Jay Rockefeller

Mr. ROCKEFELLER

Mr. ROCKEFELLER. Mr. President, I rise to express my extremely strong, very enthusiastic support for the nomination of Charlene Barshefsky to be our U.S. Trade Representative. This is an important vote for America, for its future. I urge my colleagues to give her the unanimous vote of confidence that she has, in fact, already earned through her record of incredible fortitude, ability, and a long list of trade accomplishments, even as acting USTR. The President has put forward, frankly, a most unusual person-- unusually skilled, highly qualified, for one of the most important jobs in the U.S. in Government, and that is being our Nation's lead trade negotiator and keeping up with all developments all over the world all the time. It is an incredible job. She now should have the official title to proceed with the job awaiting her in trade negotiations and efforts that offer immense opportunities and extremely high stakes for our industries, for our workers, and for our economy. In just the last year alone, on a whole host of other things, as our acting trade representative, Charlene Barshefsky has concluded a renewal of our critical semiconductor agreement with the Japanese; seen through an agreement to remove tariffs around the world on information technology products; and won agreement of a massive telecommunications pact that promises more than $1 trillion in worldwide economic benefits through the year 2010, all of this as acting trade representative. Beyond that, I would point to one of Charlene Barshefsky's strongest qualifications: Her masterful grasp of complicated issues surrounding China's integration into the global economy. We have all read, hopefully, all of the writing that has come out about China since the death of Deng Xiaoping. I believe that China is the single biggest long-term macroeconomic challenge facing the United States. We cannot duck it. We must handle it intelligently. China is the world's largest country, in terms of population, and its economy will surpass ours sometime in the not too distant future. If its accession to the World Trade Organization, in particular, is not handled properly, the ramifications for the United States could be serious and long lasting. This takes the hand of a master. That hand belongs to Charlene Barshefsky. We are also very fortunate to count on Ambassador Barshefsky as we face the challenge of our trade relationship with Japan. This winter I took, as I always do, a delegation of West Virginia business people to Japan and Taiwan. One of the messages we heard, in a troubling fashion very frequently, was that Japan was looking much more toward turning to the World Trade Organization for the settlement of previously negotiated bilateral trade agreements, turning, therefore, away from the bilateral process which has traditionally characterized our negotiating relationship with Japan. I don't blame them if they are trying to avoid a U.S. negotiating team headed by somebody as forceful and capable as Charlene Barshefsky. My response is that overall United States-Japan relations depend on our ability to deal with one another, on a bilateral basis, on our trading issues, and then have occasional recourse to the WTO, but none of this could we do any better than by having Ambassador Barshefsky at the helm representing our country, our people, the people from my State. It is impossible for me to explain how strongly I feel about the nomination and the confirmation of that nomination hopefully on this day. To turn to the amendment we are now debating, the Senator from South Carolina is one of the most forceful advocates in the Congress for American interests in the global economy. I learned a great deal about issues coming from discussions with him about the globalization of the economy. He talks about it a great deal with great erudition, and I admire and share his intense commitment to American workers and industries. The Senator from South Carolina also has a very long-time interest in the issue of foreign ownership of American telecommunications services, which, in fact, happens to be the root cause of the Senator's amendment, although this dispute is not about broadcast rights but about telecommunications services--not about broadcast rights but about telecommunications services--like cellular or international calling. Clearly, there is a difference of opinion about what U.S. law allows in the area of ownership of telecommunications services. This is a difference of opinion, not only between the Senator from South Carolina and USTR, but between the Senator and something called the Federal Communications Commission, which he declines to recognize on this matter. The Senator, as the former chairman of the Commerce Committee and the ranking member now, also disagrees with the current chairman of the committee, Senator John McCain, who has just spoken, as well as the chairman of the House Commerce Committee, Mr. Bliley, over this law. As I understand it, the U.S. offer in the telecommunications agreement tracks U.S. law, meaning this dispute is really over the interpretation of current U.S. law by the FCC, which the ranking member of the Commerce Committee does not like, not the trade agreement reached by USTR. I thoroughly agree with the Senator from South Carolina that Congress must assert its constitutional right and responsibility to oversee international trade and international commerce, and I am in full agreement Congress should act when a trade agreement makes commitments that differ from current law. But that is already the law of the land. That exists now under the current law. If a trade agreement reached by the executive branch requires a change in law, Congress must act to implement the agreement. When the President agreed to the Uruguay round, Congress had to pass implementing legislation for us to meet its terms, which we did. However, to cite another example, when the President agreed to the shipbuilding agreement at the OECD, Congress did not agree to change American law to implement that particular agreement. As somebody who, like the former chairman and ranking member of the Commerce Committee, opposed NAFTA as I did, I am certainly not saying that we should signal that this or any other administration has a blank check to make trade agreements that are not in America's interest. But that is not what the amendment of the Senator from South Carolina is about. This amendment would create a whole new role for Congress that could have a chilling effect--would have a chilling effect--on trade negotiations that, in fact, seek to serve and strengthen U.S. interests, which he talks about. My problem with the Senator's amendment is that it would do much more to reaffirm Congress' role in responding to trade agreements that require a change in our laws. By using the language in the amendment which says that any trade law which would--and then the keywords are-- ``in effect amend or repeal statutory law,'' I am afraid it would entangle Congress in a constant, complicated, unnecessary process of acting on trade agreements that do not embody actual changes in U.S. law and don't require congressional involvement to obtain the benefits of those agreements. I respect the fact that the Senator questions a part of the new telecommunications trade agreement negotiated in Geneva. Disagreements between members of the legislative branch and executive branch are very common, even on an intraparty basis. But we have existing procedures to resolve disputes like that when they come up. A challenge can be taken up with the courts or something called legislation can be offered to change the particular practice in dispute. The problem with the amendment of the Senator from South Carolina is that instead of proposing a specific change of law, which addresses his interpretation of the law affecting ownership of telecommunications services, he is proposing a new, generic, far-reaching role for Congress that could affect nearly all future trade agreements. For example, USTR recently concluded an agreement which would eliminate tariffs that were on some widely sought after anti-AIDS drugs. Under current law, this could be put into effect--under current law--in 60 days under Presidential proclamation authority. However, if the Hollings amendment were to pass, such routine and noncontroversial changes would require a new act of Congress that could mean waiting months or maybe even watching the benefits of this trade agreement never materialize. The amendment by the Senator from South Carolina calls for a major shift in U.S. trade policy. It has not been discussed or considered in the Finance Committee, which has jurisdiction over all reciprocal trade agreements. Finally, even if all these questions could be answered, the House has already said that they will ``blue slip'' the waiver resolution if it contains this amendment, because it goes against the constitutional provision that all measures which affect revenues must originate in the House of Representatives. So this amendment on the waiver resolution would doom the underlying nomination, and Charlene Bar- shefsky is too good a nominee to see that happen. With respect for my colleague from South Carolina, I strongly urge my colleagues to vote against his amendment. This is not the way, not the time, nor the policy to use in resolving the Senator's dispute over a specific provision of a specific trade agreement. That disagreement should be pursued through other avenues that all of us use on a very regular basis. In this case, the amendment would establish an entirely new process, a new law, a new role for Congress regarding all trade agreements. It is a role that is unnecessary and could prevent our trade negotiators from doing the kinds of work that we charge them to do in representing our best interests. Rarely, if ever, have I seen an international agreement that has virtually no opponents in either the business community or from American workers. Usually, people point to winners and losers in international trade agreements. Sometimes people are afraid they could lose their jobs, or they feel that their business could be disadvantaged relative to their competitors. But on this Telecom agreement, notwithstanding the objections of the Senator from South Carolina and a couple of others, I've heard barely a peep. This international telecommunications agreement truly breaks new ground. For the first time ever, an international trade agreement effectively guarantees competition. The United States put forward regulatory guidelines modeled on our own telecommunications law, and 65 countries agreed to adopt most, if not all, those procompetitive principles. That is extraordinary. This agreement between 69 countries will open nearly 95 percent of the worldwide telecommunications services market to competition. A market which will exceed $600 billion in gross revenues this year alone. Mr. President, I'd point out that in April of last year, Charlene Barshefsky walked away from the talks when only 40 countries had made offers, representing only 60 percent of global revenues. Included in this agreement are local, long-distance, and international calling services; submarine cables; satellite-based services; wide-band networks; cellular phones; business intranets; and fixed wireless services for rural and underserved regions. What this agreement did not cover are broadcast services. It is believed that competition by telecom service providers is expected to lead more than $1 trillion in economic benefits for consumers around the world through 2010. While U.S. consumers have already reaped much of the benefit of deregulation and increased competition, the FCC has pointed to billions of dollars of savings from this deal for American consumers due to the eventual lowering of costs for international calling by 80 percent--from more than $1 per minute to less than 20 cents--the actual cost of placing such a call. I'll admit that I am disappointed that some countries, such as Japan, Korea, and Canada, didn't offer to open up their markets quite as much as the United States did, but reaching this agreement doesn't in any way prevent us from further negotiations with them in this area. I'd also point out two things. First, even though these countries, and some others, maintained limits on purchasing existing providers, in most cases, American firms can still go in to those same countries and compete on their own--and the regulatory principles will guarantee that they are not blocked from connecting to existing telecommunications networks. Second, if it is Japan we are talking about, the idea that anyone plans to purchase more than 20 percent of NTT any time soon, is ridiculous. NTT is the world's largest company, worth well over $100 billion--I'm told that 20 percent would cost about $23 billion. Right now, 3 percent of NTT is owned by foreigners, and I haven't heard that anyone plans to buy much more than that. What American firms are talking about is the chance to start or invest in new common carriers in Japan, such as Japan Telecom, which is connected to the Japanese Railroad, and which anyone can invest in with no limitations. I'll admit that I am concerned with the 20-percent limitation on KDD, which is a much smaller company than NTT--about the size of one of our Baby Bells, but I'm hopeful we can work this out in future negotiations. To conclude, today we have finally reached the moment to extend the title of United States Trade Representative to somebody who I think is magnificently qualified to take that job. Superb qualifications, superbly tested, and now prepared to advance America's interests even further. What we are going through today threatens to block her, which hurts her in China, which hurts her in Japan, which hurts her all over the world, and therefore through hurting her, our interests. So I urge the unanimous vote that she deserves, that she be made Ambassador, the granting of the Dole waiver that is required, and the defeat of the amendment that does not belong here and has consequences that could truly harm, not help, American interests. I yield the floor and thank the distinguish Finance chairman.

