Jay Rockefeller

Mr. ROCKEFELLER

Mr. ROCKEFELLER. The Paralyzed Veterans of America, too, is very concerned about these new regulations, as the new system ``completely ignore[s] the other key missions of the VA health care system to care for the poor and medically indigent and those veterans with special disabilities such as spinal cord dysfunction, blindness, and mental illness.'' I ask unanimous consent that the full text of PVA's letter be printed in the Record.

Mr. ROCKEFELLER

Mr. ROCKEFELLER. Mr. President, today I introduce the Medicare Incentive Payment Program Refinement Act of 2002. This bill makes needed and long-overdue changes to the Medicare Inventive Payment Program, an initiative conceived to address the growing primary care physician shortage in some of our country's most medically underserved communities. The number of physicians needed to care for all individuals, especially our aging seniors, continues to grow in remote rural areas and in underserved urban areas. However, rising health costs and the difficulties of operating a practice in underserved communities has exacerbated the physician shortage. Although the Medicare Incentive Payment Program aims to address the financial hurdles facing physicians in needy areas, the program has failed to achieve real results. This bill will make fundamental changes to improve the program's effectiveness. Rural areas, in particular, are in need of efforts to retain primary care physicians, since the difficulties of operating a practice often drive doctors to larger areas with more resources and professional support. According to the Federal Office of Rural Health Policy, over 20 million Americans live in areas that have a shortage of physicians, and between 1975 and 1995 the smallest counties in the U.S., population under 2,500, experienced a drop in their physician-to-population ratio. More than 2,200 primary care physicians would be needed to remove all nonmetropolitan HPSA designations, and more than twice that number is needed to achieve adequate physician staffing levels nationwide. According to the National Rural Health Association, nonmetropolitan physicians treat a larger number of Medicare and Medicaid beneficiaries than their urban counterparts do, generating less income for physicians per patient. Furthermore, nonmetropolitan physicians are less likely to perform high cost medical services due to their limited number of resources. Understandably, MIPP monies can affect the quality of life for rural physicians and help prevent the mass migration of needed health care professionals from underserved areas. The Medicare Incentive Payment Program, as it exists today, has not fulfilled its original mandate, to recruit and retain primary care physicians in health professional shortage areas. Passed as part of OBRA 87, the program pays all physicians a 10 percent bonus for each Medicare recipient they treat. This enhanced reimbursement is meant to offset the financial advantage of providing service in more populous areas, as well as help physicians with the costs associated with operating a practice in an underserved community. Most importantly, the program aims to increase health care access for Medicare beneficiaries and improve the health of communities overall. However, analyses from the Office of the Inspector General of HHS, the GAO, and independent health experts confirm that the program is unfocused and largely ineffective. All physicians are eligible for bonus payments, even when they may not be in short supply. Bonus payments are 10 percent, not enough to lure physicians to underserved areas, especially if the payment is based on a basic, primary care visit. Finally, many physicians do not even know this program exists, and those that do are often unsure whether they are delivering care in a HPSA and how to bill for the payment appropriately. To improve the program, this bill increases the bonus payment from 10 percent to 20 percent and allows only those physicians providing primary care services, including family and general medicine, general internal medicine, pediatrics, obstetrics and gynecology, emergency medicine, and general surgery, to receive the incentive payment. Finally, my bill automates payments, so physicians no longer have to guess whether they are eligible for the program. These improvements will strengthen the original intent of the legislation, to recruit and retain primary care physicians in underserved areas, and strengthen the primary health care infrastructure of our country's most needy communities. I ask unanimous consent that the text of the bill be printed in the Record.

Mr. ROCKEFELLER

Mr. ROCKEFELLER. Mr. President, today I introduce the Medicare Incentive Payment Program Refinement Act of 2002. This bill makes needed and long-overdue changes to the Medicare Inventive Payment Program, an initiative conceived to address the growing primary care physician shortage in some of our country's most medically underserved communities. The number of physicians needed to care for all individuals, especially our aging seniors, continues to grow in remote rural areas and in underserved urban areas. However, rising health costs and the difficulties of operating a practice in underserved communities has exacerbated the physician shortage. Although the Medicare Incentive Payment Program aims to address the financial hurdles facing physicians in needy areas, the program has failed to achieve real results. This bill will make fundamental changes to improve the program's effectiveness. Rural areas, in particular, are in need of efforts to retain primary care physicians, since the difficulties of operating a practice often drive doctors to larger areas with more resources and professional support. According to the Federal Office of Rural Health Policy, over 20 million Americans live in areas that have a shortage of physicians, and between 1975 and 1995 the smallest counties in the U.S., population under 2,500, experienced a drop in their physician-to-population ratio. More than 2,200 primary care physicians would be needed to remove all nonmetropolitan HPSA designations, and more than twice that number is needed to achieve adequate physician staffing levels nationwide. According to the National Rural Health Association, nonmetropolitan physicians treat a larger number of Medicare and Medicaid beneficiaries than their urban counterparts do, generating less income for physicians per patient. Furthermore, nonmetropolitan physicians are less likely to perform high cost medical services due to their limited number of resources. Understandably, MIPP monies can affect the quality of life for rural physicians and help prevent the mass migration of needed health care professionals from underserved areas. The Medicare Incentive Payment Program, as it exists today, has not fulfilled its original mandate, to recruit and retain primary care physicians in health professional shortage areas. Passed as part of OBRA 87, the program pays all physicians a 10 percent bonus for each Medicare recipient they treat. This enhanced reimbursement is meant to offset the financial advantage of providing service in more populous areas, as well as help physicians with the costs associated with operating a practice in an underserved community. Most importantly, the program aims to increase health care access for Medicare beneficiaries and improve the health of communities overall. However, analyses from the Office of the Inspector General of HHS, the GAO, and independent health experts confirm that the program is unfocused and largely ineffective. All physicians are eligible for bonus payments, even when they may not be in short supply. Bonus payments are 10 percent, not enough to lure physicians to underserved areas, especially if the payment is based on a basic, primary care visit. Finally, many physicians do not even know this program exists, and those that do are often unsure whether they are delivering care in a HPSA and how to bill for the payment appropriately. To improve the program, this bill increases the bonus payment from 10 percent to 20 percent and allows only those physicians providing primary care services, including family and general medicine, general internal medicine, pediatrics, obstetrics and gynecology, emergency medicine, and general surgery, to receive the incentive payment. Finally, my bill automates payments, so physicians no longer have to guess whether they are eligible for the program. These improvements will strengthen the original intent of the legislation, to recruit and retain primary care physicians in underserved areas, and strengthen the primary health care infrastructure of our country's most needy communities. I ask unanimous consent that the text of the bill be printed in the Record.

