Jay Rockefeller

Mr. ROCKEFELLER

Mr. ROCKEFELLER. I move to lay that motion on the table. The motion to lay on the table was agreed to.

Mr. ROCKEFELLER

Mr. ROCKEFELLER. Mr. President, today I rise to introduce the Medicare Mental Health Prescription Drug Access Act of 2007-- legislation to provide our Nation's seniors and individuals with disabilities access to the mental health drugs that best meet their needs. As many of my colleagues are aware, nearly one out of four Americans, 58 million people, will experience a mental illness during any given year, and a large number of them will be senior citizens and individuals with disabilities. For far too long, mental illness has been shrouded in fear, misunderstanding and stigma. I believe it is long past time for us to address the inequitable treatment of mental illness in our broader health care system. Mental health parity is a critical part of the solution. We must fulfill the intent of the 1996 mental health parity law and expand the definition of parity to include deductibles, co- payments, coinsurance, out-of-pocket expenses, as well as scope and duration of treatment. However, parity alone is not a panacea to the problem of treating mental illness in this country. We must improve the range of mental health illnesses and treatment options covered by health plans, particularly for children and seniors. This year in the Senate, we have taken a major step toward improving access to mental health services for children by passing the Children's Health Insurance Program, CHIP, Reauthorization Act, H.R. 976, not once, but twice. Among the many important provisions included in this legislation, which I co-authored, is a provision that requires the private health insurance plans that administer CHIP to provide mental health services for children that are equivalent to the coverage provided for physical illnesses. In other words, we require full mental health parity for children enrolled in CHIP. I still believe that we must do more to ensure that all children have the broadest health care coverage possible for mental health screening and treatment, along the lines of what is provided to children enrolled in Medicaid through the Early Periodic Screening Diagnosis and Treatment, EPSDT, program. However, we have taken a significant step in the right direction toward addressing the mental health needs of our nation's children by passing the CHIP reauthorization bill. Unfortunately, the same is not true for our nation's seniors and individuals with disabilities. We haven't done nearly enough to address their mental health needs. In fact, we have taken a step backwards in the mental health coverage provided to Medicare participants, particularly those that are dually eligible for Medicare and Medicaid. Many of my colleagues will recall that the Medicare Prescription Drug, Improvement and Modernization Act of 2003 excluded certain classes of medications from the newly-created Medicare prescription drug program. Among the prescription drugs excluded were two important classes of mental health drugs, benzodiepines and barbiturates, central nervous system depressants which have multiple clinical benefits. Benzodiazepines and barbiturates are used to help seniors and individuals with disabilities who are dealing with a variety of conditions including anxiety, depression, insomnia, panic disorders, muscle spasms and seizures. Despite being some of the oldest and most effective medications for the treatment of mental illness, benzodiazepines and barbiturates are currently unavailable to most seniors and individuals with disabilities enrolled in Medicare. That is just wrong. Patients who have found success with benzodiazepines and barbiturates are reluctant to change prescriptions because of the potential side effects or the understandable fear that their conditions might return. Often, there is also an increased cost associated with alternative medications, but the efficacy of these ``replacement'' drugs may actually be less than benzodiazepines and barbiturates. So, why should we require MediCare participants to use prescription drugs that could cost more without offering any greater clinical benefit? I don't believe we should. Medicare participants deserve affordable access to the prescription medications that are best suited to treat their conditions. Many of my colleagues may be wondering why these two classes of prescription drugs were excluded from the Medicare prescription drug program in the first place. They were excluded because of an inappropriate application of existing Medicaid law to the Medicare prescription drug program. The 1990 law that established the Medicaid prescription drug rebate program gave state Medicaid agencies the OPTION to exclude barbiturates and benzodiazepines from their drug formularies. Even though no states have excluded these medications from their Medicaid formularies, the Medicare law makes this exclusion MANDATORY for seniors and individuals with disabilities. It is unfair to restrict access to prescribed medications that have been proven to be safe and effective in the treatment of mental illnesses and other conditions that commonly affect seniors and the disabled. That is why I am introducing this important piece of legislation today, and I urge my colleagues to support it. We know that mental illness is treatable, and treatment can help people to live healthy, productive lives. Yet, our Nation's focus on mental health has continued to take a backseat to our focus on physical health even though the two are interrelated. We must act now to bring an end to the silent epidemic of mental illness in our country. Mr. President, I ask unanimous consent that the text of the bill be printed in the Record.

Mr. ROCKEFELLER

Mr. ROCKEFELLER. Mr. President, I was assured that I would be given more time than that. Let that be resolved.

