Jim Ramstad

Mr. RAMSTAD

Mr. RAMSTAD. Mr. Speaker, I rise today to introduce legislation to greatly improve the Medicare coverage decision-making process. While Medicare law provides for the coverage of various categories of benefits, it does not specify a list of covered technologies and services. That's where the Health Care Financing Administration (HCFA) and its coverage process come in to play. Medical technology and innovation play an important role in this critical health care program for America's seniors. As new life- enhancing and life-saving technologies and procedures are developed, and more Americans learn about them, the process for making these coverage decisions becomes increasingly important. HCFA recently published its new proposal to completely overhaul the decision-making process, and I applaud the hard work and time HCFA staff put into developing this new process. HCFA has been attempting to make these much needed changes for over a decade, and it was Dr. Jeffrey Kang's leadership and thoughtful approach at HCFA that finally brought the effort to fruition. HCFA's proposal is a good first step in making the coverage process transparent, timely and understandable. However, I believe there are a few additional issues that need to be addressed. In addition to addressing the issue of appeals--which my good friend and Health Subcommittee Chairman Thomas is working on--and timely payment and coding updates--which I outlined in my other bill, H.R. 2030, the Medicare Patient Access to Technology Act--we also need to ensure the process encourages HCFA to work in a collaborative way with those petitioning for coverage. For example, current Food and Drug Administration law provides for early meetings and a written agreement between manufacturers and the FDA on the studies to be done for pre-market approvals. Both parties have found this to be a beneficial tool because both know what is required. In addition, I am told FDA staff has found it improves their efficiency when agreed-upon data is submitted for review. I strongly believe HCFA's coverage process should include a similar step. HCFA currently allows stakeholders to come in and informally discuss the required data, but no written agreement is ever reached. The importance of this agreement cannot be understated. Without an agreement, HCFA is not required to accept the data given to them, even when HCFA initially suggested it at the early meeting. HCFA's ability to continuously change what constitutes appropriate data has left many companies in my district stuck in an endless loop of data collection. In fact, one constituent company of mine, Empi, has been petitioning for a coverage decision for over 7 years! Given the handful of national coverage decisions that are announced each year, I believe HCFA's informal discussions could be transformed into more formalized collaborative meetings at which binding agreements could be written. That's why I am introducing this legislation today to require HCFA to meet with stakeholders and develop an agreement on the required data, should the stakeholders request to do so. Just as with the FDA process, there are exceptions in the legislation to give HCFA flexibility for changing the agreement should it become aware of a new, substantial scientific issue that would impact its ability to adequately review the technology or procedure. In addition, should HCFA wish to change the agreement for other reasons, it can do so with the written consent of the stakeholders. These meetings and agreements are practical and beneficial additions to the coverage decision-making process. I urge my colleagues to cosponsor this legislation to further improve this important process and ensure Medicare beneficiaries have timely access to life-saving and life-enhancing medical innovations.

Mr. RAMSTAD

Mr. RAMSTAD. Mr. Chairman, I move to strike the requisite number of words. Mr. Chairman, I rise in support of the substitute amendment offered by my colleague, the gentleman from Arkansas (Mr. Hutchinson). Let me say first that I have the deepest respect and admiration for the author of the underlying bill, the gentleman from Illinois (Chairman Hyde). During my 4 years on the Committee on the Judiciary, I saw firsthand his absolute integrity and effective leadership, and as I have said hundreds of times before, nobody in this body represents more integrity or greater character than our beloved gentleman from Illinois (Chairman Hyde). However, that does not mean he is always right. As chair of the House Law Enforcement Caucus, I have serious concerns about the effect that the Civil Asset Forfeiture Reform Act would have on the law enforcement community's antidrug efforts. As Hennepin County Sheriff Pat McGowan, Hennapin County in Minnesota, in my district, Sheriff Pat McGowan told me recently, this legislation would absolutely gut the most important tool of law enforcement in the war against drugs. Make no mistake about it, this forfeiture law as it currently exists is the most important tool of law enforcement in fighting the war on drugs on the supply side. The clear and convincing standard would deprive law enforcement officers of a crucial deterrent, as was explained to me by Sheriff McGowan and others, while the substantial hardship exemption in the underlying bill would let drug dealers hide their assets before trial and allow them to continue dealing drugs pending trial. Also, frivolous claims would be encouraged by this legislation, and would further damage enforcement of drug laws. According to many law enforcement officers with whom I have spoken about this legislation, the so-called buy money to enforce drug laws would essentially dry up, because much if not most of the buy money comes from forfeiture of these assets. I think Congress needs to listen to the men and women of the Fraternal Order of Police who put their lives on the line every day in fighting the drug war. We need to help the police and not hurt them by adopting the preponderance of the evidence standard of proof in the Hutchinson amendment, which is eminently reasonable, and eliminating some of the other extreme restrictions on law enforcement in the underlying bill. As a former Criminal Justice Act attorney, Mr. Speaker, a former adjunct professor of civil rights and liberties, certainly, like every Member of this body, I support individual rights under our Bill of Rights. However, the current law has consistently been upheld as constitutional. Furthermore, Congress should not aid and abet drug dealers so they can profit from their illegal actions by weakening this important law. Yes, there have been some abuses under current law. We all know that. But several unfortunate anecdotal experiences do not justify legislation that would turn back the clock in the war against drugs. Let us be smarter than that. Let us support our police officers and other drug enforcement officers on the front lines every day in this battle. Support the Hutchinson amendment, that represents the original compromise. Let us not tie the hands of law enforcement. Let us not make their difficult and dangerous jobs even harder. Vote for the Hutchinson substitute.

Mr. RAMSTAD. I yield to the gentleman from Illinois.

Mr. RAMSTAD. Mr. Chairman, reclaiming whatever time might remain, the current law, I am sure the gentleman will agree, has been upheld consistently as constitutional and not violative of the First, Fourth, Fifth, Sixth, Eighth or Fourteenth Amendments, any of the amendments in the Bill of Rights that give us our precious civil rights and liberties. Virtually every police officer with whom I have spoken, both in Minnesota and nationally, as well as FBI Director Freeh, have stressed the urgency of retaining present law here. That is what I mean by weakening law enforcement's efforts by tying their hands. Let us not do that. Let us accept the Hutchinson amendment.

