Ben Nelson

Mr. NELSON of Nebraska

Mr. NELSON of Nebraska. Mr. President, I thank the chairman for his kind remarks and for his shepherding through his committee in record time the nomination of William Riley. I have known Bill Riley since our law school days at the University of Nebraska College of Law. He had a distinguished career at the University of Nebraska, serving as editor in chief of the Nebraska Law Review. Rather ironically, his first job out of law school was clerking for one of the judges on the Eighth Circuit Court of Appeals, the same court which he seeks to preside in today. He has been a member of a number of community and professional organizations, and in addition to his professional accomplishments, he has been active in his community, participating in the Boy Scouts for more than 25 years, serving as a juvenile diversion judge as a leader for young boys and girls charged with nonfelony crimes, and offering legal services to financially disadvantaged members of the community. He possesses not only the legal intellect, the experience and the expertise to be an excellent judge, but he has also displayed throughout his entire career high ethical standards. It is a real pleasure for me to have the opportunity to comment so positively on Mr. Riley's qualifications and to thank the committee and the chair for moving this expeditiously. It is a good indication that on a bipartisan basis, this Senate can act in a very timely manner on these nominations. I thank the chairman, and I thank the Chair.

Mr. NELSON

Mr. NELSON. I thank the distinguished Senator. I appreciate her support and that of her staff on this issue, and look forward to continuing to work with her. International Space Station

Mr. NELSON

Mr. NELSON. I thank the distinguished Senator. I appreciate your support and that of your staff on this issue, and look forward to working with you. asr-9 airport radar service life extension program

Mr. NELSON of Nebraska

Mr. NELSON of Nebraska. Madam President, I rise in support of this legislation, S. 1246, and in opposition to the amendment offered by my good friend, Senator Lugar. I know he is attempting to do what he thinks is best. That is what this honest debate should be about--what is best for American agriculture and how we can best meet those needs. I notice my good friend, Senator Cochran from Mississippi, has a view that is a little different from that of Senator Lugar in that he had prepared an amendment of about $6.5 billion but is supporting Senator Lugar in his effort at $5.5 billion. But it points out that there are honest differences of opinion, even on the other side. The reason I support S. 1246 is that it is a balanced bill and one that takes into account the diversity of agricultural interests all over this country. It recognizes that the major commodities are in their fourth year of collapsed prices, yet at the same time recognizes that economic assistance cannot and should not go just to program crops, it must reach further, to add additional farmers who are suffering and who do not happen to grow wheat, corn, or rice. On a parochial level, the bill before us holds several provisions that are important to Nebraskans. It is no exaggeration to say that agriculture is the backbone of Nebraska's economy, for one of every four Nebraskans depends on agriculture for employment. It has been an ongoing source of concern for me that when the rest of our economy was booming, production agriculture was on the decline. As do other Senators, I regret having to supplement our farm policy with billions of dollars of additional emergency assistance every year. So it is, in fact, high time to move on with the writing of a new farm bill for just that reason. But until then, we have to be here to help those who produce food, who feed our Nation. This bill does that. This bill provides for an additional AMTA, or Freedom to Farm payment, at the full $5.5 billion level, which is what producers in Nebraska want. It is what producers all across our country want and what they expect us to provide. The bill passed by the House does not do so, and any package that spends just $5.5 billion cannot do so. I believe that is unacceptable. This bill provides for assistance for oilseeds, which are not a program crop. It suspends the assessment on sugar, which is critical to the beleaguered sugar beet growers of western Nebraska and other parts of our country. And it beefs up and in some cases reinstates spending for vital conservation programs, all of which face long-term and growing backlogs and many of which would expire if not extended by this bill and were left for a farm bill later this year or next year. In some cases my good friend from Texas points out some programs that do not, I suspect, seem to be quite as much of an emergency. But I think the good Senator from Iowa, Mr. Harkin, answered that and said that in every emergency bill you might question the urgency or emergency of certain aspects of it but we ought not to let that get in the way of passing a bill that deals with emergency needs. This bill also offers eligibility for LDP payments to producers who are not enrolled in the current farm program, a provision which I strongly support and which makes an enormous difference for the small number of producers who need this provision. In fact, Senator Grassley and I introduced legislation to this effect earlier this year and I am grateful to Chairman Harkin for including this provision. This morning I received a call from a constituent about this issue. So, for those who are eligible, there is no more important provision in this bill. Finally, I commend the chairman for including funding for value-added development grants. This program was first funded last year, and it has been very popular in Nebraska. In fact, I know we have several grant requests under preparation for this funding, including one for a producer-owned pork processing and marketing facility. This is exactly the kind of program that we all talk about and want to encourage. I am happy to support this package and know it will find wide support in Nebraska from farm groups and from farmers all over our State and our country. It is beyond me why some Senators and the administration are so staunchly opposed to this bill. In fact, it provides a payment for a single crop year but stretching over two fiscal years, and it is within the budget constraints. I can't find a way to explain to Nebraskans when prices are no better than last year's why the assistance provided by Congress should be cut. I can't find a way, and I don't intend to try to find a way to explain that. It just simply won't sell. The Director of OMB suggested in his letter that the spending should decrease because farm income is up. That certainly may be true for our cattle producers. But this assistance flows primarily to row crop producers and others who are not enjoying such good fortune. How can I explain to my constituent who called this morning saying that he qualified for LDPs on his farm last year but he doesn't merit any assistance this year? My point is that the tunnel vision approach that we must spend exactly and only $5.5 billion ignores an awful lot of needs in each and every one of our States. I am not willing to say that the needs of producers who grow corn in Nebraska are more important than those who grow chickpeas or to the dedicated hog producers who are working diligently to process and market their own pork that we can't find a way to afford the value- added loan program that offers them their best chance to get off the ground. How can I say to them that they will have to wait for the farm bill and maybe there will be funding available after that? This bill before us attempts to balance the needs across commodities and across the country. I think it is a great effort. I hope we can convince the House of its merits. There was a statement that some of the payments will be direct but some will be indirect, as though there is some distinction there of any importance. The fact that we are able to get direct and indirect money into the pockets of farmers today is what this is about. That is what the emergency requires, and that is what this bill does. As a fiscal conservative, I want to economize but not at the expense of America's farmers. I support this bill because I think it, in fact, will do what we need to do for agriculture on an emergency basis and give us the opportunity in a more lengthy period of time to come to the conclusion about what the ongoing farm bill should be and do that not on an emergency basis but on a long-term basis and a multiyear basis. I thank the Chair. I yield the floor.