Mr. ROCKEFELLER

Mr. ROCKEFELLER. Mr. President, the calendar has just turned to October. The long-awaited month of September has passed. Why September? September, the month of the Petraeus report, was to be the month of accountability for Iraq, for its Government, and a time for accountability of the President's policy in Iraq. Instead, the result of the long-awaited month of September is that we are, once again, staying the course, as the President would have us do. We were not able to change course through the Defense authorization bill which passed yesterday, though many of us tried. Our efforts to change the mission away from deep involvement in Iraq's civil war and toward a more narrow focus on fighting al-Qaida failed, by a narrow margin, but failed. Efforts to enforce the transition with the power of the purse came up short as well. Tragically, for well over 4 years into this war, at a time when the Army chief of staff is sounding the alarm about readiness of our Army, the Senate was not even able to provide our troops and their families with predictable deployment schedules--a stunning week. This is far less than the American people expect from us, when they elected us to do far more. Over the next few months, I implore my colleagues to use this time well and to think deeply about what our commitment in Iraq means to our future and the world. I especially want my colleagues and the American people to think about what might happen if there is another attack on the United States, which is always a possibility. The fact there has not been says there has been some interdiction and a lot of good luck, and al-Qaida takes its time in planning what it really cares about. What if that attack has nothing to do with Iraq? What if the next attack is the result of planning and plotting from al-Qaida and its terrorist affiliates who live in a safe haven on the Pakistani border? Will we regret that we did not do more to force the President to focus on the real threat facing this country--the only threat which wants to take us down in any way, shape, or form, which is possible? We cannot continue to repeat the same mistakes over and over. It is past time for a thorough understanding of how we got to be mired in Iraq's civil war, and why we must get out of it. I am often reminded of a prescient quote from Sandra Mackey in her book, ``The Reckoning: Iraq and the Legacy of Saddam Hussein,'' which was written, incidentally, before the war began. Her book posed the central question: Would a future Iraq without Saddam Hussein be even more unstable and more problematic for the security of the United States itself? Mackey did what this administration failed to do prior to the war and continues to fail to do today. She studied the historical, religious, ethnic, and political landscape that produced Iraq and the combination of the above factors that produced Saddam Hussein's dictatorship and allowed it to be sustained. She did her homework on the background and the nature of the country and the people and the ebb and the flow of the forces that have worked there for 1,500 years. She predicted that we would pay a great price for our ignorance and utter lack of understanding of Iraq as a country. She wrote in her book, looking back to the first gulf war, and now the future: Then, in August of 1990, when Iraq invaded Kuwait, the media turned its pages and air time over to Saddam Hussein. Just say the word ``Saddam,'' and you had people's attention, at least for a few moments. Ever since, it has been Hussein, not Iraq, on whom Americans and their [civilian] leaders have riveted their attention. But the time is fast approaching when the United States, for a series of perilous reasons, will be forced to look beyond Hussein to Iraq itself. That is when all Americans will pay the price for what has been a long night of ignorance about the land between the rivers. That being the Tigris and the Euphrates. What a horrible price it is: 3,800 brave men and women killed; nearly 28,000 wounded, maimed, and scarred--most mentally and/or physically for the rest of their lives. Families have been torn apart. Divorce and suicide rates are climbing rapidly. Last year, 99 of our soldiers committed suicide, which is the highest rate since the Army started keeping records on that 26 years ago. The war has cost us as a people and our security so dearly in lives, resources, our standing around the world, our sense of ourselves, our self-esteem, and our moral authority. It tears my heart out that our troops are dying every day and suffering from these horrific wounds which are the new property of the recent years because of the White House's misguided policies from which it will not move. So I ask, why must we remain bogged down in Iraq--at such great cost--when there is a far greater threat that we must face and are not facing? Instead of focusing our resources on Iraq's civil war, we should be focusing all of our efforts on the elimination of al-Qaida, and, incidentally, doing something called protecting the American homeland, which seems to be casually handled in budget and in action. We must finally understand the fundamental fact that our brave and highly skilled soldiers cannot resolve Iraq's internal political, social, and religious fights--there is no argument about that-- particularly when enormous majorities of these people--98 percent of Sunni Arabs and 84 percent of Shia--want our forces to leave the country. That is more than a hint. This is not defeat. It is not surrender. It is not retreat. It is simply getting a grip on the problems we face. The reality is, it is not our fight. We cannot contribute there. There is very little we can do to affect it, if anything. Iraq is chaotic and violent because of deep-seated, centuries-old disputes that have nothing to do with us. It will likely remain chaotic and violent for the long foreseeable future, whether our military is involved in their dispute or whether it is not involved. It will not make any difference. We had an open intelligence hearing in which a number of experts, Arabists came and told us that, in fact, America is marginal to what is going on over there. It is all about Sunnis and Shias and Kurds, and about their ancient fights going all the way back to the death of Muhammad. So this sectarian war has nothing to do at all with the United States, and it has nothing to do with our true enemy, al-Qaida, which has only latched on to the sectarian competition to take advantage of our own mistaken involvement in it. The only thing that can change the course of Iraq is the Iraqi people and their leaders, and only if they can make dramatic changes in the way they view one another. I do not think that day will come. That is this Senator's opinion. We have examples of people getting along on a temporary basis when there are lots of troops around, other things, but that is not in their nature. It is not in the nature of that part of the world. We like to think it is because that is our nature. But it is not their nature. There is, however, a vital strategic and tactical role for our military, and that is eliminating al-Qaida. But it first requires understanding that global terrorism inspired by al-Qaida is a different problem from sectarian violence between Sunni and Shia. That is what you have to understand first--very simple, very plain. Our present policy continues to follow al-Qaida's playbook by conflating these two problems to create one single-minded ``enemy,'' thereby tying several different strands of violence into a single tangled knot. We must untie this knot and address these issues separately. And we must recognize that our involvement with Iraq is drastically diminishing our ability to do anything about al-Qaida. The war against al-Qaida and affiliated terrorists has two key components, in this Senator's point of view: a tactical component-- which is tracking, catching, and killing terrorists and disrupting their plots--and a strategic component--which is addressing the circumstances that produce terrorists and countering the ideology that drives them. Our war in Iraq diverts our military and intelligence resources from the tactical component--it is very clear that al-Qaida is gaining strength along with the Taliban in Afghanistan because we moved a lot of people out to fight a war that we had no business being in, and so we suffered where we originally were about to be strong--and it limits the amount of money available to address poverty and evolution of governments in the Muslim world. But perhaps the most damaging effect of the war in Iraq is the war of ideology. The Intelligence Committee has held several hearings this year looking at the role of ideology in the struggle against violent extremism. There is plenty of evidence, including unclassified intelligence assessments, that al-Qaida has successfully exploited the war in Iraq to recruit and train a new generation of terrorists--thanks to us. We have made that a possibility for them. Civilian leadership has handed them that golden gift, and they have made good use of it. But there is longer term damage the war in Iraq is doing to our counterterrorism efforts. It is making it impossible for us to make any progress in the war of ideas throughout the Muslim world. It is clear that winning this part of the war is the only way we will have an effect in the long term on this kind of instability and chaos. Al-Qaida wants us to stay in Iraq. As I said, we are following their game plan faithfully because our presence validates everything about their message of Westerners trying to dominate Muslims and occupy their lands--all of which is sacred to them. As long as we are there, voices of moderation toward the West will be drowned out. The bottom line is this: Continued U.S. involvement in Iraq is in al- Qaida's interest, not America's. The longer we stay mired in Iraq, the stronger al-Qaida will grow. Again, declassified intelligence reports and a broad spectrum of experts have noted al-Qaida is as strong as any other time since 9/11-- this day--and growing stronger. President Bush says we should not allow Iraq to become ``a safe-haven from which they could launch new attacks on our country.'' Yet the President has already allowed al-Qaida to create a safe haven, a huge safe haven on the Pakistani border. That situation is deteriorating on a daily basis, and it allows al-Qaida to continue to plan deadly attacks. And, believe me, that is their purpose for existing and living, and that is what they want from us. We have given them what they want from us. Our struggle to eliminate global terrorism may remain a mystery to our President, but it must not remain a mystery to us in the Congress and to the American people. We do have a responsibility to act. Whether history looks kindly on this Congress or not is not really so important. But we must take every single serious measure available to force the President to face reality and refocus America's mission in that part of the world. We have created deep and profound sadness and left thousands of people sitting in wheelchairs for the rest of their lives with shards of steel through their bodies that cannot be removed by surgeons. So they sit in wheelchairs in agony for the rest of their lives. They cannot take them out because they are too close to organs, arteries, so they sit in agony, probably a great number of them wishing they had just simply been killed. I will end that part and simply say that I would also like to remind the President of the United States that signing the CHIP bill won't change anything in Iraq, but it may have a whole lot to do with changing young people in America in the way they grow up, what their opportunities are, and their sense of optimism and commitment to public service and to the good of our country.