Mr. ROCKEFELLER

Mr. ROCKEFELLER. Mr. President, perhaps the most effective way to improve the education of America's children is to ensure that they begin their education in an uncrowded classroom led by a qualified teacher. This body recognized that fact when we overwhelmingly passed the ``No Child Left Behind Act'' last year, mandating the hiring of qualified teachers by every school in every district. Unfortunately, without our help, America's poor and rural schools may not be able to attract the qualified teachers this legislation mandates and our children deserve. Isolated and impoverished, competing against higher paying and well-funded school districts for scarce classroom talent, they are already facing a desperate shortage of qualified teachers. As pressure to hire increases, that shortage will become a crisis, and children already at a disadvantage in relation to their more affluent and less isolated peers will be the ones who suffer most. Today, I propose a bill that will help bring dedicated and qualified teaching professionals to West Virginia's and America's poor and rural schools, and help give their students the opportunity to learn and flourish that every child deserves. The Incentives To Educate American Children Act, or ``I Teach'' Act, will provide teachers a refundable tax credit every year they practice their profession in the public schools where they are needed most. And it will give every public school teacher, whichever school they choose, a refundable tax credit for earning certification by the National Board for Professional Teaching Standards. Together, these two tax credits will give economically depressed areas a better ability to recruit and retain skilled teachers. One-fourth of America's children attend public schools in rural areas, and of the 250 poorest counties in the United States, 244 are rural. West Virginia has rural schools scattered through 36 of its 55 counties, and these schools face real challenges in recruiting and retaining teachers, as well as dealing with other issues related to their rural location. Attracting teachers to these schools is difficult in large part due to the vast gap between what rural districts are able to offer and the salaries paid by more affluent school districts, as wide as $20,000 a year, according to one study. Poor urban schools must overcome similar difficulties. It is often a challenge for these schools to attract and keep qualified teachers. Yet, according to the 2001 No Child Left Behind Act, every school must have qualified teachers by the end of the 2005-2006 school year. My ``I Teach'' Act will reward teachers willing to work in rural or high poverty schools with an annual $1,000 refundable tax credit. If the teacher obtains certification by the National Board for Professional Teaching Standards, they will receive an additional annual $1,000 refundable tax credit. Every teacher willing to work in underserved schools will earn a tax credit. Every teacher who gets certified will earn a tax credit. Teachers who work in rural or poor schools and get certified will earn both. Schools who desperately need help attracting teachers will get a boost. And children educated in poor and rural schools will benefit most. In my State of West Virginia, as in over 30 other States, there is already a State fiscal incentive for teachers who earn National Board certification. My legislation builds upon the West Virginia program; together, they add up to a powerful tax incentive for teachers to remain in the classroom and to use their skills where they are most needed. I have spent a great deal of time in West Virginia classrooms this year, and it has become obvious to me that our education agenda suffers greatly from inadequate funding on a number of fronts. In response, I have introduced a series of bills attacking different aspects of the problem. A qualified teacher is a great start, but children also deserve a safe, modern classroom. And so, in addition to the ``I Teach'' Act, I have introduced a measure to encourage investment in school construction and renovations. I am promoting legislation to develop Math and Science Partnerships at the National Science Foundation, to place needed emphasis on these core subjects. And to ensure that every student, including those in rural areas, has access to modern technology and the wealth of educational resources on the web, I remain vigilant in protecting the E-Rate, which provides $2.25 billion in annual discounts to connect our schools and libraries to the Internet. Education is among our top national priorities, essential for every family with a child and vital for our economic and national security. I supported the bold goals and higher standards of the 2001 No Child Left Behind Act, but they won't be met unless our schools have the teachers and resources they need. I am committed to working closely with my Senate colleagues this fall to secure as much funding as possible for our children's education. No amount of construction or technology can replace a qualified and motivated teacher, however, and making it easier for underserved schools to attract the teachers they need remains one of my most important objectives. I hope each of my colleagues will join me in supporting this important legislation which takes a great stride toward better education for every child in the United States.

Mr. ROCKEFELLER. Mr. President, I introduce a bill that will improve and protect health insurance for our nation's children. The Children's Health Improvement and Protection Act of 2002, CHIP Act, brings us back to the basics of health care--the fundamental philosophy that no child should go without needed health care. I'm pleased to be joined by my good friends Senator Chafee and Senator Kennedy to introduce the Children's Health Insurance Improvement and Protection Act of 2002. Established in 1997 to reduce the number of uninsured children, the Children's Health Insurance Program has been an unqualified success. Last year, 4.6 million children were enrolled in CHIP and the percentage of children without health insurance has declined in recent years. In my state of West Virginia, the CHIP program provides health coverage to over 20,000 children. Health insurance coverage is key to assuring children's access to appropriate and adequate health care, including preventive services. Research demonstrates that uninsured children are more likely to lack a usual source of care, to go without needed care, and to experience worse health outcomes than children with coverage. Uninsured children who are injured are 30 percent less likely than insured children to receive medical treatment and three times more likely not to get a needed prescription. However, the continued success of the CHIP program is now in serious jeopardy. The Bush Administration projects that 900,000 children will lose their health coverage between fiscal years 2003 and 2006, if Congress does not take appropriate action. This is because even as state enrollment and spending rapidly increases, federal CHIP funding dropped by more than $1 billion this year and will be reduced in each of the next two years. Known as the ``CHIP Dip,'' this reduction has no underlying health policy justification; it was solely the result of the budget compromises we had to make when enacting the balanced budget deal in 1997. As a result, a number of states will have insufficient federal funding to sustain their enrollment and they will have no choice but to scale back or limit their CHIP programs. As enrollment is cut, the number of uninsured children will increase, and as a consequence, sick children will get sicker. The biggest problem that will result from enrollment cuts in the CHIP program are the future health problems of adults who as children could have received benefits under CHIP. Yet, even as states face this funding shortfall, under federal rules, nearly $3 billion in federal CHIP funding is scheduled to expire and revert back to the Treasury over the next two years. If Congress does not act, in order to maintain our current enrollment levels, West Virginia will run out of CHIP funding in 2005. We cannot allow this to happen. We need a comprehensive and reasonable approach to shore up CHIP financing in order to avert the devastating enrollment decline and make sure that our children are protected into the future. This legislation will extend the life of the expiring funds and fully restore CHIP funding to the pre- ``dip'' levels. This legislation will provide West Virginia with $117 million over the 2004-2012 period allowing them to strengthen and protect children's access to health care. I urge Congress to enact this legislation and ensure the continued success of the CHIP program and sustain the significant progress CHIP has made in reducing the ranks of uninsured children. Mr. President I ask unanimous consent that the full text of the bill be printed in the Record.

Mr. ROCKEFELLER. Mr President, I am extremely pleased to be joined by my colleagues, Senator Collins and Senator Wyden, in introducing the Advanced Directives and Compassionate Care Act of 2002. The end of life is a difficult time for individuals and their families. A complex web of emotional, legal, medical, and spiritual demands magnify the pain and turmoil already being experienced. Loss of control can result in depression and confusion, sometimes even hastening death. And, too often, a lifetime's dignity can be stripped away in a person's final months, leaving their survivors an inheritance of sadness and regret. The Advanced Directives and Compassionate Care Act will help families and individuals avoid this bitter legacy, by helping maintain greater control of their final months. It gives patients greater information and power in determining treatment and hospice options. The legislation addresses legal issues that often arise at the end-of-life, and makes it more certain that advanced directives, such as ``living wills'' will be followed. It promotes the hospice-based care that most terminally ill patients prefer. Most important, it gives people a better chance to maintain their dignity in their final hours. I urge that the Senate take up this vital and compassionate legislation this year, and that we ensure it's passage before we return home this fall. According to a 1999 National Hospice and Palliative Care Organization survey, Americans are hesitant to talk with their elderly parents about how they would like to be cared for at the end of life. This same study showed that less than twenty-five percent of Americans have put into writing instructions for how we'd like to be cared for personally at the end of our lives. Many health care providers overlook the equally important issue of providing adequate and appropriate care such as relief of pain, or family support services to those who are at the end of life. In addition, there is great variation among State laws with respect to advanced directives. Our legislation takes real and tangible steps toward improving the practices and care that affect our citizens when they are facing death or the real possibility of death. First, and perhaps most important, the Compassionate Care Act gives patients greater power to control their final days, by directly addressing the improvement of advanced directives. In my home state, a 2000 survey showed that three-quarters of West Virginians would prefer to die at home, yet nearly 60 percent of all deaths occur in a hospital. West Virginia has perhaps the most progressive state laws with regard to living wills and power of attorney, yet only one-third of those surveyed have either. These figures are unacceptable--people need to have a greater say in their own destiny. Currently, state laws on the execution of advance directives vary greatly. Too often, this means a serious problem when the patient's wishes about their medical care are ignored--even when family members attest to their validity--because they moved to another state after creating the directive, but before or at the time that care is needed. Most of the differences that cause one state not to honor an advance directive created in another state are technical in nature--for example, one state requires two witnesses while another only one. This variance should not deny a person the type of care desired. Only a federal portability statute can address this problem. Under our legislation, an advance directive valid in the state in which it is executed would be honored in any other state in which it may be presented. In addition, the Secretary of Health and Human Services would be required to gather information and consult with experts about the feasibility and desirability of creating a uniform advance directive for all Medicare and Medicaid beneficiaries, and possibly others, in the United States, as well as study such issues as the provision of adequate palliative care. A uniform advance directive would enable people to designate the kind of care they wish to receive at the end of their lives in a way that is easily recognizable and understood by everyone. In 1990, this body passed bipartisan legislation entitled the Patient Self-Determination Act. That legislation required hospitals, and other health care facilities participating in the Medicare and Medicaid programs to provide every adult receiving medical care with written information regarding the patient's involvement with their own treatment decisions. The Compassionate Care Act builds on this Act, and the thinking behind it, to improve the quality of care and the quality of life for terminally ill patients. Our bill builds on the Patient Self-Determination Act, improving the type and amount of information available by ensuring that a person entering a hospital, nursing home, or other health care facility is helped by a knowledgeable person to create a new advance directive or discuss an existing one. The patient's own needs, desires, and values must be the basis of decision-making and, whenever possible, the patient's family and/or friends should be part of the conversation. Further, the bill requires that if a person has an advance directive it be placed prominently in the medical record where all doctors and nurses involved in the patient's care can clearly see it. Finally, under the Compassionate Care Act, a 24-hour, toll-free hotline that provides consumers with information on advance directives, end-of-life care decision-making, and hospice care would be established. Second, our legislation would require the Secretary of Health and Human Services to develop outcome standards and other measures for evaluating the quality of end-of-life care including the appropriateness of care and ease of access to high quality care. There are currently too few measures or standards available to assess the quality of care provided to Medicare, Medicaid and S-CHIP beneficiaries with terminal conditions. There are also significant variations in available medical care for patients at the end-of-life based on geographic area, ethnic group and alternative models of care. Third, this legislation would authorize demonstration projects to develop new and innovative approaches to improving end-of-life care and pain management for Medicare, Medicaid and S-CHIP beneficiaries. At least one demonstration would focus particularly on pediatric end-of- life care. Priorities include adequate pain management for terminally ill patients--40-80 percent of terminally ill patients say they do not receive adequate treatment for their pain; treatment of pediatric illnesses--28 thousand children die of chronic illness each year, but fewer than 10 percent receive hospice care; and treatment of Medicare beneficiaries in hospice care. Finally, to help improve communication between federal agencies and experts in the fields of hospice, end-of-life, and palliative care, the legislation establishes a 15 member End-of-Life Care Advisory Board consisting of end-of-life care providers, consumers, professional and resource-based groups, and policy/advocacy organizations. Recently, the Centers for Medicare and Medicaid Services has made a concerted effort to improve its involvement in the area of end-of-life care. The Advisory Board is designed to further assist the Secretary and the Centers for Medicare and Medicaid Services in the evaluation of and decisions relating to adequate end-of-life care. In addition, it would utilize the reports mandated in this bill to create its own evaluation of the field and propose recommendations for legislative and administrative actions to improve end-of-life care in America. Mr. President, death is a hard subject to talk about. It's hard to think about--and especially hard to plan for. I know this personally, as many of my colleagues may as well, from dealing with the loss of a family member to a prolonged illness. Too often discussion about end- of-life care and adequate pain management focuses around physician assisted suicide. The fact is that this quality end-of-life care-- helping the dying and their families who want better, more compassionate care--is what we should be talking about, and what our legislation does. This legislation has been endorsed by the National Hospice and Palliative Care Association, Partnership for Caring, The American Bar Association, Americans for Better Care of the Dying, and the American Academy of Pediatrics. I ask unanimous consent that several of the letters of support from these organizations and the full text of the legislation be included in the Record at the conclusion of my remarks.