Mr. NELSON of Nebraska

Mr. NELSON of Nebraska. Mr. President, I thank the Senator from Massachusetts for the opportunity to speak to this amendment. There has been a lot of discussion recently and I think most people's heads are swimming about what a DDM is and what the purpose of this amendment truly is. The purpose of this amendment is to make sure, whether you are a plan sponsor or an employer, if you are self-insured and self-administered, that you are treated the same. You have to treat one and all the same. That is what this is about. I believe there is some language being worked on that probably will be offered shortly to make it clear that is exactly what is intended by this amendment. It does not specifically carve out one group or another. It carves out all groups where there are plan sponsors or employers who are self-insured and self- administered. All other employers are in a position to have a DDM, designated decisionmakers, or they have an insurer which is a designated decisionmaker. The whole purpose of this legislation is to be able to provide additional rights and opportunities for insurance. This does it. What it also does is make sure that employers are not entrapped in unnecessary litigation and that if they don't make decisions about health care and make decisions about claims, they are not involved in litigation. Specifically, this amendment narrows it down to not being brought into Federal causes of action. It does not absolve employers or plan sponsors from any kind of litigation that may come through State courts. While it may be difficult to follow the roadmap, there is one thing that needs to be clarified and that is, it does not treat any one group in any special way. It treats all plan sponsors and all employers who self-insure and self-administer, the same way. If they choose to get a third party administrator, which becomes a designated decisionmaker, they will be absolved from liability from litigation unless they somehow participated in the claim-making process, which they would not do if they had a designated decisionmaker. This is intended to make sure we balance the interests of the right of the individuals, the right of the patients to sue, with the opportunity for employers not to be entangled in litigation where they should not be entangled. It also means that in balancing these interests, there will be fewer cases of uninsureds, and there will be fewer employers deciding to get out of the business of providing health insurance benefits to employees. We have heard from employer after employer about their concern--as a voluntary provider of these benefits, now suddenly they can be sued. This makes it clear they will not be sued and it also makes it clear that those who are plan sponsors will not also be sued unless they participate in making decisions about health care claims. That is what this is all about. I hope this clarifies it for some of my colleagues on the other side of the aisle who have raised questions. It is important to raise questions and certainly ask the question whether there is any special treatment. But if you look at the language and you look at what is being done, there is not any special treatment for one group over another. The category is the same. If you self-insure and self- administer you will be open to some exposure. However, we will make certain that exposure is limited when it comes to Federal actions. That is what this is about. I yield to my colleague from Arkansas and say before departing, thank you to my colleagues and cosponsors from Maine and Ohio. I believe this is the right way to proceed to improve this bill.

Mr. NELSON of Nebraska. I thank Senator Collins for her strong support for this amendment, and I commend my colleague, Senator Breaux from Louisiana, for his strong support and consistent efforts to find a compromise. Certainly, the effort is an improvement over where we had been. One area I want to point out I disagree with my friend from Louisiana is his suggestion that maybe the States will not do anything. If you take a look at the charts that Senator Collins and I have up, when you look at all the checks, I suggest the States have been doing something and they will continue to do something if the Federal Government does not come in and take away both the incentive and the opportunity by putting in what is termed affectionately ``a floor,'' a minimum. The problem is these minimums very often become the ceiling or they become, if you will, the top of whatever is being done because the States will not have the same opportunity, nor will they have the same willingness with the Federal deregulation, of the federalization of the regulation of State insurance as it applies to these health plans. Generally preemption occurs when the States have not acted. I cannot imagine we are now preempting what the States have done on the basis of they have done such a good job that we were able to pick and choose from the best of those protections to create this bill and now we say to them: It's a job well done; thank you very much, and, by the way, we will impose these on you and we will make sure your laws will have to be either substantially equivalent or consistent with, according to Frist-Breaux, or, with the compromise, substantially compliant. I can understand our desire to take over the role of the States in this area if the States have not done anything, but I cannot understand the desire to do it when the States have done such a good job that we have picked and chosen from the best of those efforts to comprise our bill. It does not make sense to preempt under these circumstances. That is why many of us would like to see the States have the opportunity to opt out so we will have continuing experimentation under the Jefferson principle that the States are the laboratories of democracy. I am not against all preemptions, but I do have a question about this preemption, whether it makes sense under the circumstances with the progress that the States have made. The charts will show the States have been active. They have worked very hard and diligently and are continuing to do so. Delaware just last week enacted additional patient protection laws. What we need to do is make sure we continue to permit the States to experiment. I am also worried that with the application of these standards to the States, we will not have further experimentation, we will not have further development of patient protections. I hate to think we are at a point where the status quo will be sufficient for today as well as for tomorrow. I worry this effort in having a floor will result in it becoming a ceiling. If you look at the charts, you will see to one degree or another, whether it is emergency room or whether it is the external appeals or the internal appeals, that nearly every State is doing it. Many States have decided not to do everything under every set of circumstances. I do not think they ought to be penalized where they have made a conscious decision that that is not going to work within their State. We ought not to have, in my judgment, a one-size-fits-all approach. We have not found, if you will, the Holy Grail as it relates to what patient protection truly is. If we allow the States to continue to experiment, we will find that they will be innovative and they will come up with new methods of providing even better patient protections. After all, this is coming from the grassroots; this is coming from the bottom up. I think we are making a mistake trying to drive it from the top down which will stifle and create the opportunity for stagnation rather than experimentation. I hope that will not be the case, but I do not see it really any other way. The National Association of Insurance Commissioners, the president of the National Association of Insurance Commissioners, the National Council of State Legislators all agree with this approach.

