Don Nickles

Mr. NICKLES

Mr. NICKLES. I ask unanimous consent to proceed for another 6 minutes.

Mr. NICKLES. Health club memberships, hearings aids or hearing aid exams, homemaker services, hypnosis, massage therapy, physical therapy consisting of general exercise programs, plastic and other surgical procedures primarily for cosmetic purposes, smoking cessation programs, and several others. My point is, here is a Government plan for veterans that has specifically excluded items that should not be covered. I will venture to say every private health care plan has excluded items as well. Under the bill we have before us, it says you don't have to cover excluded items except for--and then it opens the door. That, to me, says do not pay any attention to the contract. Contracts do not mean anything. What is the net result of that? If people who have contracts are not bound by the contracts, then the cost of providing health care is going to go way up. There is no real definitive way of knowing how much the coverage is going to cost because it is not defined coverage. There is nothing you can bank on. I compliment my friends and colleagues from Arizona and Nebraska for their leadership in putting this amendment together. This amendment is equally as important--maybe not quite as easy to understand but very much as important--for containing the cost of health care as anything we have considered so far. Are we going to allow people to have contracts? Are we going to live by those contracts? Or are we going to take the language in this bill and say: Contracts? We don't care. Are we going to violate what the President's Commission on Health Care said? They said you should not cover items that are excluded from contracts. Are we just going to ignore it as does the underlying McCain-Kennedy-Edwards bill? Are we going to have a medical necessity definition that is the same thing Federal employees have on their fee- for-service plans, which is a quality plan which most all of us are in and most all of us are happy with? Isn't that good enough? Can't we give some assurances that those are things that people can rely on? Again, I compliment my colleague from Nebraska, Senator Nelson, for his expertise. He brought this to my attention when I was discussing this legislation. He was exactly right. He said this has to be fixed. We are working to fix it. We can fix it. I urge my colleagues, let's not just be voting on remote control, on how some leaders tell us how to vote. Let's look at the language. Do you really want to have language that basically abrogates contracts, ignores contracts, no telling how much it can cost and also, incidentally, have liability? You could have, under the McCain-Kennedy bill, a situation where somebody doesn't provide a service that is contractually prohibited and they can be sued because some expert might determine it is medically necessary. This expert might be a acupuncture specialist and they might determine that what you need to solve your back problem is acupuncture and even though your contract, as VA's, says you do not have to cover it, you have to cover it because that is a solution and under the bill it says expert opinion. So maybe it should be covered. If you think that is a stretch, it is not a stretch. You can find experts to say almost anything in the medical field and sometimes in the legal field. My point is this bill undermines contracts in a way in which I think we should be very, very wary. We should not do this. My colleagues from Nebraska and Arizona have come up with a good fix, a good solution. I appreciate that the Senator from North Carolina said he is amenable to fixing this problem. The way to fix it is to pass the Kyl-Nelson amendment. I urge my colleagues to vote for this amendment tomorrow morning. I thank the indulgence of my colleagues I yield the floor, and ask unanimous consent the CHAMPVA list be printed in the Record.