Mr. ROCKEFELLER

Mr. ROCKEFELLER. Mr. President, I oppose amending the U.S. Constitution with a rigid requirement that every year the Federal Government must have a zero budget deficit. I don't think it is appropriate to use our Nation's most revered governing document to lock in a budget and economic policy that cannot respond to changing needs and circumstances. And I do not believe such a requirement could be enforced without forcing a constitutional crisis. In my view, Congress does not need an amendment to the U.S. Constitution to perform its responsibility to enact responsible, balanced Federal budgets. The President and the Congress have all the tools they need to reduce the deficit, to respond and adapt to the country's changing needs, and to keep us militarily and economically strong. It is not a constitutional amendment that makes these choices, but strong leadership and judgment. We must make the choices through realistic cuts in spending, reasonable and fair tax policies, and the setting of obtainable goals that show the specifics--every spending cut and every tax. Congress can and should act to reduce the deficit. A Democratic Congress did just that in 1993, and the deficit has been cut by more than 60 percent. Including an artificial, unworkable mandate in the U.S. Constitution is not the appropriate path to fiscal responsibility. I offered and withdrew an amendment which would have protected Medicare from the autopilot of the balanced budget amendment. I offered the Medicare amendment with the intention of engaging in a debate that would expose the balanced budget amendment for the budgetary strait jacket that it is. I offered the amendment with the firm belief that a debate about the effects of a balanced budget amendment on Medicare may help some of my colleagues think through what their actions will mean. People don't want Social Security to be used to balance the budget-- and, I believe Medicare is just as important to our constituents as Social Security. Medicare provides West Virginia seniors with health care security--Social Security with a measure of retirement security. My amendment says that the pursuit of a balance budget should not rob seniors of the health care security they need and deserve. The current constitutional balanced budget amendment, if passed, would force deep and devastating cuts on the Medicare Program. Such cuts would increase the already too high out of pocket costs senior citizens are forced to pay for basic health care. The pending constitutional amendment is sure to drive up the percentage of a senior's total income they must spend on health care services. Currently, seniors' out of pocket costs are, on average, about 21 percent of their total income. This balanced budget amendment is likely to force seniors to spend 25, 30, 35, or even 50 percent of their total resources on the health care services they need. This increased burden on seniors would force many seniors into poverty and make a greater proportion of them dependent on Medicaid services, in essence, shifting even more health care costs to the states. I want my colleagues to recognize the real world consequences of their vote for an automatic, constitutional balanced budget--the imposition of devastating cuts in the Medicare Program. Every Senator who I have heard speak publicly about Medicare has said they want to protect, preserve, and strengthen the program. A balanced budget amendment to the Constitution will do the opposite by devastating Medicare--simple math tells us this is true. If my colleagues mean it when they say they want to protect Medicare, they will oppose this constitutional amendment. I urge my colleagues to vote against Medicare being used as a piggy bank to be raided at the end of the year, when the budget isn't in balance, for whatever unforseen economic reason. I think my colleagues should consider the admonition of the Secretary of the Treasury about the consequences of a Constitutional balanced budget amendment for Medicare beneficiaries. I asked the Secretary what he thinks would happen to Medicare beneficiaries under a balanced budget amendment when he appeared before the Finance Committee two weeks ago. Here is our exchange about the effects of the balanced budget amendment: Senator Rockfeller. Now we have this thing called a balanced budget amendment, which, according to one of the papers this morning, may lose steam in both chambers, and I hope that is the case. But, in the event that it is not, it will be, I think, very problematic for Medicare if we go into a situation where, let us say--Senator Moynihan has heard me talk about this many times --back in the early 1980's in West Virginia we had unemployment that ran up to 21 percent, and devastation to the extent that we were laying off tens of thousands of workers. And this was not common just to West Virginia, it was true in the industrial heartland, as we were making a major economic shift that was painful. Now, if that were to happen again, and I see no reason why it will not; Japan is now going through exactly that same kind of difficulty, one that we would not have guessed that they would have gone through 10 years after we did, but they are. They are very down about it. They are going to be fine in the long-term. But if we were to run into that situation again in this country and we had a balanced budget amendment and we had to balance by the end of the year and we had to do our part here in Finance, would we not run into what we used to call sequestration? Secretary Rubin. I think that you could easily run into a situation, Senator. I think this is only one of the many problems that a balanced budget amendment creates, and that is, I do think it creates an additional threat to Medicare, if that is what you are saying. If you get to the end of the year and there is a very large, unexpected shortfall, which happens from time to time, then I think the President could be in a position where he would be forced to simply cease sending out all checks. Well, if you cease sending out all checks you will cease sending out Social Security checks, you will cease sending out Medicare checks, and you will cease sending out all other kinds of checks, I think, instead of being able to deal with it in some sort of a reasonable and sensible fashion. The Medicare trust fund should not be used as a cash cow to balance the budget in an effort to meet the restrictive requirements of a constitutional amendment. I believe it is clear that one consequence of Senate Joint Resolution 1 would be the Medicare program, which provides health services to 38 million senior citizens, will be cut in excess of what is required to protect seniors and beyond the dictates of good health policy. I am committed to charting a positive course for our Nation in the 21st century, and I believe that we are moving in the right direction. Some of us have worked very hard in the recent years to do the job of digging out from the exploding deficits of the 1980's, by reducing the deficit, and changing the priorities of the Federal budget in order to cut waste and increase investment in America's future. I have cast many votes in recent years for actual cuts, for detailed changes in policy, and for specific budget plans. These are the kinds of real votes that have cut the deficit. By working out a balance between what must be done to invest in our people, and using their hard-earned tax dollars more wisely, we have a course that is far less reckless and dangerous than strapping this amendment onto the U.S. Constitution. I truly believe we can achieve the real goal of a balanced budget amendment--fiscal responsibility--if we are brave enough to tackle the real challenges that confront us. For the sake of real fiscal responsibility and the sake of West Virginia's future, I cast my vote against the constitutional amendment to balance the budget.

Mr. ROCKEFELLER

Mr. ROCKEFELLER. Mr. President, on February 28, 1872, the West Virginia State Legislature passed a proposal to create the Concord State Normal School. Now, 125 years later, Concord College, as it is commonly referred to, educates some 2,400 students in a wide range of programs. I wanted to take this opportunity to share with my colleagues my pride in this remarkable institution that celebrates its 125th year of bringing southern West Virginia's best and brightest together. The enabling legislation that created Concord provided no State funds for the school. So the townspeople raised $1,700 by subscription to erect the first building on land donated by Mr. William Harvey Martin. On May 10, 1875, 70 students attended classes that first session in a rough frame building. In 1885, under the leadership of principal Capt. James Harvey French, the school received $5,000 in State funds to build a new brick building to recognize the service given the State by the school. That new building was completed in 1887, and the first dormitory was built in 1891, on North State Street. In 1896, the town in which the college is located changed its name to Athens in recognition of Concord's role as a crucial and influential center of education for southern West Virginia. In November 1910, the downtown facilities were destroyed by fire. The faculty and students were resilient, as typical West Virginians are, and they began holding classes the next day in other locations about town. The current campus site on Vermillion Street in Athens was bought by the town in early 1911. The campus endured a second and even more damaging fire in 1912, but Concord rebounded stronger than ever. On July 1, 1919, Concord gained its independence from the State Normal School in Huntington. The title of principal of the institution was changed to president. The school awarded its first baccalaureate degree to three graduates in June 1923. Eight years later the school changed its name to the Concord State Teachers' College. Under the direction of President Joseph Franklin Marsh, Sr., the named changed again in 1943, to the current Concord College. President Joseph F. Marsh, Jr., one of the longest serving presidents, oversaw the construction of the Alexander Fine Arts Center, Centennial Hall, three residence halls, the faculty housing units at Witherspoon Park, and the maintenance building. Years later, in the administration of President Meredith N. Freeman, enrollment grew and several new academic programs were established. And as of 1991, under the direction of current president, Jerry Beasley, Concord became one of the first institutions in the Nation to join the prestigious Bonner Scholars Program. The Bonner Program rewards students who are actively involved in public service by helping to finance their college education. This program, in particular, is very dear to me. In 1964, I moved to West Virginia as a VISTA volunteer. To see that our young people want to be involved in community service warms my heart and gives me hope for the future. In recognition of the legislative act founding Concord State Normal School, an anniversary convocation has been designated for today in Athens. Mr. President, Concord College is an enormously important part of West Virginia higher education, and continues to be an institution West Virginia residents are proud of. The 125th anniversary convocation taking place today is a program commemorating the college's beginning-- and its future. I have no doubt the school's future will continue to be a bright one.

Mr. ROCKEFELLER

Mr. ROCKEFELLER. Mr. President, I am very pleased to be reintroducing a modest but important bill that would establish a demonstration project to assure Medicare beneficiaries with cancer that Medicare will cover their routine patient costs when part of a clinical research trial. I am especially proud to have Senator Mack joining me again as my key cosponsor. It is a privilege to work with Senator Mack, who knows the anguish of fighting cancer only too well. And, we are especially glad to be joined by so many of our colleagues, including Senators Frist, Moynihan, Kennedy, Abraham, Kerrey, Craig, Wellstone, Cochran, Mikulski, Campbell, Leahy, Jeffords, Hutchison, Hollings, and Faircloth. Mr. President, cancer is the second leading cause of death in the United States. Medicare beneficiaries account for more than half of all cancer diagnoses, and 60 percent of all cancer deaths. Over 12,000 new cases of cancer will be diagnosed this year in my own State of West Virginia. Access to clinical trials is especially important in the field of cancer. With today's rapid discoveries of new cancer therapies and the lack of effective treatments for some cancers, peer-reviewed clinical trials often provide cancer patients the best available care. Given differences in biological responses according to age, research is needed on the particular effects of cancer and cancer treatments on those age 65 and older. Our legislation will promote that vital research. At the same time, it will provide the Health Care Financing Administration with the information it needs on whether coverage for experimental therapies and treatments should be eventually extended to the entire Medicare population. In the long run, the coverage of patient care costs in clinical trials will save the health care delivery system millions of dollars by telling us at the earliest possible time which medical interventions work and which do not. Our legislation is an effort to give Medicare beneficiaries the security and decency of knowing that if they are diagnosed with cancer, their treatment options will be determined by whatever therapy they and their doctor decide will give them the best shot of beating the disease. These life and death decisions should not be guided by what may or may not be paid for by the Medicare Program. Currently, Medicare's payment policies are unclear and, as a result, unpredictable. There is anecdotal evidence that Medicare, in fact, usually pays for the routine patient care costs associated with clinical research trials. But when denials do happen, they tend to be arbitrary and random. This unpredictability discourages Medicare patients from enrolling in a clinical trial, even when it may medically be their best treatment option. Three winners of the Nobel Prize in Medicine and Physiology have written me and Senator Mack in support of our legislation. They wrote, ``clinical trials represent the standard of care and are often the best hope for a successful treatment outcome. Only by supporting clinical research will we be able to advance the state of medical knowledge and learn more quickly which medical interventions are effective and which are not.'' Mr. President, our legislation is very targeted to give older Americans their best shot at fighting cancer. This bill does not create a new benefit. It merely ensures that patients enrolled in clinical studies receive Medicare coverage for the same type of routine patient care costs, such as hospital and physician fees, that would be covered outside of a trial setting. We are not asking Medicare to pay for the cost of research. These expenses will still be covered by trial sponsors, including pharmaceutical companies. In establishing a demonstration project, this bill will also provide valuable information about the costs and benefits of providing coverage for clinical trials for other life threatening diseases. We started with cancer first because cancer is a major affliction of Medicare beneficiaries. In addition, there is a well-established national cancer clinical trial system to deliver this patient care. Mr. President, this is the year to enact this bill into law. This proposal is a key Medicare reform to include in the action expected in the upcoming budget process that will deal with Medicare spending and policy. Mr. President, I ask unanimous consent that additional material be printed in the Record.