Mr. RAMSTAD

Mr. RAMSTAD. Mr. Speaker, every day politicians talk about the goal of a drug-free America. Mr. Speaker, let us get real. We will never even come close to a drug-free America until we knock down the barriers to chemical dependency treatment for the 26 million Americans presently addicted to drugs and/or alcohol. That is right, Mr. Speaker. Twenty- six million American alcoholics and addicts today. Mr. Speaker, 150,000 people in America died last year from drug and alcohol addiction. In economic terms, alcohol and drug addiction cost the American people $246 billion last year alone. That is with a B, $246 billion. American taxpayers paid over $150 billion for drug- related criminal and medical costs alone. That is more than the American taxpayers spent on education, transportation, agriculture, energy, space, and foreign aid combined; more than in all of those areas combined the American taxpayers spent for drug-related criminal and medical costs. According to the Health Insurance Association of America, each delivery of a new baby that is complicated by chemical addiction results in an expenditure of $48,000 to $150,000 in maternity care, physician's fees, and hospital charges. We also know, Mr. Speaker, that 65 percent of emergency room visits are alcohol or drug-related. The National Center on Addiction and Substance Abuse found that 80 percent of the 1.7 million men and women in prisons today in this country are there because of alcohol and/or drug addiction. Another recent study showed, Mr. Speaker, that 85 percent of child abuse cases involve a parent who abuses drugs and/or alcohol; 85 percent of child abuse cases are related to alcohol and drug abuse. Seventy percent of all people arrested in this country test positive for drugs; two-thirds of all homicides are drug-related. Mr. Speaker, I ask the question: how much evidence does Congress need that we have a national epidemic of addiction, an epidemic crying out for a solution that works; not more cheap political rhetoric, not more simplistic quick fixes that obviously are not working. Mr. Speaker, we must get to the route cause of addiction and treat it like any other disease. The American Medical Association in 1956 told Congress and the American people that alcoholism and drug addiction are a disease that requires treatment to recover. Yet, today in America, only 2 percent of the 16 million alcoholics and addicts covered by health plans are able to receive adequate treatment; only 2 percent of those with insurance for chemical dependency treatment are able to get effective treatment. That is because of discriminatory caps, artificially high deductibles and copayments, limited treatment stays, as well as other restrictions on chemical dependency treatment that are not there for other diseases. If we are really serious about reducing illegal drug use in America, we must address the disease of addiction by putting chemical dependency treatment on par with treatment for other diseases. Providing equal access to chemical dependency treatment is not only the prescribed medical approach, it is also the cost-effective thing to do; it is also the cost-effective approach. We have all the empirical data, including actuarial studies, to prove that parity for chemical dependency treatment will save billions of dollars nationally, while not raising premiums more than one-half of 1 percent in the worst case scenario. It is well documented that every dollar spent for chemical dependency treatment saves $7 in health care costs, criminal justice costs, and lost productivity from job absenteeism, injuries, and subpar work performance. A number of studies have shown that health care costs alone are 100 percent higher for untreated alcoholics and addicts than for people who have gone through treatment; 100 percent higher for those who go untreated. Mr. Speaker, as a recovering alcoholic myself, I know firsthand the value of treatment, and as a grateful recovering alcoholic for 18 years, I am absolutely alarmed by the dwindling access to treatment for people who need it. In fact, over the last decade in America, 50 percent of the treatment beds for adults are gone. Even more alarming, 60 percent of the treatment beds for adolescents are gone. Mr. Speaker, we must act now to reverse this alarming trend. We must act now to provide greater access to chemical dependency treatment. That is why I have introduced the Harold Hughes, Bill Emerson Substance Abuse Treatment Parity Act named for two departed colleagues, one Democrat, one Republican, who did so much in this field of addiction; so much to raise public awareness, so much to help people in need, people who are suffering the ravages of drug and alcohol abuse. This is the same bill, Mr. Speaker, by the way, that last year had the broad bipartisan support of 95 House cosponsors. This legislation would provide access to treatment by prohibiting discrimination against the disease of addiction. The bill prohibits discriminatory caps, prohibits higher deductibles and copayments that exist for treatment of other diseases. It also prohibits limited treatment stays and other restrictions on chemical dependency treatment that are different from other diseases. All we are saying, Mr. Speaker, is treat chemical addiction like other diseases. Mr. Speaker, this is not another mandate. It does not require any health plan which does not already cover chemical dependency treatment to provide such coverage. It merely says that those which offer chemical dependency coverage cannot discriminate, cannot treat chemical dependency different from coverage for medical or surgical services for other diseases. In addition, the legislation waives the parity for substance abuse treatment if premiums increase by more than 1 percent, and it also exempts small businesses with 50 or fewer employees. Mr. Speaker, it is truly the time to knock down the barriers to chemical dependency treatment. It is time to end discrimination against people with addiction. It is time to provide access to treatment, to deal with America's number 1 public health and public safety problem. We can deal with this epidemic now or be forced to deal with it later. But, this problem, this epidemic will only get worse if we continue to allow discrimination against the disease of addiction. As last year's television documentary by Bill Moyers pointed out, medical experts and treatment professionals agree that providing access to chemical dependency treatment is the only way to combat addiction in America. We can build all the fences on our borders, we can build all of the prison cells that money can buy, we can hire thousands of new border guards, thousands of new drug enforcement officers, but simply dealing with the supply side of this problem will never solve it. That is because, Mr. Speaker, our Nation's supply-side emphasis does not adequately attack the underlying problem. The problem is more than illegal drugs coming into our Nation, coming across our borders. The problem is more than that. The problem is the addiction that causes people to crave and demand those drugs. That is the problem, the addiction that causes people to crave drugs and to demand those drugs. So we need more than simply tough enforcement and interdiction. We need extensive education, and we need access to treatment. Drug czar Barry McCaffrey understands. He said recently, and I am quoting, ``Chemical dependency treatment is more effective than cancer treatment, and it is cheaper.'' General McCaffrey also said, ``We need to redouble our efforts to ensure that quality treatment is available.'' Mr. Speaker, the director of our National Office of Drug Policy is right. All the studies back him up. Treatment does work, and treatment is cost-effective. Last September the first national study of chemical dependency treatment results confirmed that illegal drug and alcohol use are substantially reduced following treatment. This study by the Substance Abuse and Mental Health Services Administration shows that treatment rebuilds lives, puts families back together, and restores substance abusers to productivity. According to Dr. Ronald Smith, United States Navy Captain in the Medical Corps, and also Dr. Smith was formerly vice chairman of psychiatry at the National Naval Medical Center at Bethesda, Dr. Smith says ``The U.S. Navy substance abuse program works. It has an overall recovery rate of 75 percent.'' The Journal of the American Medical Association on April 15 of last year reported that a major review of more than 600 research articles and original data conclusively showed that addiction conforms to the common expectations for chronic illness, and addiction treatment has outcomes comparable to other chronic conditions, outcomes comparable to other chronic conditions. The same study by the American Medical Association said that ``Relapse rates for treatment for drug and alcohol addiction are 40 percent,'' relapse rates. That compares favorably with those for three other chronic disorders: adult onset diabetes, 50 percent; hypertension, 30 percent; and adult asthma, 30 percent. A March 1998 GAO report also surveyed the various studies on the effectiveness of chemical dependency treatment and concluded that treatment is effective and beneficial in the majority of cases. A number of State studies have also been done that showed treatment is cost-effective and good preventative medicine. A Minnesota study, a study in my home State, Mr. Speaker, extensively evaluated the effectiveness of its treatment programs and found that Minnesota saves $22 million in annual health care costs because of our treatment programs, $22 million in the State of Minnesota alone saved because of treatment programs. A California study reported a 17 percent improvement in other health conditions following treatment, and dramatic decreases in hospitalization. A New Jersey study by Rutgers University found that untreated alcoholics incur general health care costs 100 percent higher than those like me who have received treatment. So the cost savings and the effectiveness of chemical dependency treatment are well documented. But putting the huge cost savings aside for a minute, Mr. Speaker, what will treatment parity cost? That is a question that is asked by a number of people. First, there is no cost to the Federal budget. Parity does not apply to the Federal Employees Health Benefit Plan, does not apply to Medicare or Medicaid. According to a national research study that based projected costs on data from States which already have chemical dependency treatment parity, the average premium increase due to full parity it would be two-tenths of 1 percent, that is from a Mathematica Policy Research study in March of 1998, a two-tenths of 1 percent increase in premiums for policyholders. A recently published Rand study by the Rand Corporation found that removing an annual limit of $10,000 a year on substance abuse care will increase insurance payments by 6 cents per member per year, 6 cents per member per year. Removing a limit of $1,000 increases payments by only $3.40 a year, or 29 cents a month. The worst case scenario we could find, the study that showed the worst case scenario, estimated the cost would be five-tenths of 1 percent increase in premiums per month, which translates to 66 cents a month per insured. So the bottom line, Mr. Speaker, for the cost of a cup of coffee per month we can treat 16 million Americans addicted to drugs and/or alcohol today, for the cost of a cup of coffee per month to the 113 million Americans covered by health plans. At the same time, Mr. Speaker, the American people would realize $5.4 billion in cost savings from treatment parity, according to a recent California study. So we could treat these 16 million American alcoholics and addicts who are addicted today, who are hooked today on alcohol and/or drugs. For the price of a cup of coffee we can treat 16 million Americans, and we can save in the process $5.4 billion to the American taxpayers. United States companies that provide treatment have already achieved substantial savings. Chevron, for example, reports saving $10 for every $1 it spends on treatment. GPU saves $6 for every $1 spent. United Airlines reports a $17 return, a $17 return for every dollar spent on treatment by United Airlines. Mr. Speaker, no dollar value can quantify the impact that greater access to treatment will have on people who are addicted and their families. No dollar value can measure the impact on spouses, children, other family members who have been affected by the ravages of addiction. Broken families, shattered lives, broken dreams, ruined careers, messed up kids, children on Ritalin, divorces, I could go on and on with the human impact of the ravages of this epidemic that has swept our Nation. How can we put a dollar cost on those horrible factors, those horrible results of addiction? Mr. Speaker, this is not just another public policy issue. This is a life or death issue for 16 million Americans and their families, 16 million Americans who are chemically dependent covered by health insurance but unable to access treatment. We know one thing for sure, Mr. Speaker. Treatment taught me that addiction, if not treated, is fatal. This is a fatal disease if not treated. Last year 95 House Members from both sides came together in a bipartisan way to support and cosponsor this substance abuse treatment parity legislation. This year let us knock down the barriers to treatment for 16 million Americans. This year let us do the right thing and the cost-effective thing and provide access to treatment. This year let us pass substance abuse treatment parity legislation to deal with the epidemic of addiction in America. Mr. Speaker, the American people cannot afford to wait any longer. I urge all Members to cosponsor H.R. 1977, the Substance Abuse Treatment Parity Act of 1999. I ask my fellow recovering alcoholics and addicts, all 2 million of them, to write their Members of Congress, their Member of the House, their United States Senators, and urge them to cosponsor this treatment parity bill, H.R. 1977, the Substance Abuse Treatment Parity Act. That is H.R. 1977. We need to mobilize the recovering community, we need to mobilize concerned people throughout America to pass this life and death legislation. Finally, Mr. Speaker, I ask the loved ones of those still suffering the ravages of addiction and chemically dependent people themselves who are unable to access treatment to contact their United States Senators tomorrow, contact their United States representatives tomorrow, and urge them to cosponsor H.R. 1977, 1977, the Substance Abuse Treatment Parity Act. Working together, Mr. Speaker, as Americans, as Members of Congress, working together we will knock down those barriers to treatment. We will provide access to treatment for those people suffering the ravages of addiction. We will, Mr. Speaker, get this done, but only only if the American people demand it. I hope and pray that the responses are there and that Congress wakes up to the need to deal with addiction, and this year passes the Substance Abuse Treatment Parity Act.