Mr. NICKLES

Mr. NICKLES. Mr. President, I compliment the Senator from Texas, Mr. Gramm, for offering this amendment, as well as Senator Thompson. I compliment Senator Frist for his comments and work and leadership on this bill in general, as well as Senator Gregg. People are becoming more familiar with the bill before the Senate, S. 1052, the McCain- Edwards-Kennedy bill. I have heard sponsors of the bill say employers cannot be sued under this bill. I believe that is a direct quote. That is not factually correct. Under this bill, on page 144, is language that deals with this. It says: (A) Causes Of Action Against Employers And Plan Sponsors Precluded. That sounds really good. But that is paragraph (A). Paragraph (B) on page 145 says: Certain Causes Of Action Permitted.--Notwithstanding subparagraph (A), a cause of action may arise against an employer or other plan sponsor. (A) says you cannot sue an employer and (B) says notwithstanding (A) you can sue an employer. It goes on for several pages, whether an employer had direct participation or not. But as an employer, if you have to comply with ERISA, you do a lot of things other than the exemptions provided in the legislation. In other words, under this bill, you can be sued. Some say that is not true, that is not what we meant. If it is there, we will fix it. We have a chance to fix it and we can adopt this language. This is language that says employers shall not be held liable under this law. We ought to pass it. Some have said liability is not such a problem because Texas has not had many claims--other States have not had many claims. We are looking at the Texas law which says employers shall not be liable. If we are going to say it on the floor, if we say employers are not going to be hit, let's protect them. We protected doctors in this bill, we protected hospitals in this bill. That was a change made last Thursday night. This bill has evolved and changed significantly from the bill we were considering. The original bill was Senate bill 872 and did not have that fix. We fixed it for doctors and some hospitals. Now we have a new bill S. 1052 and it did not fix it for employers. As a matter of fact, employers get more than ``fixed'' in this bill. Employers, beware. If we don't pass this amendment or something close to it, employers, beware. The majority leader says to pass it next week. I would love to conclude this debate by next week. But if you make all employers liable for unlimited damages, there are a lot of employers that would rather have Members stay and debate a bill than pass a bill that says we are sorry you provide health care for your employees. You don't have to provide your employees with healthcare, but for doing that good service for your employees, you can be sued for everything you have, maybe for everything you ever will have. There is no limit on damages. Somebody said under McCain-Kennedy there is a $5 million cap on punitive damages. There should not be punitive damages in this bill in the first place. I thought the purpose of this bill was to protect patients, not to enrich attorneys. Why are punitive damages in if you are trying to protect patients? They don't belong. That $5 million cap on punitive damages is a cap in Federal court, not in State court. There is no cap on noneconomic damages. What are those? That is pain and suffering. You get in front of a sympathetic jury, get a good trial lawyer--if you have a great big company, why not just sue for the world? If you are going to sue for a million dollars, why not make it $100 million, or make it hundreds of millions of dollars? If you do a real job on the jury, you might win. It is a little bit of a lottery. You might win the golden jackpot. You might win several hundred millions of dollars. We have seen cases recently from some juries that are in the billions of dollars. Now we are flirting with the survival of big companies. I am not so worried about the big companies, but I am worried about a lot of small companies that are struggling to survive who are providing health care for their employees because they want to--not, frankly, because it is appreciated. I will tell you as a former employer that most employers pay a lot more for health care than their employees realize. Even though you might tell them every once in a while, they don't appreciate the money being spent. If you gave employees the option, they would probably rather have the cash and risk not buying health insurance so they could have more disposable income. Those are just the facts. That is the case in many areas. Why not just do that? If we pass the McCain-Kennedy bill that is what a lot of employers will do. They will say, I don't have to provide this benefit. It is not appreciated as much as it probably should be. And now, now not only do I have to pay thousands of dollars per year to provide health care, but I can be sued for everything. Maybe this company has been going for 40, 50, or 60 years. It may be a bank. It may be a manufacturing company. A good attorney will say: Wow, no limit on pain and suffering. We had a problem. I know you didn't really have anything to do with it. But you hired this big insurance company, and they hired their doctor. That doctor wasn't very competent. Something bad happened. Somebody died. Therefore, we are going to sue you for what you have because you hired the company that hired the doctor. You are liable. You are involved. You had a direct participation. Therefore, you are liable. All of a sudden, you are going to go bankrupt. Not only do you lose health care and your health care costs go up, but you may lose your company. The employees may lose their jobs. That could easily happen under this bill. Again, I know, I have heard the sponsors of this legislation say, oh, no; that is not our intention. We are not going after employers. We are going after those big bad HMOs. If we are not going after employers, let's exempt them. We have exempted physicians and hospitals. Let's exempt employers. That is what Texas did. That probably enabled them to pass their bill. Let's exempt employers under this bill. That is one clear-cut way of not trying to define if they participated in the decision. I challenge anyone. Start reading through the definition of direct participation. Then tell me if an employer in carrying out their fiduciary duties in providing health care for their employees-- including plan determinations, reporting, enrolling people, choosing plans, maybe an optional plan, and so on--tell me they do not do more than what the exemptions are here. They are not complying with the law. This list is written basically saying, employers, you are covered. You can be sued. You can be held liable. It says Patients' Bill of Rights. It should say beware, employers. We are getting ready to come after you. Trial lawyers are looking out for themselves--not for patients. If you want to look out for patients, we could pass a bill tomorrow that will give every patient in America-- external and internal review--a place where they can get a benefit determination. If they were denied, it could be overturned. At least, it could be reviewed by medical doctors--an independent panel. That could be binding. We can do that. We can pass that overnight. They would have new, needed additional protections. No; we want to go a lot further than that. We want to be able to take not only the HMOs but also take employers to court and be able to sue them for everything they have with no limit, and no caps. As a matter of fact, we want to be able to choose under this bill between Federal court and State court, whichever is best, with no caps. We might be able to do pretty well. I urge people and employers, if you are concerned about this bill, please contact Members of the Senate because we will be voting on this amendment sometime Tuesday. There is a chance that we can fix employer liability once and for all--very clean, no exemptions, no exceptions. There is one other comment I wanted to make. I heard our colleague, the junior Senator from Missouri, say, well, Missouri passed a good patients' bill of rights. She was very proud of that. I compliment Missouri. I don't know what is in Missouri's law. But I compliment the State of Missouri for passing a good patients' bill of rights. I do not know if Senators are aware, but in the bill that we are passing, the patient protections are going to supersede whatever the State of Missouri did--as a matter of fact, whatever any State has done. There are over 1,100 patient protections that different States have passed. No matter what your State has done, we are getting ready to pass a bill which says that may not be good enough because if the State of Missouri or Oklahoma or Alaska didn't pass patient protection that is substantially equivalent and as effective as we have proposed under this bill, then you are in trouble. It doesn't qualify. It is not good enough. It is going to be replaced with this. As a matter of fact, you almost have to have identical language in this bill for the State protections to apply. Another way of saying it is the State has to adopt what we are passing. You might say that is fine. I am sure we are passing good protections here. Maybe we are. Maybe they are better. Maybe they are not. Who will be determining if these protections are better, or if the State protections are better than these? The Government is. Somebody elected? No. It would be a bureaucrat over at the offices of the Health Care Finance Administration, HCFA. They will determine whether or not State law which was probably negotiated with the State legislature and with the Governor, or maybe the State insurance commissioner, possibly with a lot of input from the participants, beneficiaries, plans, possibly with years of experience--hey, in this plan, does this benefit work? Is this excessive in cost? Is it overutilized or underutilized? They have experience. They determine if they can afford this patient protection or they can't. They made modifications. We say we don't care what your case history is, or what your State history is. We are going to replace your patient protections with one that Senator Kennedy, Senator McCain, and Senator Edwards have decided is in your best interests. I negotiated with Senator Kennedy on patient protections last year. But I refused to go along with saying that what we have done is better than what the States have done. I don't think that these protections should supersede what the States have done. That is what we are doing in this bill. This language says you have to have substantially equivalent patient protections that are at least as effective as what we have. Nobody knows how effective these are. These are not law. They have never been tried. They have never been tested. They have never been analyzed. They have never been in the real market. No one really has any idea about how much they really cost. We are saying to the State, whatever you have, it has to be as effective as these, even though we don't know if these are effective or not. Talk about a bad example of government knows best, that is exactly what we are doing in this bill. We will have an amendment that addresses that in the course of the debate next week. One other comment I want to make deals with the issue of coverage. I have kind of alluded to it. This bill says it covers all Americans. I have heard several people say that. But if they say that this bill covers all Americans, I assume they are not very knowledgeable about the bill. This bill doesn't cover all Americans. We had a conference this morning. One of my colleagues hit his head. I said: Be careful. You can't sue. You can't sue the Federal Government. We are getting ready to mandate on the private sector rights and privileges that we don't have as Senators or as Federal employees. If we took a poll amongst Federal employees and asked ``Do you believe your health care is pretty good?''--my guess is most people would say yes. We get to choose from a lot of health plans. Guess what. You can't sue your employer. This bill doesn't say the Federal Government can be sued by employees. Fine. Private sector, go out and sue your employer. Sue your HMO. Can you sue your HMO if you are a Federal employee? No. You cannot. You can sue to get a covered benefit. You can do that in the private sector right now. Some people say you can't sue your HMO. But you can sue to get a covered benefit. What people want is to get into a lawsuit lottery where they can go for millions of dollars of excess covered benefits. You can say, I sue. If you want to have coverage for a benefit that you think you are rightly entitled to, you can sue for that today. This bill doesn't cover Federal employees. This bill doesn't cover the lowest income Americans. What did you say? I said this bill that we have before us doesn't cover the lowest income Americans. It doesn't cover Medicaid. Think about that. We have a Federal insurance program called Medicaid. This bill doesn't apply to Medicaid. We don't care about low- income Americans with all of these patient protections that we are saying are so magnificent. We are giving these to the private sector, and they won't cost anything? So we are going to have this mandate on the private sector, including liability, but we do not have it for low- income people? Does that make sense? We love seniors, so I am sure this benefit applies to seniors. I read through the bill and, much to my chagrin, this bill does not apply to Medicare. Wow. I know I heard President Clinton say we are going to make these patient protections apply to Medicare. These protections do not apply to Medicare. Somebody in Medicare cannot sue the Federal Government. Somebody in Medicare cannot sue for unlimited damages through their employer. I know I heard President Clinton say I already instituted an executive order that applies these patient protections to Federal employees in Medicare, but it did not happen. He did a little something, but it did not apply anything like this bill. It was not nearly as extensive or expensive. So if we are trying to apply these patient protections to all Americans, we sort of left out a few people. We left out Federal employees. That is interesting. Employees in the State of Alaska, the Governor of Alaska, the State legislature, they have to comply. These benefits must apply to State employees in every State of the Union but not to Federal employees. Wow. We have a heck of a deal. And, oh, yes, they have to apply to every health care plan in America, every private-sector health care plan in America but not the VA. These benefits do not apply to veterans in our hospitals. These benefits do not apply to Indians in the Indian Health Service. These benefits do not apply to Federal employees. They do not apply to Medicare. They do not apply to Medicaid, to low-income people. So when my colleagues say we want these to apply to all Americans, they have not read their bill. Guess what. They do not apply to union members either, not for the duration of their contract. If you renegotiate your contract by next summer--and it could be a 10-year contract--you would not be covered in this bill for 11 years. We are going to apply it to everybody else in the private sector, but we are going to have an exemption for our friends in the unions. Wow. That is interesting. So I just make that comment. I think this bill is aimed, like a gun, at the heads of employers. Private sector, look out. Trial lawyers are after you. They are not just after the HMOs, they are after employers as well. We can fix that by adopting the Gramm amendment. We can exempt employers and make it nice, clean, and straightforward. If you want to exempt employers, vote for this amendment. Employers, if you want your Members of the Senate to exempt you, if you do not want to be strapped with this unlimited liability, I would urge you to contact your Senators between now and Tuesday and say: Please pass the Gramm amendment. It will have a real effect. It will duplicate the Texas law that exempts employers. So we can make a difference. Also, if seniors think all these great patient protections we are lauding so much are very good things, you might ask them: Why are you left out of this bill? If this is so good for the private sector, why don't we do it for the public sector as well? It seems like we have a little habit around here, every once in a while, of saying: It is just fine to sue the private sector. We can put all kinds of mandates on them. So what. Oh, but we will not do that to us. I am not sure I agree with that. We may have to have an amendment to clarify that as well. This bill, in my opinion, is fatally flawed. We are going to try to amend it to improve it. I very much want to put a bill on the President's desk in the not-too-distant future that he can sign and that we will be proud of. Maybe Senator Kennedy and I can be shaking hands behind him saying we have a good bill that really does protect patients but in the process does not threaten and scare employers. I think that is possible. I do not think it is in this bill. I think President Bush is exactly right in saying this bill would cost too much. The cost of this bill could increase health care costs 8 or 9 percent over and above inflation in health care, which right now is 13 percent nationally. That is about 22 percent for small business. Businesses and employees cannot afford another 8 or 9 percent on top of already very high medical costs. So this bill needs to be fixed. It needs to be improved. One giant step toward doing that would be the approval of the pending amendment that we will be voting on some time Tuesday. So I urge my colleagues to support the underlying amendment. We will come up with additional amendments to improve this bill in relation to liability and scope and contracts. This bill just happens to have a section that says you shall not be bound by the contract. That is interesting. It means it is totally unlimited in what this bill may cover, what somebody may have to pay for, whether it is contractual or not. We will try to fix that as well. Hopefully, we will improve this bill to the extent that it will be a good bill worthy of the President's signature and one where we can say we did a good job and passed a real bipartisan bill that will improve patient protections for all Americans. Mr. President, I yield the floor. I suggest the absence of a quorum. Mr. MURKOWSKI addressed the Chair.