Mr. ROCKEFELLER

Mr. ROCKEFELLER. Mr. President, I am pleased to be reintroducing a bill with my colleague from Rhode Island, Senator Chafee, to improve the security and protection of Medicare supplemental policies, so- called MediGap policies. I am especially pleased that Senator Jeffords, both the new chairman of the Labor and Human Resources Committee and one of the newest members of the Finance Committee, Senator Frist, and Senator Collins have joined us this year as original cosponsors of our legislation. And I continue to be pleased that similar legislation has been introduced in the House of Representatives by the bipartisan team of Representatives Nancy Johnson and John Dingell. When enacted, our bipartisan, bicameral bill will make MediGap policies more portable, more reliable, and more accessible for almost 40 million Medicare beneficiaries, including 5 million disabled Medicare beneficiaries. Last year, when we introduced this bill, we were not terribly optimistic that it would get enacted before the end of the 104th Congress. But we put forward our legislation anyway to share our proposal and objectives, begin building momentum for changes we feel are necessary, and to preview the fact that we would be back in the 105th Congress with a concerted effort to make this a legislative priority. As it turns out, having identified MediGap improvements as an area of bipartisan concern, President Clinton has responded directly by adding the same goal of new MediGap protections as a priority he shares and included it in his recently submitted budget proposal. We are very happy that our bipartisan support for improved MediGap protections got noticed by the President and will be pursued by his administration in the upcoming budget process. Mr. President, too many Americans are falling through the gaps in our health care system. For example, consider the situation of a 44-year- old disabled man from Capon Bridge, WV. He earns too much money to qualify for Medicaid and is unable to buy a private MediGap policy because of his medical condition. And, there is the 47-year-old woman from Slanesville, WV, who is in a similar situation. She was uninsured before qualifying for Medicare because of kidney disease. She and her husband have too many assets to qualify for Medicaid and they can't afford the $300-a-month health insurance policy offered by her husband's employer. They have not been able to find an insurer willing to sell them a MediGap policy to help with Medicare's hefty cost- sharing requirements. A MediGap policy would be more affordable for them than the insurance policy offered by her husband's employer which duplicates, rather than supplements, Medicare's benefits. Many of the 50,000 disabled West Virginians who qualify for Medicare are in a similar situation. This is wrong and we can do better. Mr. President, almost 8 in 10 older Americans have opted to purchase policies through private insurance companies to fill gaps in their Medicare benefits. This MediGap insurance commonly covers the $756 deductible required for each hospital stay, the part B deductible for doctor visits and doctor copayments. MediGap policies also cover copayments for nursing home care, extended rehabilitation, or for emergency care received abroad. Some MediGap policies cover prescription drugs. But even MediGap policies have gaps because of insurance underwriting practices which prevent beneficiaries from switching MediGap insurers or, as in the case of the Medicare disabled, from even initially purchasing MediGap protection. Employers, looking to lower their health care costs, are increasingly cutting back on retiree health benefits. In just 2 years, employer- sponsored retiree health benefits has dropped by 5 percent. These retirees are forced to go out on the private market and purchase individual MediGap coverage. Those lucky enough to find insurance will find their coverage compromised by preexisting condition limitations. Some won't find an insurer willing to sell them a policy at any price. In 1990, I worked with Senator Chafee, the minority leader, Senator Daschle, and the then-chairman of the Finance Committee, Senator Bentsen, On enacting a number of measures to improve the value of MediGap policies. We also successfully enacted legislation that standardized MediGap policies so that seniors could more easily compare the prices and benefits provided by MediGap insurers. At that time, Congress also mandated that insurers must sell a MediGap policy to any senior wishing to buy coverage when that person first becomes eligible for Medicare, without being subject to medical underwriting. At the time, there was a worry that including the Medicare disabled population in this open enrollment period would escalate premiums for current MediGap policyholders. As a result, the disabled were not included in this guaranteed issue requirement. Since then, 12 States have moved ahead and required insurers to issue policies to all Medicare beneficiaries in their States, including the disabled. To my knowledge, not one State has reported large hikes in premiums as a result of their new laws. We have also asked the American Academy of Actuaries for an independent analysis of our legislation. We are confident that their evaluation of our bill will lay to rest any concerns about wild hikes in MediGap premiums because of our provision to end the current law discrimination against the disabled. Mr. President, our bill would protect all Medicare beneficiaries by guaranteeing them MediGap coverage if they are forced to change their MediGap insurer, or if their employer stops providing retiree health benefits. Specifically, our bill would require MediGap insurers to sell Medicare beneficiaries a new MediGap policy without any preexisting condition limitations if an individual moves outside the State in which the insurer is licensed, or the health plan goes out of business; if an individual loses their employer-sponsored retiree health benefits; if an individual enrolled in a health maintenance organization [HMO] or Medicare Select policy moves outside of a health plan's service area, or if the HMO's contract is canceled; or if an individual enrolled in a HMO or a Medicare Select policy decides during their first 12 months of enrollment to return to a MediGap fee-for-service policy. Mr. President, our bill gives Medicare beneficiaries an opportunity to try out a managed care plan without worrying about losing their option to return to fee-for-service medicine. Understandably, many seniors worry about enrolling in a managed care organization if it means losing access to their lifelong doctor. Our bill would encourage Medicare beneficiaries to try out a managed care plan to see if it suits them, but our bill gives them a way back to fee-for-service medicine, if that ends up being their personal preference. Our legislation bans insurance companies from imposing any preexisting condition limitation during the 6-month open enrollment period for MediGap insurance when a person first qualifies for Medicare. This change from current law makes the rules for MediGap policies consistent with the recently enacted Kassebaum-Kennedy bill for the under-65 population, and with Medicare coverage which begins immediately, regardless of any preexisting conditions. Mr. President, our bill also includes a section to help seniors choose the right health plan for them by ensuring that they get good information on what plans are available in their area. It allows them to compare different health plans based on results of consumer satisfaction surveys, and will include information on benefits and costs. Our bill does not directly address affordability. And, even since we introduced our original bill last September, there is growing evidence that MediGap premiums are skyrocketing. I am hopeful that the Finance Committee will take a closer look at this issue during its deliberations on other Medicare reform initiatives. Between 1995 and 1996, large numbers of seniors received double-digit increases in their MediGap premiums. These increases were far in excess of Social Security cost-of-living increases and varied dramatically across States. In my own State of West Virginia, MediGap policies sold by the Prudential Insurance Co. increased by 17 percent between 1995 and 1996. In Ohio, premiums increased by 30 percent and in California by 37 percent. Congress has considerable history in trying to guarantee at least a minimal level of value across all MediGap policies. Under the current law, individual and group MediGap policies must spend at least 65 and 75 percent, respectively, of all premium dollars collected, on benefits. If a MediGap plan fails to meet these minimum loss ratios, they must issue refunds or credits to their customers. Mr. President, while Federal loss ratio standards help assure a minimum level of value, they do not prevent insurance companies from annually upping premiums as a senior ages. This practice, known as attained age-rating, results in the frailest and the lowest income seniors facing large, annual premium hikes as they age. I would hope that more States would follow the lead of the 10 States that have already banned attained age-rating. This would vastly improve the affordability of MediGap for the oldest and frailest of our seniors. Mr. President, to repeat what I said last year, our bill is a targeted, modest, proposal. But it would provide very real and very significant help to millions of Medicare beneficiaries who, year in and year out, pay out billions of dollars in premiums to have peace of mind when it comes to the cost of their health care. It is wrong and unfair when senior and disabled citizens in West Virginia and across the country are suddenly dropped by insurers or denied a MediGap policy just because they move to another State, or their employer cuts back on promised retiree health benefits, or because they're disabled. Mr. President, it is always a pleasure to be working on legislation with the Senator from Rhode Island. Senator Chafee has a long, impressive, and, more important, successful record in enacting legislation that has helped millions of seniors, children, and disabled. I urge my colleagues to join Senators Jeffords, Frist, and Collins in cosponsoring this bill, and to help us extend more of the health care peace of mind that older and disabled Americans ask for and deserve.

Mr. ROCKEFELLER

Mr. ROCKEFELLER. Mr. President, I am pleased to be reintroducing a bill with my colleague from Rhode Island, Senator Chafee, to improve the security and protection of Medicare supplemental policies, so- called MediGap policies. I am especially pleased that Senator Jeffords, both the new chairman of the Labor and Human Resources Committee and one of the newest members of the Finance Committee, Senator Frist, and Senator Collins have joined us this year as original cosponsors of our legislation. And I continue to be pleased that similar legislation has been introduced in the House of Representatives by the bipartisan team of Representatives Nancy Johnson and John Dingell. When enacted, our bipartisan, bicameral bill will make MediGap policies more portable, more reliable, and more accessible for almost 40 million Medicare beneficiaries, including 5 million disabled Medicare beneficiaries. Last year, when we introduced this bill, we were not terribly optimistic that it would get enacted before the end of the 104th Congress. But we put forward our legislation anyway to share our proposal and objectives, begin building momentum for changes we feel are necessary, and to preview the fact that we would be back in the 105th Congress with a concerted effort to make this a legislative priority. As it turns out, having identified MediGap improvements as an area of bipartisan concern, President Clinton has responded directly by adding the same goal of new MediGap protections as a priority he shares and included it in his recently submitted budget proposal. We are very happy that our bipartisan support for improved MediGap protections got noticed by the President and will be pursued by his administration in the upcoming budget process. Mr. President, too many Americans are falling through the gaps in our health care system. For example, consider the situation of a 44-year- old disabled man from Capon Bridge, WV. He earns too much money to qualify for Medicaid and is unable to buy a private MediGap policy because of his medical condition. And, there is the 47-year-old woman from Slanesville, WV, who is in a similar situation. She was uninsured before qualifying for Medicare because of kidney disease. She and her husband have too many assets to qualify for Medicaid and they can't afford the $300-a-month health insurance policy offered by her husband's employer. They have not been able to find an insurer willing to sell them a MediGap policy to help with Medicare's hefty cost- sharing requirements. A MediGap policy would be more affordable for them than the insurance policy offered by her husband's employer which duplicates, rather than supplements, Medicare's benefits. Many of the 50,000 disabled West Virginians who qualify for Medicare are in a similar situation. This is wrong and we can do better. Mr. President, almost 8 in 10 older Americans have opted to purchase policies through private insurance companies to fill gaps in their Medicare benefits. This MediGap insurance commonly covers the $756 deductible required for each hospital stay, the part B deductible for doctor visits and doctor copayments. MediGap policies also cover copayments for nursing home care, extended rehabilitation, or for emergency care received abroad. Some MediGap policies cover prescription drugs. But even MediGap policies have gaps because of insurance underwriting practices which prevent beneficiaries from switching MediGap insurers or, as in the case of the Medicare disabled, from even initially purchasing MediGap protection. Employers, looking to lower their health care costs, are increasingly cutting back on retiree health benefits. In just 2 years, employer- sponsored retiree health benefits has dropped by 5 percent. These retirees are forced to go out on the private market and purchase individual MediGap coverage. Those lucky enough to find insurance will find their coverage compromised by preexisting condition limitations. Some won't find an insurer willing to sell them a policy at any price. In 1990, I worked with Senator Chafee, the minority leader, Senator Daschle, and the then-chairman of the Finance Committee, Senator Bentsen, On enacting a number of measures to improve the value of MediGap policies. We also successfully enacted legislation that standardized MediGap policies so that seniors could more easily compare the prices and benefits provided by MediGap insurers. At that time, Congress also mandated that insurers must sell a MediGap policy to any senior wishing to buy coverage when that person first becomes eligible for Medicare, without being subject to medical underwriting. At the time, there was a worry that including the Medicare disabled population in this open enrollment period would escalate premiums for current MediGap policyholders. As a result, the disabled were not included in this guaranteed issue requirement. Since then, 12 States have moved ahead and required insurers to issue policies to all Medicare beneficiaries in their States, including the disabled. To my knowledge, not one State has reported large hikes in premiums as a result of their new laws. We have also asked the American Academy of Actuaries for an independent analysis of our legislation. We are confident that their evaluation of our bill will lay to rest any concerns about wild hikes in MediGap premiums because of our provision to end the current law discrimination against the disabled. Mr. President, our bill would protect all Medicare beneficiaries by guaranteeing them MediGap coverage if they are forced to change their MediGap insurer, or if their employer stops providing retiree health benefits. Specifically, our bill would require MediGap insurers to sell Medicare beneficiaries a new MediGap policy without any preexisting condition limitations if an individual moves outside the State in which the insurer is licensed, or the health plan goes out of business; if an individual loses their employer-sponsored retiree health benefits; if an individual enrolled in a health maintenance organization [HMO] or Medicare Select policy moves outside of a health plan's service area, or if the HMO's contract is canceled; or if an individual enrolled in a HMO or a Medicare Select policy decides during their first 12 months of enrollment to return to a MediGap fee-for-service policy. Mr. President, our bill gives Medicare beneficiaries an opportunity to try out a managed care plan without worrying about losing their option to return to fee-for-service medicine. Understandably, many seniors worry about enrolling in a managed care organization if it means losing access to their lifelong doctor. Our bill would encourage Medicare beneficiaries to try out a managed care plan to see if it suits them, but our bill gives them a way back to fee-for-service medicine, if that ends up being their personal preference. Our legislation bans insurance companies from imposing any preexisting condition limitation during the 6-month open enrollment period for MediGap insurance when a person first qualifies for Medicare. This change from current law makes the rules for MediGap policies consistent with the recently enacted Kassebaum-Kennedy bill for the under-65 population, and with Medicare coverage which begins immediately, regardless of any preexisting conditions. Mr. President, our bill also includes a section to help seniors choose the right health plan for them by ensuring that they get good information on what plans are available in their area. It allows them to compare different health plans based on results of consumer satisfaction surveys, and will include information on benefits and costs. Our bill does not directly address affordability. And, even since we introduced our original bill last September, there is growing evidence that MediGap premiums are skyrocketing. I am hopeful that the Finance Committee will take a closer look at this issue during its deliberations on other Medicare reform initiatives. Between 1995 and 1996, large numbers of seniors received double-digit increases in their MediGap premiums. These increases were far in excess of Social Security cost-of-living increases and varied dramatically across States. In my own State of West Virginia, MediGap policies sold by the Prudential Insurance Co. increased by 17 percent between 1995 and 1996. In Ohio, premiums increased by 30 percent and in California by 37 percent. Congress has considerable history in trying to guarantee at least a minimal level of value across all MediGap policies. Under the current law, individual and group MediGap policies must spend at least 65 and 75 percent, respectively, of all premium dollars collected, on benefits. If a MediGap plan fails to meet these minimum loss ratios, they must issue refunds or credits to their customers. Mr. President, while Federal loss ratio standards help assure a minimum level of value, they do not prevent insurance companies from annually upping premiums as a senior ages. This practice, known as attained age-rating, results in the frailest and the lowest income seniors facing large, annual premium hikes as they age. I would hope that more States would follow the lead of the 10 States that have already banned attained age-rating. This would vastly improve the affordability of MediGap for the oldest and frailest of our seniors. Mr. President, to repeat what I said last year, our bill is a targeted, modest, proposal. But it would provide very real and very significant help to millions of Medicare beneficiaries who, year in and year out, pay out billions of dollars in premiums to have peace of mind when it comes to the cost of their health care. It is wrong and unfair when senior and disabled citizens in West Virginia and across the country are suddenly dropped by insurers or denied a MediGap policy just because they move to another State, or their employer cuts back on promised retiree health benefits, or because they're disabled. Mr. President, it is always a pleasure to be working on legislation with the Senator from Rhode Island. Senator Chafee has a long, impressive, and, more important, successful record in enacting legislation that has helped millions of seniors, children, and disabled. I urge my colleagues to join Senators Jeffords, Frist, and Collins in cosponsoring this bill, and to help us extend more of the health care peace of mind that older and disabled Americans ask for and deserve.