Mr. ROCKEFELLER. Mr. President, the Senator from Florida, as usual, is correct. I thank him for his kind comments; he is not quite so correct about that. But, yes, that is very much the case. It is simply an example of why it is that America--why intelligence is the spear, the tip of the spear, and that we never do anything ever again without listening to our intelligence--not to Chalabi, not to Richard Perle, but to our intelligence--which told us all of these things, which told us what would happen, timidly at first but more boldly later on. We just live in a different world. We are homesteaders. I have always felt that way. After the industrial revolution, the East got sort of flooded up with folks who had come from other places, and they went out West with the Gold Rush and the land rush, they got their 10 square acres and built their houses and picket fences and went about educating their children and doing good things but paying very little attention to the rest of the world because there was no apparent reason to do so. We had never been attacked since 1812, and that was marginal, and 1941 had not arrived. This awakened us in many ways, but, in fact, it really didn't. Conscription for World War II passed the Congress, I believe--or one House of the Congress--I believe by one vote, after Pearl Harbor. We go over and we fight just wars, and then we come back and we disarm. It is not in our nature to know about the rest of the world. There is not a profound curiosity factor that pulls us, now that we are very much a part of the world, to understand what is going on in other parts of the world and in specific countries where there happens to be a threat of people who have come to see us as greedy, hate our green lawns and picket fences, and think that our view of life and morality is way off. They are very serious about that. We slough it aside, but they are very serious about that. So how we thought we could somehow do this, come in and mediate something which had been going on I would say since the death of Muhammad in 632--but that doesn't matter; it is a question of how his succession would be carried out. That has lasted ever since. The British and French came in and created a place called Iraq, but the tribal people who kept living all through those years there were always the same and their habits were always the same, and, in fact, it is true throughout most of the rest of the world, if you go to the Philippines, if you go to many places--revenge, tribal loyalties, as opposed to central government loyalties. I have never been convinced that a constitution or a parliament means a whit to the people of Iraq. It meant everything to us because it is sort of the definition of democracy on the rise, but I don't think it made any difference to them at all. So we misread because we don't read, we don't read and we don't study, we don't go, we don't learn languages because we don't think we have to, and we have not had to because the world has been very simple--the Soviet soldiers in uniform versus American soldiers in uniform, our various planes, tanks, and all the rest of it, but then a red phone on each side to try to calm things down. The world is no longer simple. Everybody looks like everybody else in very dangerous places. When we entered into Iraq, it was without thought, it was without study. The decision was more or less made within 2 or 3 days of 9/11, which, when you think about it, is rather silly. So there was no real understanding of Iraq, even as there is no real understanding of Iran today, no understanding of North Korea. There is a superficial understanding, the dramatic parts--nuclear this, something else that, starvation that. But who are they? Why is it that North Korea and South Korea--44 million in the south, 22 million in the north--that amongst all of those people, 66 million people, there are only 400 surnames--``Nelson'' being a surname, ``Rockefeller'' being a surname--there are only 400 surnames. The world is mixed and varied. Japan disappeared for 250 years during the Tokugawa era. Nobody could get in, nobody could get out. That was just 150 years ago, and they still bear some of that with them. Do we understand that? I don't think we do. They are a democracy. Are they? They were handed their Constitution by GEN Douglas MacArthur, and except for a period of 3 months--and I was there during those 3 months--in the last 60 years, one party has controlled the country in its entirety. So there are many things to understand in this world, but among those places we did not understand and still do not are the vicissitudes of Iraq, the Sunni and the Shiites, each of them bearing within them many layers of competition, revenge, family feuds, all the rest of it.

Mr. ROCKEFELLER. I thank the Senator.

Mr. ROCKEFELLER. I yield to the Senator from Florida.

Mr. ROCKEFELLER

Mr. ROCKEFELLER. Mr. President, I thank the Chair and I thank the Senator from Illinois. All I wanted to say is that I think the unanimous consent agreement which has been reached is the start. I want to use every fiber in my body to thank the distinguished vice chairman, Senator Christopher Bond, from Missouri, for the enormous role he played in making this happen. It was objected to only a few days ago. It was cleared last night, and I think it exemplified the partnership the Senator from Missouri and myself are trying to bring to the Intelligence Committee. This is an example of our work. I yield the floor.

Mr. ROCKEFELLER. Mr. President, we worked together on this, and I ask unanimous consent to have 2 minutes.

Mr. ROCKEFELLER. Will the Senator yield?

Mr. ROCKEFELLER. Mr. President, the Senate is poised to take action today that is more than two years overdue. Today we will pass the Fiscal Year 2008 Intelligence Authorization bill. For the first 27 years after Congress created the intelligence oversight committees, the annual authorization bill was considered absolute-must-pass legislation. Its importance to our national security was obvious to all. But in 2005 and 2006, the bills reported out of the Senate Intelligence Committee were never even brought before the Senate for consideration. I still cannot explain the reasons this happened, but thanks to hard work of the committee and the support of the majority leader, Senator Reid, we are about to correct that failing. The Intelligence Authorization bill is the tool the Congress uses to provide direction for the execution of some of the most sensitive and important national security programs conducted by the U.S. Government. This year's bill contains provisions, including specific requests from the Director of National Intelligence, intended to improve the work of the intelligence community. These provisions provide greater flexibility and authority to the DNI; require greater accountability from the intelligence community and its managers; improve the mechanisms for conducting oversight of intelligence programs; and reform intelligence program acquisition procedures. Let me take a few minutes to provide my colleagues with more detail on the provisions in each of these areas. The most significant reform of the intelligence community since its inseption in 1947 was the creation of the director of National Intelligence. With 2 \1/2\ years of experience behind us, we have begun identifying ways to bolster the DNI's efforts to better coordinate the 16 different elements of the intelligence community. Starting with personnel authority, this bill uses a more flexible approach to authorize personnel levels and also gives the DNI the ability to exceed those ceilings by as much as 5 percent. Because control of the budget is a key tool for the DNI, the bill changes reprogramming requirements to make it easier to address emerging needs, authorizes the DNI to use interagency funding to establish national intelligence centers, and establishes a contingency fund for the DNI, to react to emergencies or unforeseen opportunities. The bill also enables the DNI to fund information-sharing efforts that span across the intelligence community. Finally, it repeals several unneeded and burdensome reporting requirements. As it increases the authority of the DNI, the bill also improves oversight of the intelligence community. The bill creates a strong, independent inspector general for the intelligence community, confirmed by the Senate, within the office of the DNI, and establishes statutory inspectors general at the NSA, NRO, DIA and NGA. The bill also gives the Congress more oversight of the major intelligence agencies by requiring Senate confirmation of the directors of the NSA, NRO and NGA and establishing a Senate-confirmed deputy director for the CIA. And as we increase the DNI's flexibility to manage personnel, we require an annual assessment of personnel levels across the intelligence community to include a statement that those levels are supported by adequate infrastructure, training and funding, and a review of the appropriate use of contractors. The committee has been concerned that intelligence failures and programmatic blunders too often occur without anyone in a position of responsibility being held accountable. The bill gives the DNI the authority to conduct accountability reviews across the intelligence community if he deems it necessary or if requested by Congress. It also improves financial management by requiring a variety of actions related to the production of auditable financial statements--a standard most intelligence agencies cannot currently meet and an issue the committee has focused on for several years. The final major theme in the bill is the reform of the acquisition process. The bill requires a vulnerability assessment for all major acquisition programs, and attempts to curb the profligate cost overruns and schedule delays we have witnessed in recent years by creating an annual reporting system on all major intelligence community acquisitions similar to the Nunn-McCurdy statute for defense acquisitions. In addition to these legislative provisions, the bill is accompanied by a classified annex that includes specific budget recommendations. The budgets are necessarily classified, but any Senator wishing to review them has had that opportunity. The committee budget recommendations include a substantial increase for advanced research and development programs. The classified annex also includes language directing the intelligence community to restructure its strategy for acquiring imagery intelligence systems. All of these provisions, in the public bill and the classified annex, are important to ensuring that the intelligence community has the authority and resources it needs to protect this country, and that there are mechanisms in place for appropriate oversight of these very sensitive programs. Before I conclude I would be remiss if I did not mention the people who worked so hard to get this bill to this point. First and foremost among those is my incredibly dedicated vice chairman, Senator Kit Bond. He has been tireless in his efforts to identify and remove obstacles to the bill's passage. We would not have gotten here today without that effort. His commitment to real oversight, conducted in a bipartisan way, represents a return to the way the committee had operated for most of its history. Next let me thank the members of the staff who played such a key role in preparing the bill and the annex and who have worked many hours on this task. First, the committee staff director, Andy Johnson, has implemented the committee's aggressive oversight agenda and has led the staff with true professionalism. I rely heavily on his counsel. His counterpart on the minority side, Louis Tucker, has not just supported Vice Chairman Bond but has made an enormous contribution to the success of our efforts so far this year. The general counsel, Mike Davidson, and minority counsel, Jack Livingston, have been extraordinarily meticulous in drafting the legislative language that makes up the public bill. The committee is lucky to have them both. The budget director, Lorenzo Goco, did a superb job in putting together the classified annex. And as chairmen have been doing for the past 20 years, I give a special thanks to our chief clerk Kathleen McGhee for making everything on the committee work. I look forward to the passage of this bill and the swift completion of a conference with the House so that we can enact a bill to help secure this nation from its enemies. Mr. President, at this time I ask unanimous consent that the committee-reported amendments--which Senator Bond is about to say some words to and which he had an enormous amount to do with--be agreed to, the amendment at the desk be considered and agreed to; that the bill, as amended, be read three times; that the Intelligence Committee be then discharged from consideration of H.R. 2082, the House companion, and the Senate then proceed to its consideration; that all after the enacting clause be stricken and the text of S. 1538, as amended, be inserted in lieu thereof; that the bill be read a third time, passed, and the motion to reconsider be laid upon the table; that upon passage, the Senate insist on its amendment, request a conference with the House on the disagreeing votes of the two Houses, and that the Chair be authorized to appoint conferees on the part of the Senate; that S. 1538 be returned to the calendar, and any statements be printed at the appropriate place in the Record without intervening action or debate.