Mr. RAMSTAD

Mr. RAMSTAD. Mr. Speaker, due to inclement weather, which caused the diversion of my flight, I was not present for rollcall vote No. 204. If I had been present, I would have voted ``aye.''

Mr. RAMSTAD

Mr. RAMSTAD. Mr. Speaker, new advances in medical technology are improving the lives of millions of Americans every day: New implantable devices are restoring and repairing ailing organs. New diagnostics are permitting rapid detection of life-threatening diseases and allowing physicians to peer inside the human body without surgery. Miniature surgical devices are allowing patients to recover more quickly and new technologies are empowering patients to monitor and test their conditions from home and reduce or eliminate pain. Yet many of these life-saving and life-enhancing technologies remain unavailable to the people who need them most, America's nearly 40 million Medicare beneficiaries. This is because of the complex, interwoven systems that Medicare uses to evaluate, approve and pay for new medical technologies. That's why I am introducing ``The Medicare Patient Access to Technology Act'' to make targeted adjustments in the technical methods and systems that Medicare uses to adopt and pay for new medical products. By correcting and coordinating the payment levels and identification codes, the bill will improve access to needed therapies for millions of Medicare patients, both today and in the future. As you know, Mr. Speaker, the Food and Drug Administration (FDA) reviews medical technologies to ensure that they are ``safe and effective.'' After passing through FDA, such technologies must also be deemed ``reasonable and necessary'' by HCFA for them to be integrated into the portfolio of services that Medicare makes available to its beneficiaries. After being approved for coverage, technologies must receive a ``procedure code,'' a four or five digit identifying code that health care providers use in submitting claims to payers. Finally, Medicare must set a payment level for each technology and treatment through another reimbursement system designed for reimbursing hospitals, physicians, skilled nursing facilities and other care providers. Unfortunately, a problem at any of these stages can seriously delay a product from reaching Medicare patients. For example, Mr. Speaker: Exogen, Inc., a small company that developed an ultrasound device for healing bone fractures, has encountered 4 years of delays in getting Medicare coverage. Oddly enough, the product is currently be reimbursed by more than 800 private insurers and health plans, but not by Medicare. The Cordis Corporation, a division of Johnson & Johnson, encountered significant problems in obtaining appropriate Medicare coding and payment for coronary stents, which are stainless steel tubes used to treat narrowing of the coronary arteries. The company faced challenges in obtaining a unique code for the stent procedure from HCFA, and once the new code was assigned, Medicare took several more years to place the device in the appropriate payment category. Sadly, the reason for the delay was Medicare's database was only a partial data set and HCFA's precedent did not allow it to use sample data in determining the hospital costs of providing the stent. A manufacturer of a cochlear ear implant halted active marketing of one model and stopped research on another because of inadequate Medicare reimbursements. According to an article that appeared in The New England Journal of Medicine at the time, payment for the device remained well below its average cost, causing hospitals to ``ration the availability of the device to Medicare patients because of the financial losses involved. Eventually, so few patients received the implant that the manufacturer discontinued its production.'' (Nancy M. Kane, D.B.A., and Paul D. Manoukian, M.D., M.P.H., ``The Effect of the Medicare Prospective Payment System on the Adoption of New Technology,'' The New England Journal of Medicine, November 16, 1989, pp. 1378 1382.) The most distressing problem in all of these cases, as in many others just like them, is that Medicare patients are being denied access to beneficial therapies. I am pleased that HCFA is attempting to address the problems associated with its process for making national coverage decisions for new technologies. However, unless the shortcomings in the coding and payment systems are corrected, HCFA will not fully achieve its ultimate goal of improving Medicare's health care delivery system. Several distinct issues need to be addressed: Medicare's system for creating and assigning procedure codes to medical technologies is cumbersome and slow. Medicare's methods of updating Medicare payment levels and payment groups to accommodate changes in medical technology increase the risk that Medicare will lag behind new advances in medical technology. Medicare's refusal to use data that are developed outside of the Medicare program blinds the program to useful insights about the costs, charges and outcomes of medical technologies. To address these issues, ``The Patient Access to Medical Technology Act of 1999'' would: 1. Adjust Medicare payment levels and payment categories at least annually to reflect changes in medical practice and technology. 2. Use valid external sources of information to update payment categories if Medicare's data are limited or not yet available. More specifically, the bill directs HCFA to use a valid, statistically representative sample and also to draw on external sources of data when its own dataset is inadequate. It directs HCFA to consider statistically representative data from such sources as private insurers, manufacturers, suppliers and other non-Medicare entities. 3. Update national procedure codes (HCPCs Level II) more frequently to reduce delays and timelags. Without an accurate identifying code, technologies and procedures cannot be reimbursed appropriately by Medicare. It can take HCFA up to 18 months to approve a new code because of the way the agency structures its calendar for making such changes. This bill would make the process more efficient by eliminating the single annual deadline for applications and permitting such requests to be accepted on a rolling, quarterly basis. 4. Continue to use local procedure codes to ensure availability of the most recent advances in medical technology. Most coverage decisions are made at the local level by local contractors, which use the ``HCPCS Level III Codes'' to describe new technologies that have not yet been incorporated into the national coding process. HCFA has proposed eliminating these useful codes, but this bill would require HCFA to maintain this effective local system. 5. Establish an advisory committee on Medicare coding and payment to ensure that HCFA's coding and payment systems are open, prompt and functioning properly. This panel would complement HCFA's newly formed Medicare Coverage Advisory Committee. Mr. Speaker, this bill will correct a number of complex but significant problems that currently plague HCFA's coverage, coding and payment systems. Most importantly, it will help ensure that Medicare beneficiaries have timely access to life-enhancing and life-saving medical advances. Mr. Speaker, I urge my colleagues to support this important legislation.

Mr. RAMSTAD

Mr. RAMSTAD. Mr. Speaker, as a strong supporter of home- and community-based services for the elderly and individuals with disabilities, I rise to re-introduce legislation similar to that which I sponsored in the 104th and 105th Congresses to extend the demonstration authority under the Medicare program for Community Nursing Organization (CNO) projects. CNO projects serve Medicare beneficiaries in home- and community- based settings under contracts that provide a fixed, monthly capitation payment for each beneficiary who elects to enroll. The benefits include not only Medicare-covered home care and medical equipment and supplies, but other services not presently covered by traditional Medicare, including patient education, case management and health assessments. CNOs are able to offer extra benefits without increasing Medicare costs because of their emphasis on primary and preventative care and their coordinated management of the patient's care. The current CNO demonstration program, which was authorized by Congress in 1987 and extended for 2 years in the Balanced Budget Act of 1997, involves more than 6,000 Medicare beneficiaries in Arizona, Illinois, Minnesota, and New York. It is designed to determine the practicality of prepaid community nursing as a means to improve home health care and reduce the need for costly institutional care for Medicare beneficiaries. To date, the projects have been effective in collecting valuable data to determine whether the combination of capitated payments and nurse- case management will promote timely and appropriate use of community nursing and ambulatory care services and reduce the use of costly acute care services. Authority for these effective programs is now set to expire on December 31, 1999. Mr. Speaker, while I am glad Congress extended the demonstration authority for the CNO projects last session, I am disappointed that the Health Care Financing Administration is so anxious to terminate this important and effective program. In 1996, HCFA extended the demonstration for one year to allow them to better evaluate the costs or savings of the services available under the program, learn more about the benefits or barriers of a partially capitated program for post-acute care, review Medicare payments for out-of-plan services covered in a capitation rate, and provide greater opportunity for beneficiaries to participate in these programs. Frankly, in order to do all this analysis of the program, we need more time to evaluate the extensive data that has been collected. We should not let the program die as the data is reviewed. We need to act now to extend this demonstration authority for another three years. This experiment provides an important example of how coordinated care can provide additional benefits without increasing Medicare costs. For Medicare enrollees, extra benefits include expanded coverage for physical and occupational therapy, health education, routine assessments and case management services--all for an average monthly capitation rate of about $89. In my home State of Minnesota, the Health Seniors Project is a CNO serving over 1,600 enrollees in four sites, two of which are urban and two rural. These demonstrations should also be extended in order to ensure a full and fair test of the CNO managed care concept. These demonstrations are consistent with our efforts to introduce a wider range of managed care options for Medicare beneficiaries. I believe we need more time to evaluate the impact of CNOs on patient outcomes and to assess their capacity for operating under fixed budgets. Mr. Speaker, it is important to recognize that the extension of this demonstration will not increase Medicare expenditures for care. CNOs actually save Medicare dollars by providing better and more accessible care in home and community settings, allowing beneficiaries to avoid unnecessary hospitalizations and nursing home admissions. By demonstrating what a primary care oriented nursing practice can accomplish with enrollees who are elderly or disabled, CNOs are helping show us how to increase benefits, save scarce dollars and improve the quality of life for patients. Mr. Speaker, I urge my colleagues to consider this bill carefully and join me in seeking to extend these cost-savings and health care- enhancing CNO demonstrations for another three years.