Mr. NELSON of Nebraska

Mr. NELSON of Nebraska. Mr. President, I appreciate the opportunity to engage in a dialog with my colleague from Massachusetts. As I indicated earlier, I respect his work and many years of effort in this field. I certainly respect his judgment. If I would disagree with him, it would be that somehow there is a standard that is currently in place. As a matter of fact, last year they tried on numerous occasions to achieve a standard. They could not come up with one where they agreed. So they agreed to disagree and left the standard out. We have an opportunity now to come up with a standard that is good enough for Federal employees and put that in this bill. If it is good enough for Federal employees, then of course I think it ought to be good enough for the rest of America. As to the charts that were shown, I ask, is there anybody in this Chamber today who believes that under the definition of consistent with standards of good medical practice in the United States, any doctor would not have ordered that the cleft palate be treated? I understand the importance of having charts. I understand the importance of having faces put on the patients. But I think it is important that, as we do that, it be very clear that we understand that these cases would be treated appropriately under the standards of good medical practice in the United States. So I think we really have an opportunity today to provide more clarity, so that doctors who will have the opportunity to make medical decisions and order care will be able to do so consistent with standards. There is no way that this amendment today is designed to take away any of the authority of the doctor at all, or any other health care provider. All that it is aimed at providing is a standard. If they had come up with a standard last year and it were included in the bill, I would not be raising the question this year. This issue today is about whether to have the standard or not. I can't imagine we are even debating it. We ought to be debating what the standard is. That isn't the debate we have today. As a matter of fact, some of the objections raised earlier about this amendment could be equally said of an amendment that I suspect the Presiding Officer will be supporting today a little later, and that is to make sure you don't have those exclusions from a policy, those exclusions from a contract, ignored by a medical examiner in the whole process of the review. The important point here is that this will provide an opportunity, upon an internal or external review, for a medical reviewer to make good decisions consistent with good medical practice, consistent with the needs of the patient, so that the conditions in those pictures that were shown here--very vivid descriptions--can and will be taken care of and will not be left open without a definition, without a standard. The boundaries would be set, but they would be far broad enough to cover that and any other condition that was discussed here as an example this afternoon. It seems to me it is important that we establish a standard, and if I wanted to oppose what I am proposing today, I would come in and I would say that it was going to do something bad, that it was not going to permit something good. But that doesn't make it so. It is important to point out the language and deal with the reality of the words of this amendment, rather than setting up a straw man to attack and say that it is doing something or it won't do something that it is in fact doing. Mr. President, how much more time is there?

Mr. NELSON of Nebraska. Madam President, I understand the passion of my colleague from Massachusetts. He has done such great work in this area, and I truly appreciate and respect what he has done and the fact that he has taken a very careful look at what we are proposing. I suspect, though, that he would maybe look at me as a person who came to the party late and wants to rewrite the invitation. You can't try to change something where there has been such a history without encountering some resistance to it. I understand there is resistance to wanting to change this because it was dealt with last year. But you don't weaken this bill by making it more certain. I don't believe there is a problem. But if there is a problem within the Federal Employees Health Benefits Plan because there is not a good standard there, we can correct that by passing this amendment and this Patients' Bill of Rights, and make Federal employees subject to the Patients' Bill of Rights. My colleague from Massachusetts mentioned that there is perhaps a different manner of review for Federal employees where they have to go directly to the Office of Personnel Management rather than getting an internal or external review. We can correct that. We can make that plan subject to the Patients' Bill of Rights, and we can correct that. Or we ought to take a look at that independently. But this does not change anything that would be detrimental to those individuals my colleague from Massachusetts mentioned. For example, of the list of people, such as a person with a cleft palate, the only question about a person with a cleft palate is whether that treatment, in the judgment of the medical professional, the doctor, would be consistent with the standards of good medical practice in the United States. That is the dynamic, and I am sure that it would. There is nothing static about this definition. It will continue to change as the good standards of medical practice in the United States change. My good friend also mentioned something about making sure that we have our loved ones well protected. I agree with him and include the Federal employees as part of our loved ones. I think we want these standards to apply to all Americans. The way in which you can do that is by adopting this amendment on medical necessity. What it does not do is, it does not change the doctor's decisionmaking in relation to what kind of care to provide. What it does say is that it has to be consistent with the standards of good medical practice in the United States. I, for the life of me, do not see what the resistance to this language is, other than the fact that we tried to do it a year ago. We had the Stanford definition. We talked about other definitions a year ago. Now we have come up with a definition which I think is an excellent definition that will do it, that will establish the standard for certainty, for predictability. And now we are saying it may weaken the Patients' Bill of Rights. But certainty will strengthen this. There is no effort here to do anything that would not be consistent with--as a matter of fact, the language requires that the medical profession do something consistent with the standards of good medical practice. Whether it is an amputation, whether it is a cleft palate, whether it is deciding on cancer care, or whether it is deciding on other kinds of care, all we are saying is it ought to be subject to these standards. That is the only point that is being made. Mr. President, how much time remains?

Mr. NELSON of Nebraska. We reserve our time.

Mr. NELSON of Nebraska. I yield.

Mr. NELSON of Nebraska. I yield time to the Senator from Oklahoma.

Mr. NELSON of Nebraska. I ask my colleagues to support this amendment and move forward with the important work of the Patients' Bill of Rights. We can do that. This will improve it and will not detract from it.

Mr. NELSON of Nebraska. I again commend my colleague from Maine who has a wealth of experience in the regulation of insurance by having dealt with the professional agencies in her State. I suggest to you that she knows exactly of which she speaks, that the States have been active and have taken a very strong role in trying to protect the patients within their States. The legislatures, the Governors, and the regulators have all worked together to try to create an environment in which patients are protected. They have succeeded in doing that. The one missing piece, though, is not in what the States have failed to do but in what the Government today at the Federal level, in Congress, is now trying to do, and that is to cover the federally exempted plans. There would not be any discussion in this Chamber today about this bill if it had not been for the exemption granted in 1974, as a result of Congress' action to exempt certain plans from State laws. There is no criticism of what the States have or have not done. There isn't any suggestion that the States have not been active or that the States have not attempted to do a good job or that they have not done a good job. What we have is, overcoming an omission, taking care of something that has not been done; that is, applying these protections to the Federal laws that have been exempt from State law. That is exactly what this is about. I certainly want to praise, again, Senator Kennedy, who has been extraordinarily tolerant of those of us who have had something to say about his labor of love. He has been very tolerant. He has been very helpful. And he has been very suggestive about solutions along the way. I want him to know that I personally appreciate that. I am somewhat embarrassed to be suggesting that I might have some area of improvement, given the fact that he has worked on this for so long. It is a fact that I come fresh. I said this morning, I feel like somebody who came to the party late who now wants to rewrite the invitation. It seems to me that this bill is such that it can involve some additional improvement. This is an area where I think it could be greatly improved, by giving the States the opportunity to make their case--not that they need to be treated as though their laws are substantially equivalent--but to give them the opportunity to come in and say: We have done this. We chose not to do this in our State after carefully considering it. The Governor may have wanted it, but the legislature, in its infinite wisdom, chose not to do it, or vice versa. It works that way. That system ought to be continued. It will serve the people of our great Nation very well: The people of South Dakota, the people of Maine, the people of Nebraska, the people of Massachusetts, the people everywhere, because it has served this Nation so very well and has served the people so very well. That is a minor modification. I think it has major implications, but it is a minor modification to say that the Governors can certify, and they can seek to support that they have attempted to deal with these issues in their way, that they do not have to do it our way. That is the difference. I hope that my colleagues will see it that way and will find the capacity to continue to recognize that States have done, are doing, and can continue to do a good job. Even though there is an effort made to limit the amount of the preemption, I believe this preemption simply goes further than is necessary and further than we certainly would like to have it go. That is what the National Conference of State legislatures have said and other State organizations have said. They would prefer to have less preemption and a better recognition of their efforts and a recognition that they will continue to work to increase the level of patient protection. I yield to my colleague from Maine.