Mr. ROCKEFELLER. Mr. President, despite some signs of an improving economy, for hard-working Americans, it is, unfortunately, a ``jobless recovery.'' While we see some positive economic indicators, the unemployment rate continues to rise and shows few signs of falling. For working Americans, that is bad news. Too many people are finding themselves without a job, and without a source of income. The Labor Department reports that over the past few months, the unemployment rate has hovered around 6 percent, with 8.4 million people officially counted as unemployed. My home State of West Virginia reported an unemployment rate of 6.8 percent in June, which is only somewhat higher than the national average, but some of our counties are struggling with unemployment rates in the double digits. Not only are more people being laid off, they are also remaining unemployed for longer. From January to May 2002, the proportion of unemployed workers who were still looking for work after 27 weeks increased by 41 percent, and unemployment levels now exceed those reached in any recent recession. Workers are suffering unemployment for longer periods, and are losing benefits before they can find new jobs. In January 2002, a total of 373,000 workers exhausted their benefits, a sizeable 11 percent increase from the same time last year. We faced similar troubles in the early 1990s, when, amidst a recession, Congress enacted an emergency Federal extended benefits program designed to help unemployed workers and their families. Some analysts suggest that without that program, approximately 70 percent of unemployed families would have ended up with incomes below the federal poverty line. When our Nation faces such an economic downturn, action is essential to help hard-working Americans get back on their feet after a devastating layoff. Now, in the midst of another economic downturn, we must also act to provide American families with the assistance they need. I rise today in support of a bill to be introduced by my colleague, Senator Kennedy, that would remedy several flaws in the current unemployment benefits program. This is an enormously important piece of legislation, one that should be enacted immediately for the sake of working families who have been put out of jobs through no fault of their own. The measure would give States administrative funding so they can distribute benefit checks punctually and accurately. It would ensure that all unemployed workers receive a full 13 weeks of benefits. And it would repeal the 20-weeks-of-work prerequisite to receiving benefits that primarily punishes low-wage workers and newer entrants to the job market. Beginning in 1986, Federal and State governments began withholding taxes from the benefit checks of all aid recipients. However, no accommodations were made to offset these deductions, and recipients saw a significant reduction in benefits. To ameliorate this problem, Senator Kennedy's legislation would raise benefit levels by 15 percent or $25 a week, whichever is higher. Finally, a majority of States currently refuse benefits to unemployed workers seeking part-time work. West Virginia does cover part-time workers, but I believe every state should do this as well. Part-time work is an enormously important component of our economy, particularly as it involves large numbers of women and low-wage earners. Senator Kennedy's bill would require states to base eligibility on a worker's most recent earnings. This seemingly technical provision would greatly expand eligibility to benefits for many workers, in my state, and across the country. Millions of Americans are still struggling, and they do not have a steady source of income. I urge my colleagues to support this bill to reform America's unemployment insurance program; it is urgently needed and should be passed with great haste. This bill is the right thing to do for working Americans, and it is an essential measure for those still suffering from the effects of our uncertain economy.

Mr. ROCKEFELLER

Mr. ROCKEFELLER. Mr. President, perhaps the most effective way to improve the education of America's children is to ensure that they begin their education in an uncrowded classroom led by a qualified teacher. This body recognized that fact when we overwhelmingly passed the ``No Child Left Behind Act'' last year, mandating the hiring of qualified teachers by every school in every district. Unfortunately, without our help, America's poor and rural schools may not be able to attract the qualified teachers this legislation mandates and our children deserve. Isolated and impoverished, competing against higher paying and well-funded school districts for scarce classroom talent, they are already facing a desperate shortage of qualified teachers. As pressure to hire increases, that shortage will become a crisis, and children already at a disadvantage in relation to their more affluent and less isolated peers will be the ones who suffer most. Today, I propose a bill that will help bring dedicated and qualified teaching professionals to West Virginia's and America's poor and rural schools, and help give their students the opportunity to learn and flourish that every child deserves. The Incentives To Educate American Children Act, or ``I Teach'' Act, will provide teachers a refundable tax credit every year they practice their profession in the public schools where they are needed most. And it will give every public school teacher, whichever school they choose, a refundable tax credit for earning certification by the National Board for Professional Teaching Standards. Together, these two tax credits will give economically depressed areas a better ability to recruit and retain skilled teachers. One-fourth of America's children attend public schools in rural areas, and of the 250 poorest counties in the United States, 244 are rural. West Virginia has rural schools scattered through 36 of its 55 counties, and these schools face real challenges in recruiting and retaining teachers, as well as dealing with other issues related to their rural location. Attracting teachers to these schools is difficult in large part due to the vast gap between what rural districts are able to offer and the salaries paid by more affluent school districts, as wide as $20,000 a year, according to one study. Poor urban schools must overcome similar difficulties. It is often a challenge for these schools to attract and keep qualified teachers. Yet, according to the 2001 No Child Left Behind Act, every school must have qualified teachers by the end of the 2005-2006 school year. My ``I Teach'' Act will reward teachers willing to work in rural or high poverty schools with an annual $1,000 refundable tax credit. If the teacher obtains certification by the National Board for Professional Teaching Standards, they will receive an additional annual $1,000 refundable tax credit. Every teacher willing to work in underserved schools will earn a tax credit. Every teacher who gets certified will earn a tax credit. Teachers who work in rural or poor schools and get certified will earn both. Schools who desperately need help attracting teachers will get a boost. And children educated in poor and rural schools will benefit most. In my State of West Virginia, as in over 30 other States, there is already a State fiscal incentive for teachers who earn National Board certification. My legislation builds upon the West Virginia program; together, they add up to a powerful tax incentive for teachers to remain in the classroom and to use their skills where they are most needed. I have spent a great deal of time in West Virginia classrooms this year, and it has become obvious to me that our education agenda suffers greatly from inadequate funding on a number of fronts. In response, I have introduced a series of bills attacking different aspects of the problem. A qualified teacher is a great start, but children also deserve a safe, modern classroom. And so, in addition to the ``I Teach'' Act, I have introduced a measure to encourage investment in school construction and renovations. I am promoting legislation to develop Math and Science Partnerships at the National Science Foundation, to place needed emphasis on these core subjects. And to ensure that every student, including those in rural areas, has access to modern technology and the wealth of educational resources on the web, I remain vigilant in protecting the E-Rate, which provides $2.25 billion in annual discounts to connect our schools and libraries to the Internet. Education is among our top national priorities, essential for every family with a child and vital for our economic and national security. I supported the bold goals and higher standards of the 2001 No Child Left Behind Act, but they won't be met unless our schools have the teachers and resources they need. I am committed to working closely with my Senate colleagues this fall to secure as much funding as possible for our children's education. No amount of construction or technology can replace a qualified and motivated teacher, however, and making it easier for underserved schools to attract the teachers they need remains one of my most important objectives. I hope each of my colleagues will join me in supporting this important legislation which takes a great stride toward better education for every child in the United States.