Mr. NICKLES. I withhold it.

Mr. NICKLES. I announce that the Senator from Idaho (Mr. Craig), the Senator from New Mexico (Mr. Domenici), the Senator from New Hampshire (Mr. Gregg), the Senator from Alabama (Mr. Sessions), the Senator from Oregon (Mr. Smith), and the Senator from Wyoming (Mr. Thomas) are necessarily absent.

Mr. NICKLES

Mr. NICKLES. Reserving the right to object.

Mr. NICKLES. It is not my intention to object. I haven't seen the McCain amendment. Would it be possible for us to get a copy of that amendment?

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

Mr. NICKLES. I am informing my colleague, there are revenue measures in the bill right now. I don't think whether there is an additional amendment or not would have any additional impact on blue slip. I am perfectly willing, as the Senator from Texas said, to set up a way of taking up a House-passed bill and substituting the entire text of whatever we pass to avoid that. I am happy to cooperate in doing that at some point. I will be happy to work with my friend from Arizona to do that.

Mr. NICKLES. Mr. President, I believe the bill already has a blue slip problem. There is already a tax increase in the bill, section 502, that extends customs user fees from the year 2003 to the year 2011. That is blue slip material. It is already there.

Mr. NICKLES. Mr. President, I compliment my friend and colleague from Arkansas for this amendment. I ask unanimous consent to be listed as a cosponsor.

