Jay Rockefeller

Mr. ROCKEFELLER

Mr. ROCKEFELLER. Mr. President, I rise today to introduce the Health Information Technology Public Utility Act, legislation I have recently introduced to facilitate nationwide adoption of electronic health records, EHRs, particularly among small, rural providers. This legislation will build on the successful open source models for EHRs developed by the Department of Veterans Affairs and the Indian Health Service--as well as the open source exchange model recently expanded among federal agencies through the Nationwide Health Information Network-Connect initiative. Health information technology, IT, that is interoperable and meaningful is a necessary tool to improve the quality of health care Americans receive and make our health care system more efficient. It is the cornerstone of health care communication and coordination between patients and providers and among providers in order delivery high- quality medical care. Several of the mechanisms embedded in this technology--clinical decisions support, interoperability--achieve the long-term policy goals we are considering as part of our broader health reform discussions. It is clear that coordination and communication among providers, improved efficiencies in resource use, streamlined administration and billing, and increased access to meaningful data about quality improvement and improved health outcomes will not be possible without meaningful use of this technology among all providers. However, access to affordable technology is the primary reason why providers across the nation do not invest in this valuable tool. The licensing fees of proprietary software are expensive and beyond the reach of many of health care providers--particularly small, rural providers. Moreover, the federal government has spent substantial taxpayer dollars in the development of open source technology--with the Department of Veterans Affairs and the Indian Health Service, IHS, national leaders in open source electronic health record, EHR, development and implementation. Both the Veterans Health Administration's VistA software and the Indian Health Services' Resource and Patient Management System, RPMS, are affordable and dependable systems that have been in place for decades. Most recently, the health IT funding included in the American Recovery and Reinvestment Act, ARRA, although substantial, is likely to fall short of offering affordable options to all providers. In fact, CBO estimates that, even with funding and incentives in the ARRA, 30 percent of hospitals and 10 percent of physicians will not have adopted health IT by 2019. And, there are some providers that are ineligible for funding under ARRA altogether. The Health Information Technology Public Utility Act will address this problem by increasing access to open source software through a public utility model. The public utility model proposed in this bill would be administered by a Federal Consolidated Health Information Technology Board under the umbrella of the ONCHIT, separate from the Policy and Standards Committees. Members of this Board would represent relevant agencies across the federal government. The Board would be responsible for linking efforts of current and new VistA and RPMS user groups, and updating VistA and RPMS open source software (including provider-based EHRs, personal health records, and other software modules) on a timely basis. The legislation also establishes a new 21st Century Health Information Technology Grant Program to provide funding to public and not-for-profit safety net providers to cover the costs of implementation and initial maintenance of VistA and/or RPMS systems. Grants will focus on eligible hospitals and clinics, with some additional funding for demonstrations in long-term care, home health, and hospice. The Health Information Technology Public Utility Act fills a crucial gap in health IT affordability and accessibility. This legislation does not replace commercial software; instead, it complements the private industry in this field--by making health information technology a realistic option for all providers and by making it possible for the benefits of health IT to accrue to all patients and I urge my colleagues to join me in support of this important policy. Mr. President, I ask unanimous consent that the text of the bill be printed in the Record.