Mr. ROCKEFELLER

Mr. ROCKEFELLER. Mr. President, I am submitting this statement to express my support for the nomination of my former colleague, William Cohen, to be the Secretary of Defense of the United States of America. Unfortunately, as with today's earlier vote for Madeleine Albright to be Secretary of State, I am necessarily absent from the Senate, and am unable to cast my vote for Senator Cohen. Again, because of plans that had to be scheduled long ago, I am presently leading a group of more than 30 West Virginians on a trade mission to Japan and Taiwan that is called Project Harvest II. I personally regret, however, that I am missing a chance to vote on the nomination of William Cohen. Senator Cohen and I served together in the Senate for twelve years, and in that time he distinguished himself as a serious legislator with a keen intellect who continually transcended party boundaries to build bridges and advance America's national interests. The challenges facing Senator Cohen today are no less daunting than those faced by Secretaries of Defense in times of war and cold war. The United States stands today as the only military superpower in the world. That brings with it great responsibility to lead in all corners of the globe. Bill Cohen is uniquely talented to take on these challenges, and like my colleagues I applaud him for agreeing to take on this challenge, and the President for nominating him.

Mr. ROCKEFELLER

Mr. ROCKEFELLER. Mr. President, I am submitting this statement to express my strongest support for the nomination of Madeleine Korbel Albright to be the Secretary of State of the United States of America. Unfortunately, I am necessarily absent from the Senate, and am unable to cast my vote for Ms. Albright. Because of plans that had to be scheduled long ago, I am presently leading a group of more than 30 West Virginians on a trade mission to Japan and Taiwan that is called Project Harvest II. This trade mission, the second I have led to Asia, is vitally important to the long-term economic vitality of my State. Since the first Project Harvest Trade mission in 1995, tens of millions of dollars in contracts, and many new jobs have flowed back to West Virginia. That first trip also served as a key step in bringing companies like Sino-Swearingen and Toyota to West Virginia-- international investments that have changed the face of West Virginia's manufacturing profile. The globalization of the economy is the greatest force shaping international relations in the last years of the millennium, and the kinds of relationships that West Virginia is developing around the world are a key unifying factor in this new world order. Trade missions like Project Harvest can be an extension of America's international interest in fostering peace, stability, and prosperity across the globe. I personally regret, however, that I am missing a chance to vote on the nomination of Madeleine Albright. Mr. President, I don't think President Clinton could have made a wiser choice in selecting Madeleine Albright for this central post in his administration. I have known Madeleine Albright for many years, and have rarely seen such a combination of intelligence, skill, experience, principle, values, and, Mr. President, patriotism, in all my days. Madeleine Albright brings all these things to the service of her adopted nation. A daughter of Central European strife, she has a unique world view that brings into clear focus some of the most difficult and compelling challenges we face as the world's last true military and economic superpower. Of course the world today is a remarkably different place than the one we faced 50 years ago, 15 years ago, and even 5 years ago. I am further struck by the fact that we are defining this time by what it is not, that is the cold war--rather than by what it is--a transition time in the world's history where one historic power, Europe, is struggling to define itself; and another, China, is struggling to assert its place in the world. It is into this breach that Madeleine Albright has been tasked to define and promote America's global interests. Traditionally, American foreign policy has had Europe and the Atlantic as its focal point. While we must continue making Europe a priority, we also see Asia growing in importance in economic, military, and other terms. This means that geographically, strategically, and economically, the United States sits astride both worlds. Because of my own long-time involvement in United States-Japan relations and Asia issues generally, I want to voice my confidence that Secretary of State Albright will provide the needed leadership, insight, and attention to the Pacific region in her role as the Clinton Administration's chief of international diplomacy and as a key part of his national security team. She understands the challenges we face together as Pacific neighbors; she appreciates the differences and complexities that are presented; and she will be a clear and forceful advocate for America's peaceable interests and the goals we share with our allies and the people of nations worldwide. Mr. President, I believe that Madeleine Albright is a superb choice for Secretary of State. I ask her forgiveness that I am unable to stand and vote for her today, and I pledge to work with her in every way possible.

Mr. ROCKEFELLER

Mr. ROCKEFELLER. Mr. President. I am extremely pleased to be introducing legislation with my colleague from Tennessee, Senator Frist, that will give Medicare beneficiaries the opportunity to receive their health care services from a locally-based, provider-owned and operated, health care plan. In my own State of West Virginia, the health care landscape is changing rapidly. Managed care is becoming more prominent, and, with it, a concern that profits are being put ahead of a patient's health care needs. My constituents want to be sure that their doctor is making his or her own medical decisions on patient care and treatment. They do not want to be told that their care is being directed by anonymous insurance officials in another State available only through a 1-800 phone number. Under current law, Medicare beneficiaries have a choice of receiving their health care services under traditional Medicare fee-for-service or from a Health Maintenance Organization (HMO). Our legislation would allow seniors to choose another option and would make sure that patient care and treatment decisions remain in the hands of health care providers. This is accomplished by allowing provider-sponsored organizations [PSOs] to directly provide benefits to Medicare beneficiaries without the insurance middleman. Our bill would mean that insurance administrative and overhead costs would be reduced, freeing funds which are better spent on patient care costs. Our legislation is necessary because insurance regulations in most States do not take into account the unique characteristics of a PSO. Only 4 States have adopted licensure requirements aimed at encouraging the development of provider sponsored organizations. Our bill carves out a time-limited Federal role of 4 years for direct federal Medicare certification as a qualified PSO. During those 4 years, a PSO could apply directly to the Medicare Program to be designated as a qualified PSO that would be paid on a capitated prospective basis and could serve Medicare beneficiaries. Beginning on January 1, 2002, State licensure would replace the Federal certification process as long as a State's standards for PSOs were sufficiently similar to Federal PSO standards. PSOs could continue to apply for a Federal waiver after the initial 4 years if a State failed to act on a PSO's application within a reasonable time period or if a State continued to apply unfair or unreasonable criteria for PSOs to enter the market. Mr. President, our bill is actually quite similar to legislation enacted in the early 70s directed at promoting and fostering the growth of HMOs. According to a recent issue briefing prepared by the Congressional Research Service on the HMO debate in the 1970s, ``state solvency requirements were seen as excessive and unappreciative of the unique resources available to a HMO . . . the outcome of the debate was the Health Maintenance Organization Act . . . which enabled HMOs meeting Federal requirements to be exempt from specific State laws.'' In many States, the State HMO requirements that evolved were designed to address issues presented by large, insurer-owned and operated HMOs, not smaller community-based provider organizations. Our bill does not in any way weaken quality assurance or solvency standards for PSOs that choose to contract directly with the Medicare program. Our legislation is very specific on the solvency and quality standards that must be met in order for a PSO to be federally qualified. Overall, I believe, our standards are even more detailed and explicit than current Medicare law relating to quality and solvency for HMOs. Our bill retains all of the consumer protections in current law that apply to health plans that serve Medicare beneficiaries. Beneficiaries would continue to be protected from incurring any financial liability if a health care plan became insolvent. In addition, rules on open enrollment and arranging for continuing Medigap coverage--without any pre-existing condition limitations--would apply as they do under current Medicare law. Our legislation would also require Medicare to contract with local agencies for ongoing monitoring of PSO performance and beneficiary access to services. Specifically on solvency, our legislation builds on fiscal soundness and solvency standards that were developed by the National Association of Insurance Commissioners [NAIC]. Our bill slightly modifies the HMO Model Act to take into account how affiliation arrangements are structured within PSOs. It also recognizes a variety of alternative means, that many States already use, of meeting the solvency standards. In this way, our approach goes beyond earlier PSO legislative proposals which merely required the Secretary to develop specific solvency standards. I believe this approach will address concerns raised by some that complete secretarial discretion on fiscal soundness and solvency would somehow result in weakened solvency standards. In 1972, a proxy measure for quality was enacted by Congress which required health plans to meet an arbitrary standard of plan enrollment. Under the so-called ``50-50 rule,'' a health plan's Medicare and Medicaid enrolles cannot exceed 50 percent of its total enrollment. The underlying premise of the 50-50 rule is that if a plan has a significant enrollment of private or commercial enrolles its quality will be higher than a health plan strictly serving Medicaid or Medicare beneficiaries. This is an issue that is especially important in rural States like West Virginia. Many rural provider networks--which this bill seeks to encourage--would be unable to meet a 50-50 enrollment quota because a disproportionate share of the elderly reside in rural areas. Also, since adoption of the 50-50 rule, there have been significant advances made in measuring and assuring quality care. While still far from perfect, I believe that we have gained sufficient knowledge to adopt an approach that relies on specific quality standards, rather than a rough proxy based on a plan's enrollment mix. Quality assurance will continue to be a work in progress, but our bill begins to lay the groundwork for explicitly setting and measuring the quality of health care received by Medicare beneficiaries. Under our bill, the 50-50 rule would be waived for any health plan that contracts with the Medicare Program if the plan meets the enhanced quality requirements in our bill and also has experience in providing managed or coordinated care. PSOs would go further by adhering to additional standards governing utilization review to reduce intrusions into the doctor patient relationship, as well as how physicians participate in PSO networks. Mr. President, last year Congress debated a variety of ways to improve quality and to put an end to medical decision-making driven by a desire to earn hefty profits for a company's stockholders. Our bill gives health care providers the opportunity to get back in the driver's seat. In addition, by cutting out the insurance company middleman, more money could be spent on providing patient care instead of on processing claims and realizing profits. I look forward to discussing this issue and pursuing the goal of this new bill later this year with my colleagues in the Finance Committee as we look at a variety of ways to improve and strengthen the Medicare program. Mr. President, I ask unanimous consent that the text of the bill be printed in the Record.