Mr. NICKLES. Mr. President, I also thank my colleague, Senator Bond from Missouri. He and I and the Senator from Arkansas have been fighting for this provision for years, and we are going to get it done. This provision is basic tax equity. Why in the world wouldn't we allow self-employed individuals to deduct 100 percent of their health care premiums if we allow corporations to do so? I used to be self-employed. I used to run a corporation. Corporations get to deduct 100 percent. Every corporation in the country, if they want to provide health care for their employees, gets to deduct 100 percent of the expense of that health care. They get to deduct it. A self-employed person this year gets to deduct 60 percent. That is not fair. That is not right. It needs to be changed. It can be changed in this bill. You might ask, why are we changing this bill? There are a lot of reasons. Unfortunately, the bill we have before us, the so-called McCain-Kennedy bill, will increase the number of uninsured in the millions. Some have estimated 1 million, some 2, 3, 4 million. I think it is a higher figure, but millions of people will lose their insurance if we don't improve the bill. Last year when Congress passed a Patients' Bill of Rights, we called it the Patients' Bill of Rights Plus. Not only did we have patient protections, but we also put in some very positive provisions to help people buy health care. So we would increase access, and we would increase the number of people who have insurance. This amendment was one part of that--a small part but a vital part, an important part. Some of the people who are going to be hit the hardest under this bill are self-employed individuals, people who own their own business, people who are very small employers from a variety of different businesses. Many of these are new businesses, not the old, established ones that have been around for decades. These are new businesses that were just created. And many of them are asking what kind of compensation package do we have for our employees. They are adding health care or they hope to add health care. Then when they find out they only get to deduct 60 percent of the cost, they realize that is not fair--not when General Motors gets to deduct 100 percent, not when every corporation in America gets to deduct 100 percent. So many times their compensation package for their employees will not include health care. They might say: We will pay your salary and we hope that you will buy health care. It might be a hope. It might be a wish, but it is not a reality because the Tax Code discriminates against self-employed individuals. We can change that. The amendment of the Senator from Arkansas would change that. This Congress has passed this amendment. We passed it last year when we passed the Patients' Bill of Rights Plus. We passed it last year when we passed the minimum wage bill. We added this provision as well. We are going to give everybody a chance to pass it in this bill. I compliment my friend and colleague. If we have a bill that increases the number of uninsured and directly hits a lot of people who are self- employed, let's do something to help the self-employed. If we want to help the self-employed individual, this is one amendment that can do so. Not only that, it is basic equity. Why in the world would we have a policy where we allow corporations to deduct 100 percent and the self- employed 60 percent, next year 70 percent. It is not right. It is not fair. Somebody asked, what does this amendment really boil down to? It boils down to the difference in deducting 60 percent versus 100 percent. For an individual who has health care costs of about $6,000, it means deducting $1,600 instead of about $1,000, a difference of $600 savings in taxes for self-employed individuals. This amendment is a serious amendment. This amendment is an amendment that should be adopted. I hope this amendment will be adopted overwhelmingly. Other people have said we shouldn't be doing taxes on this bill. This is not a Finance Committee bill. This bill never went through the Finance Committee. That is correct, but it is also correct that the bill never went through the labor committee. This bill never went through the Judiciary Committee. It has a whole new tort section that creates new sections of legal action against employers and medical health care providers, HMOs, and so on, all new legal actions, tort cases, but it didn't go through the Judiciary Committee. This bill never went through the Labor Committee, and it didn't go through the Finance Committee. This bill also has sections in it that deal with the Finance Committee. I happen to be a member of that committee. I was kind of surprised to find out that there is language in here extending custom user fees for 8 years. What does that have to do with the Patients' Bill of Rights? At least the amendment of the Senator from Arkansas says we want to help people buy health care. We want to help those people who are targeted by this bill. Self-employed people who may not be able to afford insurance because of this bill, let's help them a little bit. The amendment of the Senator from Arkansas is pretty relevant. I don't know what custom fees have to do with a Patients' Bill of Rights. I don't know what doing some jiggling with Social Security trust funds and Medicare payments--there is a little tinkering going on with those provisions. I am not sure why they are in here. Maybe it is because CBO estimates that there will be billions of dollars less in the Social Security and Medicare trust funds as a result of this bill. Maybe those trust funds have some problems because there is not as much money going into it. You might ask, why is there less money going into the trust funds. Because CBO says if you greatly increase people's premiums, they are going to get less payment in wages. This is not my estimate. It is CBO's estimate. They estimated $56 billion less in wages over the next 10 years as a result of this bill; a reduction in Social Security payments of about $7 billion less going into the trust fund as a result of this legislation. Maybe that is what this is. I haven't quite figured out what the purpose is. Maybe I will ask the authors of the legislation who I don't believe are members of the Finance Committee, but I am sure there is a method in their madness. I will not cast any aspersions, but I do know it deals with the Finance Committee. I do know it deals with taxes. I do know we have a tax increase in extending custom user fees. I don't know how relevant those are to patients, but I do know the Hutchinson amendment is very relevant because he is trying to help self-employed people be able to afford insurance. This bill will greatly increase the cost of insurance for the self- employed and all employers and all employees. I say ``all employees'' because a lot of employers are going to be passing the additional cost on to their employees. I have heard some people say: It is only 50 cents. It is only a dollar. It is only a Big Mac. That is being pretty loose with the expenses and costs. Maybe people aren't figuring the cost of health care nationwide is about $7,000 per family. That is the total cost. Employers maybe pay all of it in some cases; maybe they pay half of it in other cases. If they are paying all of it, that means the employee is getting less in wages because the employer is expending that amount. Maybe it is some kind of copay. More and more employers and employees have cost sharing. Or maybe the employer is picking up 70 or 80 percent, and the employee picks up the balance. Those are all very legitimate ways of paying for health care; the point being, this bill is going to greatly increase health care costs on both the employer and the employee. If they are paying 20 or 30 percent of the health care costs, they are going to be paying more. They may have a higher deductible. They may have a higher copay. The total cost of the bill will go up. How much will it go up? CBO says 4.2 percent; 4.2 percent on $7,000 is about $300 per family. It is interesting, that is the size of the tax cut for a lot of Americans. Well, we gave Americans a tax cut they will be receiving in July and August and September of this year. That is great. We are going to take it away with this bill. I think that estimate of 4.2 percent is grossly underestimated. I notice the administration does, too. They said if the effects of litigation risk on the practice of medicine and the reduced ability of health plans to negotiate lower rates were included, CBO's estimated cost impact would be much higher, by 4 or 5 percent more. So instead of increasing the cost of health care by 4 percent, it is probably 8 or 9 percent. Clearly, when you add 8 or 9 percent on health care costs that are already rising at 12 percent in some cases, in most cases, 20 percent, you are looking at astronomical price increases for your health care costs. A lot of people won't be able to afford it. They will drop their health care as a result. Or they will say, employees, you pick up a greater share. Or they will say, employees, we can't provide this with the extended liability we now have on us and, therefore, we will give you the money. We hope you will purchase health care on the individual market. It might be more expensive for them to do it in the individual market. Some would do it and many would not. So it is this threat of liability that would greatly increase health care costs and greatly increase the number of uninsured--not to mention the fact that it would increase defensive medicine costs because plans would have to go through an appeals process. Employers might say: Wait a minute, it is cheaper to pay for the coverage even though it is not a contractual benefit, and we will do it because it is cheaper than to go through the appeals process. Maybe you will have some situations where people will say: Let's pay for it because we don't want a threat of liability. So everything is covered whether it is in the contract or not. You would have a lot of defensive medicine and a lot of people, because of the threat or the scare of liability, who would say: Let's just pay for the coverage. So health care costs will be rising, and rising dramatically--I believe, like the administration, much more so than 4 percent, probably a lot closer to 8 or 10 percent. The net result will be a disaster--a special disaster on the small businessperson. I was a small businessperson. I used to have a janitor service. We didn't provide health care for our employees. It was a business I started in college. If I would have maintained it longer, I probably would have. But I would not--if somebody said, ``Oh, Mr. Janitorial Service, you could be liable for anything you have ever gotten or ever will have under a bill that the Congress just passed,'' I would say, ``Hey, I don't have to provide this health care'' and, no, I don't think I would. A lot of people would not be doing it if they knew they could be subject to unlimited punitive damages in State court and unlimited noneconomic damages in State or Federal court. That is in this bill. I have heard some people say that the McCain-Edwards bill has a $5 million cap on damages. It has a $5 million on punitive damages in Federal Court. It doesn't have any cap, any damage limit whatsoever on noneconomic damages, which is pain and suffering. That is where the big jury awards are. We already have jury awards in the millions of dollars. Some want to do class action suits in the billions. This bill encourages class action suits. Boy, there are trial lawyers just licking their chops just thinking they are going to have a chance to get after that. Who are they going to go after? The big bad HMOs? The people who are going to really get hit are the small, self-employed individuals who want to provide health care to employees and they can't afford it. Those big bad HMOs, are they really going to be hit? Whatever they get hit for, they will pass it on. They won't pay a dime. Maybe their profits will be a little less, but they are going to pass it on in the form of higher rates, and employees and employers are both going to pay for it. The reason I say ``employees'' is employers can't pay for it out of nothing, so therefore it comes out of the employee as lost wages, or as the wage increases they might have received, or higher copays. So employees of America, this is not a bill that is going to be expanding your protection; this is going to be cutting your wages. This is going to be taking money away from employees' paychecks because they won't get the increases they hoped to get because employers will be saddled with exorbitant increases in health care costs. We can help alleviate that by making some changes in this bill. It is very much my intention to pass a positive Patients' Bill of Rights. This bill we have before us is not that. This bill is a disaster for employers and employees across the country. This bill is a recipe for litigation. This is a trial lawyer's right to bill, not a Patients' Bill of Rights. It is a trial lawyer's right to bill, and the net result is you are going to have a lot of litigation, a lot less health care, and decisions being made in the courtroom instead of by doctors. We don't have to go this route. We can pass something like we passed last year. We can pass something, as Dr. Frist proposed, that has a real appeals process--an internal and external review process that is binding. Under this bill, you don't even have to go through the review process; you can bypass it. You need not apply. Don't bother. In 181 days, you can sue for all they have. You don't have to mess with the appeals and have doctors make the decisions. Let's just go to court where you can get big awards. This bill would be a mistake. Let's not pass this bill. We are going to work over the next number of days to improve this bill. I think the amendment of the Senator from Arkansas is a small step in the right direction. It will make health care more affordable and accessible for self-employed individuals. I congratulate him and compliment him and I am happy to cosponsor his effort. I hope our entire Senate will join in this effort to pass this. I have consulted with Members in the House of Representatives and they are going to have provisions that are in the Tax Code to encourage individuals to pay for health care, and the Senate should do likewise. Some might say, wait a minute; this is a tax measure. Let's wait for the House. If it has tax measures in it now, let's go ahead and make a good tax measure, not just an increase. Let's do something to help self-employed individuals, as my colleague from Arkansas has advocated. I urge my colleagues to vote in favor of this amendment. It is a positive amendment and a step in the right direction to improving a bill that, in my opinion, is fatally flawed. We hope to have many improvements by the time this debate is concluded. I yield the floor.

