Jay Rockefeller

Mr. ROCKEFELLER

Mr. ROCKEFELLER. I thank the Presiding Officer very much.

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 President, I ask unanimous consent that the order for the quorum call be rescinded.

Mr. ROCKEFELLER

Mr. ROCKEFELLER. Mr. President, as Ranking Member of the Senate Committee on Veterans' Affairs, I have an especially strong interest in the history of illnesses and health concerns that follow military deployments. We have all observed the effects of post-conflict illnesses among our Gulf War veterans who returned with poorly understood, undiagnosed illnesses, and our Vietnam veterans with health problems related to exposure to Agent Orange. This legacy is not just a problem of our most recent conflicts; our Atomic-era veterans are still fighting for recognition of health conditions related to radiation exposures they experienced in service to their country 50 years ago. If there is any single lesson to be learned from this history, it is that the Department of Defense and the Department of Veterans Affairs have not always been aggressive enough in pursuing the immediate health consequences of military conflicts. Too many times our veterans have had to wait years before post-conflict illnesses are recognized as real problems that require firm commitments of research and treatment programs. These delays have come at a cost to the veterans who have had to fight for this recognition, and they have come at a cost to the government's credibility on this important issue. I believe it is time to consider establishing an independent entity with the capacity to evaluate government efforts to monitor the health of servicemembers following military conflicts, and to evaluate whether servicemembers are being effectively treated for illnesses that occur following such deployments. There have been suggestions for the need for such an entity within DoD and VA, but I believe that important health expertise outside these agencies is required as well. Indeed, it may be that the best approach is one that pulls together expertise from VA, DoD, and health care professionals and researchers from centers of medical excellence in fields such as toxicology, occupational medicine, and other disciplines. Therefore, I would like to submit an amendment to the Department of Defense Authorization to require the Secretary to enter into an agreement with the National Academy of Sciences to assess the feasibility of establishing, as an independent entity, a National Center for the Study of Military Health. The proposed Center for the Study of Military Health would evaluate and monitor interagency coordination on issues relating to post- deployment health concerns of members of the Armed Forces, including outreach and risk communication, recordkeeping, research, utilization of new technologies, international cooperation and research, health surveillance, and other health related activities. In addition, this center would evaluate the health care provided to members of the Armed Services both before and after their deployment on military operations. The proposed center would monitor and direct government efforts to evaluate the health of servicemembers upon their return from military deployments, for purposes of ensuring the rapid identification of any trends in diseases or injuries that result from such operations. Such an independent health center could also serve an important role in providing training of health care professionals in DoD and VA in the evaluation and treatment of post-conflict diseases and health conditions, including nonspecific and unexplained illnesses. While some have argued that it is time to take some of these responsibilities away from existing agencies, I would suggest that this is a matter for careful study and thoughtful deliberation. Therefore, this amendment would require the National Academy of Sciences to assess the feasibility of such an independent health entity. In their report to the Secretary of Defense, the Academy should provide a recommendation of the feasibility of such an entity and justification for such a recommendation. If such a center is recommended by the Academy, their report should also provide recommendations regarding the organizational placement of the entity; the health and science expertise that would be necessary; the scope and nature of the activities and responsibilities of the entity; and mechanisms for ensuring that the recommendations of the entity are carried out by DoD and VA. Mr. President, as Ranking Member of the Committee on Veterans' Affairs, there have been too many times when I have heard agency officials testify that poorly understood, unexplained illnesses are a common, inevitable occurrence of every military conflict. With the tremendous advances achieved elsewhere in medical and military technologies, I find the acceptance of these illnesses as an inevitability to be unacceptable. I hope that this amendment will offer an initial step to better prevention and treatment of these post- conflict illnesss.

Mr. ROCKEFELLER

Mr. ROCKEFELLER. Mr. President, I would like to pause for a moment to recognize the achievements of the great state of West Virginia, a land of rugged beauty, vast natural and mineral resources, and a hard-working citizenry. The people of West Virginia celebrate these qualities every day, but today is a special occasion when we celebrate West Virginia's 135th anniversary. It was June 20, 1863 when West Virginia rose from the pain of a house divided and took its place as the nation's 35th state. The patriotism and commitment to freedom that led West Virginia to split from Virginia in this country's darkest hour have defined the state's history since then. West Virginia was the first state to institute Rural Free Delivery of mail, and its miners led the way in the progressive labor movements of the early 1900's. A leading producer of coal and steel, West Virginia and its people were essential to this nation's wartime economy. West Virginia's economy continues to expand into the 21st Century. The state is now on track to become a major producer of everything from automobile engines to aircraft to telemarketing services. In addition, more tourists than ever flock to West Virginia's mountains and valleys for their scenic beauty, recreation opportunities, and friendly folk. West Virginia offers skiing in the winter, blazing colors in the fall, hiking and water sports in the spring and summer, and treasures like historic Harpers Ferry year-round. I am proud to represent West Virginia in this distinguished body. I hope my colleagues will join me in celebrating West Virginia's 135th year in the Union, and that they and their constituents can gain inspiration from West Virginia's motto, Mountaineers Are Always Free.

Mr. ROCKEFELLER

Mr. ROCKEFELLER. Mr. President, I ask unanimous consent that the order for the quorum call be rescinded, and I ask unanimous consent that I might speak for about 10 minutes, probably less, as in morning business.

