for their extraordinary contribution to this landmark legislation. In the Senate, I wish to express special commendation to Jim Jatras, Foreign Affairs Specialist with the Republican Policy Committee. Mr. Jatras is one of the most distinguished analysts of foreign policy on Capitol Hill and is a person to whom I have often turned for expert counsel. In the case of the International Religious Freedom Act, Mr. Jatras contributed vitally, both to the substance of the bill and to the process of negotiation which led to its passage. I wish, also, to express warmest thanks to Elaine Petty, with the staff of Senator Connie Mack, who was a leading original cosponsor of this act. Ms. Petty contributed many hours of work over the past 6 months toward the passage of this bill, and her efforts were especially important in discussions with other Senate offices and outside groups. Special commendation is reserved for the remarkable expertise demonstrated by Art Rynearson, Senior Counsel with the Office of Senate Legislative Counsel. Mr. Rynearson labored through numerous drafts of this bill, and distinguished himself by his command of the process of legislative drafting, by his patience and perseverance, and by his commitment to excellence in creation of U.S. law. The Senate staffers which worked most closely with him have expressed deep gratitude for his spirit of teamwork on this year-long endeavor. In addition, I wish to express gratitude to Polly Craighill, who also serves on the staff of Senate Legislative Counsel. Ms. Craighill stepped in at a critical moment in the development of this act and provided expert assistance requiring personal sacrifice on her part. Finally, I would like to recognize the important contributions made by several of the senior staff at Congressional Research Service. Larry Eig, Legislative Attorney, Joyce Vialet, Refugee Affairs Expert, Vita Bite, Foreign Affairs Expert, Jeanne Grimmet, Legislative Attorney, and Dianne Rennack, Foreign Affairs Expert, all made important contributions to the careful work of researching and scrutinizing issues involved in the content of this bill.