Mr. RAMSTAD

Mr. RAMSTAD. Mr. Speaker, every day, politicians talk about the goal of a ``drug-free America.'' Mr. Speaker, let's get real! We will never even come close to a drug- free America until we knock down the barriers to chemical dependency treatment for the 26 million American people presently addicted to drugs and/or alcohol. That's right, Mr. Speaker. 26 million alcoholics and addicts in the United States today. 150,000 Americans died last year from drug and alcohol addiction. Alcohol and drug addiction, in economic terms, cost the American people $246 billion last year. American taxpayers paid over $150 billion for drug-related criminal and medical costs alone in 1997--more than they spent on education, transportation, agriculture, energy, space and foreign aid combined. According to the Health Insurance Association of America, each delivery of a new child that is complicated by chemical addiction results in an expenditure of $48,000 to $150,000 in maternity care, physicians' fees and hospital charges. We also know that 65 percent of emergency room visits are drug/alcohol related. The National Center on Addiction and Substance Abuse found that 80 percent of the 1.7 million prisoners in America are behind bars because of drugs and/or alcohol addiction. Another recent study showed that 85 percent of child abuse cases involve a parent who abuses alcohol or other drugs. 70 percent of all people arrested test positive for drugs. Two-thirds of all murders are drug-related. Mr. Speaker, how much evidence does Congress need that we have a national epidemic of addiction? An epidemic crying out for a solution that works. Not more cheap political rhetoric. Not more simplistic, quick fixes that obviously are not working. Mr. Speaker, we must get to the root cause of addiction and treat it like other diseases. The American Medical Association told Congress and the nation in 1956 that alcoholism and drug addiction are a disease that requires treatment to recover. Yet today in America only 2 percent of the 16 million alcoholics and addicts covered by health plans are able to receive adequate treatment. That's right. Only 2 percent of alcoholics and addicts covered by health insurance plans are receiving effective treatment for their chemical dependency, notwithstanding the purported ``coverage'' of treatment by their health plans. That's because of discriminatory caps, artificially high deductibles and copayments, limited treatment stays as well as other restrictions on chemical dependency treatment that are different from other diseases. If we are really serious about reducing illegal drug use in America, we must address the disease of addiction by putting chemical dependency treatment on par with treatment for other diseases. Providing equal access to chemical dependency treatment is not only the prescribed medical approach; it's also the cost-effective approach. We have all the empirical data, including actuarial studies, to prove that parity for chemical dependency treatment will save billions of dollars nationally while not raising premiums more than one-half of one percent, in the worst case scenario! It's well-documented that every dollar spent for treatment saves $7 in health care costs, criminal justice costs and lost productivity from job absenteeism, injuries and sub-par work performance. A number of studies have shown that health care costs, alone, are 100 percent higher for untreated alcoholics and addicts compared to recovering people who have received treatment. Mr. Speaker, as a recovering alcoholic myself, I know firsthand the value of treatment. As a recovering person of almost 18 years, I am absolutely alarmed by the dwindling access to treatment for people who need it. Over half of the treatment beds are gone that were available 10 years ago. Even more alarming, 60 percent of the adolescent treatment beds are gone. Mr. Speaker, we must act now to reverse this alarming trend. We must act now to provide greater access to chemical dependency treatment. That's why today I am introducing the Harold Hughes, Bill Emerson Substance Abuse Treatment Parity Act--the same bill that had the broad, bipartisan support last year of 95 cosponsors. This legislation would provide access to treatment by prohibiting discrimination against the disease of addiction. The bill prohibits discriminatory caps, higher deductibles and copayments, limited treatment stays and other restrictions on chemical dependency treatment that are different from other diseases. This is not another mandate because it does not require any health plan which does not already cover chemical dependency treatment to provide such coverage. It merely says those which offer chemical dependency coverage cannot treat it differently from coverage for medical or surgical services for other diseases. In addition, the legislation waives the parity for substance abuse treatment if premiums increase by more than 1 percent and exempts small businesses with fewer than 50 employees. Mr. Speaker, it's time to knock down the barriers to chemical dependency treatment. It's time to end the discrimination against people with addiction. It's time to provide access to treatment to deal with America's No. 1 public health and public safety problem. We can deal with this epidemic now or deal with it later. But it will only get worse if we continue to allow discrimination against the disease of addiction. As last year's television documentary by Bill Moyers pointed out, medical experts and treatment professionals agree that providing access to chemical dependency treatment is the only way to combat addiction in America. We can build all the fences on our borders and all the prison cells that money can buy. We can hire thousands of new border guards and drug enforcement officers. But simply dealing with the supply side of this problem will never solve it. That's because our nation's supply side emphasis does not adequately attack the underlying problem. The problem is more than illegal drugs coming into our country; the problem is the addiction that causes people to crave and demand those drugs. We need more than simply tough law enforcement and interdiction; we need extensive education and access to treatment. Drug Czar Barry McCaffrey understands. He said recently, ``Chemical dependency treatment is more effective than cancer treatment, and it's cheaper.'' General McCaffrey also said, ``We need to redouble our efforts to insure that quality treatment is available.'' Mr. Speaker, General McCaffrey is right and all the studies back him up. Treatment does work and it is cost-effective. Last September, the first national study of chemical dependency treatment results confirmed that illegal drug and alcohol use are substantially reduced following treatment. This study, by the Substance Abuse and Mental Health Services Administration, shows that treatment rebuilds lives, puts families back together and restores substance abusers to productivity. According to Dr. Ronald Smith, Captain, Navy Medical Corps and former Vice Chairman of Psychiatry at the National Naval Medical Center, the U.S. Navy substance abuse treatment program has an overall recovery rate of 75 percent. The Journal of the American Medical Association (JAMA) on April 15, 1998 reported that a major review of more than 600 research articles and original data conclusively showed that ``addiction conforms to the common expectations for chronic illness and addiction treatment has outcomes comparable to other chronic conditions.'' It states that relapse rates for treatment for drug/alcohol addiction (40%) compare favorably with those for 3 other chronic disorders: adult-onset diabetes (50%), hypertension (30%) and adult asthma (30%). A March 1998 GAO report also surveyed the various studies on the effectiveness of treatment and concluded that treatment is effective and beneficial in the majority of cases. A number of state studies also show that treatment is cost-effective and good preventive medicine. A Minnesota study extensively evaluated the effectiveness of its treatment programs and found that Minnesota saves $22 million in annual health care costs because of treatment. A California study reported a 17 percent improvement in other health conditions following treatment--and dramatic decreases in hospitalizations. A New Jersey study by Rutgers University found that untreated alcoholics incur general health care costs 100 percent higher than those who receive treatment. So, the cost savings and effectiveness of chemical dependency treatment are well-documented. But putting the huge cost-savings aside for a minute, what will treatment parity cost? First, there is no cost to the federal budget. Parity does not apply to FEHBP, Medicare or Medicaid. First, there is no cost to the federal budget. Parity does not apply to FEHBP, Medicare or Medicaid. According to a national research study that based projected costs on data from states which have already enacted chemical dependency treatment parity, the average premium increase due to full parity would be 0.2 percent. (Mathematical Policy Research study, March 1998) A Milliman and Robertson study projected the worst-case increase to be 0.5 percent, or 66 cents a month per insured. That means, under the worst-case scenario, 16 million alcoholics and addicts could receive treatment for the price of a cup of coffee per month to the 113 million Americans covered by health plans. At the same time, the American people would realize $5.4 billion in cost-savings from treatment parity, according to the California Drug and Alcohol Treatment Assessment. U.S. companies that provide treatment have already achieved substantial savings. Chevron reports saving $10 for each $1 spent on treatment. GPU saved $6 for every $1 spent. United Airlines reports a $17 return for every dollar spent on treatment. And, Mr. Speaker, no dollar value can quantify the impact that greater access to treatment will have on the spouses, children and families who have been affected by the ravages of addiction. Broken families, shattered lives, messed-up kids, ruined careers. Mr. Speaker, this is not just another policy issue. This is a life- or-death issue for 16 million Americans who are chemically dependent, covered by health insurance but unable to access treatment. We know one thing for sure. Addiction, if not treated, is fatal. That's right--addiction is a fatal disease. Last year, 95 House members from both sides of the political aisle co-sponsored this substance abuse treatment parity legislation. This year, let's knock down the barriers to treatment for 16 million Americans. This year, let's do the right thing and the cost effective thing and provide access to treatment. This year, let's pass treatment parity legislation to deal with the epidemic of addiction in America. Mr. Speaker, the American people cannot afford to wait any longer. I urge all members to cosponsor the Harold Hughes, Bill Emerson Substance Abuse Treatment Parity Act.