Mr. ROCKEFELLER

Mr. ROCKEFELLER. Mr. President, I have come to the Senate floor to talk about, as others have, something of fundamental importance to the people that I represent in my State of West Virginia, and that is equal treatment for all Americans with respect to health care. I am not just talking about Congressmen, and I am not just talking about coal miners or CEOs or custodians, I am talking about all Americans and all the time. I want to talk about what I think is an urgent need here in Congress to pass legislation on the quality of health care, and that this legislation should apply to every single American. When enough of us recognize these needs, I am convinced we are going to enact legislation, and it is going to be called patient protection. It may have some other name. It may be modified, it may be expanded, who knows? But the need for it is undeniable, and it has to happen. Every single day that passes without the enactment of some kind of patient protection legislation is another day that millions of Americans, thousands of people I represent in West Virginia, are subject to the denial of needed treatments by insurance companies who are looking out for their bottom lines. Every single day that we as a Congress fail to act on the Patients' Bill of Rights Act, if we want to call it that, is another day that Americans are left vulnerable to health care decisions made by people who are not doctors--in fact, doctors complain about this all the time--but who are, in fact, business professionals. Every day that we do not act, Americans are refused the specialty treatment they need and deserve. I am going to give two examples of this which I think are scary, and which are very real. Make no mistake, if we do not respond and if we do not respond forcefully, more Americans are going to lose confidence in our health care system. It is interesting to me, having observed health care now for quite a number of years, that it used to be it was only patients, or only consumers of health care who were worried about the cost of health care, the quality of health care, the problems of health care, the paperwork of health care. Now, the people who really are coming on board in this angst are physicians themselves and nurses and people who work in hospitals who have to deal with the realities of what the health care system has become in this country. West Virginia is no exception. West Virginia may have some more problems than some other States, but we are no exception with regard to the need for patient protection. I constantly run into West Virginians when I am at home who complain to me--not at my invitation, but at theirs--about being denied the treatment they felt they were promised, or that they knew they were promised from plans, health care plans where they thought their premiums entitled them to something called quality health care and fair treatment. One complaint I hear all too often is being denied specialty care. That is a very big deal. General practitioners can take care of a lot of problems, but sometimes you come to a point where you have to have more. Under most managed care plans, a patient's primary care physician may in fact refer, as the gatekeeper or whatever, a patient to a specialist, if the primary care physician determines that specialty care is necessary. That makes a lot of sense to me. Primary care physicians are in a very good position to do that. That is a professional decision involving going to another professional. However, things may change if the specialist is not on the list often called the plan's network. Let me explain. Suddenly, someone then comes from the administrative office, or from some other division, and may take over. Suddenly, the patient who, along with the primary care physician, is anxious for that patient to see a specialist because of some health problem, finds out that the executives, not the physician, but the executives in charge of the managed care plan, people who are not doctors, not medical providers, reserve the right to refuse payment for the specialist recommended by his or her original doctor. In fact, this is a frequent occurrence for people who have insurance companies that push their employees to steer patients to only the physicians listed within their plan. That is not the way it is meant to work. Insurance companies do not always make the best medical choices because they are not trained in that business. They are trained in a different business. Too often motivated by their bottom line, which is understandable, and not often enough motivated by the patient's health care needs, many specialty referrals are refused. Now, I go to my examples and I hope my colleagues will listen. I think of a little 6-year-old boy from West Virginia who became seriously ill. Concerned, his mother rushed him to the doctor's office, his doctor's office, in fact, where he was quickly diagnosed with diabetes. His primary care physician referred him to an out-of-plan pediatric endocrinologist; a specialist in childhood diseases, that is. That was the referral, to a specialist in childhood diseases. The specialist placed this young child on insulin to control his condition. But when the child's primary care doctor referred him back to the specialist for a follow-up visit--which makes a lot of sense--the referral was denied, stating, ``* * * service available with in-plan endocrinologist.'' That doesn't sound so bad, does it? In other words, go to the in- house, in-plan endocrinologist. So while it sounds like the child could get the care that was needed from the in-plan physician, the reality is that he could not get that health care for a very subtle but basic reason. The in-plan specialist was an adult endocrinologist, not a child endocrinologist, specializing in adult diabetes. But diabetes is not the same in children and adults, and there are different specialties for adults and for children in that field. The treatment is different. There is serious risks of developing future health problems when the childhood diabetes is not dealt with properly by a proper physician. The insurance company in this case was gambling, in effect risking this child's future health for the few dollars they saved by saying: Oh, you have to go to an in-plan doctor. As bad as that case is--and I wish it were the only one, but it is not--I was recently told the story of a 14-day-old baby girl. Mr. President, 14 days old, this precious little child's health was already jeopardized by her health plan. What do I mean by that? This poor child was brought to her doctor 14 days after birth because of a urinary tract infection. Treatment of a urinary tract infection at that age requires an evaluation for urinary tract abnormalities. But the referral from the pediatrician to an out-of-plan specialist was denied, again saying services are available in-plan, an in-plan urologist. OK, if she could get the right treatment in-plan, that is what HMOs are for; right? But she could not. She could not get the help because the urologist the plan would have had her see was, once again, an adult urologist. Am I picking here? Am I just being petty? No. The problem lies in discovering and treating urinary tract abnormalities which is vital to preventing serious and permanent kidney damage, and the appropriate specialist for such a situation is a pediatric urologist. I have working in my office, thanks to the Robert Wood Johnson Foundation, a pediatric cardiologist. A pediatric cardiologist is different from an adult cardiologist. In other words, an adult and child are different and they require different specialists with different skills. It is a basic and important fact. Simply to say you have a urologist in-house is not to say that if that urologist deals with adult urology problems, that it is sufficient for a 14-day-old baby girl. This decision by the HMO was based on having an adult urologist, which urologist did not have speciality training in pediatric disorders and, therefore, was not capable of caring sufficiently for an infant. Why? Because keeping her within the plan's network of doctors costs less. I understand business, and business is important, but this business of quality of health care treatment is very serious and very scary, and that is what we have to focus on when we are thinking about what we are going to do. These are our children, the most helpless and vulnerable of all of American citizens. They have no way of defending themselves. They depend on their parents, they depend on their communities to take care of them, and these people, in turn, depend on us in Congress to ensure that they are not taken advantage of, that games are not played with their health and the health of their children. The time has come for us to pass a bill which guarantees certain commonsense protections for every single patient in America, young or old, rich or poor. This legislation--which we have the opportunity to pass, an obligation, I think, to enact this year, the Patients' Bill of Rights Act of 1998--will do exactly that. I am interested in good health care for our people, Mr. President. I don't think it is a game, and I don't think it has anything to do with politics. I think it is a very, very serious consideration. I thank the Presiding Officer and yield the floor. Mr. FORD addressed the Chair.