Mr. ROCKEFELLER

Mr. ROCKEFELLER. Mr. President, today Chairman Dianne Feinstein and I, with the agreement of Vice Chairman Kit Bond, have posted on the Web site of the Senate Select Committee on Intelligence, a document newly declassified by the Obama administration. I ask that this document be printed in the Record at the end of my remarks. In so doing we conclude an effort that I began as chairman of the committee in the last Congress to provide to the public an initial narrative of the history of the interrogation and detention opinions of the Department of Justice's--DOJ--Office of Legal Counsel, OLC. I applaud President Obama's decisive action last week not only to release four of the OLC opinions discussed in our narrative but also to state firmly our Nation's support for the front-line intelligence professionals who relied on that legal advice in good faith. I couldn't agree more. Three of these OLC documents are among those that I sought for the committee starting as far back as 2005, when it became increasingly clear to me that Congress had not been given complete information regarding the Bush administration's interrogation policies and practices. I said publicly in July of 2005 and still firmly believe today that secret legal opinions that are kept even from oversight by the Congress can lead to great error. In the years since then I--together with Chairman Feinstein and others--have sought within the committee, on the Senate floor, and in written demands to the Bush administration to launch a comprehensive investigation of these issues and to advance legislation to end coercive interrogation practices. Now, thanks to President Obama's wise decision and to the ongoing work of the Senate Intelligence Committee, we have at last begun the task of fully setting the record straight, holding our government accountable, and learning from past errors in order to protect our country into the future. Let me be clear--in the wake of 9/11 we all wanted to leave no stone unturned in our pursuit of terrorists to prevent future attacks. At that time and since, the Senate Intelligence Committee sought to work in partnership with the administration to keep America safe. But we now know that essential information was withheld from the Congress on many matters and decisions were made in secret by senior Bush administration officials to obscure the complete picture. It is my hope and intention that the document we release today helps to fill in some of the facts, even as many other pieces of the puzzle are brought forth. The genesis of this document is as follows: Last year, I sought declassification of the August 1, 2002, OLC opinion, along with a short contextual narrative to accompany it. While declassification of that opinion was resisted, we engaged instead in a joint effort with Attorney General Michael B. Mukasey to declassify a broader narrative surrounding all of the OLC's opinions on these matters. The objective was to produce a text that describes the key elements of the opinions and sets forth facts that provide a context for those opinions, within the boundaries of what the DOJ and the Intelligence Community would recommend in 2008 for declassification. By late 2008, the DOJ, the Director of National Intelligence--DNI-- and the Central Intelligence Agency--CIA--all had approved the public release of this narrative, but the Bush Administration National Security Council--NSC--held it and would not agree to its declassification. I renewed the declassification effort as soon as Attorney General Eric Holder took office in early February 2009, and I am pleased to have received the support again of the DOJ, DNI and CIA, and now also of the NSC, for its release as a contextual description of the OLC memos. Readers of the narrative should bear in mind that its text is current through President Obama's Executive orders of January 22, 2009, but has not been revised following the release of the four OLC opinions on April 16, 2009. While there is now more public information available about those four opinions, the narrative adds important facts about the approval of the interrogation program beginning in 2002 and about opinions subsequent to the four that have been released. For the moment, I would like to note three points that emerge from the narrative: First, the records of the CIA demonstrate that the lawyers at the Office of Legal Counsel--OLC--did not operate in a vacuum. Key legal officials at the CIA, NSC, DOJ's Criminal Division, the Office of White House Counsel, all participated in meetings leading to the approval of methods used by the CIA. The then Vice President and the National Security Adviser are at the center of the discussions. But, strikingly, unless there is a further story in records not yet shown to us, the Secretary of State and the Secretary of Defense, were not involved in the decision making process despite the high stakes for U.S. foreign policy and for the treatment of the U.S. military. Second, the narrative and the May 30, 2005, opinion demonstrate that the Detainee Treatment Act of December 2005, was substantially undermined by the May 30, 2005, OLC opinion. The Bush administration had already construed the main provisions of the act to authorize its full gamut of coercive techniques. Third, the narrative demonstrates that the job of declassifying the interrogation and detention opinions of the OLC is not complete. There were important opinions in 2006 and 2007 that will, among other things, show how OLC interpreted the Detainee Treatment Act and the war crimes amendments of the Military Commissions Act of 2006, and Common Article 3 of the Geneva Conventions. The prompt declassification of those opinions, accompanied by their withdrawal as valid OLC opinions, is essential to completing the progress achieved by the President's declassification and the Attorney General's withdrawal of four opinions last week. Finally, I am gratified that the release of the August 2002 and May 2005 opinions, followed by the release of this narrative of the history of OLC opinions from 2002 to 2007, are themselves but first steps. In this new environment, and with the shared determination of our new chairman, the Senate Intelligence Committee is undertaking a major review not only of the origin of the detention and interrogation program but also of its actual implementation. We will be asking probing questions about what took place during interrogations and what intelligence was gained from detainees. We will also be examining what was told to the Congress, including both the content and the limitations on the briefings that were provided. It is long overdue but certainly not too late. As we enter a new period committed to openness and change, and bid farewell to the former administration's obscurity and dishonesty, there is the potential for great progress in our intelligence and national security activities. The trust between the executive branch and the Congress was breached, and the trust and confidence of the American people has been eroded. But I remain confident that if we restore the vital role of the Congress in overseeing our intelligence activities, we can bridge the divide, restore integrity, and get back to the business of lawfully and effectively securing this great Nation. The material follows:

Mr. ROCKEFELLER

Mr. ROCKEFELLER. Mr. President, I rise today with my colleagues, Senator Corker and Senator Kennedy, to introduce the Methadone Treatment and Protection Act, legislation that provides a comprehensive solution to our country's growing problem of methadone-related deaths. In recent years, too many families have come to me with heartbreaking stories of mothers and fathers, sisters and brothers who have been seriously injured or who have died as a result of methadone. My State of West Virginia has been particularly hard-hit by the number of lives lost, with just seven methadone-related deaths in 1999 compared to approximately 120 deaths in 2005. In the face of such stark realities, we can no longer stand by and remain content with the status quo. Now is the time for a comprehensive strategy to address the misuse of methadone and prevent any additional avoidable deaths. Methadone is an FDA approved, synthetic opioid prescription drug that has been extensively tested and used in the U.S. for more than thirty years. While it was first prescribed for pain management, methadone is also widely used as a part of opioid addiction treatment. The high efficacy and low cost of methadone has resulted in a significant rise in the number of methadone prescriptions, up 700 percent since 1998. However, there has also been a steep increase in the number of methadone-related deaths. In 2005, there were 4,462 methadone deaths, representing a 468 percent increase in the number of deaths since 1999. Currently, oversight of methadone is fragmented between three federal agencies: the Food and Drug Administration, FDA, the Substances Abuse and Mental Health Services Administration, SAMHSA, and the Drug Enforcement Administration, DEA. Currently, these agencies lack the most effective tools necessary to properly monitor methadone usage and effectively prevent methadone-related deaths. The legislation we are introducing today will address this shortcoming in our public health infrastructure by providing the administrative direction, funding, education, and data necessary to effectively monitor for the potential misuse of methadone. The alarming number of accidental methadone-related overdoses indicates that both patients and practitioners do not fully understand the complex nature of this medication. Therefore, the Methadone Treatment and Protection Act will significantly improve patient and provider information about methadone by mandating the creation of a consumer education campaign and requiring additional training for practitioners who prescribe methadone and other opioids. The bill will also improve Federal oversight of methadone by creating the Controlled Substances Clinical Standards Commission--with membership comprised of the FDA, SAMHSA, and the National Institutes of Health, NIH. This new Commission will establish safe dosage levels for methadone and other opioids, determine appropriate conversion factors when transferring a patient from one opioid to another, and create specific guidelines for initiating pain management treatment with methadone. To curtail the problems of doctor shopping and diversion, this legislation also adequately funds the National All Schedules Prescription Drug Reporting Act, NASPER. Passed and signed into law in 2005, NASPER requires providers to submit prescribing information for all schedule II, III, and IV drugs to State run controlled substance monitoring programs. NASPER also requires States to share this information with one another. Funding NASPER will serve as a deterrent to those who misuse methadone from crossing State lines in order to avoid being detected. Finally, to improve access to comprehensive data on methadone-related deaths, this legislation mandates the completion of a standard Model Opioid Treatment Program Mortality Report, and requires its submission to a newly created National Opioid Death Registry. Prior to 1999, methadone did not have separate classification from other opiate- related deaths. Therefore, a study released by the Center for Disease Control and Prevention in 2006 was the first opportunity to examine the trends in methadone exclusively. By creating a National Opioid Death Registry, it will be possible to more carefully track--and hopefully prevent--methadone-related deaths. It is my belief that the multi-pronged approach provided in the Methadone Treatment and Protection Act will lead to a decrease in the number of opioid and methadone-related deaths. This legislation will improve the coordination of resources and information at the local, State and Federal level to stifle the rising death toll, while at the same time make certain methadone and other opioids remain accessible for those who truly need these medications. In light of the facts and the preventable nature of methadone-related deaths, Congress has a responsibility to the American people to guarantee individuals have access to the treatment they need in a manner that is both safe and effective. The time for action is now, and I urge my colleagues to join us in support of this important bill.