Mr. ROCKEFELLER

Mr. ROCKEFELLER. Mr. President, I am very, very proud to be a part of this resolution and to thank Senator Robert C. Byrd on behalf of the people of West Virginia certainly, but also, frankly, the people of the United States and the whole process of order, which is the way we govern ourselves. I think extraordinary in history, he is the third Senator to be elected to seven 6-year terms--a remarkable accomplishment. The Almanac of American Politics says that Robert C. Byrd is the kind of Senator that the Founding Fathers had in mind when they, in fact, wrote the Constitution about the way the Senate ought to be. That should not come as a surprise to any of us who know him well. We have heard so many times the fact of his being a truly self-made person, something which his junior colleague could not claim in quite the same fashion. But we know that he is the son of a coal miner, and we know about the law degree while he was in the House of Representatives. What we have to keep emphasizing, though, is what he means not just to the State, not just to the country, but to this institution, because more than any other person that I have read about in history, or know about, he is the conscience of the Senate. When we have a lack of civility, when we lose our sense of bipartisanship, when there is anger on the floor of the Senate, when the process breaks down, he grieves. He grieves not on behalf of himself, but on behalf of this thing called ``governance,'' which is pretty fundamental for the future of our country. I think he worries about that. I know that he places the U.S. Senate as a particularly responsible body for what is going to happen to our future and how it will happen. Will it be done in a way that is bipartisan and civil--the business of civility in this greatest deliberative body in the world? I will more or less conclude on this. I really think of him in moral terms. From time to time, when I give speeches, I like to refer to when you are really doing your best work, you are following an inner moral compass. I think that I started talking about that after watching Senator Byrd, not only when I was Governor of West Virginia and before, but also here in the U.S. Senate. He really operates out of a moral compass. He does what he thinks is right. He has a very strict sense of the discipline of what ought to happen in this body. Sometimes he lectures us on that, and sometimes people are briefly impatient with that, but they always stand back because they know he is right. They know he is right. They know he speaks for the U.S. Senate, which he reveres so much. Let me close by saying that on this coming Saturday there is going to be a statue inside the West Virginia Capitol, which is not really much smaller than the one we stand in at the present moment. It is a statue of Senator Byrd. There is no other statue of any other political person in the West Virginia State Capitol. There will be a lot of people there, and for good reason--because the relationship and the chemistry between Senator Byrd and the people of West Virginia is something that is profoundly moving and important and refreshing, frankly. We honor him for serving for 50 years, which means he has been out amongst the people all this time. He has never changed. The people of West Virginia have really never changed. He is a man of values speaking to a people of values. It is interesting. As he begins to talk, you see people fall silent. They realize they don't want to miss what Senator Byrd might be saying because they know it is not going to be trivial or political, and it is going to be important. It is going to have to do with fundamental values and the fundamental nature of the way this country ought to be and the way the State of West Virginia ought to be. So I look forward to being with him this coming Saturday. I join with the distinguished majority leader, the Democratic leader, and the distinguished Senator from Nevada in praising and being grateful to my senior colleague.

Mr. ROCKEFELLER

Mr. ROCKEFELLER. Mr. President, a few weeks ago, a number of my Democratic colleagues and I held a forum on how former Senator Dole's economic plan would affect the Medicare Program and the 37 million people who rely on it for their health care needs. Unfortunately, there have been no formal congressional hearings to examine the consequences of this mammoth plan on the lives of the American people, or in particular, on Medicare beneficiaries. Our forum heard from highly respected economic and health care experts who warned us that the Dole plan would require deep cuts in Medicare, which would force major changes in the program, cuts in payments to the professionals and institutions that provide Medicare services, and reductions in the quality of the medical care provided to Medicare beneficiaries. In my view, this is one of the most obvious and compelling reasons to do everything possible to prevent the Dole economic plan from ever becoming reality. It astounds me that we are seeing this revival of a supply-side proposal that once again puts Medicare on the chopping block in order to pay for tax relief for the wealthy. We also were privileged to hear from an extraordinary senior citizen and Medicare beneficiary, Betty Miller. Betty Miller told us that the Medicare cuts required to pay for Dole's tax cut plan would seriously threaten her health care security. Betty was a powerful witness and I think she truly represents what the majority of Medicare beneficiaries would tell us if they had the chance to share their views about the Dole plan's harsh Medicare cuts. I want all my colleagues to be able to listen to Betty's comments about Medicare. I submit Betty's testimony for the Record, and urge each of my colleagues to take the time to read what a real Medicare beneficiary cares and worries about when candidates propose financing tax breaks with their Medicare Program. Again, I thank Betty for taking the time to tell us about her health care worries, and about what Medicare means to her. This testimony underscores, I submit, the reasons to protect Medicare from being raided for anything but the future of this crucial health care program. A promise was made to Betty Miller that she could experience her retirement years with the peace of mind of health care security. And a promise was made to future retirees, who are now working hard to pay into the Medicare Trust Fund, so they can count on the same health security. The Dole plan threatens this promised health care security, and should be rejected. The testimony follows: My name is Betty Miller. I am 77 years old and in good health, fortunately. Nine years ago my husband died of emphysema and complications, amassing bills of one quarter of a million dollars. I would be impoverished today, and so would my children, if it were not for Medicare. Since then I have cost Medicare less than one hundred dollars ($82.24) for the total nine years. My pension deductions for Medicare amount to $510 annually. I have worked since I was 17 years old. In the years before my retirement ten years ago my Health Insurance tax was deducted from every salary check. I like the Medicare program. It gives me peace of mind. I can sleep at night knowing that I may not become a financial burden to my children. My four children are fine, upstanding citizens gainfully employed, but they are not wealthy. They could not face the burden of a major health expense for me. A burden which might rob my six grandchildren of a higher education or other economic requirements. This is why we are so concerned with Republican proposals, the proposal you have just heard about which my Representative and her Republican colleagues support. A 15% tax cut at my income level would be peanuts compared to my possible medical bills. At my age I do not worry about dying, but without Medicare I would worry about surviving. Many of my friends are in the same position. We need Medicare for ourselves and our children.

Mr. ROCKEFELLER

Mr. ROCKEFELLER. Mr. President, this year marked the 100th anniversary of the Olympic games. As with any Olympiad, hard work, blood, sweat, and tears culminated in 2 weeks' worth of contested international sportsmanship. The best of America, and the world, competed for the thrill of victory again on American soil in Atlanta, GA. There, over 10,000 athletes from 197 countries were brought together--with the world watching--to witness 17 days worth of comradery, expectation, determination, triumph, and defeat. I am proud that West Virginia played a key role in allowing the 1996 Olympic summer games to proceed. Two historical cities of my State, Wheeling and Martinsburg, hosted separate Olympic time-trial qualifying events for cycling. This was a first. West Virginia had never hosted an Olympic trials event. But our role contributed to the selection of the most superior men and women cyclists ever to represent the United States. For cycling enthusiasts, the eyes of the Nation were focused on these world-class riders. But they also witnessed the best attributes of my State--the beautiful outdoors, friendly people, culture, communities, and spirit that defines the proud residents of Appalachia. The 1996 Olympic games, America's Games, began on July 19 when the Olympic torch entered Olympic Stadium. The torch carried a flame that had traveled from Athens, Greece, on an 84-day voyage to the United States host city. The flame represented both an ending and a beginning. It symbolized an ending to the first 100 years of the modern Olympic games. Since 1896, we have seen our world savaged by wars, famines, Depression, and conflict. At times, it seemed unlikely that not much more than the spirit of the games would survive. But it did. Each and every time, the flame was relit--its message of hope and strength brought the world together through the efforts, the joys, and the sorrows of individual athletes. We shall celebrate the almost miraculous accomplishments of American sprinter Jesse Owens, setting record after record in Nazi Germany while the crowds cheered him to victory. And the tenacity of the Philadelphia butcher's apprentice, Smokin' Joe Frazier, who struck heavyweight gold in Tokyo even though he had a broken right hand. How about American Bob Beamon's incredible 29-foot 2\1/2\-inch. performance in the long jump in Mexico City, the longest Olympic record to ever stand. Swimmer Mark Spitz, who owned the press of the first half of the Munich games by dominating seven events. A personal memory I will always have concerns the perfect gymnastic performances of Mary Lou Retton, a Fairmont, WV, native, who in Los Angeles won the women's all-around. I will also never forget one of the most touching images of will and determination ever to occur at the games. This was showcased in Barcelona when Derrick Readman of Great Britain fell in the 400 meter competition after severely pulling a hamstring and finished the race leaning on his father. These are all old, but cherished memories. The torch also symbolized a beginning, the beginning of the next centennial in Olympic history. The challenge is set in the new centennial to rekindle the two basic values that are at the core of the Olympic movement. One is the competitive fire that spurs individuals to pursue excellence in their sport and demand the best of themselves. The other is the cooperative spirit that tempers individual competition through teamwork, harmony, and understanding. I think the 1996 Atlanta games has led us into the next centennial quite well. As host, the city translated its confidence in itself into respected internationalism. It helped guide us all once again across every barrier of race, creed, language, and culture to seek a common ground of understanding sportsmanship. This was not without cost, but the city and Olympic officials responded to the needs of athletes, coaches, spectators, tourists, and residents with swift action. They also continued to profile veteran competitors and fresh faces who embody the Olympic motto of Citius, Altius, Fortius--swifter, higher, stronger--and the epitome of excellence. People such as Michael Johnson, Kerri Shrug, members of the dream team, Dan O'Brien, Janet Evans, Tom Dolan, Jackie Joyner-Kersee, West Virginian Randy Barnes, Carl Lewis, Mia Hamm, and Gwen Torrence immediately spring to mind. They proudly represented the strong heritage and the competitive nature encompassed in the Olympic spirit, and I commend them and every other Olympian who has ever dared to follow a dream to be the best.