Mr. ROCKEFELLER

Mr. ROCKEFELLER. Mr President, I am extremely pleased to be joined by my colleagues, Senator Collins and Senator Wyden, in introducing the Advanced Directives and Compassionate Care Act of 2002. The end of life is a difficult time for individuals and their families. A complex web of emotional, legal, medical, and spiritual demands magnify the pain and turmoil already being experienced. Loss of control can result in depression and confusion, sometimes even hastening death. And, too often, a lifetime's dignity can be stripped away in a person's final months, leaving their survivors an inheritance of sadness and regret. The Advanced Directives and Compassionate Care Act will help families and individuals avoid this bitter legacy, by helping maintain greater control of their final months. It gives patients greater information and power in determining treatment and hospice options. The legislation addresses legal issues that often arise at the end-of-life, and makes it more certain that advanced directives, such as ``living wills'' will be followed. It promotes the hospice-based care that most terminally ill patients prefer. Most important, it gives people a better chance to maintain their dignity in their final hours. I urge that the Senate take up this vital and compassionate legislation this year, and that we ensure it's passage before we return home this fall. According to a 1999 National Hospice and Palliative Care Organization survey, Americans are hesitant to talk with their elderly parents about how they would like to be cared for at the end of life. This same study showed that less than twenty-five percent of Americans have put into writing instructions for how we'd like to be cared for personally at the end of our lives. Many health care providers overlook the equally important issue of providing adequate and appropriate care such as relief of pain, or family support services to those who are at the end of life. In addition, there is great variation among State laws with respect to advanced directives. Our legislation takes real and tangible steps toward improving the practices and care that affect our citizens when they are facing death or the real possibility of death. First, and perhaps most important, the Compassionate Care Act gives patients greater power to control their final days, by directly addressing the improvement of advanced directives. In my home state, a 2000 survey showed that three-quarters of West Virginians would prefer to die at home, yet nearly 60 percent of all deaths occur in a hospital. West Virginia has perhaps the most progressive state laws with regard to living wills and power of attorney, yet only one-third of those surveyed have either. These figures are unacceptable--people need to have a greater say in their own destiny. Currently, state laws on the execution of advance directives vary greatly. Too often, this means a serious problem when the patient's wishes about their medical care are ignored--even when family members attest to their validity--because they moved to another state after creating the directive, but before or at the time that care is needed. Most of the differences that cause one state not to honor an advance directive created in another state are technical in nature--for example, one state requires two witnesses while another only one. This variance should not deny a person the type of care desired. Only a federal portability statute can address this problem. Under our legislation, an advance directive valid in the state in which it is executed would be honored in any other state in which it may be presented. In addition, the Secretary of Health and Human Services would be required to gather information and consult with experts about the feasibility and desirability of creating a uniform advance directive for all Medicare and Medicaid beneficiaries, and possibly others, in the United States, as well as study such issues as the provision of adequate palliative care. A uniform advance directive would enable people to designate the kind of care they wish to receive at the end of their lives in a way that is easily recognizable and understood by everyone. In 1990, this body passed bipartisan legislation entitled the Patient Self-Determination Act. That legislation required hospitals, and other health care facilities participating in the Medicare and Medicaid programs to provide every adult receiving medical care with written information regarding the patient's involvement with their own treatment decisions. The Compassionate Care Act builds on this Act, and the thinking behind it, to improve the quality of care and the quality of life for terminally ill patients. Our bill builds on the Patient Self-Determination Act, improving the type and amount of information available by ensuring that a person entering a hospital, nursing home, or other health care facility is helped by a knowledgeable person to create a new advance directive or discuss an existing one. The patient's own needs, desires, and values must be the basis of decision-making and, whenever possible, the patient's family and/or friends should be part of the conversation. Further, the bill requires that if a person has an advance directive it be placed prominently in the medical record where all doctors and nurses involved in the patient's care can clearly see it. Finally, under the Compassionate Care Act, a 24-hour, toll-free hotline that provides consumers with information on advance directives, end-of-life care decision-making, and hospice care would be established. Second, our legislation would require the Secretary of Health and Human Services to develop outcome standards and other measures for evaluating the quality of end-of-life care including the appropriateness of care and ease of access to high quality care. There are currently too few measures or standards available to assess the quality of care provided to Medicare, Medicaid and S-CHIP beneficiaries with terminal conditions. There are also significant variations in available medical care for patients at the end-of-life based on geographic area, ethnic group and alternative models of care. Third, this legislation would authorize demonstration projects to develop new and innovative approaches to improving end-of-life care and pain management for Medicare, Medicaid and S-CHIP beneficiaries. At least one demonstration would focus particularly on pediatric end-of- life care. Priorities include adequate pain management for terminally ill patients--40-80 percent of terminally ill patients say they do not receive adequate treatment for their pain; treatment of pediatric illnesses--28 thousand children die of chronic illness each year, but fewer than 10 percent receive hospice care; and treatment of Medicare beneficiaries in hospice care. Finally, to help improve communication between federal agencies and experts in the fields of hospice, end-of-life, and palliative care, the legislation establishes a 15 member End-of-Life Care Advisory Board consisting of end-of-life care providers, consumers, professional and resource-based groups, and policy/advocacy organizations. Recently, the Centers for Medicare and Medicaid Services has made a concerted effort to improve its involvement in the area of end-of-life care. The Advisory Board is designed to further assist the Secretary and the Centers for Medicare and Medicaid Services in the evaluation of and decisions relating to adequate end-of-life care. In addition, it would utilize the reports mandated in this bill to create its own evaluation of the field and propose recommendations for legislative and administrative actions to improve end-of-life care in America. Mr. President, death is a hard subject to talk about. It's hard to think about--and especially hard to plan for. I know this personally, as many of my colleagues may as well, from dealing with the loss of a family member to a prolonged illness. Too often discussion about end- of-life care and adequate pain management focuses around physician assisted suicide. The fact is that this quality end-of-life care-- helping the dying and their families who want better, more compassionate care--is what we should be talking about, and what our legislation does. This legislation has been endorsed by the National Hospice and Palliative Care Association, Partnership for Caring, The American Bar Association, Americans for Better Care of the Dying, and the American Academy of Pediatrics. I ask unanimous consent that several of the letters of support from these organizations and the full text of the legislation be included in the Record at the conclusion of my remarks.