Mr. ROCKEFELLER

Mr. ROCKEFELLER. Mr. President, I rise today to recognize Becky Cain as she prepares to retire from an outstanding six year term as president of the League of Women Voters. Becky Cain has shown remarkable leadership for the League and her community of Charleston, West Virginia as well as a strong dedication for the well being of the people of her state and her nation. For generations, the League of Women Voters has had a tradition of working for campaign finance reform, defending the National Voter Registration Act, working for consumer protection legislation for health care, ensuring health care for seniors by protecting and enhancing Medicare, and protecting Clean Air standards, and strengthening the United Nations by providing adequate funding. This is an organization of leaders, and Becky Cain is certainly a great leader among leaders. As the volunteer head of the League of Women Voters, Becky Cain has been an articulate and committed spokersperson for citizens' interest in government. Under her direction, the League has been the leader in the passage of the National Voter Registration Act and has been stalwart in continuing efforts to preserve and strengthen this important legislation. Under her leadership one of the priorities of the League has been a comprehensive, nationwide campaign entitled, ``Making Democracy Work.'' This effort, involving different branches of the League and civic leaders in over 1,000 communities across the nation, is a long term effort to engage citizens in the important issues affecting them, to strengthen our democracy at the community level as well as bringing a diverse group of citizens together to face a larger challenge that faces us as a nation. Finally, I would like to thank Becky Cain and volunteers like her who give of themselves so selflessly for the good of their community, their state, and our nation.

Mr. ROCKEFELLER

Mr. ROCKEFELLER. Mr. President, I would like to take a moment to recognize an outstanding teacher, mentor, and West Virginian--Ms. Lucille Smith Watkins. For almost 50 years, Lucille has taught at Logan County Elementary School with unmatched enthusiasm. At 73, she is still fiercely committed to teaching and harbors no intention of quitting, saying ``I like getting up and going to teach every day. The children seem to do real well. When I feel like I'm not helping them anymore, I'll retire.'' Lucille credits her family for instilling an early appreciation and love for education--influenced by the sacrifices and efforts that they exerted in order to make higher education a possibility for herself and her six brothers and sisters. Her early love of education blossomed into a consuming lifelong passion of service to the school as she has often found herself cooking and buying groceries for the school along with teaching. Her outstanding commitment to teaching hasn't gone unnoticed in the state. On May 5, she received the very first Lucille Smith Watkins Award, an award in her honor presented annually by her school to the county's outstanding educator. On May 8, she won the Mary L. Williams black educator award during a West Virginia Education Association conference in Charleston. Yet, these awards and honors cannot match her smiles and pride for the achievements of her students. Beaming with price about her student's recent Young Writer's Award and her students' trophy for perfect attendance in her classroom, Lucille is a testament to her own love of teaching, and most importantly her love of her students. There is no better way to make a profoundly lasting impact upon the future than through nurturing the mind of a young child. Lucille is a refreshing example of the strength and endurance of one woman's attempt to make a difference. Speaking for the citizens of West Virginia, I am proud to have such an outstanding woman in our state and challenge others to strive to affect and mold the lives of children as successfully as she has.

Mr. ROCKEFELLER

Mr. ROCKEFELLER. I ask unanimous consent for the second reading of H.R. 3978.

Mr. ROCKEFELLER. I ask for regular order of H.R. 3978, for its first reading.

Mr. ROCKEFELLER

Mr. ROCKEFELLER. Mr. President, I join today with Senator Shelby to introduce legislation intended to strengthen the manufactured housing industry. Manufactured housing provides a major source of affordable housing for American families and seniors. This industry represents almost 30 percent of new single-family homes sold in the United States. In my state of West Virginia, manufactured housing represents more than 60 percent of new homes. Manufactured housing should play a strong role to increase the availability of affordable housing. This issue will be especially important to seniors. According to a recent national survey, 45 percent of households living in manufactured homes are headed by a person more than 50 years old. Manufactured housing is affordable housing, and it is the fastest growing type of housing nationally. The average cost of a new manufactured home without land in 1997 was $38,400. Even with land and installation fees, this cost is well below the typical costs of a newly constructed site-built home. But this industry faces challenges. Unlike other housing, manufactured housing is regulated by the 1974 National Manufactured Housing Construction and Safety Standards Act by the Department of Housing and Urban Development, (HUD). Because of reform in HUD management, the federal officials overseeing manufactured housing have declined from a staff of 34 to only eight. This decline in staff has occurred at the same time that the industry has grown. Unfortunately, due to a lack of staff, HUD cannot keep pace with the need to update the code on a consistent basis and timely manner. For example, there are new nationally recognized standards for fire protection prepared by the National Fire Protection Association and endorsed by the National Institute for Standards and Technology (NIST). However, there is no indication that HUD is ready to act on using these new standards to upgrade its codes for manufactured housing. In fact, between 1989 and 1996, a consensus committee has made 140 suggestions to HUD about changes for the federal codes on manufactured housing. More than 80 of these provisions are still pending in the Department. In 1990, Congress established a National Commission on Manufactured Housing and pushed the commission to forge a consensus on key issues for this important industry. Unfortunately that effort collapsed in 1994. This legislation is a new effort to address the challenges facing the industry. Introduction of the bill is just a first step. We all understand that the legislative process is designed to seek a consensus and improve legislation. I believe that we must work hard to forge a consensus between the industry and the consumers. This will be a challenge, but the potential rewards can be great for both sides. The industry can win and prosper with a more effective, streamlined regulatory process that keeps pace with improvements and standards. Consumers will win if safety standards and regulations are adopted more efficiently, such as the pending fire safety standards. Also, if the industry can use newer standards to provide better housing, manufactured housing could be designed to meet a wider variety of needs including modules for assisted living and stack able units for urban sites. My hope is that all sides will see this legislation as an opportunity to come together and develop a new, improved program for manufactured housing. Affordable housing is a major issue for families and communities. Manufactured housing is playing a key role in affordable housing, but more could and should be done. To achieve success, we need to develop a bipartisan, consensus approach. We need to help the industry and assure consumers that safety and standards will be retained and improved, not weakened. This is worth our combined effort to provide more affordable housing.