Mr. ROCKEFELLER. Mr. President, I yield the floor.

Mr. ROCKEFELLER. Mr. President, I ask unanimous consent that the Senate proceed to the immediate consideration of Calendar No. 222, S. 1538.

Mr. ROCKEFELLER

Mr. ROCKEFELLER. Mr. President, it is my great honor to highlight the work of a devoted and difference-making West Virginian. Dennis Sutton, through his work in the Children's Home Society, has been a true asset to adoptive and foster parents and adoption agencies both in West Virginia and across the Nation. I would like to take a moment to highlight his service to his community and congratulate him on receiving the Congressional Adoption Caucus's Angel of Adoption Award. As the CEO of Children's Home Society of West Virginia, Dennis Sutton has dedicated his organization's program to securing loving homes for West Virginia's children in need--a derivative from his belief that every child is entitled to a loving family and home. Children's Home Society of West Virginia's utmost priority of bringing children and families together has been the result of more than 110 year experience, skilled and well-informed staff, certification by the National Council on Accreditation, and readily available statewide service. Dennis Sutton's commitment to our Nation's vulnerable children can be further seen in his participation as a founding member of Children's Home Society of America. A national organization, CHSA is comprised of the leading child welfare agencies across the country and aims to promote the safety, nurturing, and well-being of vulnerable children. This remarkable organization is working to make the adoption process easier for everyone involved but put children in the care of stable families, give them the tools to succeed in today's world, and give them hope. To me, it is clear that this kind of work merits the Angel in Adoption Award. Because of Children's Home Society of America, more than 250,000 children are now living in stable environments. That is an extraordinary accomplishment, one that will benefit our communities now and in the future. Dennis truly has been a passionate advocate for our children in need, has laid the groundwork for a better adoption process, and has put forth the bold vision to enrich and strengthen the fabric of this Nation. I am delighted to have had this opportunity to highlight not only the wonderful cause but the person who is working on this in my State of West Virginia. To Dennis and the Children's Home Society of America, I offer my most profound respects and deepest appreciation.

Mr. ROCKEFELLER

Mr. ROCKEFELLER. Yes. We do hope to pass the full FAA authorization this session, and it contains the EAS mileage waiver. In the interim, it is the intent of the Committee that EAS funding should continue to these airports.