Mr. RAMSTAD

Mr. RAMSTAD. Mr. Speaker, I rise today to introduce legislation to promote the coverage of frail elderly Medicare beneficiaries enrolled in innovative Medicare+Choice programs. This bill will exempt certain innovative programs specifically designed for the frail elderly living in nursing homes from being impacted by the new risk-adjusted payment methodology designed by the Health Care Financing Administration (HCFA) during its phase-in period. While the concept of a risk-adjusted payment methodology would actually be beneficial for such programs, the interim methodology is limited in scope and is primarily based on hospital encounter data. This focus on hospitalizations will put programs that are designed to provide care in non-hospital settings, thus reducing the need for expensive hospitalizations, at a distinct disadvantage. One such program is EverCare, an innovative health care program for the frail elderly in Minnesota and other states. A recent study by the Long Term Care Data Institute (LTCDI) has concluded that EverCare's revenue alone will decrease 42% under this new methodology. The program could not continue with such dramatic cuts. Recognizing that EverCare and programs like it may be adversely impacted by the new methodology, HCFA granted certain programs limited exemptions. However, HCFA acknowledged that additional steps may be necessary by stating they would also be ``assessing possible refinements to the risk adjustment methodology'' as it relates to these programs and was considering developing a `hybrid' payment methodology for them. I appreciate HCFA's understanding of the uniqueness of the programs and the need to treat them differently than traditional Medicare+Choice plans. However, I am concerned that over four months have passed and we have not seen action on the part of HCFA to develop such a methodology. In addition, I am concerned that they have not applied the exemption to other similar programs specifically designed for the frail elderly living in nursing homes. Along with the bill and statement today, I am submitting some testimonials I have received from those involved with this critical program. I believe they will do a better job than I could of explaining the uniqueness and importance of these programs. Mr. Speaker, the risk adjusted payment methodology is intended to ensure reimbursements which reflect the health care status and needs of Medicare beneficiaries, not deny access to pioneering new programs. That's why I urge my colleagues to cosponsor this legislation to ensure cost-effective and care-enhancing programs like these are not unintentionally and fatally impacted as HCFA gradually moves into an appropriate, comprehensive methodology. I urge my colleagues to cosponsor this MERITorious bill. The EverCare Story--Clinical Success Stories Submitted by Site Phoenix Site Sara Roth was a 75 year old EverCare resident of Shadow Mountain Care Center. Sara's primary diagnosis was S/P frontotemporal craniotomy for a massive subdural hematoma. She was now essentially bedridden and as a result had pressure sores complicating her current medical status. Less than 9 months prior to her enrolling with EverCare, she had been essentially alert and dependent. Sara's family was pursuing legal interventions with her previous health care providers. Sara's family felt isolated, tremendously frustrated and out of control prior to her enrolling in EverCare. Sue was able to help this family who had unrealistic expectations, make difficult, but informed decisions. Ultimately, Sara was able to die with compassion and dignity. The family was comforted and supported by the team during this difficult time, as their attached letter attests. This example truly represents the unique aspects of the EverCare model in action--protecting the quality of life, and when this is no longer possible, creating the most therapeutic environment to protect life's end. Scottsdale, AZ July 20, 1998. Re Ms. Sue Freeman, nurse practitioner. Ms. Kathryne Barnoski, Clinical Director, EverCare, Phoenix, AZ. Dear Ms. Barnoski: I write this letter to express our family's deep appreciation for all of Ms. Freeman's help in regard to our mother, Sara Roth, who passed away on July 1 at the Shadow Mountain Nursing Home in Scottsdale. Prior to EverCare, our family felt alone and frustrated in dealing with all Sara's medical needs at Shadow Mountain. It was difficult reach a doctor or getting answers from her nurses regarding her condition or explanation of medications. EverCare became like a fairy godmother who orchestrated a wonderful team approach to caring for our mother. Communication between Dr. Sapp, Ms. Freeman and myself was excellent and that in itself did wonders for my peace of mind. I would like to take this opportunity to thank one of your shining stars--Ms. Sue Freeman. What a wonderful woman! She is articulate, highly skilled, organized, professional, and has a great heart! I always felt like Sara was a top priority with Sue and for that, we will always be grateful. EverCare works. That is important for you to know. God only knows what would have happened to Sara's quality of life without Dr. Sapp and Ms. Freeman. Thank you from the bottom of our hearts. Sincerely, Eleanor Shnier.

Mr. RAMSTAD

Mr. RAMSTAD. Mr. Speaker, I rise as a cosponsor and strong supporter of the important resolution before us today to honor those brave police officers who have given their lives to keep our communities safe. As co-chair of the bipartisan Law Enforcement Caucus, I applaud the courage and dedication to duty of all peace and police officers serving their communities. These officers put their lives on the line for us, every day they put on the badge. Their courage and sacrifice was demonstrated in a very dramatic way last summer, when shots rang out in the Capitol and two of the U.S. Capitol Police's finest lost their lives. It is fitting that we consider this resolution during National Police Week. I encourage members of this body and the public to participate in other events this week honoring America's fallen police officers. On May 13, the 11th Annual Candlelight Vigil will take place at 8 p.m. at the National Law Enforcement Memorial grounds, followed by a reading of the 312 names newly engraved on the Memorial. At noon on May 15, the 18th Annual National Peace Officers' Memorial Day Service will take place on the west front of the Capitol, with a wreath-laying ceremony to follow. In my home state of Minnesota, May 8 was Law Enforcement Appreciation Day at the Metrodome in Minneapolis, where ``Top Cops'' were honored during the Minnesota Twins game. I encourage my fellow Minnesotans to attend events on May 15, in which uniformed officers will stand in silence all day at the Peace Officers Memorial on the State Capitol grounds. Also, a 5-kilometer ``Race to Remember'' will be held in St. Paul, and a candlelight service will be held at 7:30 p.m. at the Peace Officers Memorial. Mr. Speaker, 156 law enforcement officers were killed in the line of duty in 1998, and over 15,000 officers have been killed since our nation began recording their deaths. My home state of Minnesota has lost 207 officers. On average, a law enforcement officer is killed every other day in America. Each year, one in nine officers is assaulted and one in 25 is injured while on duty. These sacrifices are made daily to fight crime and make our citizens safer. These law enforcement heroes and their families deserve our gratitude and respect, during National Police Week and throughout the year. We must never forget their sacrifices, including the ultimate sacrifice paid by too many officers. We must all work for a day when no more names will be added to the Law Enforcement Memorial wall, and a resolution like this will no longer be necessary.

Mr. RAMSTAD

Mr. RAMSTAD. Mr. Speaker, I rise today to bring attention to an important program called Operation Day's Work and to the hard work of members of a ninth grade class at St. Louis Park High School in Minnesota who are implementing this excellent program in our country to help those less fortunate than themselves. Operation Day's Work is a youth-operated fund-raising program started in Norway 35 years ago. Last year alone, the hard work of student in Norway generated $3,000,000 in grants for those in need. I'm pleased that this fantastic program has moved across the ocean to the U.S. to eight enlightened high schools, including St. Louis Park High School in Minnesota. These motivated ninth graders have committed the time and energy to start and organize this program. They have decided to volunteer a full day to work at area businesses, doing odd jobs and other work. In exchange, their employers will donate the wages earned by these students to an important livestock training and responsibility plan for Haitian youths. The Haitian families will receive dairy products and eventually return one offspring of the goat to the program, which will then be awarded to another youth. Mr. Speaker, I was fortunate to meet with four students who are working on the program during the recent district work period. Their motivation, commitment and generosity of spirit were truly impressive. Charles Warthington, Zvi Geffen, Ashley Ericson, Elizabeth Stapleton and their classmates deserve to be honored here on the House floor for their vigorous efforts on behalf of those who are less fortunate through Operation Day's Work. I also want to pay tribute to Kristin King Stapleton, a good friend of mine who's also a newspaper columnist and highly respected advocate for people in need, for her role as parent advisor. I hope all Americans will support the important efforts of Operation Day's Work.

Mr. RAMSTAD

Mr. RAMSTAD. Mr. Speaker, I rise to express my serious concerns about this legislation before us. I strongly believe that free and open trade between nations improves the world economy, creates high-paying jobs, and lowers prices for consumers. I certainly understand the seriousness of foreign countries and companies illegally selling goods below the price of production in our country. The United States must fight these dumping violations and must hold countries accountable for these activities. However, H.R. 975 isn't the answer. This illegal, quota bill won't help American industry and will harm American workers. We've lived through failed, protectionist economic eras. I also oppose this legislation and the hasty retaliatory measures within it because it violates our World Trade Organization (WTO) obligations by creating quotas to limit the importation of steel. If the U.S. expects to maintain a viable economy free from retaliatory protectionism, we cannot break trade laws ourselves. A full scale trade war is in no one's interest. This legislation would have real negative consequences for American consumers, manufacturers and the economy as a whole. Mr. Speaker, while I believe every Member of the House is concerned about dumping and is willing to support strong actions against such occurrences, two wrongs don't make a right, and to retaliate with this illegal, protectionist measure is counterproductive to American workers and consumers. At a time when we are fighting the Europeans for their flagrant violation of international trade law, we cannot thoughtlessly toss aside our own commitments to follow the rule of law. And we must make sure that we do not put in place measures that will hurt American workers and consumers. I urge my colleagues to vote against this protectionist bill before us today.