Mr. ROCKEFELLER

Mr. ROCKEFELLER. Mr. President, I join today with Senator Shelby to introduce legislation intended to strengthen the manufactured housing industry. Manufactured housing provides a major source of affordable housing for American families and seniors. This industry represents almost 30 percent of new single-family homes sold in the United States. In my state of West Virginia, manufactured housing represents more than 60 percent of new homes. Manufactured housing should play a strong role to increase the availability of affordable housing. This issue will be especially important to seniors. According to a recent national survey, 45 percent of households living in manufactured homes are headed by a person more than 50 years old. Manufactured housing is affordable housing, and it is the fastest growing type of housing nationally. The average cost of a new manufactured home without land in 1997 was $38,400. Even with land and installation fees, this cost is well below the typical costs of a newly constructed site-built home. But this industry faces challenges. Unlike other housing, manufactured housing is regulated by the 1974 National Manufactured Housing Construction and Safety Standards Act by the Department of Housing and Urban Development, (HUD). Because of reform in HUD management, the federal officials overseeing manufactured housing have declined from a staff of 34 to only eight. This decline in staff has occurred at the same time that the industry has grown. Unfortunately, due to a lack of staff, HUD cannot keep pace with the need to update the code on a consistent basis and timely manner. For example, there are new nationally recognized standards for fire protection prepared by the National Fire Protection Association and endorsed by the National Institute for Standards and Technology (NIST). However, there is no indication that HUD is ready to act on using these new standards to upgrade its codes for manufactured housing. In fact, between 1989 and 1996, a consensus committee has made 140 suggestions to HUD about changes for the federal codes on manufactured housing. More than 80 of these provisions are still pending in the Department. In 1990, Congress established a National Commission on Manufactured Housing and pushed the commission to forge a consensus on key issues for this important industry. Unfortunately that effort collapsed in 1994. This legislation is a new effort to address the challenges facing the industry. Introduction of the bill is just a first step. We all understand that the legislative process is designed to seek a consensus and improve legislation. I believe that we must work hard to forge a consensus between the industry and the consumers. This will be a challenge, but the potential rewards can be great for both sides. The industry can win and prosper with a more effective, streamlined regulatory process that keeps pace with improvements and standards. Consumers will win if safety standards and regulations are adopted more efficiently, such as the pending fire safety standards. Also, if the industry can use newer standards to provide better housing, manufactured housing could be designed to meet a wider variety of needs including modules for assisted living and stack able units for urban sites. My hope is that all sides will see this legislation as an opportunity to come together and develop a new, improved program for manufactured housing. Affordable housing is a major issue for families and communities. Manufactured housing is playing a key role in affordable housing, but more could and should be done. To achieve success, we need to develop a bipartisan, consensus approach. We need to help the industry and assure consumers that safety and standards will be retained and improved, not weakened. This is worth our combined effort to provide more affordable housing.

Mr. ROCKEFELLER

Mr. ROCKEFELLER. I thank the Presiding Officer.

Mr. ROCKEFELLER. Mr. President, will the Senator from West Virginia be speaking in morning business?