Mr. ROCKEFELLER

Mr. ROCKEFELLER. I thank the chairman of the Finance Committee. I am very happy that the chairman of the Finance Committee made the comments he just did because I was absolutely bowled over by the comments which preceded him from the other side of the aisle. It is sort of basic when you say the word ``universal.'' It means everybody, but it does not necessarily mean it has to be run by the Federal Government, and anybody who makes that kind of an error is either really playing politics or really needs to go to grad school. In any event, this program is totally optional. And there is nothing about it which--in fact, several of the previous speakers said that States could do this and States could do that, but on the other hand it was all Government run, so therefore how could the States do it on their own? It is sort of a sad argument. Several months ago, four Senators--two Republicans and two Democrats--stood in a room, shook hands, and made a promise to each other. It was a wonderful moment. It was a wonderful moment. We vowed not only to reauthorize the Children's Health Insurance Program for millions of kids who rely on it for basic medical care but also to reach out to millions more children. Today, these many months later, we are one step closer to making the promise into a reality for nearly 10 million children. I am very proud to be working with those Senators, grandfathers and fathers themselves, Senators Baucus, Grassley, Hatch, and others, and what they have accomplished in the Senate on the CHIP bill. The legislation before us today is the result of months of some of the most bipartisan working by both the Senators and the staff of the Senators that I have ever seen. It went on for months, night and day. Every day, the four Senators involved in this met for 2 hours so that we could work out differences and make sure it was bipartisan, and I am so happy to say that it is. Many Members of the House and Senate had hoped for something different in this bill. Obviously, some wanted more, some wanted less. Some wanted to simply reauthorize the status quo, some wanted to even decrease the children's health insurance funding, and others wanted to add benefits. That is not necessarily evil. Because you did something 10 years ago does not mean it has to stand written in stone forever, such as eye exams. Some wanted to restore coverage to the children of legal immigrants. Some wanted to increase funding to $50 billion. Individually, we all believed what we proposed was the right thing to do, but ultimately we did not do those things because we compromised because we were determined to be bipartisan and we wanted this bill to pass for the sake of 10 million children. So the promise of the handshake brought us back to the table each and every time and to the common ground we walk today. Each of us knows the statistics in our own State. I am proud that nearly 40,000 West Virginians were enrolled in our Children's Health Insurance Program last year. These kids can see a doctor when they get sick, they can receive necessary immunizations, and they can get preventive screenings. In fact, at the very beginning, it was very hard to get preventive screenings. Now they can. They will be able to, so they can get a healthy start in life because of this important program. The passage of this bill means thousands more of West Virginia's children will have affordable and stable health insurance, including access to basic care. A personal comment. This is all incredibly important to me. Four decades ago, or more, I came to West Virginia as a VISTA volunteer. I did not plan to stay; went to a community where nobody had any health insurance, any job, any water, any sewer, any schoolbus. That was an experience which turned me around, gave meaning to my life. It was a small mining community in southern West Virginia where I learned just exactly how important health care can be in the lives of people who work hard every day to raise a family and to do right by their children and how painful it is when they don't have it. That experience has had a profound influence on me, has influenced me every day of my public service career since. Providing children, especially those who are in the grips of poverty, with health care is moral. It is a moral obligation. It speaks to our deepest humanity and to the better angels of our Nation's character. It was a promise that got started, in fact, with the recommendations of the National Commission on Children, which I was proud to chair and have since worked to implement its recommendations, many of which, including the earned-income tax credit and others, are in effect. It was, as some remember, a very different time in 1997 when this CHIP program was begun. A decade ago when the debates on CHIP took place, there was a genuine frustration that we could not solve broader problems plaguing America's health care system. We were, in fact, the wisdom was, at the breaking point. That is when a bipartisan group of equally committed Senators at that time were in the finance executive room with no staff and worked long into the morning to develop a CHIP program. It was one of the most glorious moments I can remember. People who had never spoken about children suddenly rose, because we were all by ourselves around a table, and spoke about the importance of doing health insurance for children. It was moving. Some people actually stood as they spoke. We were all around a table and there was no need to stand, but their feelings were so deep and they poured forth because there we were, by ourselves, with our consciences, with the future of children in our hands. We knew we could not solve the entire problem, but we committed to trying to do our best by putting children first. The time has come for Congress once again to put our children first, and the bill before us today does exactly that. So having said what it exactly does, I want to say what it exactly does not do, this bill. To start with, we keep our promise that all those currently enrolled will keep their health insurance by investing $35 billion over the next 5 years. We give States the resources to reach out and enroll millions more kids, which, in fact, sounds very easy, but in rural areas--and I think, of course, of Appalachia--it is a very hard thing to do where, in fact, many parents of children, and therefore the children themselves, are scared of health care, scared of doctors, scared of clinics, scared of hospitals, and want to stay as far away from health care as possible. So it is a very difficult thing to get them to join, but we are determined to do that. We have included, yes, expanded access to dentists and mental health counselors. All of the history of health care shows those things are incredibly important for children. In fact, even as baby teeth come in, they determine what mature teeth will be, and if you do not tend to them early, the children are in for terrible problems. I have seen so much of that. We have made it easier for States to identify those children who are eligible but not enrolled in CHIP by reviewing food stamp records, school lunch programs, WIC programs, and all kinds of things that States will decide to do, every State being different, parts of States being different. So there are people--the Governors and those running these programs as they do, not the Federal Government, but the Governors of the States will decide how to do this. We have maintained the unique public-private partnership that has been the hallmark of the CHIP program which has been universally recognized as the most cost-effective and efficient way of reaching all those children who desperately need access to something sacred called basic medical care. Most importantly, we have preserved the State flexibility, so the program fits the needs in every State--different in one State as opposed to another. Now, let me be equally clear about what the bill does not do. It does not raise eligibility limits to families making $83,000 dollars a year. It simply does not do that. I challenge anybody to come on the floor and say otherwise. Our bill does not encourage people to give up private insurance to enroll in CHIP. It does not do that. It does not unfairly raise taxes on the poor and middle class to pay for CHIP. In fact, throughout, both looking backward and looking forward to the passage of this bill and hopefully the signing of this bill, 91 percent of all the children who are covered by the Children's Health Insurance Program will be at 200 percent of poverty or below. That is not wealth. They go out in the private market, and in some places it can be $12,000 dollars, and in others, $9,000. Families cannot afford that. This bill is incredibly important to them. This bill does not cover illegal immigrants. It does not expand coverage to adults. In fact, it cuts adults off the program over the next several years. It does not turn CHIP into some massive Government- run health care program. The President knows this. He should know this. He is a former Governor. And he has spoken about this favorably. So he should understand this. So what is the President's plan for children's health care? For starters, provide a bare minimum of Federal funding to keep CHIP on life support and at the same time throw 1.6 million kids currently in the program out of the program. And what is his answer to those kids and the 721,000 who joined the ranks of the uninsured last year? Go to the emergency room. That is the worst increase of health care known in this country. So sit for hours to see a doctor, only to be prescribed medicine that your parents cannot afford. It is not American. That is not American. Adding to the Nation's growing health care crisis is not a solution. If anything, it would lead to the one thing the President is accusing us of: shifting the burden of paying for health care to taxpayers. We do not do that. Threatening to veto our bill is a mistake. The majority of Americans believe we need to live up to our obligations to provide children with health care. How many people wandering around the streets of Washington or any other place in this country would ask: Don't you agree with me that children shouldn't have health care, children who can't afford it, that only the rich should have it? You wouldn't get any takers on that. People care about children. They know they are the future. They want them to have health care. So it is a moral obligation for our children, and the President is squarely on the wrong side of the issue. All of us here, I know, will do the right thing by our Nation's children. I sincerely hope the President will look deep into his heart and do the same. I yield the floor and thank the Chair.