Mr. RAMSTAD

Mr. RAMSTAD. Mr. Speaker, I rise today to pay tribute to a great Minnesotan who represented the very best in public service for more than three decades as Assistant Sergeant-at-Arms for the Minnesota Senate. Ralph Graham passed away January 28 and leaves a loyal legion of friends at the Capitol in St. Paul, friends and former State Senators like me, who benefited so greatly from his wit, wisdom and key assistance. Mr. Speaker, when I was first elected to the Minnesota Senate, Ralph Graham was one of the first people I met. His dedication to the Minnesota Senate and the law-making process was truly impressive. He quickly became a trusted friend and I was often blessed to be the recipient of his pragmatic, bipartisan insights on the important issues facing our state and the Legislature. He was very proud of his job, and that's why he excelled at it. He kept watch over the Senate like a father over a child, the pride evident in his face and every gesture. The commitment he brought to his job each and every day was inspiring. Mr. Speaker, Ralph's heart, energy and dedication made coming to the Senate a special pleasure. He guarded the Senate chamber's doors and decorum with a patient yet relentless zeal, plainly revealing a love for his job and deep respect for the integrity of the Minnesota Senate. Ralph's sense of history and duty to his state and country was most remarkable. His father, Charles, also worked at the Capitol. And for nearly 40 years, Ralph helped our nation's brave veterans by working as an X-ray technician at the Minneapolis Veterans Medical Center and, before that, as a messenger in the veterans hospital's administration department. Mr. Speaker, Ralph Graham's pride and performance set a tremendous example for generations of Senators and their staffs. His values, devotion to Senate traditions and the dignity he brought to the chamber will be sorely missed. Mr. Speaker, on behalf of all the people of our great state and nation, I want to express my heartfelt sympathy to his family, and my thanks for all he did to make our democracy stronger in so many ways. The Minnesota Senate has lost a valued officer and treasured friend.

Mr. RAMSTAD

Mr. RAMSTAD. Mr. Speaker, I thank my distinguished chairman, the gentleman from Illinois (Mr. Crane) for yielding me time. Mr. Speaker, I rise in strong support of the bill before us today. This critical legislation contains two very important provisions to lower prices for consumers and increase trade to and from Minnesota, as well as the rest of the Nation. The first provision is based on H.R. 411, which I introduced, to correct an error in the tariff classification code for 13-inch televisions which is driving up costs considerably for consumers. Despite the fact that a reduced tariff rate which was implemented in 1995 was supposed to apply to traditional 13-inch monitors, manufacturers and importers were notified in 1997 that Customs would begin reclassifying them at the higher duty rate for televisions of 19 inches and larger due to a simple error. As a strong free trader, I thank the gentleman from Illinois (Mr. Crane) for including this important provision to correct this error and lower prices for consumers by reducing import duties. This means $28 million in savings to consumers, Mr. Speaker. The second provision, based on legislation the gentleman from Illinois (Mr. Crane) and I introduced last year, would allow the Customs Service to access funds in the user fee accounts and enhance inspector staffing and equipment at preclearance service locations in foreign countries. This is important because if Customs eliminates these positions, preclearance for passengers to the United States will slow, travel will be disrupted in the tourism industry, and many states will suffer. Allowing the preclearance services to continue means a great deal to many employers in my district, the Third District of Minnesota, including the Mall of America. By the way, Mr. Speaker, the Mall of America attracts more visitors each year than Disney World, Graceland, and the Grand Canyon combined. Just a little plug, Mr. Speaker. The Customs Service has said there are insufficient resources in its salaries and expenses account to fund the enhanced preclearance positions. So this bill gives access to that account without any additional cost to taxpayers. Commissioner Banks testified before the Committee on Ways and Means in support of the bill, and the airline industry supports it as well. So I appreciate strong support of the body on both sides for this important legislation.

Mr. RAMSTAD

Mr. RAMSTAD. Mr. Speaker, I rise today to pay tribute to a great Minnesotan who represents the absolute best in public service for his sterling leadership and remarkable professional career in law enforcement. You see, Mr. Speaker, my hometown's Director of Public Safety and Chief of Police in Minnetonka, MN, Richard W. Setter, has had a profound impact on my career. After 14 years in his current position, and following four distinguished decades in law enforcement, Richard Setter is retiring. He leaves an immense legacy. Tough. Fair. Integrity. A real leader. Those are just a few of the descriptions that come to mind when you think about Dick Setter's impressive career. He has superbly led the Minnetonka Police Department since April 30, 1984. In 1994, when he became Director of Public Safety as well as Chief of Police, he smoothly and effectively merged the police, fire and emergency management departments. With 149 full and part-time personnel serving our city of 53,000 people, Chief Setter has helped make the Minnetonka Department of Public Safety well known throughout Minnesota as a shining lighthouse of an example for other communities. Mr. Speaker, when it comes to implementing community-oriented policing, organizing neighborhood crime watch groups, forging cooperative anti-drug task forces and creating anti-crime programs at multiple housing and shopping center sites, Chief Setter's Minnetonka Public Safety Department has shown the way. And when it comes to steering youth away from at-risk behavior, Dick Setter has been a real trend-setter. He knows how important it is to prevent crime by fighting its root sources and by putting resources into the front end, which saves our communities and the nation expensive resources in the long run. It has been a long and remarkable run for Chief Setter, who has been honored repeatedly for this pioneering, visionary police work. The Boy Scouts of America named him recipient of the Silver Beaver and Youth Services Awards. Rotary selected him as a prestigious Paul Harris Fellow. The NAACP has praised Dick's public service. And our area's largest radio station, WCCO, has chosen him for its well-recognized ``Good Neighbor'' award. This record of excellence pervades all that Dick Setter touches. Starting with his first position as a patrol officer in rural Owatonna, MN, and continuing wherever he has gone--including 23 years as a patrol officer, investigator, supervisor and chief of police in nearby St. Louis Park--Dick has been successful in making our streets, schools, and neighborhoods safer. Dick Setter's superior performance has resulted in his repeatedly being asked to lead important law enforcement and crime-fighting efforts. Most recently, Chief Setter served as President of the 1,500- member FBI Law Enforcement Executive Development Association. He has been a member of that group for 17 years and in a leadership position for 12 years, including as a counselor at the FBI Academy in Quantico. He has also served as Chair and Vice Chair of the Minnesota Peace Officers Standards and Training Board, President and Vice President of the Hennepin County Chiefs of Police, a member of the board of the Minnesota Chiefs of Police Association, and in many other leadership positions. Mr. Speaker, by any measure of merit, Chief Setter is one of America's best and brightest law enforcement professionals, and he will be sorely missed by the people of Minnetonka. I truly value all the wise counsel Chief Setter has provided me through the years on so many matters. It is not possible to find words adequate enough to properly convey my appreciation for all Dick Setter has done for me and for the people of our community and State. Mr. Speaker, Dick Setter's influence on my career has been substantial. As a direct result of my interaction with him, I have made the fight against crime and drugs--a battle which has ravaged our cities, infiltrated our schools and dramatically affected our neighborhoods and families--my top priority over the past 18 years as a State senator in Minnesota and here in Washington. Because of Dick Setter and other good friends in law enforcement, I have successfully sought leadership positions in government to make a real difference on crime and drug policy, such as my present position as Co-Chair of the House Law Enforcement Caucus. Mr. Speaker, I want to wish Dick Setter the very best in all his future endeavors, including his professorship at the Minnesota State University in Mankato--where he has been inspiring future law enforcement officers for two decades. I can't imagine a better role model. Thanks again, Dick, for all you have done for the people of Minnetonka and for our State and Nation. God bless you and your wonderful wife Patty. You have made our community immeasurably stronger and safer, and we're deeply grateful!