Mr. ROCKEFELLER

Mr. ROCKEFELLER. Mr. President, I will address two subjects, primarily veterans and the highway technical corrections bill. But in this morning's Congressional Daily, the majority leader, when referring to the question of the matter of the treatment of disabled veterans who have been addicted to smoking and have become disabled because of that, said, ``Where was Rockefeller when we passed this bill?'' And that is a quote. The majority leader has publicly questioned my record on the issue of veterans' smoking-related disability rights, and I really thought I had a duty to set the record straight. The Clinton administration has met with me on several occasions on the veterans smoking issue. I told the Director of OMB and I told the Secretary of Veterans' Affairs at least a year ago that I would vigorously oppose their proposal to deny veterans' disability rights. I have maintained that exact position all along. When the Senate considered this year's Republican budget resolution in March, I offered an amendment to strike the budget language which would have transferred the smoking disability rights issue to the Transportation Appropriations Subcommittee and assumed denial of smoking-related disability rights--assumed denial of those rights. My amendment was defeated, frankly, fairly much along party lines. When the ISTEA bill was brought to the floor by the committee, there were no provisions at all in that highway bill which would have denied veterans disability rights. I support, therefore, highways and I supported the ISTEA bill. I voted for it. But in the course of the highway bill conference, language was inserted to deny smoking-related disability rights in the deep of the night, with no consultation--nothing. Of course, as we know now, even this midnight raid was not done correctly and requires major corrections, and I refer to the highway technical corrections bill. Since the conference report was not amendable, there was nothing that I could do about that. There was no opportunity to reverse at that point the injustice that was being done. I could not offer an amendment. It was called a conference report. The corrections bill on TEA 21 provides for the first time, therefore, the opportunity to fully protect highways and veterans. We no longer need to make a choice of one over the other. Highways will remain fully authorized. They will not lose a dime. Veterans' disability rights will be preserved. The Republican leader asked where was Rockefeller? I am pleased to respond that I have been busy protecting the rights of disabled American veterans. That is where I have been. Further, Mr. President, I rise to urge the Republican leader to bring up H.R. 3978, the highway corrections bill, for immediate floor consideration in the Senate. Our failure to have this corrections bill considered immediately will have a devastating impact on veterans' disability rights. As I indicated yesterday to my colleagues, when H.R. 3978 is considered, I plan to offer an amendment--and nothing will stop me from offering an amendment if that bill comes up, and I will object to other bills coming up in order to force that bill to come up if I am able to so exercise my due parliamentary rights --I plan to offer an amendment to strike the veterans' disability compensation offset from the underlying conference report on H.R. 2400. I have asked for a very limited time agreement of 30 minutes equally divided--15 minutes for each side does not seem to me unreasonable--and then a vote. As the Presiding Officer is very well aware, adoption of my amendment will have the effect of preserving current law; that is, it will preserve existing disability rights for veterans, the status quo. It will simply preserve what already exists--nothing new--what already exists, and will fully preserve each and every highway project that was included in the ISTEA bill. That is such an important point to make. Some people think we are talking about removing billions of dollars from highways. We are not. Not one dime will be lost to highways. All of that money is going to have to be appropriated by the Appropriations Committee in any event. Let me repeat that: Every highway project in ISTEA, now TEA 21, will remain fully authorized after my amendment is adopted, if adopted. They will be in law, so to speak. The highways will be in law. If the leadership permits the TEA bill to stand as is by failing to raise the corrections bill, veterans' disability rights will be eliminated and the current law will be changed. Smoking will be considered an act of ``willful misconduct'' in the military, and we will be cutting smoking-related disability benefits for veterans who became ill on active duty and those who became ill due to exposure to Agent Orange and those who became ill due to exposure to ionizing radiation. This goes far beyond the intended scope of even the conferees, I have confidence in that. Mr. President, roads and bridges are, obviously, very important to the State of West Virginia, which is only 4 percent flat. I support highways. I support highway funding. Not a single project in West Virginia or in any other State--I repeat and repeat again--will be affected in any way by the amendment which I will put forward if given a chance. This amendment is a proveteran amendment. It is simply whether we are going to deny disabled American veterans the rights they now have under the law. There has been a great injustice done to America's veterans, and this corrections bill is an opportunity to remedy that injustice. Existing law requires the payment of disability compensation to veterans who can prove in a very complicated process that they became addicted to tobacco while in military service, if that addiction continued without interruption and resulted in an illness and in a disability. Addiction is the illness; addiction is the issue. The conference report on the highway bill rescinded--that is, cut--this compensation to disabled veterans for tobacco-related illnesses resulting from nicotine addiction that began in service. This cut in veterans' disability compensation generated $17 billion in what only can be called the most extraordinary paper savings that I have come across in my 13 years in the Senate, and these paper savings were literally stolen from veterans and used to partially fund an unprecedented increase in the ISTEA fund. Of course, anyone familiar with these claims for compensation for tobacco-related illnesses, and there will be few who are, knows that OMB's cost estimate is just a guess. They just guessed, and they sort of guessed in a way that they could pay for a lot of the other President's program ideas. I didn't appreciate that, but that is the game they decided they were going to play, and so that is what they did. They tried to talk me out of my objections to it, and they could not. That is my administration, not the Presiding Officer's. The so- called savings we are spending on highways are just that, they are paper savings. Since 1993, the Veterans' Administration has only received less than 8,000 claims--the Presiding Officer will be interested in this; since 1993, there have been only 8,000 claims for these tobacco-related disability illnesses-- and has granted only 200 to 300--200 to 300. So 27 million veterans and only 200 to 300 disability claims for smoking- related illnesses granted by the Veterans' Administration. In arriving at its $17 billion estimate, the administration, for some unexplained reason, estimated that 500,000 veterans would apply for tobacco-related claims every year, Mr. President. It is absurd; it is ridiculous. It is a shell game. It was intended to pay for some of their other programs. And in the process, they wanted to cut off disability claims for veterans who are owed them. It is make-believe. The amendment that I offer would maintain current law as is by reversing the highway bill's raid on veterans. My amendment strikes no highway project. My amendment merely preserves VA's disability compensation for tobacco-related conditions as is. I am sure we will hear a good deal of doomsday projections about the effect of this amendment. Again, here are the facts. The amendment does not otherwise affect the highway bill or the projects that it authorized. They remain the same. They are unaffected. My amendment will not bring down the highway bill, will not create a sequester. I can read you law on that. But I will spare the Presiding Officer that. But those who say that, ``Oh, this will cause a sequester and a cut in Medicare, Social Security,'' the Presiding Officer and others will hear that argument--that argument is wrong. That argument is wrong. Those are the contentions of those who would deny disability benefits to veterans. When we argued this issue 2 months ago, when my amendment to the budget resolution was debated, I warned my colleagues that veterans would be justifiably outraged by this raid on their disability compensation program, and they are. America's veterans perceive that Congress has turned its back on the Government's responsibility and promise to care for its veterans and on the role it played in fostering their addiction to tobacco--that is well known to the Presiding Officer and all other Members--distribution of free cigarettes in C-rations and K-rations; reduced prices; and they delayed the warning that appeared on tobacco in the military cigarettes until 5 years after it had been done at the civilian level. Mr. President, we have spent weeks talking about addiction to tobacco and how powerful that addiction is and how that addiction has been fostered. Why is it when it comes to the issue of veterans and tobacco, it is viewed solely as a matter of personal choice? Why is it that this administration and this Congress believe that veterans should have had greater knowledge about tobacco's addictive properties when they began smoking than the general public did? Veterans believe in doing their share and carrying their weight. They always have; they always will. But the Congress is not asking for cuts in all accounts this year, oh, no. In fact, we are not even demanding that others, such as Social Security disability recipients, lose smoking-related compensation. Again, only veterans are singled out for this treatment. There has been a lot of talk about veterans and smoking in the last few months. So I want to make sure that my colleagues are not confused. The amendment that was adopted on Tuesday to direct a portion of the proceeds from the tobacco bill to VA health care in the tobacco bill, by voice vote, is only for health care. The tobacco-related amendment does not deal with disability benefits, compensation; only with health care, not compensation, benefits for tobacco-related illnesses. That is a major point. Those of my colleagues who will seek refuge in the tobacco legislation need to reconsider. And, in fact, in some sadness I am not even sure there will be tobacco legislation. I hope otherwise. But one cannot be confident at this point. In any event, some will say--and I close on this point--that the corrections bill puts in $1.6 billion for other veterans programs. And indeed it does. But our friends in the veterans community speak with one voice on this issue. And I agree. They cannot support the increase in benefits to one set of veterans to be paid by the cutting of important benefits to another set of veterans. Veterans across this Nation reject this attempt to buy them off. That is why I urge support of my amendment. It is a simple choice. Again, the choice is not highways versus veterans. Highways are fully protected. Veterans are not. Please choose veterans. I thank the Presiding Officer and I yield the floor. Mr. DeWINE addressed the Chair.

Mr. ROCKEFELLER

Mr. ROCKEFELLER. Would the majority leader yield?

Mr. ROCKEFELLER. I would ask the majority leader if he intends to bring up the highway corrections bill, because if he does, I have an amendment I would like to offer. It is a very simple amendment, very direct amendment. And I cannot do that unless it is brought up.