Mr. NICKLES

Mr. NICKLES. I announce that the Senator from Kentucky (Mr. McConnell) and the Senator from Oklahoma (Mr. Inhofe) are necessarily absent. I further announce that, if present and voting, the Senator from Kentucky (Mr. McConnell) would vote ``aye.''

Mr. NICKLES

Mr. NICKLES. To further clarify, I heard the intention that you would like to have this completed by the Fourth of July, but correct me if I am wrong. We spent a little over 2 weeks on the education bill just on the motion to proceed. I believe on the education bill in total we spent 6 or 7 weeks, and the education bill is a very important bill. Likewise, this is a very important bill. And this bill, like the education bill, in my opinion, needs to be amply reviewed. I don't know the period of time, but at least it is this Senator's intention we thoroughly consider what is in the language and how it can be improved. Some Members want to have significant changes so the bill can be signed. I am not sure if that can be done or completed in the time anticipated or hoped for. I appreciate the dilemma the majority leader is in and his desire to conclude it a week from Thursday or Friday, but I am not sure that is obtainable. We will see where we are next week.

Mr. NICKLES. I thought I understood the majority leader to say we would hold votes ordered on Friday to Tuesday.

Mr. NICKLES. Does the leader have any indication how late we will vote on Friday?

Mr. NICKLES. So the State of Massachusetts still does not comply with the Health Insurance Portability Act we passed several years ago?

Mr. NICKLES. I was just wondering.

Mr. NICKLES. I heard the leader say we would be working on the legislation, considering amendments on Friday. Did the leader clarify whether or not there will be votes on Friday?

Mr. NICKLES. Mr. President, I ask unanimous consent that the order for the quorum call be rescinded.

Mr. NICKLES. I ask unanimous consent for an additional 5 minutes.