Mr. ROCKEFELLER

Mr. ROCKEFELLER. Mr. President, I rise today with Senators Kyl and McCaskill, as well as 12 original cosponsors, to introduce an important piece of legislation, the Medicare Teaching Anesthesiology Funding Restoration Act of 2007. This legislation would restore equitable Medicare reimbursement for teaching anesthesiologists and address our nation's growing shortage of trained anesthesiologists. As many of my colleagues are aware, in 1991, the Centers for Medicare & Medicaid Services, CMS, rolled out a new rule that singled out academic anesthesiology programs for a 50 percent reduction in Medicare reimbursement when teaching anesthesiologists supervise residents in two concurrent cases. The rule took effect in 1994. No other medical specialties or nonphysician providers were affected by this policy change. In fact, payments to nonanesthesiology teaching physicians continue to be paid using the conventional Medicare Physician Fee Schedule. All teaching physicians, except anesthesiologists, can collect the full Medicare fee for working with one resident and also collect an additional full Medicare fee for working with a second resident on an overlapping case as long as the teaching physician is present during the ``critical and key'' portions of each procedure and is immediately available to return to a case when not physically present. This arbitrary and unfair payment reduction has had a devastating impact on the training of anesthesiologists across the country, anesthesiologists who we rely on daily for safe surgical procedures, cesarean deliveries during childbirth, emergency and critical care procedures, pain management, and care of our wounded warriors. Because of this policy change, teaching hospitals receive only half the cost of anesthesiology treatment for Medicare patients. This shortchanges academic anesthesiology programs an average of $400,000 annually, with some programs losing more than $1 million per year. As a result, academic anesthesiology programs have experienced increased difficulty filling faculty appointments and sustaining vital research and development programs. But even more disturbing is the fact that this inconsistent and arbitrary payment policy has forced 28 academic anesthesiology programs to close since 1994, leaving only 129 programs nationwide. In my home State, we have only one academic anesthesiology program, at the West Virginia University in Morgantown. This program is losing nearly $700,000 per year because of this unfair Medicare payment policy. When you take into account the fact that many private insurance companies follow Medicare's lead on reimbursement, the final dollar impact is even greater. Other departments within the medical school are being called upon to subsidize these losses instead of using their resources to advance important research initiatives or recruit highly qualified faculty. West Virginia students interested in studying anesthesiology are also at risk. Because this is the only academic anesthesiology program in the State, far fewer West Virginians will have the opportunity to enter the specialty of anesthesiology if this program is forced to close. This will have a direct impact on our State's health care infrastructure because the majority of graduates from West Virginia University's anesthesiology residency program stay in West Virginia. If this program closes, the number of qualified anesthesiologists in West Virginia could plummet, leaving residents with severe access problems for surgery, emergency care, and other high risk procedures. This is not just a West Virginia problem. This is a national problem with severe implications in every community. Academic anesthesiology programs treat the sickest of the sick, patients with multiple diagnoses, unusual conditions and/or in need of highly complex and sophisticated surgeries. The arbitrary Medicare payment reductions for teaching anesthesiologists could mean that patients of all ages and in all communities could see increased anesthesiology shortages in operating rooms, pain clinics, the military, critical care units, labor and delivery rooms, and emergency rooms. In order to address this problem, the Medicare Anesthesiology Teaching Funding Restoration Act eliminates the Medicare payment inequity for physicians who teach anesthesiology. It restores Medicare reimbursement for academic anesthesiology programs to the level in existence before 1994 and subjects teaching anesthesiologists to the same ``critical and key'' portion rule as other physicians under Medicare. This payment restoration will provide physician residents with sufficient opportunities to pursue the specialty of anesthesiology. It will also provide patients, especially high risk patients, with continued access to quality anesthesia care when they need it. And, finally, this vital legislation will allow academic anesthesiology programs to continue making advances in patient safety through research and development. I ask unanimous consent that the text of the bill be printed in the Record.

Mr. ROCKEFELLER

Mr. ROCKEFELLER. Mr. President, I rise today with Senators Kyl and McCaskill, as well as 12 original cosponsors, to introduce an important piece of legislation, the Medicare Teaching Anesthesiology Funding Restoration Act of 2007. This legislation would restore equitable Medicare reimbursement for teaching anesthesiologists and address our nation's growing shortage of trained anesthesiologists. As many of my colleagues are aware, in 1991, the Centers for Medicare & Medicaid Services, CMS, rolled out a new rule that singled out academic anesthesiology programs for a 50 percent reduction in Medicare reimbursement when teaching anesthesiologists supervise residents in two concurrent cases. The rule took effect in 1994. No other medical specialties or nonphysician providers were affected by this policy change. In fact, payments to nonanesthesiology teaching physicians continue to be paid using the conventional Medicare Physician Fee Schedule. All teaching physicians, except anesthesiologists, can collect the full Medicare fee for working with one resident and also collect an additional full Medicare fee for working with a second resident on an overlapping case as long as the teaching physician is present during the ``critical and key'' portions of each procedure and is immediately available to return to a case when not physically present. This arbitrary and unfair payment reduction has had a devastating impact on the training of anesthesiologists across the country, anesthesiologists who we rely on daily for safe surgical procedures, cesarean deliveries during childbirth, emergency and critical care procedures, pain management, and care of our wounded warriors. Because of this policy change, teaching hospitals receive only half the cost of anesthesiology treatment for Medicare patients. This shortchanges academic anesthesiology programs an average of $400,000 annually, with some programs losing more than $1 million per year. As a result, academic anesthesiology programs have experienced increased difficulty filling faculty appointments and sustaining vital research and development programs. But even more disturbing is the fact that this inconsistent and arbitrary payment policy has forced 28 academic anesthesiology programs to close since 1994, leaving only 129 programs nationwide. In my home State, we have only one academic anesthesiology program, at the West Virginia University in Morgantown. This program is losing nearly $700,000 per year because of this unfair Medicare payment policy. When you take into account the fact that many private insurance companies follow Medicare's lead on reimbursement, the final dollar impact is even greater. Other departments within the medical school are being called upon to subsidize these losses instead of using their resources to advance important research initiatives or recruit highly qualified faculty. West Virginia students interested in studying anesthesiology are also at risk. Because this is the only academic anesthesiology program in the State, far fewer West Virginians will have the opportunity to enter the specialty of anesthesiology if this program is forced to close. This will have a direct impact on our State's health care infrastructure because the majority of graduates from West Virginia University's anesthesiology residency program stay in West Virginia. If this program closes, the number of qualified anesthesiologists in West Virginia could plummet, leaving residents with severe access problems for surgery, emergency care, and other high risk procedures. This is not just a West Virginia problem. This is a national problem with severe implications in every community. Academic anesthesiology programs treat the sickest of the sick, patients with multiple diagnoses, unusual conditions and/or in need of highly complex and sophisticated surgeries. The arbitrary Medicare payment reductions for teaching anesthesiologists could mean that patients of all ages and in all communities could see increased anesthesiology shortages in operating rooms, pain clinics, the military, critical care units, labor and delivery rooms, and emergency rooms. In order to address this problem, the Medicare Anesthesiology Teaching Funding Restoration Act eliminates the Medicare payment inequity for physicians who teach anesthesiology. It restores Medicare reimbursement for academic anesthesiology programs to the level in existence before 1994 and subjects teaching anesthesiologists to the same ``critical and key'' portion rule as other physicians under Medicare. This payment restoration will provide physician residents with sufficient opportunities to pursue the specialty of anesthesiology. It will also provide patients, especially high risk patients, with continued access to quality anesthesia care when they need it. And, finally, this vital legislation will allow academic anesthesiology programs to continue making advances in patient safety through research and development. I ask unanimous consent that the text of the bill be printed in the Record.

Mr. ROCKEFELLER

Mr. ROCKEFELLER. Has the distinguished vice chairman asked me a question?