Mr. NELSON of Nebraska. I thank my colleague from the New England State of Maine for such a glowing recommendation. I hope my colleagues do not think I believe I know more than they do. But it is a subject I have spent a good deal of my life involved in as an insurance regulator and as a Governor, somebody who has dealt with the business of insurance. I appreciate so much the opportunity to join with Senator Collins to bring this amendment to the attention of our colleagues. It typically is a lot more instructive to talk about the importance of patient care and to talk about those who aren't getting good patient care and certainly to bring to our attention those folks who suffered great injustices under their current health care system. I respect that. I certainly am interested in that aspect. That is why I support a Patients' Bill of Rights. That is why I continue to do that. But I have found that any bill which comes before this body or that comes before any legislative body is hardly ever such without some amendment and some improvement. I think what Senator Collins and I are offering today is in that category of an improvement. When our founders created this Union they established a system of Government that, pursuant to our Constitution, provided for a divided Government, a Government consisting of our States, and under a well- considered principle of Federalism, a Federal Government. We have been best served by this Government when we have permitted it to work for us. While pursuant to the 10th amendment, the Federal Government may preempt States in certain respects, it seems clear from that amendment and from the practice over the last 200-plus years that such preemption should be limited to those areas where the States have failed to act in some manner. This is not one of those cases. The bill before us presents a dilemma for me and for my colleagues because most of us believe that, with some modifications, this is a good bill. The same may be said of the Frist-Breaux-Jeffords bill. At the outset, let me state unequivocally that I support the purpose and the protection of this bill. What I don't support is its preemption of State laws in an unnecessary manner. Let me explain. As my colleague has indicated by the chart, the States have acted. They have acted rather aggressively and consistently and in many ways. As a matter of fact, they acted so aggressively and so consistently that the best of those protections which the States passed were assembled to create this bill. Let me ask you if that isn't some action on the part of the States. When Congress passed the ERISA preemption in 1974, it did so because some multi-State employers were having problems complying with the diversity of the State regulation of health insurance. First, it was described as a pension issue to which they couldn't quite comply. Then they said, as long as we are getting a preemption, let's grant it in the health insurance area as well. So Congress exempted certain plans from State law. That level of exemption involved fewer insured than were continued to be served by State regulated insurance plans. What we are faced with today is dealing with the problem that began in 1974 with the exemption from consumer protections of these Federal plans. Now we are faced with solving that problem. Some have said, as long as we are solving that problem, let's move away from diversity and go to uniformity. I am not opposed to having uniformity. But to serve uniformity for uniformity sake and ignore what the States have done, the fact is that under the principles espoused by Thomas Jefferson States have only been acting as laboratories of democracy by experimenting. Fortunately--and thank goodness--the States have experimented because it is from these experiments and from this diversity that we are now able to assemble for the protection of the ERISA plan this group of patient protections. That is what is important about this. If we look at it to a certain extent that virtually all content is taken from various State laws, that is at least some form of congratulations to the States for their efforts. But they ought not to be rewarded by that great effort by the preemption where it is unnecessary. The framers of the legislation that is before us as well as those of the Frist-Breaux-Jeffords bill have really worked hard to try to find a way to balance this out. I commend them for that. Their work does not go unnoticed. I appreciate their efforts. But whether the standard is substantially equivalent as in the McCain-Kennedy Edwards bill or in the Frist-Breaux bill consistent with or in a compromise that is under consideration right now which says substantially compliant, the fact is the States are going to have to come to the Federal Government with the plans and say, ``Please let us out'' or they will not be able to get out from under the requirements of this legislation unless they are ``substantially equivalent to.'' ``Substantially equivalent to'' means the filings of these State protections would have to be made by their Governors to the health and human services agency, and they will have to find out whether or not the plans they are submitting are substantially equivalent--not whether they are good or bad but whether they are substantially equivalent. The theory is, if they are substantially equivalent, they are at least as good as or better. But I don't know why we should engage bureaucracies in the Federal Government to try to look over the shoulders of the States that have seriously considered each and every one of these protections. Why are we doing it? Because we want to solve the problem that exists. Why should we try to solve a problem where there is no problem? Under the Collins-Nelson effort, we give the States the opportunity to opt out if their plan is consistent with the purposes of this law. It seems to me that we just simply make it clear that the States can continue to experiment. It is easy to suggest that if you take away the incentive of the State to experiment, the experimentation will either wither or will at least stagnate. We want to continue to be sure that there are incentives for the States to continue to experiment because I suggest to you right now this is a dynamic process. Over the next several years, we are going to find some better patient protections, and we are more likely going to find those from the States than we are engaged in the body of this legislative Chamber trying to find those answers. I would prefer that experimentation continue. Then we can pick and choose the best of the class in each case. I spoke today with the Secretary of Health and Human Services, Tommy Thompson, also a former Governor, and I asked him whether he thought his agency could do this. He said simply that he doesn't think that it can. Let me add that I think that translates into, ``I can't unless I have a larger bureaucracy of several dozens or more Federal bureaucrats and more staff to look over and second-guess Governors and second-guess State legislatures.'' I asked if that is necessary. Quite frankly, I don't believe that it is. And with the stroke of the pen this bill can be amended so that it won't become law so States can opt out and Governors will have the opportunity, as State legislatures, to decide what is the policy that will work within their State. We are looking for balance with this legislation. All of us want to balance being able to have the right kind of protection for patients and the availability and affordability of insurance. The last thing we need to do is to tip the balance one way or the other and end up with a more severe problem than we are trying to solve with this effort. I suggest to you that Thomas Jefferson might be looking at us at the moment. Furthermore, I think he would be pleased if we had a dual system that recognized that this Federal bill and these Federal protections would apply to the Federal plan, and we would allow the States to continue as they have to protect the people at that level and to serve to provide experimentation and better ideas along the way and permit us to allow them to continue as they have to protect the citizens. I truly believe that government, when it is functioning at the local level, will function best and certainly can function better in this area than we can function. We have already taken the step of exempting the Federal plans. Let us not now make a mistake of applying what we need to permit for those State plans where there is already much protection and probably even more protection. Just this week, Delaware added additional patient protections. It seems to me that we ought to continue to support that. We ought not to do anything that detours it or takes away the incentive for the States to continue to do as they have been doing. I yield the floor.