Mr. ROCKEFELLER

Mr. ROCKEFELLER. Mr. President, a little more than 5 years ago, the Commerce Committee held a hearing to test the mettle of a nominee to head the Federal Aviation Administration. The nominee came to Washington from her long-time home of Massachusetts to serve in the Federal Highway Administration, and her years of experience in various modes of transportation--primarily highways and airports--made her a strong candidate for the FAA position. At the time, Jane Garvey sat before us as the first nominee to be appointed to a fixed, 5-year term to head the FAA. For years, the position of chief of the FAA had served as a revolving door--with many well-qualified people, but few able or willing to stay. The lack of continuity left its mark on many projects--the headlines, often from Congressional sources or the General Accounting Office, usually read ``delayed and over budget.'' That changed when Jane Garvey took the reins of the FAA on August 4, 1997. We knew that the FAA faced a daunting task in rebuilding and modernizing our air traffic control system and expanding our nation's airports. Over these last 5 years, we have watched and learned as Administrator Garvey testified countless times before numerous committees about the needs of the agency and her future vision of the FAA. The FAA Administrator's job is one of the toughest in government. When things go right, no one notices; but when things go wrong, everyone knows--and that is when the finger-pointing starts. Jane Garvey has handled this pressure with tremendous grace and an uncommon resolve to improve on the FAA's core commitment to safety. Every day, over 35,000 commercial flights travel across our skies-- safely and efficiently. During the last several years, safety-related tragedies have been the exception, not the norm. Through Administrator Garvey's leadership and the dedicated staff of the FAA, we have come a long way to revamping the FAA's mission, its organization, and its future. Today, there are major airport expansion construction projects across the country, as we make room for an expected 1 billion annual passengers by 2013. Thousands of new pieces of equipment have been tried, tested, and installed to increase the reliability and capacity of the air traffic control system. Jane Garvey has worked tirelessly with all of us--the various segments of the aviation community and the employees of the FAA--to improve the performance of the FAA. In fact, Government Executive magazine's privately run Federal Performance Project Team gave the FAA high scores in its 2002 report card for improving in all five management areas that it grades. Since its last report card 3 years ago, Government Executive noted Administrator Garvey's vast improvement of human resources management at the agency, and her significant progress in technology upgrades and creating tools for accountability. Administrator Garvey's tenure has been marked by a tremendous improvement in labor relations at the FAA. Her commitment to the 49,000 employees of the FAA is well recognized, and has contributed significantly to the productivity and achievement of the agency as a whole. She has established a better working relationship with the nation's 20,000 air traffic controllers than at any point over the past 20 years. Indeed, the president of the National Air Traffic Controllers Association recently identified her as the ``finest administrator in the history of the FAA.'' Since Jane Garvey took over at the FAA in 1997, I have had the opportunity to see her in action, and it has been a pleasure to work with her on a number of issues of importance to West Virginia and the nation. Her ``can-do'' spirit is infectious and has resulted in an agency that strives to improve on past performances and does not blindly accept shortcomings as inevitable. Through her tireless support of many of the important initiatives that we have worked on together, she has proven to be not just a good administrator, but a good friend. Five years seems like along time in Washington, but perhaps it is too short, for we will miss the strength and character of Jane Garvey. Our country owes her a great debt of gratitude for profound dedication to our aviation system. Finally, I would like to submit for the record some excerpts from a speech Administrator Garvey recently delivered before the Aero Club of Washington. Her remarks offer valuable perspective and direction for all of us who work in and care about aviation policy. Today, you could say that our nation's economic engines run on jet fuel. The economic impact of aviation is so big it's almost beyond measure. Revenues generated by airports like Chicago, O'Hare, Dallas/Fort Worth, and Hartsfield Atlanta run in the billions. U.S. aerospace industries have become America's leading exporter in the manufacturing sector. And as we were reminded so painfully after September 11, tourist travel, which depends on the airlines, accounts for one out of seven jobs in America, and is among the top three employers in 29 states. In this era of globalization, technologies like cable modems and cell phones make vital connections--still, they're virtual connections. If you really want to reach the rest of the world, you've got to board a plane. Simply put, there is no globalization without aviation. That's why, on any given day, as many as 1.9 million Americans take to the skies on one of 33,000 commercial flights. Internationally, each year, that number is as high as 1.6 billion--more than one-fourth of the people on this planet. We chart our progress by numbers like these--billions of passengers, billions in revenue, millions of tons of cargo, minutes (at most!) of delay. But, of course, it's not just numbers that count. It's people. It's the men, women and children who board our planes every day--to attend a daughter's wedding; to leave for college for the first time; to attend an important meeting on the other side of the world; or to visit a new grandchild just a short flight from home. As I said in 1997, our first and most important priority was to make the world's safest skies even safer, in the face of dynamic industry growth, expanding demand, and public concerns. And we had to modernize the nation's air space system in a timely and cost effective way. From my first days in office, these have been my goals. Just as important, they have been yours as well. I believed then--and believe even more strongly today, after the experience of these past five years--that the only way to meet these challenges is to face them together, government and industry, pilots and air traffic controllers, labor and management the FAA and Congress. Collaboration isn't just a management style; consensus isn't just something to strive for. In aviation, they are essential elements in any real plan for progress. As the pilot Lane Wallace has written: ``In one sense we are all alone, whether in an airplane or on the ground, and we have final responsibility for whatever path we take through life or the sky . . . [But] we understand that while we may fly solo, we are also all connected, and we need each other in order to survive.'' That's true not only for pilots, but also for controllers, technicians, mechanics, flight attendants--and the FAA Administrator. We've stopped defining ourselves by our competing interests and started applying ourselves to our common goals. Those goals haven't changed: we're focused, as ever, on safety, efficiency, and adding capacity. But the way we pursue our goals has been evolving. We now pursue them as a community. We acknowledge--even embrace--our interdependence. And that, in my view, has made all the difference these past five years. It's certainly made a difference in the accident rate. Working together, we reduced the accident rate for U.S. airlines by 29 percent over our baseline last year. We did so by agreeing on an unprecedented strategic plan for safety-- Safer Skies. We now base our priorities on what the data, not the headlines, say. Through new partnerships like ASAP, the Aviation Safety Action Program, and by sharing data, we can identify early warning signs, intervene in targeted ways, and track the effectiveness of our efforts. I'm proud that we've met every annual target in the accident rate, and I'm confident that by 2007, we'll reach our greater goal: reducing the commercial accident rate by 80 percent. Over the past five years, we have met many other imperatives of modernization with the same determination. Since 1997, we've completed more than 7,100 projects, installing new facilities, systems, and equipment across the U.S. and integrating them into the National Airspace System. We've done more than 10,000 upgrades of ATC hardware and software. Today, you can visit every one of our centers in America and won't find a single piece of hardware that's been around longer than I've been in this job (it only feels like a long time). With the FAA's commitment to RNP--which takes advantage of the aircraft's capabilities--we're taking crucial steps in our transition from a ground-based to a satellite-based system, and toward safely handling more aircraft in less airspace. I think the way we achieved all this is not less remarkable that what we've achieved. You know, it seems sort of obvious that when you're designing new technological tools, you ought to consult the people--controllers, technicians, pilots--who are going to use them. For too long, that just wasn't the case. When new equipment arrived at the loading dock, it was a little too much like Christmas Day--no one knew what was inside the box; the instructions were near impossible to follow; and batteries were not included. Today, everyone knows what to expect--and how to use it. When we develop new products and programs, we do it not only with the users in mind, but at the drawing board. With all this new hardware and software, delays due to equipment are down 70 percent from this time last year. A Eurocontrol report shows that the productivity of U.S. controllers is about twice as great as in Europe--and that our air traffic management is about twice as efficient. It's true: you just don't hear about outrages anymore. Instead, you hear about more direct routes, lower fuel consumption, and--let us not forget--better service for the men, women, and children who entrust us with their air travel. Of course, they're less concerned with who's using what technology than with getting to their destination safely, swiftly, and affordably. These new efforts help them to do so. It is this clear progress in air traffic management that is so critical for aviation's recovery from the one-two punch of the terrorist attacks and last year's recession. After an inevitable decline--in traffic, yields, revenue--we expect to see traffic returning to pre-recession levels next year. Those one billion annual passengers we've been projecting may not be in the departure lounge just yet, but they're on the way. Demand will continue its historic rise--and we're determined to meet it. Transportation Secretary Norm Mineta talks frequently about closing the gap between demand for air travel and the capacity of our infrastructure. Whether or not we build it, they will come. And as Phil Condit reminded us in recent speech. ``Economic growth follows infrastructure.'' That's why the government and the aviation community reached agreement last year on the Operational Evolution Plan, which, as you know, is the centerpiece of the FAA's efforts to build and expand infrastructure over the next decade. The OEP includes new runways, new technologies, and new procedures. It's not a wish list; it's a set of marching orders--clearly setting out the responsibilities of the FAA, airlines, and airports. These ideas are meant for action. And we're already seeing what action can achieve. Look at Detroit. Detroit's new runway opened last December. Overnight, the number of flights per hour that Detroit Metro can handle jumped from 146 to 182 in good weather--a 25 percent increase. We've targeted our efforts toward the worst bottlenecks in the system. The controllers among you have told me that conflict probe, now in use at four en route centers, is the biggest improvement in the en route environment they've seen in their entire careers. It cuts costs even as it cuts emissions. With results like this, I am more confident than ever that we are going to meet our goal: increasing capacity by up to 30 percent over the next ten years. We are already looking at how we can accelerate initiatives and reach for more capacity. The critical question--which we are already tackling with industry--is, ``What's next? '' All of this progress flows directly from one source: our spirit of community. It is incredible to behold. I have seen it in so many ways on so many occasions during my five years in office. And in all that time, the spirit of community was never stronger than on September 11. Among the countless acts of heroism on that terrible day, history will record the way the aviation community pulled together, in the worst of circumstances, to bring the planes down quickly and safely-- and bring the system back up smoothly in the weeks that followed. We have realized more and more the potential of flight. We have mitigated more of its risks. But in many ways, we've only begun. Moving forward, our mission must be to build on this foundation--and create a legacy worthy of our children. The next Administrator will face many challenges--some I've just discussed, and surely many new ones. One of the greatest will be the challenge of staying focused on modernization and safety, in the face of new security pressures. For obvious reasons, security concerns will continue to command the headlines. They demand our attention and deserve our vigilance. The FAA's mission is just as important as ever. Not only the new administrator, but also all of us, must keep our focus on that. The industry faces an additional challenge in providing a higher and higher level of service to its customers. I do not want to leave office without saying how grateful I am to Presidents Bush and Clinton, and Secretaries Mineta and Slate, for entrusting me with this awesome responsibility. And I am grateful to you for helping me, to the best of my abilities, to fulfill it. I took office on the cusp of a new century; and depart with those new horizons, and the new possibilities we foresaw, a little closer in reach. It is you who made it so; you who created this moment of opportunity; you who will carry us forward. Every time I visit a control facility or an airport, or talk to a pilot, or see the launch of a new technology, I am impressed anew by your dedication and professionalism. I am uplifted by your commitment to our mission. I know my successor will count on your insights and energies just as much as I have. Because if one thing is clear to me as I leave office, it is that our roles, like our lives, are interdependent; our goals are interconnected. Modernization, for example, is dependent on the financial health of the industry. Safety depends not only on new technology but also on the century-old concern of labor relations. Efficiency in the air has a lot to do with security provisions on the ground. And so on. None of us is flying solo.