Mr. NICKLES. Mr. President, I rise to speak on the issue of the Patients' Bill of Rights. I love the title. It is a great title. I hope we can pass a positive and good Patients' Bill of Rights--one that really provides patient protections but doesn't increase costs and doesn't scare employers away. Unfortunately, I don't think that is the case with the bill we are considering today, S. 1052. I haven't quite figured it out. Last week, we were on the McCain- Edwards-Kennedy bill, S. 871. That was last Wednesday. I was reviewing it and trying to become more familiar with the sections and what that bill meant to employers, to people providing health care, to Federal employees, and so on. Now we are considering a different bill, S. 1052. It is important for us to know as Senators because we are going to be voting on the legislation. This is one of a few bills. Every once in a while we consider legislation that will have a significant impact on everybody's lives. We did that when we passed the tax cut package recently. That will change everybody's taxes. People are going to see tax refunds coming in the mail in the next couple of months. I think that is very positive. People are going to see their rates reduced effective July 1. I think that is positive. That is a positive impact bill. This is a bill that will have a significant impact on everybody who has health care. A lot of people have health insurance. Then some people have health care. There is a difference. A lot of people are uninsured. When we wrestle with the problem of health care, we need to address the number of people who are uninsured, and we need to reduce that number. By all means, we shouldn't pass any legislation that is going to increase the number of uninsured. Everybody realizes when we have 42,500,000 uninsured people, that is too many. I think Democrats and Republicans, conservatives and liberals, agree with that. We ought to be working to reduce the number of uninsured as much as we possibly can. We probably will never get it down to zero, but we ought to make some improvement. But for crying out loud, let's not pass legislation that will increase the number of uninsured. Unfortunately, I believe that is what would happen if we passed this so-called McCain-Edwards-Kennedy bill. I believe if we pass this bill in its present form, we are going to increase the number of uninsured, probably in the millions. I wish that were not the case. I hope by the time we finish the debate and amendment procedure in this Senate Chamber that will not be the case. I very much hope President Bush can join with us and sign a bill and we can be shaking hands. I have mentioned this to Senator Kennedy--we have been adversaries on this issue for a couple years now--I hope we can be shaking hands and saying we have done a good job; we have protected patients, and we did it in a way that did not really increase costs very much, and maybe we did some things that would increase the number of insured in the process, so that we did not do any damage. We should do no harm. Congress would be much better off not to pass any bill than to pass a bill that greatly increased the cost to people buying health care and/or increasing the number of uninsured. Let's say we want to pass a Patients' Bill of Rights. Great. But let's do no harm. Let's not increase costs dramatically. Let's not increase the number of uninsured, especially if we are talking about millions. And that is what we are talking about in the bill before us today. I wish that were not the case. Let's go through the bill. And I think we will have some time. We need some time since we have not had any hearings on this bill. This bill has never been through a Senate markup. In the last Congress, we did mark up the Norwood-Dingell bill. We did not pass Norwood-Dingell in the Senate. We passed a substitute bill on which many of us worked. I thought it was a positive piece of legislation. I thought it had a lot of good things. It would have addressed the problem our friend, the Senator from North Carolina, just addressed. He said an individual, Steve Grissom, was denied health care. That was unfortunate. The bill we passed last year had internal-external appeals. That external appeal would have been quick. That person would have had health care and would not have had to go to court and would not have had to choose between State court and Federal court, seen trial attorneys--would not have had to do any of that. They would have had health care. They would have had an appeals process, and that appeals process would have been binding. Somebody said: We need accountability. We need enforceability. We had it binding where, if the plan did not comply with the external appeal, they would be fined $10,000 a day. So I think in that case--and that is a terrible case, where maybe somebody, unfortunately, was denied care--they would have gotten the care; and they would have gotten it quickly; and they would not have gone to court. They would not have received the care in the courtroom but would have received it by doctors. I agree. Let's solve that problem. We were very close to an agreement on internal-external appeals to resolve 99 percent of these cases. That is not the case with the bill we have before us. In the bill we have before us, I would say, for the 128 million private-sector Americans who are in private health care, who receive their health care from their employer, look out, because there is legislation coming, with a very good name, that makes the employer liable in almost all cases, not just the HMOs, and it makes them liable to the extent that a lot of employers are going to be scared to offer their employees health care. Some may opt out. In addition, it will increase costs so significantly that a whole lot of people are going to say: Wait a minute, these costs are so high, I can't afford it. My employees didn't appreciate how much money we were spending on health care. So I asked them, instead of me spending $5,000 or $6,000 a year per family on health care--up to $7,000 now--would you prefer the money and you can buy health care on your own? A lot of employees will say: Yes, count me; I would like to have that money. Maybe they will buy health care on their own, and maybe they won't. Unfortunately, a lot of employees would not, so the number of uninsured would rise, and I believe rise dramatically. So employers would be scared from the cost standpoint, and they would also be frightened because there would be unlimited liability. There has been some misrepresentation by some, saying: This bill has caps on liability. It does not have any caps on noneconomic damages. There are all kinds of damages. And this bill has new causes of action for Federal lawsuits. It has new causes of action for State lawsuits. It allows people to be able to jury shop: Let's find a good jury in a good county. With one good jury, you can become a billionaire nowadays. Wow. A lot of employees would say: Thank you very much, but I can't afford that exposure; I can't afford that liability, the fact that one jury case, for something I had nothing to do with whatsoever, could put me into bankruptcy. So they might say: We are just going to opt out. We don't have to provide this benefit. Some people would like to mandate that employers provide health care, but that is not going to pass, and they know that is not going to pass. So the net effect is, a lot of employers will say: I don't have to provide this benefit. I want to, but I can't afford the exposure. I just met somebody today who owns a restaurant. Actually, today, I met with two people who own a restaurant each. I heard people say: Hey, you are going to choose between the HMOs and the people. I met with two people today who each owns and operates a restaurant. One owns a small restaurant in Maryland. They said, if this bill passes, because of the liability provisions, they probably won't provide health care for their employees. They just started providing health care for their employees. Restaurants are the type of business where not everybody provides health care for their employees. All the major automobile manufacturers provide health care for their employees. They will probably continue to do so because of collective bargaining agreements. Interestingly, there is a little section that exempts collective bargaining agreements. Whoops. I thought we were providing all these protections for everybody. But there is a protection for organized labor here that kind of exempts the organized labor contracts for the duration of their contracts. So they might be exempt for years. We will get into some of the loopholes left in this provision. But this small restaurant owner said: I don't think I can afford the liability. I am afraid of doing that. And this person--female--operates her own business, which is family operated, I believe second generation, and they have had the business for 30-some-odd years, I believe. It is not all that large. About half her employees now have health care. She said today, she does not think she can continue providing health care if this bill passes. I met with a restaurant owner who has a larger restaurant not too far from here in Northern Virginia. This person started providing health care for their employees and said: No way, not with this liability. You would make it impossible. Wait a minute; employers are exempt. I heard that today. Oh, employers are exempt? Yes, there is a section in this bill exempting employers, on page 144: ``Causes of Action Against Employers and Plan Sponsors Precluded.'' Great. That will make Don Nickles happy, and others happy. That sounds pretty good. That is paragraph (A). Paragraph (B): ``Certain Causes of Action Permitted. Notwithstanding subparagraph (A), a cause of action may arise against an employer or other plan sponsor. . . .'' Look out, employers. You had better read paragraph (B). You are liable. Oh, there are a few little exemptions. If they do this, this, and this, they will not be liable. But it does not cover everybody. I promise you, as an employer, if they complete their fiduciary responsibilities, they are liable. And when employers find out they are liable, they are going to be scared of this bill and the results of this bill, and a lot of them will quit providing health care for their employees. In other words, if we take legislative action, maybe with very good intentions, there may be very adverse results. They did that in the State of California on energy. They passed a bill that had a great title calling it a deregulation bill, but it had all kinds of regulations, and it had a lot of adverse results. This bill, I am afraid, if we passed it today, and it became law, would have a lot of adverse results. President Bush has said he would veto this bill. And he is right in doing so. And we have the votes to sustain that veto. Some people said: Why not pass this bill as it is, let the President veto it, you sustain his veto, and, hey, you have covered the subject? I do not think that is responsible legislating. Maybe it would be the easy way out. That way, we can just raise a few objections, vote no, and let him veto the bill. I do not think that is responsible. I think we need to review this bill. I think every Senator should know what is in this bill. I will tell you, from the public comments I have heard, in some cases the sponsors of this bill may not know what is in this legislation. So we need to consider what is in this bill. We need to talk about it. We need to see if we can improve it. Hopefully, we can improve it to the degree that we will have bipartisan support for a solution with perhaps 80 sponsors of the bill and have overwhelming support. I