Mr. NELSON of Nebraska. Madam President, I appreciate the opportunity to join with my colleague, Senator Kyl from Arizona, to support and pursue the opportunity for making certain there is a definition and a standard in the Patients' Bill of Rights legislation that will give certainty and clarity to the standard by which medical claims can be submitted and the providing of medical care can be made. There is some concern about whether or not the Federal Employees Health Benefits Plan definition of ``medical necessity''--which is essentially the definition, the standard, if you will, that is being proposed in our amendment--is something where the Office of Personnel Management would be bound by the plan's determination. We have never said that the plan, in this case the medical reviewer, would have to be bound by the plan, but they would have to be bound by the definition. That is what this is about. It is making certain there is certainty, clarity, and an understanding, a meeting of the minds, about what will be covered and to what extent, always subject to outside standards, outside review. I support having a Patients' Bill of Rights that provides the kind of patient protections that are included within this bill. I support the opportunity for a patient to have a review from the internal side and from the external side, and I support the opportunity and the right of the patient to sue the HMO to ensure the medical decisionmaker in conjunction with any questions that are provided for in the level of support that is provided within the current bill. It is important as the decisions are made about the claims that there is at least certainty and clarity as to a standard. I do not think even the proponents of the legislation would deny it is important to have a standard. As a matter of fact, I understand the history of this bill to some degree, and I know that in the past there was an effort to arrive at a standard. There were two groups with two different pieces of legislation, and they could not quite achieve an understanding as to what the standard should be or the definition. Perhaps out of frustration, and certainly out of not coming together, the decision was made to leave this open. The problem with leaving it open is there is no basis of a standard; there is no way to know what the definition of ``medical necessity'' can be. It can be about anything. When you have a contract and when you have two parties to it, an insurer and insured, you need some degree of certainty. That is what we are asking for, so you can know of what medical necessity truly consists. As to the question about whether or not this language, which is taken right out of OPM's definition that is included in the Federal Employees Health Benefits Plan--as to whether or not that is adequate language, it seems to me there should be no question about it. This is to what the Federal employees are subject. You and I, those who are insured, are subject to the language, the standard, and the definition that is included within this amendment. I find that it would be unusual if somebody objected to this standard, but our plan provides, even if there is a concern about this standard, that under the rulemaking and the negotiations of regulations another standard could be arrived at with the stakeholders to this legislation. The stakeholders, about 19 of them, would all be assembled, and if they did not like this particular standard, then they could achieve, upon agreement, another standard. This is about having a standard, and there seems to be very little concern about whether or not the current standard that is included within this amendment is an adequate standard, certainly from the standpoint of Federal employees. In other words, if it is good enough for me, it ought to be good enough for other people. If it is good enough for the thousands of Federal employees, then it ought to be good enough to be included. What does it provide? It provides that the determination of services, drugs, supplies, be provided by hospital or other covered provider appropriate to prevent, diagnose, treat, a condition, illness, or injury, and that they must be consistent with standards of good medical practice in the United States. That is a standard we can all live by because we cannot ask for more than having care that is consistent with standards of good medical practice in the United States. There are some other requirements as well, but they are essentially the same as what I just read. I cannot imagine anyone would want to argue for not having a standard or having a contract that is open-ended and not know that would, in effect, leave uncertainty, a lack of clarity, and an openness that nobody wants to propose or support. I hope my colleagues will take a look at this as we fight to keep down the high cost of health care, the availability of health care, and that we work toward making this standard the kind of standard that can be included as part of the Patients' Bill of Rights. Anything that establishes clarity and certainty is desirable in the context of this legislation, and certainly that is included within this amendment. There are some who thought the standard might consist of something such as a cost benefit. This does not involve any kind of cost-benefit analysis regarding medical care. There are some who were concerned about that. I would be concerned about that. This does not do that. There is some concern that somehow the plan might not be bound by the decisionmaking. It is not, but it ought to be bound by the definition. I realize this is a very complex area that the average person is not going to deal with every day, so I apologize for the complexity, but I do not apologize for having something that will simplify it, that will give us the certainty and the clarity of having a definition and a standard that we can all understand and one with which we can agree and against which good medical care, under good medical practice in the United States, might be compared. That is what we are looking for. There is a proposal that I understand will be coming forth for consideration this afternoon that will solve part of this problem, but it does not solve the problem of the standard of care and the definition.