Mr. RAMSTAD

Mr. RAMSTAD. Mr. Speaker, this has been the most difficult, gut- wrenching decision I have made in my 18 years of public service. In making my decision, I have been obligated to put personal feelings and political concerns aside to focus solely on my constitutional obligation. The impeachment matter is a trauma for our nation and the decision demands careful and thoughtful deliberation and much soul searching. A decision of this magnitude required me to examine all of the evidence, listen to all the legal arguments and search my conscience. As a former Criminal Justice Act lawyer, I have objectively reviewed all the evidence, heard all the arguments and searched my conscience. I have regrettably and sadly concluded that sufficient evidence of perjury exists to send this matter to the Senate. I cast my votes solely on the evidence and the law consistent with my conscience. Impeachment is similar to an indictment, or a formal charge of wrongdoing, and I believe the evidence of perjury before the grand jury and obstruction of justice meet the ``clear and convincing'' threshold for moving the process forward. I have also concluded these charges rise to the level of an impeachable offense pursuant to the Constitution of the United States. In the final analysis, it all comes down to perjury and covering up perjury. The compelling reason for impeachment is that the President's perjury has undermined the rule of law. The laws against perjury are the glue that holds our legal system together. To remain a nation of laws governed by the rule of law, all people, including the President, must be treated equally and held accountable. The President must abide by the same laws as every other American. In analyzing the four articles of impeachment, I have concluded that the charge of perjury before the grand jury is substantial by clear and convincing evidence. As the chief law enforcement officer of the United States, the President has an obligation to tell the truth, under oath, in judicial proceedings. He chose not to. Similarly, I concluded that there was sufficient evidence that the President obstructed justice in order to cover up his perjury. At the same time, I have concluded that Articles 2 and 4 do not present clear and convincing evidence of impeachable offenses by the President. In my judgment, the second article concerning perjury in a civil deposition does not meet the ``clear and convincing'' standard because of questions about materiality. In addition, the charge of abuse of power--for the answers by the President's lawyers to the Judiciary Committee's questions--is not justified by the evidence and raises Due Process concerns. This is truly a sad day for America and the American people. But, long after the words spoken today have faded, and long after this painful ordeal is concluded, we will remain a nation of laws. This means we must sometimes make difficult decisions to ensure that our national principles survive and public trust is maintained. By the grace of God, I pray that this painful chapter in our nation's history will be quickly put behind us by the Senate so we can address our nation's pressing needs, heal our wounds and show the world America's enduring strength and resiliency.

Mr. RAMSTAD

Mr. RAMSTAD. Mr. Speaker, I rise today in strong support of the men and women of the U.S. armed forces deployed in the Persian Gulf for their professionalism, patriotism, dedication and courage. As the new millennium approaches, the greatest threat to our national security is the proliferation of biological and chemical weapons. Saddam Hussein's regime has demonstrated again and again its desire to manufacture and use these weapons of mass destruction. We simply cannot allow Saddam the capability and the resources to complete this awful task. Day in and day out, the men and women of our armed forces perform the vitally important job of protecting our national security. I'm proud of their work, and I am deeply grateful to those who have accepted this challenge in the Persian Gulf. With over 24,000 U.S. troops in the Persian Gulf, we must give our brave soldiers our unequivocal support and encouragement at this difficult time. We applaud our brave troops and thank them for their service to our country. Our thoughts and prayers are with our troops and their families.

Mr. RAMSTAD

Mr. RAMSTAD. Mr. Speaker, I rise in support of this bill before us today, which includes provisions to provide for the continuation of preclearance activities for air transit passengers. I want to thank Mr. Crane and Mr. Shaw for working with me on these important provisions to help facilitate the services Customs provides to process the massive amounts of people and products entering and exiting our country. These provisions, which are similar to legislation Mr. Crane and I introduced last April, would allow the Customs Service to access funds in the User Fee Accounts and enhance inspector staffing and equipment at preclearance service locations in foriegn countries. This is significant because if U.S. Customs eliminates these positions, preclearance for passengers to the U.S. will slow, travel will be disrupted, and the tourism industry in many states will suffer. Allowing the preclearance services to continue means a great deal to many employers in my district, like Northwest Airlines and all those affiliated with the Mall of America--which attracts more visitors each year than Disneyworld, Graceland and the Grand Canyon combined. The Customs Service has said there are insufficient resources in its salaries and expenses account to fund the enhanced preclearance positions. This bill gives access to excess funds in the User Fee Account, without any additional cost to taxpayers. Acting-Commissioner Banks testified before our Ways and Means Committee in support of our earlier version of the legislation, and the airline industry supports it as well. I appreciate how quickly the House has recognized the merits of these provisions, as well as the other important elements of the bill to reduce tariffs on various products, and allowed us to bring it to the floor today. I urge my colleagues to join me in support of this critical bill.

Mr. RAMSTAD

Mr. RAMSTAD. Mr. Speaker, during this 105th Congress, I was honored to join many of my colleagues, as well as other distinguished U.S. officials, in participating in the first national recognition ceremony to honor the valor and sacrifice of Hmong and Lao combat veterans in the Vietnam War. Many people from my home state of Minnesota, and from around the nation, organized and participated in the important events, which were held at the Vietnam War Memorial and the Arlington National Cemetery. Mr. Speaker, I would like to thank a number of people from Minnesota and across the United States who made the national events honoring the Hmong veterans possible, including Major General Vang Pao, Colonel Wangyee Vang, Cherzong Vang, Chong Bee Vang, Ying Vang and Philip Smith. Over a thousand Hmong veterans and their families traveled from Minnesota to Washington, DC, to participate in this historic ceremony. I am proud that two of the largest Hmong non-profit organizations serving their communities in Minnesota, the Lao Family Community of Minnesota, Inc. and the Lao Veterans of America organization, played a leadership role in organizing and participating in this unprecedented event. They have helped bring long-overdue honor and recognition to the Hmong and Lao veterans and their families, as well as to educate policy makers and the American people about the critical wartime sacrifices of the Hmong and Lao combat veterans. William Branigin from the Washington Post wrote an important article about the event that I would like to insert into the Record. (insert: Washington Post article Thursday, May 15, 1997). Mr. Speaker, once again, I heartily applaud these distinguished Hmong and Lao combat veterans for their sacrifices. Recognizing U.S. Allies in `Secret War'--`Long Overdue' Honors Go to Hmong, Lao Vets Twenty-two years ago this month, the predominantly Hmong recruits of America's ``secret war'' in Laos began a protracted and painful exodus from their homeland as communist forces seized power. Yesterday, some 3,000 Hmong and Lao veterans and their families gathered at the Vietnam Veterans Memorial to receive congressional recognition for the first time, and then marched across the Potomac to commemorate their fateful crossing of the Mekong River into permanent exile. Clad in jungle camouflage fatigues, flight suits and other uniforms, the veterans stood in formation on the Mall as speakers ranging from serving members of Congress to retired CIA station chiefs paid tribute to their courage and sacrifice in unsung service of the United States. Among those in attendance were former Special Forces officers, pilots of the top-secret Ravens unit and civilian officials from the Kennedy, Johnson and Nixon administrations. It was a day of what a congressional commendation described as ``long overdue recognition'' of the CIA-funded army's role in protecting sensitive U.S. installations, rescuing downed American pilots and holding off tens of thousands of North Vietnamese troops who might otherwise have been thrown into combat against U.S. forces. But it was also a day of atonement for the United States. For in honoring the ethnic. Hmong tribal people and Laotians who made up the bulk of the 40,000-member clandestine force, participants in the ceremony acknowledged that America had betrayed them, breaking long-standing promises and abandoning them to bloody reprisals by Lao and Vietnamese communist forces in which untold thousands died. ``There is a real feeling among many people who served there that the Hmong were betrayed,'' said Philip Smith, the Washington director of Lao Veterans of America, which represents about 40,000 Hmong and Lao veterans and family members. ``Many commitments were made to them in the field that were then forgotten in Washington.'' Among those who received the Vietnam Veterans National Medal and a congressional citation yesterday was Nor Pao Lor, a disabled 61-year-old Hmong who served in the secret army for 13 years and then spent four more years fighting in the jungles of Laos until forced to flee across the Mekong River to Thailand on a bamboo raft. He then spent eight years in a Thai refugee camp before being accepted for resettlement in the United States. He now lives in Wisconsin. ``We felt very sorry that maybe America forgot us,'' he said as he stood with a crutch near dozens of his disabled comrades. ``It was very painful for us.'' As a lieutenant in the army led by Gen. Vang Pao, who was also present yesterday, Nor Pao Lor was wounded three times while defending Lima Site 85, a top-secret U.S. base that was used to direct airstrikes against targets in North Vietnam. Described by historians as perhaps the most critical intelligence-gathering site in South-east Asia during the Vietnam War, Lima Site 85 was linked directly to the White House under President Lyndon B. Johnson until the base fell to North Vietnamese troops in 1968. As Nor Pao Lor told his story, one of the event's speakers, Jane Hamilton-Merritt, who wrote a book called ``Tragic Mountains: The Hmong, the Americans, and the Secret Wars for Laos,'' asked the assembled veterans how many of them had helped rescue a downed American pilot. Hundreds, including Nor Pao Lor, raised their hands. After the ceremony on the Mall, the veterans marched across Memorial Bridge to Arlington National Cemetery, where they placed flowers on the grave of President John F. Kennedy. Nearby is a memorial that is to be dedicated today to ``the U.S. Secret Army, Laos 1961-1973.'' In the Lao and Hmong languages, the plaque on the granite monument concludes, ``You will never be forgotten.''