Mr. ROCKEFELLER. He is talking about our bill, the bill I am now talking about. The Rockefeller-Levin bill is the bill the DNI is referring to in his statement. I am not shy about saying that; I am proud of it. The bill he provided to us last evening--that is our bill, not the other one, our bill--is not the Bond bill that was filed 2 days ago. It is our bill. Our bill takes the DNI's preferred bill and modifies it in a limited number of ways to make it stronger without in any way diminishing the fundamental intelligence authorities the DNI needs. Our bill includes a sunset provision of 6 months, the same sunset provision or period that is contained in the Bond bill, I might add, and we are told that the DNI accepted. In fact, he has told us specifically he accepts it. Our modified DNI bill--Director of National Intelligence--would allow our intelligence community to begin the surveillance of terrorist suspects, targets located overseas, immediately upon the signing of the bill, even if those targeted calls enter the United States. In other words, you start immediately in the collection. Why is this? Because the collection is not complete. We are not going in all places we should be, and that is the national requirement because of various warnings that have been issued. So there is no delay--immediate collection--provided there has been a determination by the Attorney General and the DNI that the target is foreign. The only requirement in this bill on the collection is the requirement that the Foreign Intelligence Surveillance Court must be presented, for its review and approval, the Attorney General's guidelines on how the determination is to be made that targets of surveillance are overseas. So the Foreign Surveillance Intelligence Court remains very much a part of our bill, the bill the DNI prefers. This process of court review and authorization of procedures--not individual targeting determinations but a straightforward review that the procedures are reasonable--is at the heart of both the DNI's bill and ours. While the DNI proposal of last night sets forth a 90-day period during which this intelligence collection can take place before the court needs to issue another authorizing of the collection, our bill modifies the time involved in this process--we thought that was too long--which we believe will be relatively straightforward and noncontroversial, so that the application, including the guidelines, is submitted to the FISA Court within 10 days after surveillance begins and that the court must act within 30 days, which the court could then extend if additional time is, in fact, needed. All during this 30-day period of application submission and court review, the collection against foreign targets continues. I keep making that point because it was very hard for people to come to terms with that. This is not case-by-case review. Methods are established, authority is given, and collections can continue. Moreover, once the court approves the guidelines, the Attorney General is not required to return to the court for further approval for the remainder of the 6-month period of this legislation. This process provides minimal and yet essential oversight while not inhibiting or delaying the intelligence collection from proceeding. The Rockefeller-Levin bill accepts the DNI-requested authority to proceed during this FISA Court review. The Bond bill, on the other hand--and I greatly respect and have strong affection for my vice chairman, but we have competing bills, and let the difference be known. The Bond bill, on the other hand, provides a weak and practically nonexistent court review of the procedures for how to determine that a target is foreign and not American. The Bond bill would not require the Attorney General to submit the application and guidelines in the FISA Court until 4 months into the 6-month life of the bill, and then the Bond bill would not require court approval until 6 months has gone by. In other words, under the Bond bill, court approval of these simple and straightforward guidelines on how the Attorney General would determine whether a target is indeed foreign, guidelines that DNI has told me personally exist already--let me repeat, guidelines that he has said exist already--the guidelines that would have to exist before collection could begin in the first place for the surveillance to be legal under the Bond bill. These guidelines would not have to be submitted until 4 months into the 6-month life of the bill and would not have to be approved by the court until the last day that the law would be in effect. Is that meaningful court review over what is a straightforward matter of court review and can easily be handled within 30 days? It is, of course, not, and is, frankly, a farce. The Rockefeller-Levin modified DNI bill makes sure the Attorney General has guidelines in place to address the concerns of many, including our intelligence officials, that surveillance of foreign targets not inadvertently result in the reverse targeting of Americans and their communications based on innocent communications swept up between Americans and individuals overseas. Our modified DNI bill also states right up front that a court order is not required for the surveillance of foreign-to-foreign communications, even if the interception of the communication occurs in the United States. The DNI and others have made a huge point about keeping the surveillance of foreign-to-foreign communications outside the FISA process, and I agree. The Rockefeller-Bond bill made clear that this is the case. I could spend additional time explaining why the Bond bill falls short of the bill that the DNI asked us to pass, in public, earlier this evening. I could spend additional time explaining the merits and protections contained in our bill. But time has run out. Before us now is a very simple question, and I say this with some heat: Will the Senate pass a bill that the DNI wants, a bill that gives him the collection tool he needs for the next 6 months, and then we review the whole process again, a bill which both Republicans and Democrats can support and can rally around, to clearly demonstrate that we put national security above politics and that we are ready to break with the partisan gridlock of the past and produce results, results which give all Americans some comfort that we have our priorities straight? And we do. I urge my colleagues to support the Rockefeller-Levin modified DNI bill, and I close, with some lack of subtlety, with the words of the DNI earlier this day: I urge Members of Congress to support legislation I provided last evening to modified FISA and equip our intelligence community with the tools we need to protect our Nation. That is our bill; not their bill--our bill. Passage of the Rockefeller-Levin bill--not the Bond amendment, our bill--would give the DNI the tools he needs with the necessary court review and oversight as we continue over the next 6 months on more legislation to reform FISA. Exhibit 1 Director of National Intelligence, Washington, DC, August 2, 2007. Statement by Director of National Intelligence Subject: Modernization of the Foreign Intelligence Surveillance Act (FISA) I greatly appreciate the significant time many Members of the Senate and the House of Representatives have taken to discuss with me the urgent need to modernize FISA. I also appreciate the bipartisan support for ensuring the Intelligence Community can effectively collect the necessary intelligence to protect our country from attack. In view of the significance of this issue, its impact on the Intelligence Community's ability to be effective and the continuing dialogue to come to closure on an effective bill, it is important for me to discuss the essential provisions needed by the Intelligence Community. We must urgently close the gap in our current ability to effectively collect foreign intelligence. The current FISA law does not allow us to be effective. Modernizing this law is essential for the Intelligence Community to be able to provide warning of threats to the country. Critical Changes Needed First, the Intelligence Community should not be required to obtain court orders to effectively collect foreign intelligence from foreign targets located overseas. Simply due to technology changes since 1978, court approval should not now be required for gathering intelligence from foreigners located overseas. This was not deemed appropriate in 1978 and it is not appropriate today. Second, those who assist the Government in protecting us from harm must be protected from liability. This includes those who are alleged to have assisted the Government after September 11, 2001 and have helped keep the country sate. I understand the leadership in Congress is not able to address before the August recess the issue of liability protection for those who are alleged to have helped the country stay safe after September 11, 2001. However, I appreciate the commitment of the congressional leadership to address this particular issue immediately upon the return of Congress in September 2007. Provisions that Harm Intelligence Community Operations The Intelligence Community should not be restricted to effective collection of only certain categories of foreign intelligence when the targets are located overseas. We must ensure that the Intelligence Community can be effective against all who seek to do us harm. The bill must not require court approval before urgently needed intelligence collection can begin against a foreign target located overseas. The delays of a court process that requires judicial determinations in advance to gather vital intelligence from foreign targets overseas can in some cases prevent the rapid gathering of intelligence necessary to provide warning of threats to the country. This process would also require in practice that we continue to divert scarce intelligence experts to compiling these court submissions. Similarly, critical intelligence gathering on foreign targets should not be halted while court review is pending. However, to acknowledge the interests of all, I could agree to a procedure that provides for court review--after needed collection has begun--of our procedures for gathering foreign intelligence through classified methods directed at foreigners located overseas. While I would strongly prefer not to engage in such a process, I am prepared to take these additional steps to keep the confidence of Members of Congress and the American people that our processes have been subject to court review and approval. I appreciate the President's and the congressional leadership's commitment to provide the Intelligence Community the necessary tools to protect our country and keep us safe from those who seek us harm. My most solemn duty is to protect America, provide warning, and ensure that our Intelligence Community acts within our Constitution and laws.