Mr. ROCKEFELLER

Mr. ROCKEFELLER. Mr. President, I rise today with my colleagues, Senator Corker and Senator Kennedy, to introduce the Methadone Treatment and Protection Act, legislation that provides a comprehensive solution to our country's growing problem of methadone-related deaths. In recent years, too many families have come to me with heartbreaking stories of mothers and fathers, sisters and brothers who have been seriously injured or who have died as a result of methadone. My State of West Virginia has been particularly hard-hit by the number of lives lost, with just seven methadone-related deaths in 1999 compared to approximately 120 deaths in 2005. In the face of such stark realities, we can no longer stand by and remain content with the status quo. Now is the time for a comprehensive strategy to address the misuse of methadone and prevent any additional avoidable deaths. Methadone is an FDA approved, synthetic opioid prescription drug that has been extensively tested and used in the U.S. for more than thirty years. While it was first prescribed for pain management, methadone is also widely used as a part of opioid addiction treatment. The high efficacy and low cost of methadone has resulted in a significant rise in the number of methadone prescriptions, up 700 percent since 1998. However, there has also been a steep increase in the number of methadone-related deaths. In 2005, there were 4,462 methadone deaths, representing a 468 percent increase in the number of deaths since 1999. Currently, oversight of methadone is fragmented between three federal agencies: the Food and Drug Administration, FDA, the Substances Abuse and Mental Health Services Administration, SAMHSA, and the Drug Enforcement Administration, DEA. Currently, these agencies lack the most effective tools necessary to properly monitor methadone usage and effectively prevent methadone-related deaths. The legislation we are introducing today will address this shortcoming in our public health infrastructure by providing the administrative direction, funding, education, and data necessary to effectively monitor for the potential misuse of methadone. The alarming number of accidental methadone-related overdoses indicates that both patients and practitioners do not fully understand the complex nature of this medication. Therefore, the Methadone Treatment and Protection Act will significantly improve patient and provider information about methadone by mandating the creation of a consumer education campaign and requiring additional training for practitioners who prescribe methadone and other opioids. The bill will also improve Federal oversight of methadone by creating the Controlled Substances Clinical Standards Commission--with membership comprised of the FDA, SAMHSA, and the National Institutes of Health, NIH. This new Commission will establish safe dosage levels for methadone and other opioids, determine appropriate conversion factors when transferring a patient from one opioid to another, and create specific guidelines for initiating pain management treatment with methadone. To curtail the problems of doctor shopping and diversion, this legislation also adequately funds the National All Schedules Prescription Drug Reporting Act, NASPER. Passed and signed into law in 2005, NASPER requires providers to submit prescribing information for all schedule II, III, and IV drugs to State run controlled substance monitoring programs. NASPER also requires States to share this information with one another. Funding NASPER will serve as a deterrent to those who misuse methadone from crossing State lines in order to avoid being detected. Finally, to improve access to comprehensive data on methadone-related deaths, this legislation mandates the completion of a standard Model Opioid Treatment Program Mortality Report, and requires its submission to a newly created National Opioid Death Registry. Prior to 1999, methadone did not have separate classification from other opiate- related deaths. Therefore, a study released by the Center for Disease Control and Prevention in 2006 was the first opportunity to examine the trends in methadone exclusively. By creating a National Opioid Death Registry, it will be possible to more carefully track--and hopefully prevent--methadone-related deaths. It is my belief that the multi-pronged approach provided in the Methadone Treatment and Protection Act will lead to a decrease in the number of opioid and methadone-related deaths. This legislation will improve the coordination of resources and information at the local, State and Federal level to stifle the rising death toll, while at the same time make certain methadone and other opioids remain accessible for those who truly need these medications. In light of the facts and the preventable nature of methadone-related deaths, Congress has a responsibility to the American people to guarantee individuals have access to the treatment they need in a manner that is both safe and effective. The time for action is now, and I urge my colleagues to join us in support of this important bill.