Mr. NELSON of Nebraska

Mr. NELSON of Nebraska. Madam President, I rise today to offer, along with my colleague and friend from Arizona, Senator Jon Kyl, an amendment to protect the sanctity of health insurance contracts, to provide certainty and clarity so that both the issuer and the insured can know what coverage they have. This amendment will preserve a patient's right to receive the health benefits that they paid for while keeping insurance premiums affordable. In more colloquial terms, this amendment is what is needed to see that the people who pay for health care coverage get it. It may sound extraneous, and this is anything but exciting language, but I know from my experience as a State insurance commissioner in Nebraska two decades ago that this amendment is essential for the preservation of what I believe is an extraordinarily fundamental patient right. Before I elaborate further on this point, let me state that I think a Patients' Bill of Rights is not only a good idea; it is an excellent idea. I believe Congress should be acting in the best interests of all Americans to enact such legislation. We need a Patients' Bill of Rights to ensure that doctors make medical decisions. We need a Patients' Bill of Rights to protect patients and federally regulated health care plans that are currently unprotected and have been unprotected for more than two decades. We need a Patients' Bill of Rights to guarantee patients' access to independent and external medical review and, only as a last resort, to guarantee them access to the courts. There is no shortage of reasons why this legislation merits passage. But before my support for a Patients' Bill of Rights is misconstrued as an ``anything goes'' approval, I want to be clear that while I believe the Senate should approve a Patients' Bill of Rights, I think that some improvements are justifiable. And right now, we have the opportunity to make those much-needed improvements which will ultimately increase the effectiveness of the Patients' Bill of Rights. I believe the bill needs to carefully consider matters such as the issue addressed by this amendment pertaining to the sanctity of health insurance contracts. And I hope that the sponsors of the legislation will look very favorably on this matter and that we will be able to work out an arrangement or agreement to get it included as part of the bill. First, this amendment would ensure that patients receive the care that they are entitled to under the plans to which they subscribe. External reviewers would be required to assess treatment options based on the contract that exists between the patient and the plan. Patients would be entitled to the care outlined as a provided benefit within the contract that exists. External reviews would not be able to circumvent the contract to force employers to expand coverage for any particular patient unless the patient was entitled to the care as specified by the care contract. This will help keep down the high cost of health care and, at the same time, will enable employers to continue to provide their employees with the best care possible. More importantly, this amendment will provide three safe harbors for employers with respect to protecting them against unnecessary litigation over treatment. While patients will have the right to sue under this bill, this amendment will more clearly define the parameters by which treatments can be determined as ``medically necessary'' and thus will provide a safeguard of medically necessary standards for employers that administer their own health plans. The McCain-Edwards-Kennedy bill contains something that I think would currently require external reviewers to abide by the standard for the determination of medical necessity included in the bill, but it doesn't bind the reviewers by the insurers' definitions for medical necessity. This is problematic as it relates to the existing contract between patient and provider and provides a great deal of unclarity and uncertainty. So to remedy this situation, this amendment proposes to identify three separate and distinct sources of definitions that employers could choose to use in the contract by which reviewers will be bound. The three options that we create for the plans are: One, a definition that plans are required to use by State law. This would protect the previously existing and any newly created State laws that require plans to use a definition put forward by the State. Second, any definition used by a plan which is codified by the language in the fee-for-service agreement that is currently covering maybe 50 to 75 percent of the Federal employees under the FEHBP, or the Federal Employees Health Benefit Program, would be used by the plans covering those who would be covered under these ERISA plans. What that means is, if it was good enough for Members of Congress and Federal employees, this certainly ought to be good enough for everyone else. Three, a definition that is to be developed through negotiated rulemaking. This option requires the Secretary of Labor to develop a rulemaking committee that will seek public comment to develop a definition of ``medical necessity.'' In other words, State laws will be recognized and respected. Secondly, there will be a definition that is now included as a fee-for-service definition in the current Federal Employees Health Benefit Program. And in the event that a rulemaking process is negotiated through the Department of Labor, the rulemaking committee will seek public comment to develop a definition of what is ``medical necessity.'' The negotiated rulemaking committee, the third item of this three- pronged approach, will consist of at least one individual representing each of the following groups: Health care consumers, small employers, large employers, physicians, hospitals, other health care providers, health insurance issuers, State insurance regulators, health maintenance organizations, third party administrators, the Medicare Program, the Medicaid Program, the Federal Employees Health Benefits Program, the Department of Defense, the Department of Veterans Affairs, and the Agency For Health Care Research and Quality. That is quite a list of individuals for public comment and public input. This committee would have until 1 year after the general effective date of the bill's implementation to propose a rule to the Secretary. The Secretary, then, would be required to publish the rule within 30 days of the receipt. Madam President, our goal is to ensure that all patients have access to all treatment options available under their plans. We need to provide this access without undermining the integrity of the contract between the patient and the provider. Without some standard for a definition on ``medical necessity,'' these objectives would be impossible to obtain. Both parties are entitled to certainty and predictability. This will provide it. Without passage of this amendment, there will be both uncertainty and a lack of predictability and neither party will be benefited. I ask my friends and colleagues to consider this amendment as one that will improve the McCain-Edwards-Kennedy HMO reform bill. I ask for their support.

Mr. NELSON of Nebraska

Mr. NELSON of Nebraska. Mr. President, I would like to express my support for the Elementary and Secondary Education Act. Although my support is not without reservation, I believe that the bill before us today contains much that will ultimately benefit America's schools and the children who attend them. The legislation's intent--increasing student achievement, narrowing the achievement gap among minority and disadvantaged students, strengthening accountability, and increasing local flexibility--are important goals. Commitments in this bill to improve school safety, to improve bilingual education, and to fully fund title I and IDEA were critical factors in my decision to cast an affirmative vote. Were it not for the inclusion of such key components, I would be less inclined to support this bill today. The issue of education itself is non-controversial; the way in which we educate our children, however, is. Because we are trying to define the way in which we can improve education and the way that can best be accomplished, this bill deserves serious debate. Personally, I have always believed that the Federal Government has a role as a junior partner in crafting education policy. The U.S. government in that role, though, should not usurp the State and local governments' power to make education decisions that are more appropriately handled at the State and local level. The line between the Federal Government's role in education and the State's role is a delicate one, and it should be respected. One area where I believe this bill treads dangerously close to crossing that line is with respect to the issue of unfunded mandates. Specifically, as a former governor, I am concerned by the inclusion of language in this bill that requires States to conduct assessments and meet Federal standards of progress under threat of financial penalty, yet refuses to provide the resources local communities need to meet the often expensive requirements. This bill mandates 316 new tests nationwide, but it does not provide the funding to the States to implement them. Such mandates are irresponsible and burdensome for State and local governments, and will force them to short change other priorities or raise local taxes. In my State of Nebraska, rigorous standards and assessments are in place; the additional tests mandated by this legislation are not critical to improving our schools. This issue aside, I am encouraged by the programs and the commitment to education quality improvement included in this legislation. The adoption and inclusion of the Mentoring for Success Act in ESEA is a victory for children throughout the country who need the benefit of a stable and caring role model. Programs like this one, which seek to narrow the gap between the have's and the have-nots, are vital. If no child is truly going to be left behind by our education system, it is imperative that we fund initiatives like this mentoring program, as well as other programs like the President's literary initiative, Reading First. This bill contains these initiatives, and they are one of the reasons why I will support it. Overall, this legislation makes great strides toward improving our educational system. It will help ensure that all children, especially the neediest, will have access to the quality education they deserve. Measures like loan forgiveness for Head Start teachers and efforts to improve teacher quality, will assist in making certain that all children have access not to just any education, but access to a quality education. As I previously indicated, this bill is headed in the right direction, but it is not without flaws. I am hopeful that in the conference report critical funding issues will be addressed. While the initiatives the Senate has approved are well intentioned, they will not be worth the paper they are printed on if we cannot fully fund them. If education is truly a priority for this Administration and for this Congress, the reality of funding levels in this bill must be carefully considered. It is with confidence that I will support this bill, however, in anticipation that the conferees will work together diligently to author a conference report that is sensible, balanced, and fiscally responsible. Our children deserve nothing less; it is Congress' duty to make good on our promises to leave no child behind.