Mr. ROCKEFELLER

Mr. ROCKEFELLER. Madam President, as the Ranking Minority Member of the Committee on Veterans' Affairs, I am enormously pleased that the Senate is considering H.R. 3118, a bill that would, among other things, reform current law relating to eligibility for VA health care. I urge my colleagues to give their unanimous support to this measure as it will be amended with a final compromise developed by the two Veterans' Affairs Committees. Madam President, before I discuss the content of this legislation, I will provide a brief procedural history so that those seeking to understand the background of the measure as it comes before the Senate today will be able to do so. H.R. 3118, as it will be amended, which I will refer to as the compromise agreement, includes a number of provisions in three titles. Title I of the bill contains the provisions which revise the law setting forth the criteria for eligibility for VA health care. The provisions in title I are a compromise between H.R. 3118 as passed by the House on July 30, 1996, and an original bill which the Senate Veterans' Affairs Committee ordered reported on July 24 of this year. Unfortunately, the committee was unable to complete and file its report on this legislation prior to today's action, so there is no formal record of our committee's efforts on this vital issue, a result I deeply regret. I will endeavor to provide some background on our committee's efforts later in my statement. Title II of the compromise agreement addresses VA medical construction matters, including providing authorization for specific projects. These provisions are a compromise between H.R. 3376, passed by the House on June 4, 1996, and an original bill ordered reported by the Senate Veterans' Affairs Committee on July 24. As with the eligibility reform legislation, the committee was not able to complete and file a report on this legislation prior to today's consideration by the Senate, so there is no formal record of our actions. Title III of the compromise agreement addresses a range of VA health care programs and services, including several that I have been particularly interested in for a number of years. These provisions are a compromise between a number of House bills--H.R. 1384, passed by the House on October 10, 1995; H.R. 3643, passed on July 16, 1996; and H.R. 3118 and H.R. 3376--and a comprehensive Senate bill, S. 1359, as ordered reported by the Senate Veterans' Affairs Committee on July 24. The committee's report on that legislation, which was filed on September 26, describes the various bills which were combined in the bill as reported. Madam President, because a description of all of the provisions of the compromise agreement are set forth in the explanatory statement which Senator Simpson will place in the Record, I will just discuss some of the issues which are of particular interest to me. The explanatory statement was developed in cooperation with the House Committee on Veterans' Affairs and that committee's chairman, Rep. Stump, will insert the same explanatory statement in the Record when the House considers this measure. Eligibility Reform While I supported the Senate committee's action in ordering reported eligibility reform legislation and I support the inclusion of provisions derived from that measure in the compromise agreement, I do so with some significant reluctance. My reluctance is twofold--first, I remain unconvinced that there is a compelling need for this action at this time; and second, it is unclear that the course of action we are pursuing is the most appropriate. Before discussing these concerns, I will outline briefly the legislative history of this legislation, and most particularly the activity in the Senate Committee on Veterans' Affairs. As I noted earlier, although eligibility reform legislation was ordered reported by our committee on July 24, a report was never filed. I believe it is important to provide some background on our committee's role in this effort. Madam President, the current drive for eligibility reform legislation--that is, legislation which would amend those provisions of title 38, United States Code, which set forth which veterans are eligible to receive what care from VA--dates back to at least 1985, my first year in the Senate. Late that year, in the context of reconciliation legislation, both Houses passed legislation which would have amended the then-current law on access to VA care. The differences between those measures were resolved and the final compromise, which set forth a hierarchy of veterans as to whom VA was required to furnish inpatient care, was enacted in title XIX of Public Law 99-272, the Consolidated Omnibus Budget Reconciliation Act of 1985. That first attempt at setting forth in law exactly which veterans should be guaranteed what care from VA was limited to inpatient care because of significant differences between the House and Senate over the potential impact of providing such a guarantee for outpatient and other care, concerns that have persisted through to this Congress and that, as I will discuss later in my statement, remain largely unresolved. Indeed, there is some suggestion that those concerns cannot be resolved without some specific data-gathering initiative. And while it is not the sort of data-generating undertaking that I would prefer, what we are doing in the pending measure may be the way in which the Congress finally gets the information we need about demand for VA care and VA's ability to meet that demand within currently available resources. Following the enactment of COBRA, the next step in the effort to modify the law relating to access to VA care came in 1988 with the enactment, in Public Law 100-322, of legislation which set forth those groups of veterans who would be guaranteed certain access to outpatient care. Because of ongoing concerns about the demand for outpatient care and VA's ability to meet that demand in a timely fashion, the universe of veterans described in the law as guaranteed access to outpatient care was smaller than the universe with access to inpatient care and, within that group, only a small portion was guaranteed unlimited access to ambulatory care. Thus, under the law as it has been in effect since 1988, only a very small percentage of the veteran population--those with service- connected disabilities rated at 50 percent or more disabling, a number less than 470,000 out of a total service-connected population of 2.2 million--have comprehensive access to both VA inpatient and outpatient care. For the rest of the eligible veteran population, the greatest access to care is provided for inpatient care, with access to outpatient care much more restricted. Since 1988, there have been various efforts to amend the law. Last Congress, under my chairmanship, the committee made significant progress toward that goal. However, our efforts were carried out as part of the national health care reform effort. When that larger effort died, so too did the work of our committee. This Congress the issue was again before us and a number of events led up to our markup in July to consider eligibility reform legislation. For example, beginning early in 1995, I worked with the four veterans service organizations that prepare the Independent Budget--AMVETS, Disabled American Veterans, Paralyzed Veterans of America, and Veterans of Foreign Wars--to develop a draft eligibility reform bill based on those groups' testimony before our committee. Senator Simpson and I introduced this bill, S. 1563, in February of this year as a ``by request'' bill. In so doing, we both indicated that we were not endorsing the bill but merely making it available for consideration by the committee. Last September, VA submitted eligibility reform legislation to the Congress which Senator Simpson introduced, by request, as S. 1345 on October 18, 1995. Also last September, The American Legion, during its annual legislative presentation, presented its eligibility reform proposal. Finally, late in the first session, the House Committee on Veterans' Affairs included eligibility reform provisions as part of the legislation which that committee ordered reported to comply with reconciliation. These provisions were very similar to VA's proposal. Although the reconciliation measure passed the House with the eligibility reform provisions included, those provisions were not included in the conference report on that legislation. This session, the House again passed the eligibility reform provisions in H.R. 3118, which passed the House on July 30, 1996. Against this backdrop of activity and strong expressions of support from VA and the veterans community for committee action on eligibility reform legislation, our committee held two hearings on the issue. The first, on March 20, 1996, heard testimony from the General Accounting Office and a number of veterans organizations. The second, on May 8, 1996, took testimony from VA and the Congressional Budget Office. Following those hearings and significant work to develop a proposal which could gain the support of the committee, the committee met on July 24 and ordered reported an original measure. It was that measure which became the basis for the compromise agreement which is before the Senate today. Our committee's action was premised on the position that whatever legislation we endorsed would have to eliminate the complexity and confusion in current law about which veterans would receive what care, but do so in a budget-neutral manner. To that end, the committee started from an approach similar to that incorporated in the VA and House bills, both of which sought to eliminate differences in the law on eligibility for inpatient and outpatient care and differences among groups of veterans in the access to types of outpatient care. In an attempt to achieve budget neutrality, both of those approaches made access to all care for all groups of veterans ``subject to appropriations,'' a limitation not included in current law. In addition, the House bill included a provision requiring VA to utilize an enrollment system to manage care. However, that provision did not appear to limit care to those veterans who participated in the enrollment system. The bill our committee ordered reported added three elements to the general format of the VA and House bills. I am pleased to note that provisions derived from two of those changes are included in the compromise agreement, and I regret that the third element is not included. The first change that our committee incorporated in the bill we ordered reported related to the way in which veterans' access to care is described in the law. As I just noted, both the House bill and the VA proposal use the phrase ``shall, subject to appropriations'' to describe access to care for all veterans. Under current law, the word ``shall,'' with no limitation, is used to describe the access to care of those veterans who are included in what is known as the mandatory or ``category A'' group, and the word ``may'' is used to describe the access of those veterans in what is known as the discretionary category. While there is some disagreement about the full meaning or scope of the word ``shall'' in the context of access to health care, it is important to note that it is not otherwise limited in current law. The bill ordered reported by the committee did not go as far as the House or VA bills, nor did we insist on maintaining current law. Instead, we took a middle ground. The bill we ordered reported provided that access to VA care for four subsets of the veterans' population-- veterans with service-connected disabilities rated at 50 percent or greater for any disability, all veterans with service-connected disabilities seeking care for those disabilities, former prisoners of war, and veterans of the Mexican border period and World War I--would remain as in current law, that is, by using ``shall'' without any limitation. For all others in the mandatory or category A classification, the ``shall, subject to appropriations'' approach of the House and VA bills was used. The approach adopted by our committee was designed to ensure that those veterans who have the highest claim on VA resources--veterans seeking care for their service-connected conditions and those more seriously disabled veterans for the treatment of any disability, as well as two categories of veterans whose service distinguishes them-- receive the care they need, with no reference to any external limitation. As a practical matter, that result should be ensured by other provisions of the legislation relating to priorities for care, but it was my view, shared by others on the committee, that the Congress should not be cutting back on the promise of current law as to those veterans with the greatest claim on the system. Unfortunately, Mr. President, this effort to ensure that access to care is not compromised for these veterans for whom the system was established is not reflected in the compromise agreement. Initially, there was agreement that the compromise agreement would follow the Senate bill as to two of the four groups in the Senate bill--the more seriously disabled veterans and for the treatment of service-connected disabilities--and would apply the ``subject to appropriations'' limitation to all other category A veterans. However, very late in the process of developing the compromise agreement, the Congressional Budget Office, which had previously expressed no concerns about the approach in the Senate bill, suggested that the use of ``shall'' as to these veterans would create an entitlement to care and that, as a result, spending for such purposes would be mandatory spending, rather than discretionary spending as VA health care funding has always been treated. This, of course, raised budget problems for the legislation. One way to have avoided this problem would have been to drop the ``subject to appropriation'' language and restore the approach found in current law. However, this approach did not enjoy unanimous support from the Members working on the compromise agreement. While I feel very strongly that appearing to cut back on the guarantee for care for these most deserving veterans is not the course we should be following, I realized that my insistence on either the Senate approach or a return to the phrasing of current law could well jeopardize the enactment of this legislation in this legislative session. Thus, I reluctantly agreed to the use of the ``subject to appropriation'' language as to all veterans. As I noted earlier, as a practical matter, these veterans will still be guaranteed first access to VA care as a result of the priority scheme in the compromise agreement. The second key difference between the bill our committee ordered reported and H.R. 3118 as passed by the House is the requirement that VA establish a rigorous enrollment system, rather than the apparently nonbinding system incorporated in the House bill. Under the approach in the Senate bill, only those who enroll, with certain exceptions, would be able to receive VA care. The purpose of this enrollment requirement is to create a mechanism that will ensure that those who desire VA care will know with some measure of certainty whether they will or will not receive such care within a particular enrollment period, which I anticipate will run for a year. Madam President, I am pleased that this enrollment provision has been included in the compromise agreement. So as to give VA the opportunity to prepare to implement this enrollment system, the requirement that veterans enroll in order to receive care will not take effect until October 1, 1998. It is my expectation that, in the coming year, VA will begin to implement an enrollment process so as to gain experience with this system, but will not deny care to any veteran because of a failure to have enrolled. The third difference between the bill our committee ordered reported and the House bill, at least as it was reported by the House Committee on Veterans' Affairs, was the inclusion in the Senate bill of a cap on the fiscal year 1997 appropriations so as to remove any doubt about the budget neutrality of the bill. This limitation is designed to avoid any suggestion that, if new demand for VA care is generated by the changes in access to care, additional appropriations will follow to meet the demand in the absence of specific authorization. The House bill was amended prior to House passage to include a similar cap, so there is no longer any substantive difference between the bills on this provision. Madam President, that is a brief outline of our committee's efforts on eligibility reform legislation. I regret that a more complete discussion is not available in a committee report, but I hope this discussion will shed some light on what our committee did and how we reached the final compromise agreement. Earlier I noted that my support for both the Senate committee's action and the pending final compromise is reluctant, at best. I will turn now to an explanation of my position, not so as to highlight my personal concerns but rather to note what I believe are pitfalls in what we are doing and as to which we must be aware as the eligibility reforms are put in place. At the outset, I note that I understand the concerns that many have expressed about the existing rules which set forth which veterans are eligible to receive what types of care from VA. The criticism that many raise about the complexity of these rules is certainly justified, as is the position that these eligibility rules do not reflect current trends in how and where health care is furnished. Madam President, I note one ironic aspect about this current effort to amend the VA eligibility law, namely that, as VA facilities convert to a primary care model under which veterans are assigned to primary care teams which manage how and when care is furnished, there is less and less attention being paid at the facility level to the limitations in the law on who is eligible for specific care. In fact, it might fairly be said that, at least as to those veterans who are already receiving VA care, eligibility reform is already taking place. In any event, while a case can be made that the current eligibility system is complex and difficult to defend, it has evolved as an appropriate response to demand and resources constraints over time and may have, to the extent it continues to be observed, a couple of advantages. First, it is a known system, and facilities and veterans across the system understand its implications in any given locale. Changing it, especially if the changes appear to broaden access to care, as the compromise agreement surely does, can easily create false expectations. The second advantage, related to the first, is that the current eligibility system is working to ration care. Facilities know when to use its restrictions--most especially on access to ambulatory care--to cut back on access so as to stay within budget. Replacing this system with an untested approach that relies on providing VA facilities with an unspecified authority to deny some veterans access to care is difficult to defend as a step forward. The current system's role in rationing care seems particularly important in this time of fiscal constraint. In past years, when the issue of eligibility for VA care has been debated, there were those who expressed the belief that any increased demand resulting from a change in eligibility would be addressed by increased appropriations. No one appears to hold that view today. Thus, it seems clear that some form of rationing will continue to be needed if the population of those veterans who are eligible for VA care is not adjusted to meet VA's capacity to provide care. Having said that, however, I note that my concerns about the compromise agreement bill do not stem from a view that the current eligibility rules must remain inviolate. Rather, my reluctance about this legislation is grounded in my belief that the Congress has a more involved role to play in determining the scope of VA health care than is reflected in the bill the Senate ordered reported or in the compromise agreement. Madam President, throughout our committee's efforts on this legislation, I have held to the premise, on which I think there is general agreement, that whichever veterans are made eligible for VA care should be able to receive all the care they need, of whatever sort, with the possible exception of long-term care, because of the costs of that care. It certainly could be otherwise--that is, certain groups of veterans could be given access only to certain care--but that seems to be directly contrary to the spirit of eligibility reform. With that as a guiding premise, and my certainty that VA will not receive any significant infusion of resources for health care at any time in the foreseeable future, it has been my view throughout the debate on eligibility reform that we, the Congress, should expressly set forth in law the population of veterans who are to receive comprehensive care from VA so that there would be no need for VA to make rationing decisions at the facility or other management level. However, as the debate progressed, it became increasingly clear that developing such an approach was highly unlikely, both because we lacked data on which we might base a more comprehensive action and because reaching consensus on the specifics of such an approach was highly improbable. During the eligibility reform debate, the key questions as to which I have sought answers have been: First, in crafting legislation to define which veterans are to receive what care from VA, can we guarantee that those who are told they are eligible for care will be able to get that care without extensive delay? Second, if we assume that we should expand access to outpatient care--and I do--but that there will be no significant increase in VA's medical care appropriation, will the demand for care, and the costs associated with that demand, increase, remain static, or decrease? Who should make the inevitable rationing decisions? Third, and finally, do we have the necessary information to make informed decisions on these issue? While I acknowledge that these are difficult questions, without easy solutions, I have been greatly disappointed in the lack of answers that I have received, particularly from VA. While I believe that I have gained some further insight into some of these issues, much remains far from clear. For example, nothing VA has said has given me any satisfaction that the proposed eligibility reform proposals will help veterans or VA health care professionals answer with certainty the question of which veterans will receive care in a given time period. Likewise, nothing VA has provided sheds any light on the likely demand for care that will follow from the enactment of this reform package and the almost certain publicity about that will follow which will lead many veterans to believe that they now are eligible for comprehensive care from VA. However, as I noted earlier, one clear benefit of our action is that there will finally be an opportunity to see what happens when apparent access to VA care is expanded with no concomitant increase in resources. Once eligibility reform actually takes place, there will finally be some hard information on the impact of changing the definition of which veterans receive what care. This, in turn, will finally enable us to develop some understanding of whether those who believe that VA can furnish more care to more veterans within existing resources, or whether, as other believe, that eligibility reform legislation will generate significant new demand for care. Madam President, during our committee's consideration of eligibility reform we heard some very different views on this issue. Some, including CBO and GAO, believe that amending the law to provide such expanded access to VA care will result in a significant increase in demand, which either would be met through increased funding or, if new funding is not provided, will lead to delays in getting care or outright denial of care which in turn will generate significant unrest in the veteran community. Others believe that there is little, if any, suppressed demand for VA care and therefore do not believe that eligibility reform will result in any significant increased costs. Indeed, some who testified in support of eligibility reform expressed the belief that it is possible that changing the law will result in a net decrease in the cost of VA care because veterans will be able to be treated in the most appropriate setting, rather than being forced into inpatient care because that is the extent of their current eligibility. At this point, even after our hearings and all the followup actions associated with them, little more than speculation and best guesses support any of these positions. What is known is that VA has been appropriated just over $17 billion for medical care in fiscal year 1997. It may be that, operating under revised eligibility criteria, the Department will be able to furnish more care to a larger cohort of veterans at that funding level. But, in any event, that will be all the funds that will be available, come what may. Madam President, I am confident that the two committees and the Congress will be vigilant in our oversight of VA's implementation of this proposal, and, should it prove unsuccessful at matching scarce resources to demand for care, it will be modified in the years ahead. Madam President, I have a final thought on this issue before I turn to other parts of the bill. During this debate on eligibility reform, VA expressed the view that any eligibility reform legislation should meet six objectives: First, the eligibility system should be one that both the persons seeking care and those providing the care are able to understand. Second, the eligibility system should ensure that VA is able to furnish patients the most appropriate care and treatment that is medically needed, cost effectively and in the most appropriate setting. Third, veterans should retain eligibility for those benefits they are now eligible to receive. Fourth, VA management should gain the flexibility needed to manage the system effectively. Fifth, the proposal should be budget neutral. Sixth, the proposal should not create any new and unnecessary bureaucracy. Were I to grade the compromise agreement against this list, I'd say the only element that is clearly met is the fifth one--the measure is budget neutral. And while there can be some discussion about some of the others, the one that I think the bill fails to meet most dramatically is the first. Nothing in what we are doing, without a great deal more experience with the new eligibility criteria, will result in a system that can be understood by patients and providers alike. In fact, I believe that just the opposite is true--we are setting in place a system that no one will be able to predict or, at least in the near future, understand. Since it is clear that whatever changes are to take place must occur with no additional resources, it is a virtual certainty that VA will still need to ration care and to make decisions about how to do that. While this bill may, in time, yield a flexible, streamlined bureaucracy that establishes clear rules about which veterans are to get what care, that result is far from guaranteed. In the early years of this new system, it is far more likely that more resources will have to be dedicated to making decisions about who gets what care, resulting in a confusing, labor-intensive system. Madam President, despite my misgivings, it is clear that there is widespread support for our action on this issue. I intend to watch very closely as it goes forward and will be prepared to support any amendatory legislation needed as VA moves into this new era. Contracting Authority Madam President, the compromise agreement contains two separate provisions relating to VA's authority to contract for health care services--section 301, which amends subchapter IV of chapter 81 of title 38, relating to VA's authority to share medical resources with non-VA entities; and section 304, which amends section 8110(c) of title 38 relating to VA's authority to contract with outside entities for the conversion of VA activities to private activities. Taken separately, these two provisions both break substantial new ground in terms of giving VA greater latitude to provide services other than through in- house resources. Together, the enactment of these provisions represents a potential sea change in how VA meets its health care mission. Madam President, I want to be very clear that the enactment of these provisions is meant to give VA managers greater flexibility to operate the VA health care system in the most effective manner available, consistent with meeting the obligation to furnish quality medical care to those veterans who are eligible for VA care and who seek such services and benefits. I intend to monitor very closely VA use of this new flexibility and will not hesitate to seek to reimpose limitations on the Department's contracting authority if it appears that either authority is being used in a manner that impinges on veterans' access to care in the name of fiscal restraint. I invite input from the veterans organizations, veteran patients, VA employees and their representatives, those organizations which represent groups of VA professionals, and others with an interest in the integrity of the VA health care system.