Mr. ROCKEFELLER

Mr. ROCKEFELLER. Mr. President, I introduce a bill that will improve and protect health insurance for our nation's children. The Children's Health Improvement and Protection Act of 2002, CHIP Act, brings us back to the basics of health care--the fundamental philosophy that no child should go without needed health care. I'm pleased to be joined by my good friends Senator Chafee and Senator Kennedy to introduce the Children's Health Insurance Improvement and Protection Act of 2002. Established in 1997 to reduce the number of uninsured children, the Children's Health Insurance Program has been an unqualified success. Last year, 4.6 million children were enrolled in CHIP and the percentage of children without health insurance has declined in recent years. In my state of West Virginia, the CHIP program provides health coverage to over 20,000 children. Health insurance coverage is key to assuring children's access to appropriate and adequate health care, including preventive services. Research demonstrates that uninsured children are more likely to lack a usual source of care, to go without needed care, and to experience worse health outcomes than children with coverage. Uninsured children who are injured are 30 percent less likely than insured children to receive medical treatment and three times more likely not to get a needed prescription. However, the continued success of the CHIP program is now in serious jeopardy. The Bush Administration projects that 900,000 children will lose their health coverage between fiscal years 2003 and 2006, if Congress does not take appropriate action. This is because even as state enrollment and spending rapidly increases, federal CHIP funding dropped by more than $1 billion this year and will be reduced in each of the next two years. Known as the ``CHIP Dip,'' this reduction has no underlying health policy justification; it was solely the result of the budget compromises we had to make when enacting the balanced budget deal in 1997. As a result, a number of states will have insufficient federal funding to sustain their enrollment and they will have no choice but to scale back or limit their CHIP programs. As enrollment is cut, the number of uninsured children will increase, and as a consequence, sick children will get sicker. The biggest problem that will result from enrollment cuts in the CHIP program are the future health problems of adults who as children could have received benefits under CHIP. Yet, even as states face this funding shortfall, under federal rules, nearly $3 billion in federal CHIP funding is scheduled to expire and revert back to the Treasury over the next two years. If Congress does not act, in order to maintain our current enrollment levels, West Virginia will run out of CHIP funding in 2005. We cannot allow this to happen. We need a comprehensive and reasonable approach to shore up CHIP financing in order to avert the devastating enrollment decline and make sure that our children are protected into the future. This legislation will extend the life of the expiring funds and fully restore CHIP funding to the pre- ``dip'' levels. This legislation will provide West Virginia with $117 million over the 2004-2012 period allowing them to strengthen and protect children's access to health care. I urge Congress to enact this legislation and ensure the continued success of the CHIP program and sustain the significant progress CHIP has made in reducing the ranks of uninsured children. Mr. President I ask unanimous consent that the full text of the bill be printed in the Record.