Mr. NELSON of Nebraska

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

Mr. NELSON of Nebraska. Mr. President, I rise to ask the Senate's support for the Mentoring for Success Act, the amendment that is before the Senate today. This amendment concerns the welfare of our Nation's most precious asset, our children. Children comprise only 20 percent of our population, but they are 100 percent of our future. I am hopeful my colleagues will carefully consider their significance. This amendment gives us the opportunity to support our children and the future of our country at the same time. The environment in which many of our children are raised looks nothing like the one in which I and many of my colleagues grew up. Close to 50 percent of our children are raised in single-parent households. In most cases, single parents work long hours. Their energy and resources are stretched thin. While there are many successful single parents, there are some cases where a single parent simply cannot and does not, for a variety of reasons, adequately serve as the role model a child might need. As a consequence, many of these children replace that void with drugs, alcohol, and violence. Other children who may not come from single families are faced with a home life that may be particularly difficult because of an abusive parent or maybe a parent incapacitated due to illness. This amendment is for these children. Of course, it can't fix family problems or bring broken families back together, but it can help change these children's lives and brighten their future. I am proud to say that this amendment is inspired by the success of a mentoring program in my State which was originally started by Congressman Tom Osborne, the sponsor of companion legislation adopted by the House. As many know, before my friend and fellow Nebraskan Tom Osborne became a Congressman this last year, he was coach of the beloved University of Nebraska Huskers football team. This man knows a thing or two about winning strategies and how to implement them, not just on the field but in the community as well. In 1991, he and his wife Nancy began the Team Mates Program in Lincoln, NE, which paired members of the University of Nebraska football team with middle school students. He had such great success with the program that he expanded it across the State of Nebraska in 1998. I was proud to assist him in that effort as Governor at that time, and I joined the Team Mates board of directors so I could continue my involvement with such an effective and important mission. Now Congressman Osborne has taken his experience and turned it into worthwhile legislation. This amendment would authorize $50 million for a new competitive grant program to award local school districts, community-based organizations, or a partnership between the two to find mentoring initiatives. Each State would receive at least one grant under this program. I am pleased to be here today and to continue my support for mentoring programs. Mentoring programs funded by grants made available through this legislation would pair children with role models who could provide stable emotional support, academic assistance, and exposure to positive experiences that they may not otherwise receive. The mentors are not parental replacements. Rather, they are helping hands who offer a glimmer of hope to kids who are forced, through no fault of their own, to contend with tough situations and bleak prospects. Priority would be given to programs that serve children with the greatest need in rural areas, high crime areas, or troubled home or school environments, and only programs that require thorough background screening of participating adults would be eligible to receive funding. Mentoring for Success is intended to provide guidance to children in need, to promote personal and social responsibility, to improve academic achievement, to discourage use of illegal drugs, alcohol, violence, gang involvement, or other harmful behavior, and to encourage children to set goals for themselves, including postsecondary training or education. Young people today are confronted on a daily basis with situations that my generation simply didn't know could exist. I was fortunate enough to be raised in a loving and caring household. My generation needed support, encouragement, and stability. Today our kids need it, too. That is one thing that simply has not changed. Mentors can provide that support. I know it works. It has in Nebraska. I am convinced that Mentoring for Success will prove it will work everywhere. What began as a spark in Nebraska has the potential to become a flame of optimism for at-risk children all across the country. I am proud today to be able to convey that this measure will in fact help our children.

Mr. NELSON of Nebraska. Mr. President, I ask unanimous consent that amendment No. 533 be modified with the changes that are at the desk.

Mr. NELSON of Nebraska

Mr. NELSON of Nebraska. Mr. President, I rise today to ask the Senate's support for the Carnahan-Nelson amendment. As my colleague has stated, it is a simple, straightforward measure that would require the Federal Government to pay 100 percent of the costs of all new federally mandated tests that would be required by the pending bill. In any year that the Government fails to provide funding to the States, the States simply would not have to administer the tests, and the States could not be sanctioned for falling behind schedule in developing their systems of assessment. Six years ago, Congress passed, and the President signed, the Unfunded Mandates Reform Act. The bill passed the Senate by a vote of 98-1. This was cause for celebration among the Nation's Governors. We had been urging Congress for a long time to enact this kind of legislation. I took a great deal of personal satisfaction when the law was signed because as the Governor of Nebraska, I had invested years urging its passage. As Governor, I testified before committees in both the House and the Senate on the problems that were caused by unfunded Federal mandates. I became interested in curbing unfunded Federal mandates the very first year I sat down to work on my new State budget. As the years went by, I often wondered if I had actually been elected Governor of Nebraska or simply branch manager for the Federal Government. I cannot count the number of times that I had to cut my part of the budget, say no to a good project or turn down a group of Nebraskans with good ideas because all my available revenue was tied up complying with yet one more unfunded Federal mandate handed down by Washington. When the bill passed, I breathed a sigh of relief. In the Senate-- also at that time under new leadership--the unfunded Federal mandates bill was designated as S. 1, signifying the priority placed on the legislation. Coincidentally, S. 1 is the designation placed on the bill we are currently considering. Senators from both sides of the aisle at that time praised the unfunded mandates bill. One Senator said: The result of these mandates is that local governments are forced to abandon their own priorities, to offer fewer services to the public, and to ultimately charge higher taxes and utility rates . . . The solution to the problem of unfunded mandates is to require Congress to pay for any mandate it places on State and local governments. Another Senator said: This legislation will increase accountability. There has been a lot of talk about accountability during the current debate on this bill. We are asking teachers, parents, and schools for accountability. We are going to hold States accountable for the money the Federal Government will be spending. But where is the accountability from Congress and the White House for the dollars that States are going to have to spend for the testing requirements of this bill? I commend Senator Jeffords for his efforts to provide at least partial funding for the testing that this bill will require, but I do not believe it will be enough. This bill will require the States to administer 12 different tests for students in grades 3 through 8. It will also require each State to participate in the NAEP test annually in grades 4 and 8, which accounts for 4 more tests. That is a total of 16 tests per year. As we can see from this chart, not all States currently administer tests with that kind of frequency. Fewer than a third of the States administer reading and math tests at all six grade levels each year. Another four States conduct reading and math tests at five of those grade levels, three States at four levels, and nine States at three levels. The remaining 19 States test students annually in reading and math at two or fewer grade levels. If we don't count participation in NAEP, we are requiring States to develop and administer another 216 tests. If we add in NAEP, we are requiring the States to administer 316 tests per year. You get the idea of the magnitude of testing involved in this bill. As the other Senator from Minnesota explained several days ago, if the goal of these tests is to improve education, then you can't give cut-rate tests. An inexpensive, off-the-shelf test will not be able to accurately tell us how well or how poorly our students are doing. Given the stakes involved, States are not going to be able to administer their testing on the cheap. These tests are going to cost the States a great deal of money, and they should. In Nebraska, early in my tenure as Governor, we explored the costs of testing students in four core curriculum subjects. We received an estimate that ranged from $305 million for a basic test, and up to $13 million for one that would meet the standards for a good assessment in a single test. That was almost 10 years ago. Our own experts in Congress, the Congressional Research Service, have said that complete information on the costs associated with student testing is impossible to obtain. The National Governors' Association estimated that these testing requirements could cost States at least $900 million. The National Association of State Boards of Education has estimated that they could cost between, as my colleague from Missouri said, $2.7 and $7 billion, well above the $400 million provided for in the bill. The chart behind me shows the estimated cost to each State. No one can for sure say how much this will cost the States, as the Senator from Maine acknowledged yesterday with her amendment. I am willing to wager that the roughly $400 million per year that is in the bill, despite the best efforts of the Senator from Vermont, simply will not be enough. I understand that the administration has also circulated some numbers that show that the costs might be less than what is contained in the bill. If that is the case, I will be pleased. But if it isn't the case, I hope the Senate will in fact adopt the amendment Senator Carnahan and I have proposed. Our amendment simply requires the Federal Government to pay 100 percent of the cost of all new federally mandated tests. If 100 percent of the cost is less than what is currently in the bill, then perhaps we can use the leftovers to hire and train more teachers, which many think might be a good answer to the problem in any event. If 100 percent of the cost is more than the $400 million in the bill, then we have a real dilemma. As the bill now stands, States will be responsible for every additional penny that these tests cost. As we have seen, potential costs can be very high. In my State of Nebraska right now, there is not a lot of extra money available. I am sure there is not a lot of money available in the State of Missouri or the State of Florida, but there is no shortage of critical needs in the education field in every State. We are facing a teacher shortage in Nebraska that is of crisis proportions. Forty percent of our teachers, more than 8,000 of them, are going to be eligible to retire in the next 10 years. Our State won't be able to replace the excellent teachers who are retiring if too much of our State's money for education will be used to give tests instead of raising teacher's pay and other educational priorities. Nebraska won't be able to meet these critical needs because the extra money simply isn't there and won't be there. The only alternative in my State may be to shift the cost to the taxpayers through higher property taxes. I am here to tell my colleagues that isn't acceptable in Nebraska. In talking with some of my colleagues about this amendment, I have heard some additional concerns that I will address. I would like to be clear that neither I nor the Senator from Missouri oppose testing or setting high standards for students. While I was Governor, I severed as chairman of the National Education Goals Panel, which is part of the Goals 2000 effort, which called for setting high and measurable standards for students. I led in the State, despite some determined opposition, for developing strong educational standards in Nebraska. Nor do we have any desire to weaken the accountability provisions of this bill. Our amendment doesn't do that. If our schools aren't preparing every child to succeed in the 21st century, then we are obligated to fix them. I have no doubt that Nebraska's teachers, students, and schools can compete with any of those in any State in our Nation. This amendment would only prevent the Federal Government from sanctioning a State for falling behind schedule if it doesn't receive full funding for the cost of testing. I have also been told that some Senators are worried about writing a blank Federal check to the States. They are concerned about a race to the top in terms of cost. As the bill is now written, the Senate doesn't seem to be concerned about writing a blank check on each of the State's bank accounts without their permission. I see the irony of that, and I hope others do, too. But to address the concerns of my colleagues, we have added provisions that require the Secretary of Education, as my colleague has pointed out, to provide a report every year to both the authorizing and appropriating committees that details the costs of testing. If States are somehow gaming the system, we will know about it the first time it happens, and then we can correct it if it is necessary. As I said at the beginning of my remarks, this is a simple, straightforward amendment. It requires the Federal Government to pay the full cost of the tests mandated by the bill. Unless we commit to do so, States will have to sacrifice funding for their own identified priorities or be forced to once again shift the cost to taxpayers in the form of higher property taxes. I opened my remarks with a quote from a Senator who was describing the Unfunded Mandates Reform Act that this body passed 6 years ago. I think it might be worth repeating, as I come to a close. The Senator said: The result of these mandates is that local governments are forced to abandon their own priorities, to offer fewer services to the public, and to ultimately charge higher taxes and utility rates . . . The solution to the problem of unfunded mandates is to require Congress to pay for any mandate it places on State and local governments. I do not think I could say it better, and I may not have said it better today. Mr. President, I ask for the yeas and nays.