Mr. ROCKEFELLER. May I say to the majority leader, I also am very anxious to get it done, but in the spirit of being able to offer amendments. And unless I am able to offer an amendment, I would have to object to----

Mr. ROCKEFELLER

Mr. ROCKEFELLER. Mr. President, as the Ranking Member of the Senate Committee on Veterans' Affairs, I, along with Senators Specter, Lott, and Daschle submit a Senate Concurrent Resolution that will allow the Disabled American Veterans to sponsor an event on the U.S. Capitol grounds on June 16 and 17, 1998, during which they will donate 147 transportation vans to the Department of Veterans Affairs. Senator Specter, Chairman of the Committee on Veterans' Affairs, and I were asked to help coordinate this unique event, and we are grateful for the support of the Leadership on both sides of the aisle. As my colleagues are aware, Senator Specter is unable to be here today due to recent surgery. Mr. President, the Disabled American Veterans (DAV) was chartered by the Congress of the United States in 1932 and serves as an incredibly strong advocate for our Nation's disabled veterans. In 1987, as part of their mission, DAV organized a nationwide transportation program to help sick and disabled veterans receive the essential medical care they so desperately need. From the time of its inception to the present, DAV will have donated 750 vans in support of this program. In my state of West Virginia, thousands of veterans live in rural areas, miles from the nearest VA medical center, and often in areas with no public transportation. So I am acutely aware of how veterans not only in West Virginia, but from coast to coast, rely on the DAV transportation program to receive essential medical care. I am proud to have worked with DAV to help foster this program. I ask all of my colleagues to join us in supporting legislation to authorize use of the Capitol Grounds for this remarkable event. And I, along with Senators Specter, Lott, and Daschle, commend DAV for their donation and work on behalf of our Nation's veterans.

Mr. ROCKEFELLER

Mr. ROCKEFELLER. Mr. President, I am pleased that my colleagues have agreed to secure a small piece of the tobacco revenue to improve veterans' access to health care. The amendment offered by my colleague, Senator McCain, is similar to an amendment I had planned to offer which would have set aside $2.7 billion for veterans health care; and I am delighted that he shares my views on this matter. In my view, given the significant increased costs of providing VA health care due to smoking- related illnesses, it only seems fair to do something to fortify the veterans' health care system. Specifically, this amendment, Amendment No. 2446 to S. 1415, would dedicate $600 million per year of the spending included in the tobacco bill to help reimburse VA for their smoking-related expenses and expand access for direct smoking-related services to other veterans. I want to talk about the amount of funding for the moment. I arrived at this formula because the VA's increased costs due to smoking are about 7 percent of the estimated total federal health care costs due to tobacco-related illnesses. This amendment is really a modest one. I ask my colleagues to look at the estimates for VA's cost of providing smoking-related health care. In 1997, VA spent $3.6 billion, and over the next five years, will spend $20 billion. I believe many of my colleagues would be surprised to learn that VA spends so much. But it is true. Veterans have a very high prevalence of smoking-related diseases and illnesses, because as young servicemembers, they were encouraged to smoke by the military and became addicted. Let me remind my colleagues that the military distributed free cigarettes in C-rations and K-rations and sold tobacco products at vastly reduced prices to service members, a practice that continued until very recently. And in the aggregate, veterans are older, and, therefore, the long- term effects of smoking are likelier to have taken a toll on their health status. To put it all in perspective, we are not asking our colleagues to approve an amendment to completely reimburse VA for their full health care costs--though many believe this would be justified. No, this amendment would be limited to just a fraction of VA's true costs-- approximately 15% of what they are actually spending taking care of veterans afflicted by diseases and illnesses caused by smoking. Quite obviously, providing tobacco-related health care places a tremendous financial burden on the VA health care system. I want to make one thing perfectly clear: because of limited resources, the VA health care system is not and has never been accessible to any veteran who walks in the door. There is no entitlement to health care for all veterans. Because all of the health care provided at VA hospitals and clinics is subject to the availability of funding, VA enrolls veterans according to certain priorities. Those veterans with service-connected disabilities, or low incomes, or those who are members of certain groups, like former prisoners of war, are enrolled first, and second, and third, and so on. With an essentially frozen budget, when VA covers the health care costs for smoking-related care, it means that other veterans are denied care. Though modest, the amendment would do wonders to VA's ability to provide more health care to veterans. Some 240,000 veterans who would not gain access to VA's health care system would now be able to see VA doctors and nurses. Veterans dying of smoking-related illnesses could spend their final days in VA hospices. Finally, Mr. President, I find it quite ironic that this amendment comes on the heels of the elimination of a $16 billion existing veterans' benefits to offset funding in the highway bill. That particular battle has been lost, and nothing can make amends for cutting an existing veterans benefit to pay for highways. Though the damage is done, I am pleased that my colleagues have chosen with this amendment to provide a measure of security for veterans and the health care system dedicated to serve their needs.

Mr. ROCKEFELLER

Mr. ROCKEFELLER. Mr. President, I wish to draw attention to legislation I have cosponsored that will create the Medical Innovation Tax Credit. This bill will facilitate the development of lifesaving medical treatments at medical schools and teaching hospitals. I am pleased to join my colleagues, Senators D'Amato, Feinstein, Boxer, and Hutchison, in this initiative. In my own State of West Virginia, and throughout this country, academic medical centers are feeling the changes in the health care marketplace. With limited reimbursement under managed care and cuts in Medicare payments, these medical institutions are under increasing financial pressures. To compound these stressors, academic medical centers also support certain services, such as burn units or trauma centers, which are vital to the community but financially draining to a hospital's budget. West Virginia University's Ruby Memorial Hospital, for example, operates a trauma unit which serves as a lifeline to victims of serious injuries. Our legislation would help these academic medical centers to avoid choosing between research and the day-to-day activities associated with the running of a hospital. Under the Medical Innovation Tax Credit, pharmaceutical or biotechnology companies would receive a tax credit equal to 20 percent of the funds spent for medical research expenses conducted at eligible sites. This incentive will make them a more attractive site for clinical trials. Given the important role played by academic medical centers, I believe this support is warranted. Mr. President, our bill will add a freestanding section to the Internal Revenue Code to create this research incentive. It is intended to complement the existing research-targeted tax credits--the Research and Experimental Tax Credit and the Orphan Drug Tax Credit, both of which have been credited with stimulating billions of dollars in research. Initial clinical studies are just the beginning, however. Additional studies are frequently needed to determine combinations for administering drugs and for providing the most appropriate therapies to patients. The Medical Innovation Tax Credit is geared toward promoting this type of research. Aside from medical schools and teaching hospitals, National Cancer Institute-designated centers will also be eligible sites. Peer-reviewed clinical trials are credited with providing cancer patients the best available care. Our legislation will indirectly promote these opportunities for care. Department of Veterans Affairs hospitals affiliated with teaching hospitals will also be eligible under the legislation. VA research is not only supported by an appropriation, but by private donations largely from pharmaceutical companies in support of clinical drugs trials. Clinical research conducted in VA medical centers has a significant and lasting impact on the care provided to veterans. Mr. President, if America is to continue leading in the field of biomedical research, we must do all we can to assure that valuable research programs at medical schools and teaching hospitals do not suffer because of financial pressures and changing market conditions. Research is just too important. I look forward to discussing this issue and pursuing the goal of this legislation in the coming months with my colleagues on the Finance Committee as we look at a variety of ways to improve and strengthen our valuable research program.