Mr. ROCKEFELLER

Mr. ROCKEFELLER. Mr. President, I rise in opposition to the conference agreement on the Andean Trade Preferences Act of 2002 that will grant the President authority to negotiate trade agreements and send them to Congress for a straight up or down vote on an expedited schedule. This Administration has not demonstrated that it will preserve our existing trade laws when making international agreements. That means American workers are very likely to be injured by new trade deals, and I cannot in good conscience give up my rights to protect them through the traditional legislative process. I will vote no on this conference agreement. I remind my colleagues that within the first few months of this Administration, U.S. trade negotiators put our trade laws on the table at the urging of foreign interests, as they sought to reach an agreement for the agenda of the upcoming trade round in Doha, Qatar. That happened even though 62 Senators had written the President and told him that we did not want any weakening of our trade laws as part of those negotiations. And it happened even though personal commitments had been made to me, as a Member of the Senate Finance Committee, that such actions would not be taken. The Administration knew very well that a clear, strong bipartisan majority in the Senate believed we should fully protect our trade laws, and they made them a bargaining chip anyway. Without the assurance that our existing unfair trade laws--including our antidumping, countervailing duty laws, will be protected and aggressively enforced in all instances, I cannot give new authority to the President to negotiate treaties that could leave American workers without needed remedies for unfair trade. West Virginia's hard experience with illegal trade shows why we must maintain the minimal protections provided by our existing trade laws. As a member of the Senate/House conference committee that hammered out this agreement, I know that Members of good faith worked hard to produce a bill that balances trade promotion and assistance for workers displaced by trade. In my judgment, the beneficial provisions that help displaced workers in this package do not offset the damage that could be done to American workers through the virtually inevitable weakening of our trade laws. During the Senate debate, I made it clear that I had tremendous concern about the potential for new trade agreements to weaken U.S. trade remedy laws, in particular the antidumping and countervailing duty laws. These essential laws level the playing field on which our firms and workers compete internationally, and they serve the crucial function of offsetting and deterring some harmful unfair trade practices affecting international trade today. I know the Chairman of the Finance Committee shares my concern that we preserve these laws, but we have a disagreement over the effect that granting fast track to the President will have on our ability to do so. While I believe it would be a serious mistake for any Administration to think that a trade agreement or package of agreements can be successfully presented to Congress for any approval, fast-track or otherwise, if it includes weakening changes to our trade remedy laws, I fear that is exactly what this Administration has demonstrated, through its own actions, that it intends to do. This trade bill will make it considerably easier for the Administration to change our trade laws in international negotiations because it deletes the Dayton-Craig amendment that I, and 60 of my Senate colleagues, voted in favor of adopting. The Dayton-Craig amendment would have ensured that the Senate could separately consider any changes to the trade laws. The final conference agreement, regrettably, diminishes congressional leverage to protect the trade laws. The conference agreement replaces Dayton-Craig with a process whereby either House can pass a nonbinding resolution expressing opposition to proposed changes to our fair trade laws. The Administration could ignore this resolution with no penalty. Arguably, the conference report changes might make it even more difficult for Congress to withdraw fast track, because it would allow only one of either the nonbinding resolution or the more meaningful ``procedural disapproval resolution'', withdrawing fast track, on any trade agreement. Therefore, if a nonbinding resolution had already been reported out of the Senate Finance Committee or the House Ways and Means Committee, both houses would then lose the right to introduce ``procedural disapproval resolutions'' on the same. The procedural disapproval resolution was a key element of how the original Senate bill sought to protect U.S. trade laws, and losing the right to introduce it will actually limit Congress' ability to withdraw fast track. As a conferee on this trade bill, I entered conference negotiations understanding that many of the conferees believed we needed to make adjustments to the Dayton-Craig language. Unfortunately, the final agreement did not retain the basic underpinnings of Dayton-Craig--that we include some mechanism to allow Congress to remove any efforts to weaken our trade laws from trade agreements returned under fast track. This is a grave failure of the conference. I believe we will come to deeply regret the conference changes in this regard and that American workers will suffer for it. For my part, I will continue to strongly oppose any weakening changes to our trade laws, whether in the WTO, as part of any deal brought back under fast track negotiating authority, or in any other form. But the final language of the conference agreement will make it harder for me to protect U.S. trade law in the future, and that is a major reason I will oppose this bill. I am very proud that the final conference agreement retained much of the Senate's good work on expanding and improving the Trade Adjustment Assistance program. Under this bill, when workers lose their jobs due to imports, they will now, for the first time ever, have some help accessing health care coverage. That is a critical new benefit, and is one of the provisions that was fundamental to moving this legislation in the Senate. Health care coverage for displaced workers is an essential transitional benefit that American workers deserve and that is long overdue. I believe the health credit provisions in the Senate bill were superior to the provisions of the House bill and to the final provisions of the conference report in many fundamental ways. The Senate's TAA health provisions worked better than the conference report to ensure that workers could access the health credit established by the bill and could afford the health care coverage they need. The Senate bill included necessary insurance market reforms to ensure that the new TAA health credit would be available to the workers who needed it, but the conference report unacceptably dilutes those protections. Unfortunately, in the interest of reaching a quick agreement before the House adjourned, the amount of the Senate's health subsidy was reduced from 70 percent of benefit costs to 65 percent, making it that much more difficult for unemployed workers to be able to afford the coverage. I very much regret that conferees did not retain the senate's worker provisions in whole. However, I have to not that the final agreement includes one very important addition to the Senate bill by providing health care coverage to early retirees whose companies went bankrupt and who are receiving a check from the Pension benefit Guarantee Corporation, (PBGC). It's only a small portion of the retirees I had hoped would get some health care coverage from this trade bill, but it will make a real difference in the lives of tens of thousands of retirees. And I am extremely pleased we have set a precedent that just because people are retired, their lives are no less affected by trade. The House had added a provision that helped PBGC beneficiaries access its health credit, as it attempted to muster the necessary votes to appoint House conferees. The last-minute House provision established a new precedent to extend TAA benefits to retirees, but also included unrealistic income limitations that would have effectively made the credit impossible to access for most early retirees, including retired steelworkers who very much need help with their health care coverage. I am very pleased that the conference negotiations built on the House provision and improved it substantially. The conference agreement will give these workers, aged 55-65, access to a more affordable health credit. The final PBGC provision has the complete market protections of the final package, and these early retirees whose companies have shut down can access this health coverage for the duration of the TAA program as long as they meet the age criteria, are receiving a PBGC check, and do not have access to other health care coverage. There will be no unrealistically low income limitations on retiree eligibility for this program. I know that at some point, some West Virginia retirees will have to rely on this provision, and I am very glad that the final agreement does not forget them. My hope had been to extend the health credit to all steel retirees who lose the health benefits they have earned when their companies go bankrupt, and not only to early retirees under age 65. Senators Mikulski and Wellstone introduced an amendment during the original trade bill debate in the Senate that would have done this. Fifty-seven Senators agreed that protecting steel retirees was the right thing to do, but our amendment fell just short of the procedural requirement of 60 votes, so the Senate bill did not ultimately include this protection. But the final conference agreement at least says we should help a small group of early retirees, and I am very pleased that provision will become law. The Senate's TAA provisions on secondary workers and shift in production were far superior to the House's, and the final conference erodes some of the Senate's work, to the detriment of American workers who will need the help of TAA. Those concessions are a disappointing retrenchment from the Senate bill, and I am disappointed that we did not prevail so that all workers substantially affected by trade could access TAA benefits. In conclusion, despite the hard work of my Chairman who worked himself to exhaustion to complete this agreement under terrible time constraints as well as the consistently excellent work of his dedicated staff, this agreement does not retain the full benefits of the senate bill, and American workers lose as a result. Fundamentally, I do not believe the assurances and trust that would need to exist between the Administration and Congress on preserving our trade laws and protecting American interests is sufficient to warrant ceding Congress' constitutional responsibility on trade.

Mr. ROCKEFELLER

Mr. ROCKEFELLER. Mr. President, despite some signs of an improving economy, for hard-working Americans, it is, unfortunately, a ``jobless recovery.'' While we see some positive economic indicators, the unemployment rate continues to rise and shows few signs of falling. For working Americans, that is bad news. Too many people are finding themselves without a job, and without a source of income. The Labor Department reports that over the past few months, the unemployment rate has hovered around 6 percent, with 8.4 million people officially counted as unemployed. My home State of West Virginia reported an unemployment rate of 6.8 percent in June, which is only somewhat higher than the national average, but some of our counties are struggling with unemployment rates in the double digits. Not only are more people being laid off, they are also remaining unemployed for longer. From January to May 2002, the proportion of unemployed workers who were still looking for work after 27 weeks increased by 41 percent, and unemployment levels now exceed those reached in any recent recession. Workers are suffering unemployment for longer periods, and are losing benefits before they can find new jobs. In January 2002, a total of 373,000 workers exhausted their benefits, a sizeable 11 percent increase from the same time last year. We faced similar troubles in the early 1990s, when, amidst a recession, Congress enacted an emergency Federal extended benefits program designed to help unemployed workers and their families. Some analysts suggest that without that program, approximately 70 percent of unemployed families would have ended up with incomes below the federal poverty line. When our Nation faces such an economic downturn, action is essential to help hard-working Americans get back on their feet after a devastating layoff. Now, in the midst of another economic downturn, we must also act to provide American families with the assistance they need. I rise today in support of a bill to be introduced by my colleague, Senator Kennedy, that would remedy several flaws in the current unemployment benefits program. This is an enormously important piece of legislation, one that should be enacted immediately for the sake of working families who have been put out of jobs through no fault of their own. The measure would give States administrative funding so they can distribute benefit checks punctually and accurately. It would ensure that all unemployed workers receive a full 13 weeks of benefits. And it would repeal the 20-weeks-of-work prerequisite to receiving benefits that primarily punishes low-wage workers and newer entrants to the job market. Beginning in 1986, Federal and State governments began withholding taxes from the benefit checks of all aid recipients. However, no accommodations were made to offset these deductions, and recipients saw a significant reduction in benefits. To ameliorate this problem, Senator Kennedy's legislation would raise benefit levels by 15 percent or $25 a week, whichever is higher. Finally, a majority of States currently refuse benefits to unemployed workers seeking part-time work. West Virginia does cover part-time workers, but I believe every state should do this as well. Part-time work is an enormously important component of our economy, particularly as it involves large numbers of women and low-wage earners. Senator Kennedy's bill would require states to base eligibility on a worker's most recent earnings. This seemingly technical provision would greatly expand eligibility to benefits for many workers, in my state, and across the country. Millions of Americans are still struggling, and they do not have a steady source of income. I urge my colleagues to support this bill to reform America's unemployment insurance program; it is urgently needed and should be passed with great haste. This bill is the right thing to do for working Americans, and it is an essential measure for those still suffering from the effects of our uncertain economy.