Mr. ROCKEFELLER

Mr. ROCKEFELLER. Mr. President, I rise today to introduce the Pre- existing Condition Patient Protection Act, legislation to provide crucial protections for individuals with chronic and preexisting conditions. Unfair insurance market rules, including those which allow insurance companies to exclude coverage for preexisting health conditions, have forced thousands of American families into dire medical and financial situations. Addressing this issue is a priority of the President and should be a priority for Congress. As we begin to consider comprehensive health reform, including significant coverage expansions for the uninsured, this reform should also address the gaps in coverage for the 25 million Americans who are underinsured often due to their preexisting condition. Health insurance coverage should be meaningful and available when people need it. The Centers for Disease Control and Prevention, CDC, estimates that nearly 45 percent of Americans--or 133 million people--have at least one chronic condition. Furthermore, a report recently published in the Annals of Internal Medicine found that nearly one-third of all uninsured Americans in 2004 had received a chronic condition diagnosis. Early intervention and adequate treatment for those with chronic conditions is vital. Unfortunately, preexisting condition exclusions are often a barrier for individuals seeking access to comprehensive health insurance coverage. Congress passed the Health Insurance Portability and Accountability Act of 1996, HIPAA, P.L. 104-191, over 10 years ago with the objective of protecting Americans from interruptions in health insurance coverage resulting from job changes or other life transitions. HIPAA provides this protection by restricting when private insurers can use preexisting conditions to limit health insurance coverage. HIPAA has been successful, and many individuals have come to rely on its protections. However, after more than a decade, certain gaps in HIPAA's protection have become apparent. First, individuals who have been without health insurance coverage for 63 days or more are at risk of being permanently uninsurable. This is particularly true of individuals with preexisting conditions, because a 63-day gap in coverage eliminates any prior creditable coverage. If an employee cannot demonstrate that he or she had prior creditable and continuous coverage, an employer can exclude coverage for preexisting conditions for up to 12 months. Second, employers can restrict coverage for preexisting conditions to otherwise qualified employees based on a 6-month ``look-back'' period. This means that an employer may use medical recommendations, diagnoses, and treatments within the most recent six months to deny health coverage for a ``preexisting condition'' for up to 12 months. Third, the protections offered to individuals moving into a group health plan, or moving into the individual insurance market from a group plan, are not available to individuals attempting to shop around for policies within individual market. As a result, individuals who purchase policies in the nongroup market and never have a gap in coverage still have no protection against the preexisting condition exclusions that insurers may choose to impose. In most cases, there is no limit on the length of time an insurer can deny coverage under an individual insurance policy for a preexisting condition. An individual with a chronic condition who is buying coverage in the individual market today is likely to pay a high deductible, have a large monthly premium, and have the very illness they need coverage for written out of their policy. The Pre-existing Condition Patient Protection Act I am introducing today would address all three of these gaps in the current HIPAA law by eliminating preexisting condition exclusions in every single market. While this change is not the only insurance market reform necessary, it is a great step forward in improving the health coverage available to the 133 million Americans living with at least one chronic condition. Access to treatment is critical for these individuals, and a permanent fix to the law regarding coverage exclusions is crucial for our Nation in reforming our health care system. Therefore, I urge my colleagues to join me in supporting this important bill. The time for action is now. Mr. President, I ask unanimous consent that the text of the bill be printed in the Record.

Mr. ROCKEFELLER

Mr. ROCKEFELLER. Mr. President, I rise today to introduce the Pre- existing Condition Patient Protection Act, legislation to provide crucial protections for individuals with chronic and preexisting conditions. Unfair insurance market rules, including those which allow insurance companies to exclude coverage for preexisting health conditions, have forced thousands of American families into dire medical and financial situations. Addressing this issue is a priority of the President and should be a priority for Congress. As we begin to consider comprehensive health reform, including significant coverage expansions for the uninsured, this reform should also address the gaps in coverage for the 25 million Americans who are underinsured often due to their preexisting condition. Health insurance coverage should be meaningful and available when people need it. The Centers for Disease Control and Prevention, CDC, estimates that nearly 45 percent of Americans--or 133 million people--have at least one chronic condition. Furthermore, a report recently published in the Annals of Internal Medicine found that nearly one-third of all uninsured Americans in 2004 had received a chronic condition diagnosis. Early intervention and adequate treatment for those with chronic conditions is vital. Unfortunately, preexisting condition exclusions are often a barrier for individuals seeking access to comprehensive health insurance coverage. Congress passed the Health Insurance Portability and Accountability Act of 1996, HIPAA, P.L. 104-191, over 10 years ago with the objective of protecting Americans from interruptions in health insurance coverage resulting from job changes or other life transitions. HIPAA provides this protection by restricting when private insurers can use preexisting conditions to limit health insurance coverage. HIPAA has been successful, and many individuals have come to rely on its protections. However, after more than a decade, certain gaps in HIPAA's protection have become apparent. First, individuals who have been without health insurance coverage for 63 days or more are at risk of being permanently uninsurable. This is particularly true of individuals with preexisting conditions, because a 63-day gap in coverage eliminates any prior creditable coverage. If an employee cannot demonstrate that he or she had prior creditable and continuous coverage, an employer can exclude coverage for preexisting conditions for up to 12 months. Second, employers can restrict coverage for preexisting conditions to otherwise qualified employees based on a 6-month ``look-back'' period. This means that an employer may use medical recommendations, diagnoses, and treatments within the most recent six months to deny health coverage for a ``preexisting condition'' for up to 12 months. Third, the protections offered to individuals moving into a group health plan, or moving into the individual insurance market from a group plan, are not available to individuals attempting to shop around for policies within individual market. As a result, individuals who purchase policies in the nongroup market and never have a gap in coverage still have no protection against the preexisting condition exclusions that insurers may choose to impose. In most cases, there is no limit on the length of time an insurer can deny coverage under an individual insurance policy for a preexisting condition. An individual with a chronic condition who is buying coverage in the individual market today is likely to pay a high deductible, have a large monthly premium, and have the very illness they need coverage for written out of their policy. The Pre-existing Condition Patient Protection Act I am introducing today would address all three of these gaps in the current HIPAA law by eliminating preexisting condition exclusions in every single market. While this change is not the only insurance market reform necessary, it is a great step forward in improving the health coverage available to the 133 million Americans living with at least one chronic condition. Access to treatment is critical for these individuals, and a permanent fix to the law regarding coverage exclusions is crucial for our Nation in reforming our health care system. Therefore, I urge my colleagues to join me in supporting this important bill. The time for action is now. Mr. President, I ask unanimous consent that the text of the bill be printed in the Record.

Mr. ROCKEFELLER

Mr. ROCKEFELLER. Mr. President, for the Committee on Commerce, Science, and Transportation I report favorably the following nomination lists which were printed in the Record on the dates indicated, and ask unanimous consent, to save the expense of reprinting on the Executive Calendar that these nominations lie at the Secretary's desk for the information of Senators.