Mr. ROCKEFELLER

Mr. ROCKEFELLER. Mr. President, as the Ranking Minority Member of the Committee on Veterans' Affairs, I am enormously pleased that the Senate is considering S. 1711, a bill that would make amendments to a number of veterans benefits and services. I urge my colleagues to give their unanimous support to this measure as it will be amended with a final compromise developed by the two Veterans' Affairs Committees. Mr. President, because a description of all of the provisions of this measure--which I will refer to as the ``compromise agreement''--are set forth in the explanatory statement which Senator Simpson will place in the Record, I will just discuss some of the issues which are of particular interest to me. The explanatory statement was developed in cooperation with the House Committee on Veterans' Affairs and that Committee's Chairman, Bob Stump, will insert the same explanatory statement in the Record when the House considers this measure. Overturning the Davenport Decision Mr. President, section 101 of the compromise agreement amends various provisions of chapter 31 of title 38, United States Code, to effectively reverse the results of the decision of the U.S. Court of Veterans Appeals in Davenport v. Brown, 7 Vet. App. 476 (1995). In the Davenport decision, the Court invalidated VA regulations relating to eligibility for VA vocational rehabilitation benefits, holding that the VA regulations, which required the showing of a connection between a veteran's service-connected disability and the veteran's employment handicap, were not consistent with the underlying law. Because the facts of the case--in terms of the background of the veteran claimant, his disability, the apparent lack of any employment handicap related to that disability, and the vocational rehabilitation benefit he sought--were so egregious and because of the potential results of the Court's decision on other claimants for vocational rehabilitation benefits, many seemed to challenge the validity of the Court's action. While I am fully supportive of the provision in the compromise agreement which will reverse the result of the decision, I think it is vital that all understand that the Court's decision was proper and completely correct. The Court was not ruling on the merits of the veteran claimant's disability or on the veteran's need for vocational rehabilitation services. Rather, the Court was ruling on the narrow, legal question--was VA's regulation which was being challenged authorized by the underlying statutory scheme. Mr. President, reviewing the validity of VA regulations is just one of the vital functions for which the Court was established, one that the Court carries out very well. Rather than expressing any concern about the Court's decision in the Davenport case, we should applaud the Court for its action in ruling that VA had overstepped its legal authority in issuing the regulation in question. To the extent there was a problem in the law that the veteran in that case sought to exploit--and there was--the fault lies with the Congress for our failure to have included the requirement that there be a connection between a veteran's disability and employment handicap when we revised chapter 31 in 1980 in Public Law 96-466. Conversion of Certain VA Life Insurance Mr. President, I am very pleased that the compromise agreement contains a provision, in section 403, which would permit individuals covered by either of two VA insurance programs--SGLI, Servicemembers' Group Life Insurance, and VGLI, Veterans' Group Life Insurance--to convert their policies to commercial policies at any time, rather than, as under current law, being unable to convert a SGLI policy to anything other than a VGLI policy upon leaving active duty and then having to wait five years after leaving service to convert a VGLI policy to a commercial policy. There are numerous advantages to this change but one of the key ones--and the reason I highlight this provision--is the opportunity it will afford an individual with a terminal illnesses to convert his or her SGLI or VGLI policy, which can not otherwise be converted prior to death, to a commercial policy. The commercial policy would then be available for conversion to cash through one of two means-- acceleration, in which an insured collects on an insurance policy prior to death, or the viatication process, in which an insured sells the policy to a viatical agent who collects at the time of the insured's death. Extension of Veterans' Claims Adjudication Commission Mr. President, as one of the authors of the legislation, enacted in Public Law 103-446, which established the Veterans' Claims Adjudication Commission, and as one of the Commission's major proponents, I am delighted that the compromise agreement, in section 503, contains a provision which extends the Commission through the end of this year so as to enable it to complete its work. The preliminary report, submitted by the Commission earlier this year, showed the depth and breadth of the Commission's work and I look forward with anticipation to the Commission's final report. Extension of Period of Vietnam Era for Certain Veterans Mr. President, for purposes of veterans benefits, the ``Vietnam era'' is defined in title 38 as the period beginning on August 5, 1964, and ending on May 7, 1975. The starting date is tied to the incident in the Gulf of Tonkin which led to the adoption of the Tonkin Gulf Resolution on August 7. However, prior to that time, U.S. forces had been serving in Vietnam for a number of years. Under current law, any individual who served in Vietnam but who left active duty prior to August 1964 is not considered a Vietnam era veteran. An effort has been underway in the Senate for a number of years, dating back to the early 1980's, to amend title 38 to provide for an earlier starting date for the Vietnam era for those veterans who served in Vietnam. However, despite Senate passage on at least four prior occasions, the House has never agreed to this change. Finally, Mr. President, we have, this year, reached agreement with our colleagues in the House and the compromise agreement, in section 505, would amend the definition to provide that the Vietnam era includes the period between February 28, 1961, and August 4, 1964, for those who served in Vietnam during that period. The date of February 28, 1961, was chosen because that is the approximate date on which American military advisers began to accompany their Vietnamese counterparts on military missions and, as such, is used as the starting date for the Vietnam conflict in a number of other contexts. Increase in Amount of Accrued Benefits Mr. President, as my colleagues know, the VA claims adjudication system is under serious stress and there are frequently great delays in the processing of claims. With these significant delays, there often are awards of significant back due benefits, dating back to when a claim was first filed, when claims are finally awarded. However, under current law, when a veteran dies while pursuing a claim for benefits, if the claim is ultimately awarded, the veteran's survivors are limited to so-called accrued benefits, which are limited to a maximum of one year's worth of benefits. This result applies, regardless of what the size of the award would have been had the veteran been able to pursue the claim to its conclusion. This result frequently deprives survivors of significant benefits. Mr. President, I think this result is wrong and should be corrected. My preference is to eliminate the limit on accrued benefits totally. However, there is a need for more information on such an effort, especially the cost implications, before it can move forward. As a first step, therefore, I am pleased that the compromise agreement contains, in section 507, a provision which extends the period of accrued benefits from 1 to 2 years. Mr. President, in closing, I acknowledge the work of my colleagues in the House, Chairman Bob Stump and the ranking minority member, Sonny Montgomery, and our committee's chairman, Senator Simpson, in developing the comprehensive legislation. Mr. President, I thank the staff who have worked extremely long and hard on this compromise--Jill Cochran, Beth Kiker, Pat Ryan, Mike Brinck, Kingston Smith, and others on the House committee, and Bill Brew, Jim Gottlieb, Bill Tuerk, Chris Yoder, and Tom Harvey with the Senate committee. I also thank Bob Cover and Charlie Armstrong of the House and Senate Offices of Legislative Counsel for their excellent assistance and support in drafting the compromise agreement.