Mr. ROCKEFELLER

Mr. ROCKEFELLER. Mr. President, I am pleased today to introduce the following legislation, ``The Department of Veterans Affairs Primary Care Providers Incentive Act of 1998.'' This legislation is intended to revitalize the VA's Health Professionals Education Assistance Program, thereby reducing waste, targeting primary care professions and under-served areas, and making the VA more competitive with private employers for skilled personnel. I am pleased to be joined by my respected colleague from Maryland, Senator Mikulski, in this effort. I urge our colleagues to join us in supporting this legislation. The VA health care system is in the midst of a major reorganization that is simultaneously reducing the current workforce and creating the need for more primary care health professionals. This reorganization has dramatically changed the way the VA delivers health care, by shifting the emphasis to outpatient rather than inpatient care. As part of this process, the Department of Veterans Affairs has set a goal of doubling the number of primary care providers in the VA health care system, and we want to assist them. There are two good ways to hire and keep highly skilled professionals--offer incentives to current employees to get training in new areas of need by providing scholarships, and recruit new primary care providers by offering assistance in paying off student loans. This legislation, which includes both a scholarship program and an education debt reduction program, can help. The VA needs educational assistance programs such as these to effectively recruit and retain trained primary care health professionals. In the VA hospitals and clinics, some of the most difficult positions to fill are those of nurse practitioners, physical therapists, and occupational therapists. In my home state of West Virginia, for example, at one of the VA hospitals there has been a vacancy for an occupational therapist for over twelve years! Two of the VA hospitals have no physical therapists at all. This is simply unacceptable. The plain fact is that the VA cannot offer the same starting salaries as those available in private practice. The Education Debt Reduction Program included within the Primary Care Providers Incentive Act gives the VA a financial recruitment tool that will be an enormous help in making the VAMCs more competitive for these much- needed and highly skilled individuals. This program was first designed by Senator Mikulski in 1993 in recognition of this very problem. It was needed then, and it is still needed now. Recruitment is only half the problem in building a new workforce that is geared toward providing primary care. Retention of trained people, especially in the face of low morale due to budget cuts, is equally important. The scholarship program in this legislation is designed to answer this very need. Eligibility is limited to current VA employees, thus enabling VA to build staff morale. The scholarship program provides a means for vulnerable employees to protect themselves against future RIFs by acquiring training in the new areas of need. And, VA gets the workforce they need, composed of motivated and loyal employees. Professional associations representing primary care health workers, VAMC human resources personnel, and past recipients of VA scholarships are strongly in support of this legislation. Although this is a time of budget reductions in health care, these programs are a worthwhile investment, enhancing morale of the VA health care providers in the short term, while building a workforce that matches VA's needs and improves veterans' health care in the long run. Mr. President, I ask that the text of the bill be printed in the Record at this point.