Mr. ROCKEFELLER

Mr. ROCKEFELLER. Mr. President, these are difficult times in our country. American families are facing challenges that we have not seen in decades, we have record budget deficits, and we are fighting two wars. The national economic crisis is affecting so many people across our Nation and in West Virginia, and we must give the economic recovery plan time to do what it was designed to do--create jobs and reinvest in the American dream. In West Virginia, factories and businesses are closing their doors. Unemployment rose in all 55 counties in January 2009. Our statewide unemployment rate jumped from 4.4 percent in December to 6.2 percent in just 1 month. And February and March have brought additional plant closures, and more employees have lost their jobs. As we work in Congress on ways to get our economy back on track and create new jobs, I stand ready to help and take bold action that will deliver real, workable solutions to families. And I am committed to working with our State leaders to do everything we can to bring opportunities to West Virginia. It is very important that we in Congress do everything possible to uphold the public trust, protect taxpayer dollars, and show with our actions and not just our words that we take seriously our obligation and honor to serve the people. One of the ways the legislation before us today, H.R. 1105, the Omnibus Appropriations Act of 2009, does that is by prohibiting the annual cost-of-living pay adjustment, COLA, for Members of Congress from taking effect in calendar year 2010. This is a good, small, but important step, and I thank our leadership for including this important provision. Now is not the time for an increase in the COLA for Members of Congress. I represent constituents who earn $25,000 to $35,000 annually, and the notion that we in Congress would allow a COLA increase for ourselves, while they are just trying to put food on the table and make ends meet, is completely unacceptable. Given the state of the economy, and the income and job losses across this Nation, I strongly oppose a congressional pay increase in this bill. I also strongly support efforts to suspend permanently the automatic congressional COLA. It will be some time before our economy turns around and the American people feel a sense of financial security again. And especially in a recession, any congressional pay increase should be subject to an up-or-down vote each year, and not simply occur automatically. That is why I am glad to be a cosponsor of S. 542, legislation introduced by Majority Leader Reid to repeal the provision of law that provides automatic COLAs for Members of Congress. I do not believe we should amend the pending bill to do this--the amendment, like so many others offered by the minority over the past week, is really a Trojan horse to kill or delay the Omnibus Appropriations Act, which is already overdue and meets our basic obligation to keep the government running. But the issue is an important one, deserving of immediate action and I appreciate the leader's commitment to act quickly on it. I believe having transparency, accountability, and an up-or-down vote on the COLA every year makes a lot of sense--both for Congress and the American people. The American people deserve to be represented by Members of Congress who are in touch with the everyday struggles of the very people who elected them. Just like their family budgets, Congress has to budget and live within our means and make careful spending decisions based on our most pressing priorities. I support this bill today because it is the absolutely right thing to do and West Virginia families deserve no less.

Mr. ROCKEFELLER

Mr. ROCKEFELLER. Mr. President, I rise today with Senators Schumer, Kohl, Leahy, and Brown to reintroduce an important piece of legislation, the Fair Prescription Drug Competition Act. Our legislation eliminates one of the most prominent loopholes that brand name drug companies use to limit consumer access to lower cost generic drugs; it ends the marketing of so-called ``authorized generic'' drugs during the 180-day exclusivity period that Congress designed to specifically allow true generics to enter the market. An authorized generic drug is a brand name prescription drug produced by the same brand manufacturer on the same manufacturing lines, yet repackaged as a generic. Some argue that authorized generic drugs are cheaper than brand name drugs and, therefore, benefit consumers. In reality, authorized generics only serve to reduce generic competition, extend brand monopolies, and lead to higher health care costs for consumers over the long-term. As I have said many times, authorized generics are a sham. They are brand name prescription drugs in disguise. After up to 20 years of holding a patent for a brand name drug, the manufacturer doesn't want to let go of their enormous profits. So, they repackage the drug and refer to it as a generic in order to achieve a very simple goal--to drive true generics out of the market by offering the drug at a lower price initially; then, when victory is assured, raising the cost on the so-called ``authorized generic'' to gain a larger profit. This is a huge problem and one that is becoming even more prevalent as patents on some of the best-selling brand name pharmaceuticals expire. In 1984, Congress passed the Hatch-Waxman legislation to provide consumers greater access to lower cost generic drugs. The intent of this law was to improve generic competition, while preserving the ability of brand name manufacturers to discover and market new and innovative products. Over time, brand name manufacturers found ways to exploit certain loopholes in the Hatch-Waxman law to the detriment of generics. As a result, Congress enacted amendments to the Hatch-Waxman Act as part of the 2003 Medicare prescription drug law. These amendments were designed to close long-standing loopholes that were delaying generic competition and hindering consumer access to lower-cost generic drugs. These reforms were also intended to strengthen the 180-day period of market exclusivity for generic manufacturers that pursue costly patent challenges. The Hatch-Waxman Act and the additional reforms included in the 2003 Medicare law provide crucial incentives for generic drug companies to enter the market and make prescription drugs more affordable for consumers. As health care spending continues to skyrocket, finding ways to reduce costs is crucial. Today, generic medications comprise more then 56 percent of all prescriptions in this country, but they only generate 13 percent of our Nation's drug costs. Furthermore, generic drugs are 50 percent to 80 percent cheaper than brand name drugs. In fact, generic drugs save consumers an estimated $8 to $10 billion a year at retail pharmacies. For working families, these savings can make a huge difference, particularly during a recession. We must protect the true intent of the Hatch-Waxman Act and increase access to affordable prescription drugs for all Americans. The Fair Prescription Drug Competition Act does just that by eliminating the authorized generics loophole, protecting the integrity of the 180 days, and improving consumer access to lower cost generic drugs. I urge my colleagues to support this timely and important piece of legislation.