Mr. NELSON of Nebraska

Mr. NELSON of Nebraska. Mr. President, this circuit breaker does not specify any action to be taken if the midcourse review legislation is not enacted into law. What it does is it simply permits any Senator to bring up a privileged motion that deals with spending or tax cuts but exempts Social Security, Medicare, and COLA's from being subject to any potential spending cuts in the midcourse correction. I hope my colleagues will support this amendment. I ask they do so.

Mr. NELSON of Nebraska. Mr. President, I call up my amendment No. 769 and ask unanimous consent to modify it.

Mr. NELSON of Nebraska. I ask unanimous consent reading of the amendment be dispensed with.

Mr. NELSON of Nebraska

Mr. NELSON of Nebraska. Mr. President, I would like to express my support for the tax cut bill. Simply stated, the time has come for a sensible tax cut. The American people deserve it; the budget can support it. Now, it's time for Congress to authorize it. I sincerely believe this legislation will serve as an efficient delivery vehicle for responsible tax relief that will benefit all Americans. While I support this tax cut plan for several reasons, the most concise justification for my position is that the $1.35 trillion in tax cuts over 11 years provided in the bill will cut taxes without cutting hope. Since the beginning of this debate, I have repeatedly and consistently voiced my support for a substantial tax cut, as long as it would not interfere with our ability to fund our domestic budgetary priorities. I am pleased that this tax cut plan will not sap our resources for important obligations like agriculture and defense. It is reassuring to know that implementation of this plan will not be at the expense of our critical responsibilities. This legislation will provide across-the-board tax relief for the people of Nebraska, as well as all Americans, without interfering with Social Security and Medicare or hampering our efforts to pay down the national debt. Clearly, the cornerstone of this bill is responsible tax relief. Perhaps even more significant in this bill's eleven-year, $1.35 billion tax cut package is the inclusion of a $100 billion up-front stimulus package. This two-year economic stimulus package will have an immediate impact on our economy, which has been showing all the symptoms of a slow-down. Such tangible, instant relief is precisely what is needed to counteract the threat of an economic recession. While the reduction of personal income tax rates and the economic stimulus package are the highlights of this bill, I would like to emphasize the fact that there are several other components of this legislation contributing to its overall efficacy. This bill includes raising the exemption for estate tax relief followed by a gradual repeal of the estate tax, a doubling of the childcare tax credit by 2010, the dissolution of the so-called marriage penalty tax, and pension reform that will allow larger contributions to IRAs and 401(k) plans. I know Nebraskans have supported these initiatives for quite some time, so it brings me great satisfaction to know that they will soon be implemented. I commend Senators Grassley and Baucus for their efforts to achieve substantial bipartisan support for this tax cut bill. Their work has resulted in legislation that skillfully and responsibly addresses many of the major points of contention among the members of the Senate. It is in that same spirit of bipartisanship that I hope the Conference Report will be crafted. If the Conference Committee will follow the Senate Finance Committee's lead and work to build bipartisan support for the Conference Report, I am confident that the American people will finally receive the tax relief they deserve.