would love to see that happen. I will work to see that happen. I have invested a lot of time on this issue. I want to pass a good bill. This bill does not meet that definition. I heard a couple people say this bill is consistent with the principles the President outlined. That is factually inaccurate. That is a gross misinterpretation of the President's principles. They were not written that fuzzily. I will outline in another speech what are the President's principles and where this bill falls fatally short--not short in a gray area but fatally short. I am just concerned that maybe some people are a little loose in their statements, saying this is consistent with what the President wants, and so on, this is consistent with the Texas plan, and so on. I do not think that is factually correct. So I wanted to mention that. I want to do a good bill. This does not fit the pattern. What about a couple of other things? Should the Federal Government take over what the States are doing in the regulation of health care? Some people obviously think we should. As a matter of fact, I look at the scope sections of the bill, and I am almost amused. We are going to have a preemption: State flexibility. It says, on page 122, ``[nothing shall] be construed to supersede any provision of State law which establishes, implements, or continues in effect any standard or requirement solely relating to health [insurers]. . . .'' Boy, that sounds good. I like that section. I don't know if there is a bait-and-switch section in here or what, but that sounds so good. That sounds like something I would put in there. But it doesn't stop there. It goes on. Then it says, on the next couple pages: If the State law provides for at least substantially equivalent and effective patient protections to the patient protection requirements which the law relates. In other words, we are not going to mess with the States unless the States, of course, have to provide at least substantially equivalent and effective patient protections as this bill does. Well, what does substantially equivalent and effective mean? It means, States, you need to do exactly what we tell you to do. We are going to preempt everything you have. If you have an ER provision, it has to match our ER provision, our emergency room provision. If you have access to OB/GYN, you have to match our access provision to OB/ GYN. And there is a lot of difference. If you have clinical trials in your State, you have to match these clinical trials, which are enormously expensive clinical trials, which are covered by anything that NIH would offer or anything by FDA or anything by DOD or anything by the VA. There are a lot of clinical trials. You have to pay for them. It may be the State of New Jersey did pay for them or did not. Under this bill, there is not one State in the Union that meets the clinical trial provisions of this bill. Why? Because they are very expensive provisions; because they are unknown provisions; because no one knows how much they would cost. And so the States have been kind of cautious on putting in clinical trial provisions. They have done it rather cautiously. The State of Delaware is considering clinical trials today, legislation on a patients' bill of rights. They have a clinical trial provision, and it is not nearly as expensive as the one that is mandated in this bill. The essence of this bill is, State, we don't care what you have negotiated. We don't care how many hearings you had. We don't care if the legislature worked on this for months and negotiated it with the Governors and the providers in your State. We don't care because we know what is best. One size fits all. I guess two or three Senators decided they know what is best. They know better than every single State insurance commission. They know better than every State legislature. They know better than every Governor, every person who is in the buying business. We are going to mandate that these have to be in your contract, in your coverage. I accidently said the word ``contract.'' Most of this is done by contract. There is a provision in here that says you don't have to abide by the contract. That is a heck of a deal. So when people try to have a contract, here is what we will cover, here is what we don't cover, so you can have some kind of limitation on cost. There is a little provision in the bill that says the reviewer shall consider but ``not be bound by the definition used by the plan or issuer of medically necessary and appropriate.'' Not be bound--in other words, they can provide anything they want to provide. It doesn't make any difference what is in the contract. That is in this little bill. How do you get a cost estimate of how much this bill is going to cost? Because no one knows. The contracts aren't binding. Wow. There are a lot of things in here. Then I have heard people say: We are going to make sure the States have provisions that are substantially equivalent and as effective. Who is going to determine if something is as effective? We are going to have the Federal Government. HCFA is going to review the State standards. HCFA will determine whether or not you are substantially equivalent and as effective. The only way you are going to get there with any certainty is to have identical language. And then who is going to know whether or not it is as effective? That is as subjective as it could possibly be. You have a standard that is higher than HCFA. You have a standard higher than anybody has ever imposed. It says: Here is everything we mandate. If you want Federal, nationally dictated health care, it is in this bill. Wow. I didn't know we were taking over for the State. I didn't know we had the people to do it. Guess what. We don't. There is no way in the world the Federal Government has the resources in HCFA, the Health Care Finance Administration--which now has a new name which I can't remember and won't for the time being--there is no way in the world they could do this. Every State has insurance commissioners or regulators that are in charge of making sure the insurance companies in their State are adequately financed, meet their fiduciary responsibilities, that they meet their insurance responsibilities, that they uphold what they say they are going to do in the contracts, every State. I would imagine in New Jersey, it is hundreds of people--hundreds. I am sure it is in the hundreds. My State of Oklahoma is in the hundreds. HCFA, the Health Care Finance Administration, couldn't enforce that. There is no way in the world. There is a list of patient protections that every State has done. In my State, it is 40 some; in most States it is 30, 40, 50 different State protections. We are going to say: We don't care what you have done. Those aren't good enough. We are going to basically say these protections are preeminent. These will supersede what your State has done. You must do as we tell you to do. If you don't, the Federal Government will take over enforceability of those provisions. Then you will have the awkward situation of having the Federal Government enforce some provisions in your health care contract but not all the provisions. That is really going to make a lot of sense. Then there is going to be this little period of time where the State has been enforcing these State regulations. Now we have a new Federal regulation, and it is supposed to be prevailing. But the State regulation, we are used to enforcing it. Which one do we abide by? They are not familiar with the Federal enforceability. No one has ever enforced this one before. So should the State enforce the Federal regulation? They can't do it. The HCFA person hasn't signed off. Therefore, HCFA is going to take over, and they don't have anybody to enforce it. Now what you have is language saying you have these protections, but you don't have anybody to enforce it because HCFA can't do it. They absolutely can't do it. Somebody should ask the Secretary of Health and Human Services, do you have the capability to regulate State insurance to enforce these provisions that the McCain-Kennedy-Edwards bill would do? The answer is no. No, they couldn't do it. So we are going to have a long list of protections that we supposedly are telling everybody they have: look what we have done for you, but there is no enforceability because the Federal Government doesn't have the wherewithal to do it. And we shouldn't do it. That is not our responsibility. Yet we are going to have that kind of takeover. I think that would be a serious mistake as well. Then what about this comment: Under this bill, we insure all Americans. Wow, sounds really good. We are really going to provide protections for all Americans. First, I should ask: Are we disabusing Federal employees? Are we disabusing our families, Senators' families who are under the Federal employees health care plans? Do they have such a crummy deal that we need to change their plans? The truth is, we don't change Federal employees. We change State employees. I hope everybody knows that we are going to go out and tell every Governor, every State insurance commissioner: we are going to change your public employees' health care plans. We are going to mandate you do all these things. We exempted Federal employees. Whoops. You mean we are going to mandate all State employees, all teacher plans. We are going to mandate that all of those have to have what we have decided big government knows best. Yet for Federal employees, whoops, we exempted them. Organized labor, if they have a contract, we exempted them. Medicare, for we exempted them. Medicaid, low-income individuals, whoops, these don't apply to Medicaid. They don't apply to Medicare. They don't apply to Federal employees. They don't apply to union members, until their contract is renewed, maybe 5 years or so before that happens, if they have a long-term contract. There are a lot of little gaps. If this is so good for the private sector, why don't we put it on the public sector? Why don't we put it on the Senate? A Senator or their family members, can they sue the Government? If they are aggrieved, can you sue the Government? The answer is no. You still can't. Even if this bill passes, you can't sue the Government. Everybody else can sue their employer. You can't sue yours. I wonder if cost has anything to do with it. There are some things that just don't fit. It is fine for us to do this on all private sector plans, act as if that will only cost 37 cents a day. Maybe they said a week. The cost of health care right now for a family is about $7,000. At 4.2 percent of $7,000, figuring this up, you are talking about $300 a year. Some people say: That is just cents; that is a dollar a week or something. It is not a dollar a week. It is $300 a year. Maybe that is about a dollar a day. That is about the equivalent of the tax cut that a lot of Americans are going to receive this year. We are just going to take it away. So we give a tax cut with one hand and we take it away with higher health care costs in the next by this bill? We can sure do that. Somebody said: I broke even for the year. What if you are one of the 1 or 2 million people who lost your health care because your employer dropped it? You came out on the real bad end of the deal. This didn't cost you a dollar a day. This didn't cost you a Big Mac. This cost you your health care--probably to a person who needs health care the most. A lot of people who are in that low-income bracket, maybe working for a small restaurant in Montana, or someplace, and maybe their employer just started to provide health care, or wants to provide it, and they could not do it because they could not afford it, or because they are afraid of the liability.