Mr. ROCKEFELLER

Mr. ROCKEFELLER. Mr. President, as Chairman of the Committee on Veterans Affairs, I urge the Senate to pass this legislation that would help VA--and our entire Nation--prepare for the potential medical consequences of another terrorist attack. As Congress seeks ways to avert the threats posed by biological, chemical, radiological, and other potential terrorist weapons, we must make certain that we use our existing national resources as efficiently as possible. I thank Ranking Member Specter and his staff for their efforts in helping to ensure that VA--the Nation's largest integrated healthcare system--is prepared for the role that it can and must play during emergencies. The pending measure is an omnibus bill that would improve VA's ability to fulfill its responsibilities to veterans, its staff, and communities during disasters, and would also address VA nonprofit research corporation activities. ``The Department of Veterans Affairs Emergency Preparedness Act,'' as reported, which I will refer to as the ``Committee bill,'' acknowledges VA's role in offering health care and support to individuals affected by disasters, and would give VA staff the tools that they need to continue serving veterans during emergencies. The committee bill would establish four medical emergency preparedness research centers within the Department of Veterans Affairs health care system. VA researchers possess expertise in the long-term health consequences of biological, chemical, and radiological exposures, and sustain an unparalleled clinical management research program. The centers authorized by this legislation would make the most of these resources to learn how best to manage--or prevent--the mass casualties that might arise from the use of terrorist weapons. The committee bill also includes provisions requested by the Administration that would create an office, directed by an Assistant Secretary, to coordinate preparedness strategies within VA and with other Federal, State, and local agencies. I strongly believe that this new office represents an essential step in helping VA improve emergency preparedness while maintaining its primary mission of caring for the Nation's veterans. Another emergency preparedness provision within the committee bill would create no new responsibilities or missions for VA, but would authorize VA's enormous contribution to public safety and emergency preparedness. In 1982, Congress charged VA to care for active duty military casualties during a conflict or disaster. Since then, VA has taken a much larger share of the Federal responsibility for public health during emergencies, supporting mass care as part of the Federal Response Plan for disasters and serving as a cornerstone of the National Disaster Medical System. VA has responded to every major domestic disaster of the last two decades with personnel, supplies and medications, facilities, and--when necessary--direct patient care for overwhelmed communities. VA health care providers who care for disaster victims serve not only as part of the Federal response to emergencies, but as part of the communities in which they live. The committee bill would acknowledge VA's emergency response missions by authorizing VA to provide medical treatment for individuals affected by or responding to disasters. The committee bill also makes changes in law affecting VA's nonprofit research corporations. The first allows employees of nonprofit VA research and education corporations assigned to approved VA research, education, or training projects to be considered VA employees for purposes of the Federal Tort Claims Act. The other provision clarifies that VA Medical Centers may enter into contracts or other forms of agreements with nonprofit research corporations to provide services to facilitate VA-approved research and education projects. These changes would further VA's research and education missions. In conclusion, I urge my colleagues to support these research and emergency preparedness enhancements for VA. This bipartisan commitment to our Nation's veterans and VA represents a small investment with potentially enormous rewards. I ask unanimous consent that a summary of the bill be printed in the Record.

Mr. ROCKEFELLER

Mr. ROCKEFELLER. How much time is remaining to this side?

Mr. ROCKEFELLER. I yield to the Senator from Nebraska 4 minutes.

Mr. ROCKEFELLER. We have 14 minutes left; is that correct?

Mr. ROCKEFELLER. Madam President, this is an extremely important vote. It is very important because in the Congress we worry not only about the Nation as a whole, but as a nation of its individual parts, that is made up of 50 different States, all of whom are getting clobbered by something called a loss of Medicaid money. We have a chance with the amendment before us to adjust that situation. We felt so strongly about the situation and the loss of Medicaid money for our most vulnerable citizens, and also the damage it does in the aggregate to our hospitals, nursing homes, and every part of our health infrastructure. Whether you are in an urban or rural area--and the Presiding Officer's State includes both urban and rural-- you are faced with hospitals and other facilities that depend overwhelmingly on Medicaid. The States now have an enormous shortfall in their budgets. In fact, there are deficits of $40 billion to $50 billion. No State, with the exception of Vermont, can go into deficit financing like we do in the Federal Government. They have to balance their budgets. So what happens if they get to a situation where they don't have money? I was a Governor for 8 years, and I was in that situation for a full 5 years, where we actually had to lower moneys because the revenue was less than the previous year. We had to lay off people and the other things Governors have to do. We are in a position to help now. We have done nothing on health care, basically, except the children's health insurance program, which affects 2 million children, but it needs to affect many more. We have done nothing about universal health care, prescription drugs, or this Medicaid problem, and about virtually all of the areas of health care that we talk about all the time and simply do not perform on. So this is a real test for the 100 people who will come here to vote on whether they want to see their States drown in debt and have to cut Medicaid and hurt not only children but families and hospitals and nursing homes and home health--all the aspects of where Medicaid makes a difference. We felt so strongly about this after September 11, which was an enormous day in the history of the world, that we included this in the stimulus package. We did that prior to last Christmas, which was a long time ago. We did it and we decided it was so important to do, even at that time, it being a worse situation now, that we would treat it in an emergency fashion and not require it to be offset. Some people say you need to offset that. When you get into economic times like we have now--much worse than they were then--the underpinnings are weaker in general, and now we really do have to act. So what I am going to do is not use up all of our time, but wait for some colleagues to come down to speak on this amendment and why it is important that we waive the Budget Act and that we do the right thing by States and Medicare. This is an extremely important vote; it is a test vote about whether the Senate is really willing to do anything for the States and for health care. So far, we have failed on all fronts. Now we have a chance to reverse ourselves on a small, but important, aspect of it. We have, as I say, so many cosponsors that I will not even take the time to read them. But it is very bipartisan, with 35 cosponsors, including 8 Republicans. We should, in fact, prevail on this and get the 60 votes that we want because it is good. This is an emergency, I say to the Presiding Officer. This is important now even more so because Medicaid bears all of the brunt of the rising cost of prescription drugs because it is only Medicaid and the Veterans' Administration that pays for prescription drugs. This is not Medicare, this is Medicaid, and it is suffering terribly. This is an emergency. We deemed it such after 9/11. The situation is worse now. We have a chance to do something about it. I yield the floor and reserve the remainder of my time.

Mr. ROCKEFELLER. I yield 5 minutes to the distinguished Senator from Nebraska.

Mr. ROCKEFELLER. Madam President, I happily yield 5 minutes to the distinguished Senator from Maine.

Mr. ROCKEFELLER. Mr. President, I yield.

Mr. ROCKEFELLER

Mr. ROCKEFELLER. Mr. President, let me make a couple comments. No. 1, my friend from Texas speaks with enormous passion about the overriding power of the budget, and at the very last moment of his last statement, for the first time he used the word ``people.'' I sat in the same Finance Committee with him for a long time when we were debating tax cuts--and I am not here to argue whether it was a good or bad thing, but there was no question that we went from a $5.6 trillion surplus to a $165 billion annual deficit probably for the next 10 years, if nothing gets worse--and I never heard him make the argument-- for some reason, maybe I missed it, maybe I wasn't there at the moment--that we shouldn't do that tax cut which was the largest tax cut that this particular Senator from West Virginia, who does not need it, has ever received from the Federal Government--I never heard him talk about the possibility of budget deficits. So it does become a matter of priorities. It is fair, as the Senators from Nebraska, Massachusetts, and Maine have mentioned, to talk about 40 million people. And to say we are doing this to bail out the States, good grief, it is quite the opposite. The States are not powerful in the same sense that the Federal Government is. The States cannot go into deficit financing--with the exception of Vermont--as can the Federal Government. They have to balance their budgets. I was a Governor; I know that. The Senator from Nebraska was a Governor; he knows that. The States are not being bailed out. If the States cut their Medicaid eligibility, they cannot receive any of this money, unless they restore their portion through legislative action to the proper eligibility rate and, only then, on a temporary basis, for 1 and a half years, written into law, do they get this money. I want to close on the concept of people. Sometimes it appears to me on this floor that helping people is sort of a bad thing to do because if you help people, it implies that it might cost some money. It almost always does. It also costs an awful lot more money if you don't, on some occasions. This is one of those occasions. If we do not support the motion to waive, then health infrastructure all across this country is going to be hurt because of its dependency upon Medicaid. Forty million people are going to be hurt, including disabled people, children, seniors, and others, because of this motion. I need to tell you that this is not a bailout. This is temporary. This was in the original emergency stimulus package. Nobody argued then. Now, all of a sudden, they argue. It is very important for the States to be healthy and for the States to be able to balance their budgets, and therefore I strongly urge colleagues to support the motion to waive the point of order.

Mr. ROCKEFELLER. I yield 30 seconds or such time as he might need to the distinguished Senator from Nevada. Appointment of Conferees

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

Mr. ROCKEFELLER. How much time is left?