Mr. ROCKEFELLER

Mr. ROCKEFELLER. Mr. President, I rise today with Senators Schumer, Kohl, Leahy, and Brown to reintroduce an important piece of legislation, the Fair Prescription Drug Competition Act. Our legislation eliminates one of the most prominent loopholes that brand name drug companies use to limit consumer access to lower cost generic drugs; it ends the marketing of so-called ``authorized generic'' drugs during the 180-day exclusivity period that Congress designed to specifically allow true generics to enter the market. An authorized generic drug is a brand name prescription drug produced by the same brand manufacturer on the same manufacturing lines, yet repackaged as a generic. Some argue that authorized generic drugs are cheaper than brand name drugs and, therefore, benefit consumers. In reality, authorized generics only serve to reduce generic competition, extend brand monopolies, and lead to higher health care costs for consumers over the long-term. As I have said many times, authorized generics are a sham. They are brand name prescription drugs in disguise. After up to 20 years of holding a patent for a brand name drug, the manufacturer doesn't want to let go of their enormous profits. So, they repackage the drug and refer to it as a generic in order to achieve a very simple goal--to drive true generics out of the market by offering the drug at a lower price initially; then, when victory is assured, raising the cost on the so-called ``authorized generic'' to gain a larger profit. This is a huge problem and one that is becoming even more prevalent as patents on some of the best-selling brand name pharmaceuticals expire. In 1984, Congress passed the Hatch-Waxman legislation to provide consumers greater access to lower cost generic drugs. The intent of this law was to improve generic competition, while preserving the ability of brand name manufacturers to discover and market new and innovative products. Over time, brand name manufacturers found ways to exploit certain loopholes in the Hatch-Waxman law to the detriment of generics. As a result, Congress enacted amendments to the Hatch-Waxman Act as part of the 2003 Medicare prescription drug law. These amendments were designed to close long-standing loopholes that were delaying generic competition and hindering consumer access to lower-cost generic drugs. These reforms were also intended to strengthen the 180-day period of market exclusivity for generic manufacturers that pursue costly patent challenges. The Hatch-Waxman Act and the additional reforms included in the 2003 Medicare law provide crucial incentives for generic drug companies to enter the market and make prescription drugs more affordable for consumers. As health care spending continues to skyrocket, finding ways to reduce costs is crucial. Today, generic medications comprise more then 56 percent of all prescriptions in this country, but they only generate 13 percent of our Nation's drug costs. Furthermore, generic drugs are 50 percent to 80 percent cheaper than brand name drugs. In fact, generic drugs save consumers an estimated $8 to $10 billion a year at retail pharmacies. For working families, these savings can make a huge difference, particularly during a recession. We must protect the true intent of the Hatch-Waxman Act and increase access to affordable prescription drugs for all Americans. The Fair Prescription Drug Competition Act does just that by eliminating the authorized generics loophole, protecting the integrity of the 180 days, and improving consumer access to lower cost generic drugs. I urge my colleagues to support this timely and important piece of legislation.

Mr. ROCKEFELLER

Mr. ROCKEFELLER. Will the Senator yield?

Mr. ROCKEFELLER. Mr. President, I say to the distinguished Senator from California, I need to find out if the Senator from Alabama-- because we are meant to go back and forth--will take time.

Mr. ROCKEFELLER. If the Senator does not wish to speak, we can do it on our side.

Mr. ROCKEFELLER. I ask unanimous consent that the time be extended until 3:30, but it already has been. By what mechanism, I know not, but it doesn't make any difference. That is why the Senator from Iowa was able to continue. Since it is now 7 of and Senator Nelson and I both wish to speak, I ask unanimous consent that the time for debate be extended until 3:30, with the time equally divided between the leaders or their designees under the same provisions of the previous order.

Mr. ROCKEFELLER. Mr. President, I note that my bill managing colleague is not here.

Mr. ROCKEFELLER. I yield 7 minutes to the Senator from Arkansas.