Mr. ROCKEFELLER

Mr. ROCKEFELLER. ``A nation reveals itself not only by the men it produces but also by the men it honors, the men it remembers.'' What better way to pay tribute to America's veterans on this Memorial Day than to quote our former President, John F. Kennedy. He knew then, in 1963, that it was imperative we honor and remember our veterans, as should know today. We must not forget the sacrifices of the many men and women who gave so much for the sake of this great country, and we must honor them with our gratitude. I stand before you today to salute these veterans. In my home state of West Virginia, generations of veterans have served in the Armed Forces, and many have lost their lives. This country would not be the world power that it is today had it not been for these men and women who fought so bravely. Let us not just know that this day is Memorial Day, let us take a moment to put names, faces, on these veterans. Husbands, wives, mothers, fathers, and children. Friends to us all; friends who fought for our freedom. Freedom that we share every single day of our lives. Freedom that makes America as great as it is. Stand proud when you see the American flag waving high in the air. Sing along to the Star Spangled Banner. Nod your head in respect when you pass by a veterans' cemetery. Behind these symbols of America are the people who have made them so remarkable, the veterans of this country. They deserve our gratitude on this day and everyday. So many veterans gave their lives for this Nation. We cannot forget what they did for us. The lives that were lost and the lives that were changed forever. It does not matter whether they served in combat or peace time. Each left behind familiar surrounds, undertook risks, and faced the unknown. We should honor them all for their courage. They joined the Armed Forces of this country to defend and protect it, to make it safe for their, and our, loved ones. We vowed to take care of our veterans when they returned home to us. In many ways, we have, by setting up a benefits program and a health care system, creating two Committees in Congress to oversee these efforts, devoting enormous amounts of resources to their health and well being. But I am forced to say that the recent record of this administration, and of many in Congress, has deteriorated in the area of protecting veterans' benefits. Our commitment to meeting the needs of veterans has been eroded, and we can and must do better. There are still many areas that need improvement. It is not a perfect system. We must strive to better it and not let any of our veterans be shortchanged of the benefits and care they so dearly earned and deserve. I would like to speak about just a few of the ordeals that our veterans have had to face after their return from service. I do this to acknowledge these problems and to pledge to continue in my fight for solutions. Gulf War veterans. Even though the war is over, many are struggling with illness, often undiagnosed, but nevertheless debilitating. Seven years have passed since the end of the Gulf War, and DOD and VA still do not know what is wrong with the veterans who fought in this war. We need to be able to answer the questions of ``How many veterans are ill?'' and ``Are our ill veterans getting sicker over time?'' We also need to provide a permanent statutory authority to compensate these veterans. That is why I have introduced legislation, S. 1320, that targets these important issues. It took our government 20 years after the Vietnam War to assess the effects of Agent Orange and 40 years after World War II to concede the problems of radiation-exposed veterans. We must learn from the lessons of the past and act. We cannot allow our Gulf War veterans to keep waiting for the benefits and care that they earned seven years ago. Or take atomic veterans, who were exposed to ionizing radiation during service. I have serious concerns about the way atomic veterans' claims are being handled and the way regulations to administer those claims are being created. These veterans were intentionally placed in harm's way, sworn to secrecy, and abandoned by their government for many years. It is critical that we search for a better way to address their compensation claims. I recently cosponsored legislation that would authorize health care for veterans treated with nasopharyngeal radium irradiation, veterans who have so far been excluded from access to VA services. These veterans, primarily Navy submariner and Army Air corps pilots, received nasopharyngeal radium treatments in the 1940's and 1950's to treat and prevent inner ear problems that developed due to the inadequate pressurization of their respective vessels. Unfortunately, the health effects of the treatments that were given to these veterans are unknown. However, when such high levels of exposure are sustained, we must be concerned about long-term health effects, and thus, we have a responsibility to ensure these veterans' access to health care. Simply put, it is the right thing to do. We owe these veterans. They risked everything for us--their health and sometimes even their lives. We should, at least, give them appropriate research, health care, and compensation. At least. An important issue concerning veterans at this time is the VA budget for benefits and health care. I would like to share with America where these issues stand. First, the benefits side of the budget. The administration this year requested a very modest increase of $565 million in funds for benefits payments, just what is needed to cover cost-of-living allowances. VA has also requested $850 million--$63.5 million above the FY 98 level-- for the account that funds the administration of nonmedical benefits. Although these amounts appear to be an increase, VA's benefits delivery staff will lose 45 FTE. In a time when it takes VA 157 days to decide a new compensation claim, and years longer in appeals cases, it concerns me greatly that VA is seeking funds that will not allow it even to maintain, at the very least, its current level of staffing. I am particularly troubled by the proposal by the administration, adopted this very day by the Congress, which cut $10.5 billion from the veterans' benefit account over the next five years. This was done by removing VA's existing authority to pay compensation to veterans who suffer from tobacco-related illnesses, based on the nicotine dependence they developed while in the service. The money saved from cutting this benefit will be put into more highway spending. Although I support a strong highway bill, I firmly believe that it should not be funded by cuts in veterans benefits, particularly a program cut that totally bypassed the Senate Committee on Veterans' Affairs. That is why I offered an amendment to the Budget Resolution to protect the funding to the veterans account. Unfortunately, my amendment was defeated by a vote of 52-46. On the health care side, the VA budget request for medical care is $30 million less than last year. The base appropriated funding level of $17.03 billion would be supplemented by approximately $560 million from veterans' copays and collections from insurance companies. When the base funding level is combined with these collections, the VA health care system would have $17.6 billion to spend next year--approximately what it is spending this year. Unfortunately, this flatlined budget makes no allowance for cost-of-living increases for VA employees and other rising costs due to inflation. The VA health care system is a system in transition. Recent changes in lines of authority, resource allocations, and methods of health care delivery, as well as downsizings and facility integrations, have buffeted the system. While all this reorganization is underway, I am concerned that VA have good systems in place to ensure that high quality health care is the standard practiced at all VA facilities, regardless of where they are located around the country. I will continue my efforts to make sure that VA, as the nation's largest health care provider, upholds the highest standards of quality of care. What is clear is that we still have a lot of work to do for our veterans. We have come a long way, but there are still many miles to cover. They promised us they would risk their lives. We promised them we would take care of them. Caring for our veterans is the least we can do. On this day, ladies and gentlemen, be proud of the men and women-- veterans and service members from every branch and action--who have served our nation with courage. And, my colleagues, match your pride with a pledge to maintain the nation's commitment to them. Veterans have earned our respect and admiration. I am committed to upholding their honor the offering them the thanks they so richly deserve. I ask you, America, to do no less.

Mr. ROCKEFELLER

Mr. ROCKEFELLER. Mr. President, I am pleased today to introduce the following legislation, ``The Department of Veterans Affairs Primary Care Providers Incentive Act of 1998.'' This legislation is intended to revitalize the VA's Health Professionals Education Assistance Program, thereby reducing waste, targeting primary care professions and under-served areas, and making the VA more competitive with private employers for skilled personnel. I am pleased to be joined by my respected colleague from Maryland, Senator Mikulski, in this effort. I urge our colleagues to join us in supporting this legislation. The VA health care system is in the midst of a major reorganization that is simultaneously reducing the current workforce and creating the need for more primary care health professionals. This reorganization has dramatically changed the way the VA delivers health care, by shifting the emphasis to outpatient rather than inpatient care. As part of this process, the Department of Veterans Affairs has set a goal of doubling the number of primary care providers in the VA health care system, and we want to assist them. There are two good ways to hire and keep highly skilled professionals--offer incentives to current employees to get training in new areas of need by providing scholarships, and recruit new primary care providers by offering assistance in paying off student loans. This legislation, which includes both a scholarship program and an education debt reduction program, can help. The VA needs educational assistance programs such as these to effectively recruit and retain trained primary care health professionals. In the VA hospitals and clinics, some of the most difficult positions to fill are those of nurse practitioners, physical therapists, and occupational therapists. In my home state of West Virginia, for example, at one of the VA hospitals there has been a vacancy for an occupational therapist for over twelve years! Two of the VA hospitals have no physical therapists at all. This is simply unacceptable. The plain fact is that the VA cannot offer the same starting salaries as those available in private practice. The Education Debt Reduction Program included within the Primary Care Providers Incentive Act gives the VA a financial recruitment tool that will be an enormous help in making the VAMCs more competitive for these much- needed and highly skilled individuals. This program was first designed by Senator Mikulski in 1993 in recognition of this very problem. It was needed then, and it is still needed now. Recruitment is only half the problem in building a new workforce that is geared toward providing primary care. Retention of trained people, especially in the face of low morale due to budget cuts, is equally important. The scholarship program in this legislation is designed to answer this very need. Eligibility is limited to current VA employees, thus enabling VA to build staff morale. The scholarship program provides a means for vulnerable employees to protect themselves against future RIFs by acquiring training in the new areas of need. And, VA gets the workforce they need, composed of motivated and loyal employees. Professional associations representing primary care health workers, VAMC human resources personnel, and past recipients of VA scholarships are strongly in support of this legislation. Although this is a time of budget reductions in health care, these programs are a worthwhile investment, enhancing morale of the VA health care providers in the short term, while building a workforce that matches VA's needs and improves veterans' health care in the long run. Mr. President, I ask that the text of the bill be printed in the Record at this point.

Mr. ROCKEFELLER

Mr. ROCKEFELLER. The Senator says ``foreigners,'' people who are not from this country.