Mr. RAMSTAD

Mr. RAMSTAD. Mr. Speaker, I rise in support of this bill before us today to provide for the continuation of preclearance activities for air transit passengers. I want to thank Mr. Crane and Mr. Shaw for working with me on this important legislation to help facilitate the services Customs provides to process the massive amounts of people and products entering and existing our country. This bill, which is similar to legislation Mr. Crane and I introduced last April, would allow the Customs Service to access funds in the User Fee Accounts and enhance inspector staffing and equipment at preclearance service locations in foreign countries. This is significant because if U.S. Customs eliminates these positions, preclearance for passengers to the United States will slow, travel will be disrupted, and the tourism industry in many states will suffer. Allowing the preclearance services to continue means a great deal to many employers in my district, like Northwest Airlines and all those affiliated with the Mall of America--which attracts more visitors each year than Disneyworld, Graceland and the Grand Canyon combined. The Customs Service has said there are insufficient resources in its salaries and expenses account to fund the enhanced preclearance positions. This bill gives access to excess funds in the User Fee Account, without any additional cost to taxpayers. Acting-Commissioner Banks testified before our Ways and Means Committee in support of our earlier version of the legislation, and the airline industry supports it as well. I appreciate how quickly the House has recognized the merits of this legislation and allowed us to bring it to the floor today. I urge my colleagues to join me in support of this critical bill.

Mr. RAMSTAD

Mr. RAMSTAD. Mr. Speaker, two weeks ago I spoke before this House in favor of renewing fast track trade authority for the President. I called for my colleagues to choose statesmanship over politics and vote for this important legislation simply because it is the right thing to do and they know it. I was deeply saddened that we did not have the support of the White House and many key Democrats in that fight--Democrats who typically understand the importance of fast track for opening new markets for U.S. farmers and exporters. I was saddened they were too concerned about the timing of passing the legislation and not the fact that their constituents need it, America's farmers need it, small businesses need it and consumers need it. Mr. Speaker, I am more than saddened today. I am completely perplexed and frustrated. Yesterday, President Clinton spoke before International Monetary Fund and World Bank officials and called for expanded trade for next year and strategies to spur economic growth. I am very glad to hear him say these things, but his speech is a bit hypocritical. It moves me to ask why the President will promote fast track authority renewal in January and wouldn't just two weeks ago? How is it the President can say it is ``inexcusable and reckless to hold up [IMF] money based on other issues at a time when the world needs U.S. leadership? President Clinton's failure to be engaged in the recent fast track debate directly contributed to its demise at a time when U.S. exporters needed his leadership--and the international economy needs U.S. leadership. I want my constituents to know that I have concerns about IMF funding because of, in the words of my colleague from Florida, Rep. Stearns, ``the countless evidence of the malfeasance and mismanagement of IMF.'' Mr. Speaker, my concerns have nothing to do with what time of the year it is or because certain advocacy groups have threatened political ramifications. My concerns have to do with pure policy issues and a true desire to see U.S. taxpayer dollars used appropriately. And on the issue of taxes, I don't think I could say it better than Senator Roth: ``Why should we expect Japan to push through a Kemp-Roth style tax reduction . . . when the White House opposes any domestic tax rate cut that would spur growth?'' Mr. Speaker, I am disappointed that politics have replaced real leadership at the other end of Pennsylvania Avenue. America needs to be a strong leader out in the global market place. We need to set the parameters of debates and make sure we are included in market access agreements that would benefit our farmers and businessmen and women. America needs fast track trade authority and a President who truly wants it.

Mr. RAMSTAD

Mr. RAMSTAD. Mr. Speaker, I rise today to pay tribute to a Minnesotan who represents the greatness and goodness that is America. I rise today to pay tribute to one of our State's top teachers and coaches who personifies Minnesota values. I rise today to pay tribute to my good friend of some 20 years, Coach Roger Lipelt of Wayzata High School. Roger Lipelt, the highly successful head coach and outstanding teacher at Wayzata the past 22 seasons, is retiring this year after a legendary career. Under Coach Lipelt, the Wayzata Football Trojans have won 204 games and 11 conference championships. His boys' tennis team won a State title several years ago. Coach Roger Lipelt has received countless honors during his brilliant coaching career: Coach of the Year, Head Coach of the Minnesota All- Star Football Team, Hall of Fame selection by his alma mater, Hamline University, to name just a few. Despite all the attention this legendary coach has drawn, if a stranger walks up to Roger Lipelt and asks him what he does, he will most likely say, ``I am mainly a social studies teacher.'' Yes, teaching is what Roger Lipelt is mainly about. Roger has taught all of his students and his athletes many valuable lessons about life, about winning and losing, about family and faith, about love of country and community, and about how to treat other people. Through his inspirational leadership and by his example, Roger Lipelt has profoundly affected the lives of countless young people, and shown them the way to lead healthy and productive lives. Never give up on yourself, Roger Lipelt tells his students and his athletes. For 22 years, Roger's spirited coaching has made the Wayzata Football Trojans one of the most consistently successful football teams in the State of Minnesota, season after season. Mr. Speaker, I have known Roger Lipelt, I am grateful to say, for two decades. I could tell the Members firsthand the power and the guidance he has brought to so many young people's lives. He has been a member for many years of a small Bible study group that I am part of. We meet every Saturday at a local restaurant in Wayzata. Members of our Saturday morning group have been truly blessed by Roger's friendship and his faith. Above all, Roger Lipelt's life is about faith, family, and friends. Roger's love for his family is an inspiration to all of us who know him. Roger's wonderful wife, Jo, and their daughters Heidi, Heather, and Holly, have been Roger's biggest boosters, and have shown all of us the true meaning and the importance of family. Mr. Speaker, on behalf of all those people whose lives Roger Lipelt has touched through the years, I am honored to stand here today to pay tribute to our Wayzata hero on his well-deserved retirement. We wish Roger and Jo Lipelt many more years of happiness together. Congratulations, Coach, on a great career, and thanks for all the memories. Thanks, also, Coach, for putting the ball in the air.

Mr. RAMSTAD

Mr. RAMSTAD. Mr. Speaker, yesterday we took steps to bank 90 percent of the budget surplus to save Social Security. Today we will give back a small portion to help people who gave us the surplus in the first place--American taxpayers. The marriage penalty tax relief will help 24 million American couples--875,000 people in my home state of Minnesota alone. Seniors will be able to earn more before the government confiscates their social security payments. Countless farmers and small busienss entrepreneurs need our help with estate taxes, health insurance costs and expensing. Farmers need the added relief of permanent income averaging, an expanded Net Operating Loss carryback period and market transition payment help. And aside from the tax relief in real dollar terms, we provide needed tax simplification. Fewer Americans will have to itemize because of the doubled standard deduction for married taxpayers. Millions of other Americans will be able to fill out a simple EZ form because of the small interest and dividend exemption--a provision that will help 1.4 million Minnesotans keep more of their savings. And many more Amercians will be spared from paying death taxes and making the excruciating calculations required by the Alternative Minimum Tax. This bill also provides critical assistance for school districts and state and local governments through the school construction bond provisions and the increase in the private activity bonding cap. The community renewal provisions will provide hope to desperately hurting communities. We also extend expiring provisions crucial for American competitiveness, for charitable giving, and for moving Americans off welfare and into the workforce. Mr. Speaker, the government is taking more taxes from Americans today than at any time in U.S. history. Families know better what to do with their own money than the federal government. It's time to let the taxpayers who need it most to keep more of what they earn.

Mr. RAMSTAD

Mr. RAMSTAD. Mr. Speaker, I would like to dispel some of the misleading hyperbole the American people are being fed today. Americans are sick of political double talk. They want the truth--so here it is. This surplus we are talking about here today--do you know where it came from? It came from you--your hard earned pay checks, your savings accounts, your investments and even the deaths of your family members and friends. It's not the government's money--it's yours! You know what happens to your money when it gets to Washington? Well, for the last 40+ years, the Democratic majority spent it--spent well above it--and often wasted it. In fact, if it weren't for the Republican majority you elected, we wouldn't even be standing here today talking about a surplus or how to use the excess taxes you have sent us. You deserve some of your money back. And, yes, your money--$1.4 trillion--should also go toward preserving and protecting Social Security. Both can be done. Let me reassure you right now that under the bill before us today, fully 90% of your surplus goes into a ``Protect Social Security Account.'' Some $1.4 trillion of your money is set aside until we pass legislation to ensure the long term solvency of Social Security. And do you know what the impact on the Social Security Trust Fund will be from giving you back 10% of your money? None. Let me repeat that. None. The Social Security Trust Fund will not lose one dime by passing this legislation today and the tax bill tomorrow. Not a penny. So, to recap the truth for Americans sick of all the political legalese and double talk: Passing this legislation gives you, the overtaxed American, 10% of your money back. It secures 90% of your money in a new account to be used for preserving and protecting your Social Security program. Let's pass the ``Save Social Security Act.''