Mr. NICKLES. My point is, let's be very careful not to do damage to the system, not to do damage to a quality health care system that is far from perfect. Let's do some things to make sure that we increase the number of people who have insurance. Let's not do anything that would increase the number of uninsured. That is doing a very serious harm. If anybody says, hey, this bill has so much momentum, so let's pass it regardless of what it costs or what the consequences are, I beg to differ. It is worth spending a little bit of time to try to be at least responsible in this area. Let's not do damage. Let's not supersede the States. Let's not act as if the Federal Government knows best: Sorry States, we are going to take over the regulation of your health care system because we know better. Every person here who works in this system for very long knows that we do not know better. We do a crummy job. HCFA does a crummy job in administering Medicare. They are way behind even in enforcement and compliance with the Health Insurance Portability Act. Some States still aren't in compliance. HCFA is supposed to take over regulation of that act. If they haven't done that, how in the world can they do it for private care? They could not do it. Let's pass a positive bill. I stand ready to work with my colleagues on both sides of the aisle to do that. I am willing to spend a lot of time to work out a real bipartisan bill, one that has support by a majority of the Members on both sides. To say that this is a bipartisan bill when you have 3 Republicans sponsoring it and 40-some odd vigorously opposed to it is stretching it. That is not bipartisan. Let's have a bipartisan bill where you have a majority of both Democrats and Republicans supporting the bill. That is real bipartisan bill. Let's get a bill that President Bush will sign and become law, not just have campaign rhetoric. Let's make something happen that we can say we have passed a positive bill. I hope we can do so. It remains to be seen. There is going to have to be some willingness to compromise. Some people say we have compromised enough. This bill is not a compromise. This bill is to the left of the Norwood-Dingell bill that we had last year. It is more expensive than that bill. The liability provisions are more intrusive and expensive than the bill Congressmen Norwood and Dingell and Senator Kennedy were pushing last year. It is not a compromise. It is a move in the wrong direction. Let's move toward the center. I have shown a willingness--maybe more than I should have--to compromise and try to come up with a positive bill. Let's work together as both Democrats and Republicans to come up with a bill that we can all be proud of, that President Bush can sign, and one that can become law. I yield the floor.

Mr. NICKLES. Will the Senator yield for a question?

Mr. NICKLES. Did I understand my friend and colleague to say the State of Massachusetts now complies with the Health Insurance Portability Act?