Mr. ROCKEFELLER. I thank the Presiding Officer. Mr. President, I wish to clear up a couple of quick points. I think I will be the last speaker from our side, and I am not sure about the other side. But we have until 3:30, and I will not speak that long. I think it is important to point out a couple things. No. 1, the point has been made that we rushed this thing and we are jamming it down the throats of people. Well, first of all, if we are doing that, we are not doing it in quite as numerically an advantageous way as we should. Secondly, I think two of the most important committees that handle this whole matter--the Finance Committee and the Appropriations Committee--have been through full markup, have had hearings on this. I remember our markup in the Senate Finance Committee lasted 12 consecutive hours on our section of this bill. So it has been very well thought through. It has been very well debated. Amendments have been raised. Amendments have been rejected. We had 45 votes on the floor about this. They have been debated back and forth. They have been discussed. It is not clear to me if we did this for another week that we would be any wiser or we would have any crisper or more targeted bill than we have today. The second point I wish to make is, when it is pointed out that as a percentage of total spending State spending is doubled, tripled, and all the rest of this--as if the States have been acting in some kind of very irresponsible fashion--I was a Governor. And Governors are capable of doing that from time to time. But I want to point out that as a percentage of total spending, State spending has not increased at a greater rate than any other of the sectors in our economy. It is just that the price of health care and the price of everything else-- inflation, all of it--has caused that. So people can say it is a $1.2 trillion bill, but that does not take into account all the reasons I have enumerated. There are a lot of costs that are going to go up, and that is why at the end of a period of time it may be that, but we are not voting on something which is 5 years in the future or 8 years in the future. We are voting on something which has to take effect right now. That brings me to what I want to say, and that is two points. We have wandered, it seems to me, a bit in this debate away from the people who I think haunt us in their tragedy. I regret that. People have talked about individual amendments they want to get. There is an enormous--42 percent of it is in tax cuts. That is probably more than most Democrats would do. But, on the other hand, the tax cuts tend to be more toward the middle class and small business, which is what the ranking member of the Finance Committee wants. He wants more, and I understand that. But we all want more or less of something. But what we do not want is for the American people to suffer, as they are now suffering. That is the only reason we are here. It is the only reason we are here. This is only the beginning. We have at least two other major bills we are going to have that are going to require a lot of money that we are going to have to deal with. This is the first one. This is our first test. I think it is extraordinary, the point the Senator from Florida made, and others have made, that it took three Republicans and one Democrat to come together in essence to put forward a bill which I think is going to end up passing if we can work out our differences with the House in conference, which I think we will be able to do. Now, why do I say this? I say this because we have no choice but to come to the aid of the American people. I am not saying that Government spending is the answer to everything, as I am not saying that tax cuts are also the answer to everything. And incentives are good. The tax cuts over the last 8 years, which went to primarily people who did not need those tax cuts--I do not think that ended up in more jobs. It may have ended up in more money and, therefore, more income tax revenue for the Government, but it was not stimulative in the way we are trying to do today. So we want jobs. We want road construction. We want education. We have had to cut--I have my list of tragedy here of all of the programs we have had to cut in order to meet the needs of the more moderate bill, the $780 billion bill. I look down at this list, and I look at so many programs that I think need to be increased. But then I stop and I think: Well, they are being increased. They are not being increased by as much as the Democrats, as a main, wanted, and so we call them what is stated here: ``Quick Review of Cuts Made.'' That is not cuts made to the program from where they are now. That is cuts made to where we wanted to put them. Why did we want to put them there? Because that would help stimulate the economy and to bring more jobs to our people. You cannot make light of this. You cannot talk about this without talking about what is happening to American families. You cannot do that. I come from a State which is not wealthy but which is full of incredibly hard-working people, incredibly hard-working people who have been working hard all their lives to stay afloat because that is the nature of our State and it is the nature of our topography, it is the nature of the resources we have and the way they have been handled. So, yes, I battle for them and, on the other hand, I also have to battle for the entire Nation through this program because we all live or die together. Part of this is in the mind. People have to have confidence that the Senate has passed a bill and that we are moving in the right direction. It is not a question just of supporting a President from a Senator from this side of the aisle who happens to be a Democrat. It is a question of doing the right thing by the American people. And if it takes as many billions of dollars--$780 billion--to do that, then I say we have to do it. We have no choice. Sometimes I have the feeling from the other side that what they want to do is adjust a number of amendments to increase the number of tax cuts, but that the plight of the American people is talked about, is used in not rhetoric but in their words, and used stirringly, but their real thinking is not there, it is in getting more to the way the other party has chosen to see progress hopefully happen in this country, and that is through tax cuts. I cannot help but reiterate what has been said; that is, when President Clinton left office, he left a $5.6 trillion surplus. To some degree, I criticized him for something he actually could not have done but he could have done morally, and that is to go to the Congress, call a special session or whatever, and say: We have $5.6 trillion. We also have a whole world to confront, wars to fight, an entire Nation to rebuild--which was going to be my second point--and we can start right now doing that. That was while the economy was still prosperous. He was still President. Then we entered into this massive period of borrowing for wars, which the intelligence showed was not right in this Senator's judgment. And now we are in Afghanistan and now we are in Pakistan, and who knows where it will stop. Well, al-Qaida is in 50 or 60 other countries, so it may not stop for quite a while. I will say to the Presiding Officer, I can remember when I was a Peace Corps volunteer in the Philippines. I suspect the Presiding Officer had not been born yet. I was in the southern part of Mindanao in the city called Zamboanga City. It is the headquarters of Abu Sayyaf, who is the al-Qaida leader for Southeast Asia, and all of the same kind of slaughtering and mass killing between ethnic groups or religious groups was taking place then. It is taking place all over the world--has been for centuries. You can go back to the English kings and the way they tortured people. What we do in this country is not something we can always be proud of. So it is the nature of people to fight. The whole question of the war on terror, on one hand, trying to control that, but then, on the other hand, how do we mitigate the need for it, gets into questions of something that nobody wants to talk about. Nobody ever has wanted to talk about it, and that is substantial amounts of foreign aid, to give people in other countries a feeling that we care about more than just killing high-value targets or Guantanamo or whatever, but we care about their lives. First, we have to start by showing the American people that we care about their lives. That is why we are here. This is the first of three bills. This bill has to pass. This bill is a good bill. It is not the bill I would have written. There are cuts made which are very painful to me in terms of not just my State objective, but also my responsibilities in the Senate over the Commerce Committee and then over the Intelligence Committee. But we have to do that. We have to do that. We have to do that because people are suffering. When people are suffering, they turn to their ministers for a while, but essentially they know it is only the government that can come in, in emergencies, in critical situations, in desperate situations, and infuse money in certain areas which will create jobs. Now, the President has been very clear that some of these jobs will come more quickly, saying a lot of them will--and a lot of the tax cuts will become available by September of next year. That is some time. A lot of them before that. Some of the jobs would not take place right away because you can't suddenly build a bridge. You have to have your plans, they all have to work, and it takes time. But we have to do that. We have to do that. We have to put people back to work. People without work who can work and who have families to support have no reason to have hope. If they give up hope, then they become part of not just people who are unemployed but people who have given up on employment, and they don't show up in the unemployment figures. They are called the people who have given up. My own feeling is the unemployment rate is probably closer to 13 or 14 percent in this country right now. A lot of people have just lost all hope. They are the same people, they have the same values, the same families as others do. So I hope we can pass this bill. I hope this is not a matter of anytime the Government intervenes, it wastes money. When the Government intervenes, sometimes, yes, it does. When Wall Street gives out bonuses and takes trips to spas and things of that sort, I call that wasting money, and I think we are paying attention to that. So it is part of human nature. Yet I think we are going to have an enormous effort on oversight of this program. I know the President is, I know the Congress will, so that as little money as possible will be wasted and people will get back to work. Work is what people want to do. Work is what gives people dignity. I remember that from my early days in West Virginia when I went to a place where nobody had work and they couldn't hold their heads up high. Sometimes even people I love and who changed my life, who were what I call my secular rebirth in life, sometimes the men, when we had community meetings, would squat on their haunches and face away from the meeting. Psychologically, they were saying: I don't really believe what is going to come out of this is going to help me. I am here because you asked me to come, but I am not really here because I don't have faith. We have to restore that faith, and we do that by giving people a sense that things are on the move, that things are going to get better, that bills pass as opposed to fail. I don't want to see a bill which is mostly passed by Democratic votes and with a very few Republican votes. I don't want to see that. I will take it because it will get the program under way, but it is not the way it should be. Senator Nelson is correct. This looming partisanship is still a part of our problem in the Senate. The discipline of the party on the other side is usually a bit better than the party on my side, so they can be very effective in slowing things down, as I think we have seen. The last point I wish to make is, this is not just a matter of helping people in desperate need and helping them as quickly as possible. Nonaction is not an option. Standing by and watching is not an option. It doesn't do any good for anybody to vote against this bill, even if it isn't what they want, because it will create activity. It will create confidence. It will create momentum. The final point I wish to make is, it will create something more. We need in this country--and we have needed it for a long time, and it is why I wish President Clinton had taken that $5.6 trillion, pulled us all together and said, OK, we are going to spend 4 trillion of these dollars on re-creating America, re-creating schools, re-creating higher education, science and technology, re-creating a sense of fairness. Yes, arts, yes--not just $20 million contracts for athletes but people who add to the luster of our Nation. We have a long way to go. We don't have an air traffic control system which is digitalized. Mongolia is building them. We are behind Mongolia. Every other industrial country in the world has an air traffic control system which is digitalized and operates off a GPS system. Therefore, we have 33 percent more air traffic congestion than we need, and danger is increased. So we have to rebuild an entire Nation: elementary schools, secondary schools, high schools, colleges, postgraduate. We have to attract scholars into the areas where we need innovation. There is nothing like innovation. Senator Nelson knows this better than anybody because of what happens at NASA, but we need it. We need people who want to serve in government. We want people to go into public service. If I had my way, I think I would probably get quite a few cosponsors who would say we ought to have a bill that requires every single American to take a period of 2 years out of their life and commit it to public service, community service. They could go into the military. They could go into teaching. They could go into nursing homes, home care, research, whatever, but 2 years out of their track so they could look at themselves and their country, so they wouldn't just be doing the same thing every day. I was lucky to have that experience twice in my life, and it has made me a better person. I think it is the way you bring America together again so that you have everybody in the trenches together. Everyone is equal. The rich don't get a break; the poor don't get help. If they can't afford not to do this without help, then they get help. That would be expensive, but I think it is something this Nation needs in order to heal itself. So let me end by saying we have absolutely no excuse whatsoever for not passing this bill or what comes out of the conference. We have no excuse. It would be a shame and an act of cruelty to do that to the American people who are now suffering. In the process of so doing, and of helping them, and of giving them some sense of hope about their own lives which, let's face it, is very important in how hard people choose to try and fight, participate in community affairs, and do all kinds of things. But we need to rebuild our Nation. If this crisis had never happened, I would be giving the second half of my speech. We have to rebuild the Nation, Mr. President, because we have let it slide over the last 50 years. Infrastructure is the most obvious example. I can name so many other areas. Broadband gets cut. That hurts me because that is the way people can achieve much faster communication, through the Internet. Long distance learning has been cut. It is still much more than it is now, but it has been cut from the original Democratic bill. That is the way people in a poor county in southern West Virginia learn Japanese from the University of Nebraska because they can do it online and then remake their careers and give themselves hope. So I hope we will be large in our thinking, small in our politics, and generous and encouraging to the American people by passing the bill before us. I thank the Chair and note the absence of a quorum.