Mr. ROCKEFELLER. I don't need to. The head of National Intelligence has made it very clear and has issued a public statement that he supports our bill. He says: I reviewed the proposal that the House of Representatives is expected to vote on this afternoon to modify the Foreign Intelligence [et cetera]. The House proposal is unacceptable, and I strongly oppose it. [et cetera] I urge Members of the Senate to support. . . .

Mr. ROCKEFELLER. Mr. President, I thank the distinguished majority leader and the distinguished Presiding Officer. Mr. President, the Rockefeller-Levin bill before the Senate will provide the Director of National Intelligence, Mike McConnell, the temporary authorities he needs to expand his ability to collect time- sensitive intelligence against foreign targets as the Congress continues to work on a more lasting effort to reform the Foreign Intelligence Surveillance Act, or FISA, after 6 months has passed. I wish to make this very clear. The Rockefeller-Levin bill is the bill of the Director of National Intelligence, who was appointed by the President to be in charge and make all decisions with respect to this matter. In the statement DNI McConnell put out at 4:39 this evening, he said: I urge Members of Congress to support the legislation I provided last evening to modify FISA and equip our intelligence community with the tools we need to protect our Nation. Mr. President, I ask unanimous consent to have printed in the Record the DNI's full statement at the conclusion of my remarks.

Mr. ROCKEFELLER. Does the vice chairman yield?

Mr. ROCKEFELLER

Mr. ROCKEFELLER. Mr. President, today I rise with Senators Inouye and Sanders to introduce a very important bill--the Build, Update, Improve, Lift, and Design Health Centers Act of 2007. Also known as the BUILD Act, this legislation would provide building grants and loan guarantees to community health centers qualified under Section 330 of the Public Health Service Act. This widely-needed source of funding would be used for clinic renovation, replacement, modernization, and/or expansion in order to support community health centers in their on-going efforts to deliver high-quality health care in medically underserved areas. Research from the National Association of Community Health Centers and the Robert Graham Center indicates that there are 56 million Americans that do not have access to a primary care provider, regardless of insurance. Another 45 million Americans lack health insurance or the funds to pay out-of-pocket for their basic health care needs. This means that more than 100 million Americans do not get the medical treatment they need each year. Established over 40 years ago, community health centers are the backbone of America's health care safety net. Encompassing a network of over 1,000 centers, they provide much needed care to nearly 16 million people each year, including one in five children. 40 percent of health center patients are uninsured while Medicaid and CHIP cover approximately 36 percent. More than 70 percent of patients live in poverty. The average annual cost per patient is small, roughly $1.25 per day. However, the benefits of community health centers are great. People in areas served by these clinics are less likely to use emergency room services and have unmet health care needs. Without these centers, many people, particularly those in rural areas, would have nowhere to turn. Clearly, our Nation's health centers bring health care to those in need, but these health centers are in need as well. Renovation and modernization are important to keep these buildings intact and up-to- date. According to the National Association of Community Health Centers, 30 percent of the buildings are more than 30 years old and 12 percent are more than 50 years old. Narrow operating margins, however, mean that most health centers do not have the resources necessary to pay for the capital improvements or new facilities needed to continue providing effective health care. In recent years, the President and the Senate have supported dramatic increases in funding to create a number of new community health centers. However, there has been no corresponding commitment to address the desperate need for renovation and modernization of the older centers. Currently, the Federal Government has no authority to provide grants or loan guarantees to address the building and capacity needs of existing community health centers. The BUILD Act provides such authority and, in doing so, supports the ability of these clinics to continue offering high quality, cost-effective care now and into the future. I urge my colleagues to join me in support of this critical legislation. I ask unanimous consent that the text of the bill be printed in the Record.

Mr. ROCKEFELLER

Mr. ROCKEFELLER. Mr. President, today I rise with Senators Inouye and Sanders to introduce a very important bill--the Build, Update, Improve, Lift, and Design Health Centers Act of 2007. Also known as the BUILD Act, this legislation would provide building grants and loan guarantees to community health centers qualified under Section 330 of the Public Health Service Act. This widely-needed source of funding would be used for clinic renovation, replacement, modernization, and/or expansion in order to support community health centers in their on-going efforts to deliver high-quality health care in medically underserved areas. Research from the National Association of Community Health Centers and the Robert Graham Center indicates that there are 56 million Americans that do not have access to a primary care provider, regardless of insurance. Another 45 million Americans lack health insurance or the funds to pay out-of-pocket for their basic health care needs. This means that more than 100 million Americans do not get the medical treatment they need each year. Established over 40 years ago, community health centers are the backbone of America's health care safety net. Encompassing a network of over 1,000 centers, they provide much needed care to nearly 16 million people each year, including one in five children. 40 percent of health center patients are uninsured while Medicaid and CHIP cover approximately 36 percent. More than 70 percent of patients live in poverty. The average annual cost per patient is small, roughly $1.25 per day. However, the benefits of community health centers are great. People in areas served by these clinics are less likely to use emergency room services and have unmet health care needs. Without these centers, many people, particularly those in rural areas, would have nowhere to turn. Clearly, our Nation's health centers bring health care to those in need, but these health centers are in need as well. Renovation and modernization are important to keep these buildings intact and up-to- date. According to the National Association of Community Health Centers, 30 percent of the buildings are more than 30 years old and 12 percent are more than 50 years old. Narrow operating margins, however, mean that most health centers do not have the resources necessary to pay for the capital improvements or new facilities needed to continue providing effective health care. In recent years, the President and the Senate have supported dramatic increases in funding to create a number of new community health centers. However, there has been no corresponding commitment to address the desperate need for renovation and modernization of the older centers. Currently, the Federal Government has no authority to provide grants or loan guarantees to address the building and capacity needs of existing community health centers. The BUILD Act provides such authority and, in doing so, supports the ability of these clinics to continue offering high quality, cost-effective care now and into the future. I urge my colleagues to join me in support of this critical legislation. I ask unanimous consent that the text of the bill be printed in the Record.