Mr. ROCKEFELLER. Mr. President, add on 3 more minutes.

Mr. ROCKEFELLER. Mr. President, I know the manager on the other side is not here, so how much time would the Senator from Nebraska require?

Mr. ROCKEFELLER. I say to the Senator from Arizona, it probably is a good idea if you try to play by the rules here. We are going back and forth. Each Senator has a certain amount of time. We can engage, but I don't think that you, as my friend and counterpart, should feel you need to make a speech after every point that is made on our side. I think that is a tendency right now, and it doesn't do service to others on your side or my side who want to speak.

Mr. ROCKEFELLER. All right.

Mr. ROCKEFELLER. That is fine.

Mr. ROCKEFELLER. Mr. President, this is a chance for us to engage in constructive discussion. It is still a very interesting proposition. I think it is going to pass, and it will be, in spite of what was said last night, bipartisan. In fact, it could not possibly pass without that being the fact. There are a number of things in here which are called cuts, but I think it is very important we remember that these are, for the most part, not cuts from the present situation but cuts from the original stimulus package, which was cut by over $100 billion, and therefore they appear to be cuts, but they are not cuts. They are actually, for the most part, additions--substantial additions--to what we already have. So if the bill had not passed, a lot of these programs would cease to exist. So I think it is a positive document. It is not without flaws. We have a conference committee coming and that will be very important. I look forward to the engagement today and to the conference committee and to the passage of the bill. I yield the floor.

Mr. ROCKEFELLER. Mr. President, I yield 7 minutes to the Senator from Minnesota.

Mr. ROCKEFELLER

Mr. ROCKEFELLER. Mr. President, today the Senate will resume consideration of H.R. 1, the Economic Recovery and Reinvestment Act. The time for this discussion will be from now until 3 p.m. It will be equally divided and controlled between the two leaders or their designees. There will be no rollcall votes today, for the information of Members. The next vote will occur at 5:30 p.m. on Monday.