Mr. ROCKEFELLER

Mr. ROCKEFELLER. Mr. President, as the ranking minority member of the Committee on Veterans' Affairs, I urge the Senate to pass the pending legislation, S. 1791, the proposed Veterans' Compensation Cost-of- Living Adjustment Act of 1996. Mr. President, effective December 1, 1996, this bill would increase the rates of compensation paid to veterans with service-connected disabilities and the rates of dependency and indemnity compensation [DIC] paid to the survivors of certain service-disabled veterans. The rates would increase by the same percentage as the increase in Social Security and VA pension benefits for fiscal year 1997. The Congressional Budget Office currently estimates that rate of increase will be 2.8 percent. Mr. President, in my State of West Virginia, there are over 23,400 service-disabled veterans and almost 7,500 survivors who depend on these compensation programs. Nationwide, the numbers are 2.2 million service-disabled veterans and 300,000 survivors. For many of the more seriously disabled individuals, this compensation is their primary source of income; this is certainly the case in my home State. Even small changes in the daily cost of living can produce hardship as they struggle to make ends meet, to put food on the table and to clothe and house their families. That is why the cost-of-living adjustment in the rates of VA compensation that we are now considering is so important. This adjustment is not a luxury--it is a necessity to protect the income of service-disabled veterans and their families from the continual erosion of inflation, thereby ensuring a standard of living that is decent and fair. Mr. President, these families have already sacrificed several fold for our country. First, they disrupted their lives, leaving behind the comforts and security of home, the companionship of family, friends, and loved ones, to go to strange places, live in cramped and difficult circumstances, and place themselves in harm's way. Then, they returned with disabilities that changed the course of their lives forever, and the lives of the family members who live with them. Truly we can never fully repay these veterans and their families for the sacrifices they have made. But we have a fundamental obligation to try to meet the financial needs of those who became disabled as the result of military service, as well as the needs of their families. And once we have put in place a compensation program, we have an equal obligation to periodically review that program to make sure that it remains adequate to meet those needs. This bill fulfills that obligation. Since 1976, Congress has consistently acted to safeguard the real value of these benefits by providing an annual COLA for compensation and DIC benefits. Most recently, on November 22, 1995, Congress enacted Public Law 104-57, which provided for a 2.6-percent increase in these benefits, effective December 1, 1995. The bill we currently consider carries on that proud and fitting tradition. Mr. President, I urge all of my colleagues to support this vitally important measure.

Mr. ROCKEFELLER

Mr. ROCKEFELLER. Mr. President, today I want to acknowledge a group of citizens in West Virginia who are speaking out on the issue of lawsuit abuse in an effort to serve the public. In many areas of West Virginia, local citizens have volunteered their time to start Citizens Against Lawsuit Abuse groups and to initiate public awareness campaigns in their areas about what they see as the problems of lawsuit abuse. The CALA groups focus on education. These citizens are speaking out about an issue that has statewide and national implications. The costs of lawsuits can include higher costs for consumer products, higher medical expenses, higher taxes, and fewer jobs due to lost business expansion and forgone product development. Citizens Against Lawsuit Abuse has a straightforward goal. They want to help the public prevent unnecessary lawsuits that do more harm than good. West Virginians are not the type of people to walk away from a problem. When we see something that's clearly wrong, we work to make people aware of it, and we try to make it right. CALA members believe that they have the opportunity to reform our laws so that the legal system is more fair, more effective, and more sensible to serve everyone's interests. These nonprofit groups have raised local funds to run educational media announcements and are speaking to local organizations and citizen groups across the State to raise public awareness on the lawsuit abuse issue. While the local groups have thousands of supporters, there are also a few individuals who should be recognized for their leadership and for dedicating countless volunteer hours. These individuals are: Tom Harriman of Kingwood, founding chairman of CALA of northern West Virginia; Jim Thomas of Charleston and Jack Klim of Huntington, cofounders and spokespersons of CALA of southern West Virginia; and Ken Lowe of Shepherdstown, founding chairman of CALA of eastern West Virginia. Citizens Against Lawsuit Abuse groups have declared September 22 through September 28, 1996, to be Lawsuit Abuse Awareness Week in West Virginia. I want to commend all of the individuals who are involved in Citizens Against Lawsuit Abuse for their dedication and commitment to this important citizen education project. As someone who has been a leader in the battle of product liability reform, I continue to hope for the kind of education, dialog, and consensus-building clearly needed to address problems in our legal process that hurt consumers, victims, and the private sector. I encourage CALA to continue raising these issues and promoting solutions that ensure justice and improve the legal system. West Virginia and the country as a whole need informed, educated, and dedicated citizens to help elected officials address serious issues and achieve reforms when necessary.

Mr. ROCKEFELLER

Mr. ROCKEFELLER. Mr. President, on July 12-14, 1996, a 6-foot replica of a stamp honoring legendary railroad worker John Henry was the centerpiece of a weekend of festivities in the small town of Talcott in Summers County, WV. This stamp was part of a set of four folk hero stamps recently issued by the U.S. Postal Service also honoring Paul Bunyan, Pecos Bill, and the Mighty Casey. The Postal Service had initially only planned to announce the stamp in Pittsburgh and issue it in Anaheim, CA, at an annual show. However, I am proud to have been part of an effort launched by my colleague, Congressman Nick Rahall, and the residents of Talcott to ensure that this folk legend and this great town which gave him birth were honored with a personalized unveiling and stamp cancellation ceremony. In the latter part of 1995, the townspeople of Talcott were disappointed to learn that the U.S. Postal Service announced in Pittsburgh, PA, instead of West Virginia, the design of a 1996 stamp honoring John Henry. I asked for the rationale behind this decision and was advised by the Postal Service that this site was selected because of the city's linkage to railroad yards. While I could easily understand such a ``thematic'' or ``geographical'' approach--a Steel- Driving Man being recognized in the ``Steel City''--virtually all of the residents of my State strongly believed that John Henry's legend is based on the classic tale of his competition against the mechanical steam drill at Big Bend Mountain in Talcott. So it only would make sense for West Virginians to be able to celebrate the legend of John Henry and the issuance of his stamp with an appropriate ceremony of their own. I asked the Postmaster General to plan a special ceremony in West Virginia for the John Henry stamp. I also urged him to organize a specific event in Talcott related to the 1996 John Henry stamp as the home of this folk legend. The fact that West Virginia is the true home of the John Henry legend made it a natural choice for a special recognition ceremony to celebrate the emergence of this new stamp. John Henry's fame has fascinated millions of people throughout the world and continues to interest new generations to this day. He is a symbol of the importance of human determination and skill, which is increasingly meaningful given the rise of technology in today's culture. His significance in representing human labor and a tireless work ethic also play a compelling role in West Virginia's history. But overall, to emphasize why this issue is so important, it is necessary to understand the legend and his link to West Virginia. Let me share with you a little of the history. The details of the John Henry folklore sprang from the construction of the Big Bend Tunnel on the Chesapeake and Ohio railroad in Talcott in 1873. Various stories led to the legend of John Henry; but, unfortunately, no documentation exists because earlier C&O Railroad records were destroyed in a fire in 1880. Local historians do know that from 1870 to 1872, a gang of hand-drillers working from the railroad actually carved out rock from the Big Bend Mountain for the railroad. This tunnel stands as proof today that the legend of John Henry has roots in reality, and a statue of this folk hero tops this tunnel. John Henry was assumed to be an African-American slave who worked on the team of Big Bend Tunnel drillers. Famed Appalachia folklore historian Dr. James Gay Jones of Glenville, WV, noted in his 1979 book, ``Haunted Valley, and More Folk Tales of Appalachia,'' that of all the railroad workers in the area of the time, a man known as John Henry was held in the highest esteem because of his prowess, immense size, brute strength, and great labor ethic. John Henry ``became known as a driver of steel,'' that is, he used these great sledgehammers to drive steel rods deep into red shale rock walls. The rods were then removed, explosives were placed in them, and portions of the wall were removed blast by blast. When a new steam power drill, the Burleigh, was brought to the Big Bend Tunnel for testing purposes, legend has it that John Henry agreed to a wager to see if he could drive more steel and clear more tunnel than the machine. A contest was held, and the legend is that John Henry drove a deeper hole than the machine. It is the contest in the mountains of West Virginia that created the legend and made the point that man can triumph in the competition against machine. There is some controversy over how and when John Henry died. Some claim that he died because of the contest when a blood vessel burst in his head. Others say he was killed in a rock fall in the Big Bend Tunnel. Regardless of the circumstance, his legend was born and nurtured by West Virginia to share with the world, and it lives on today. It is a bit of West Virginia's contribution to basic folklore which has enriched our Nation's culture and heritage, and West Virginians like me are very proud to take an active part in recognizing and preserving this heritage.

Mr. ROCKEFELLER

Mr. ROCKEFELLER. Mr. President, I join my colleague from Rhode Island, Senator Chafee, in introducing a bill that aims at taking another significant step in extending the kind of health care security we want for all Americans. I believe the recent enactment of the Kassebaum-Kennedy health reform bill confirms that those of us who want to expand health care access, coverage, and quality for Americans have every reason to press on. And the Senator from Rhode Island and I have very deliberately adopted the same principles of bipartisanship and pragmatism in crafting this new bill to take the next steps forward in health reform. Our bill responds to a clear need among Medicare's beneficiaries, especially the 4 million disabled Americans who rely on Medicare, to be able to count on supplemental insurance when they seek it. As important as Medicare is, it covers less than one-half of beneficiaries' total health care costs. As a result, almost 80 percent of all Medicare beneficiaries buy private, supplemental insurance that gives them extra coverage and financial relief. But it turns out that seniors and the disabled are having all kinds of difficulties in obtaining or holding onto this supplemental insurance. Our bill solves some of these problems, by making Medigap policies portable, more reliable, and more accessible in different situations. Specifically, our bill requires insurers to issue a Medigap policy to a Medicare beneficiary who loses his or her Medigap coverage because he or she moves out of a plan's service area; because an HMO or managed care plan goes out of business or withdraws from the market; or because an employer drops, or substantially cuts back, retiree health benefits. This legislation responds to changes we are seeing that are hurting older and disabled Americans, which includes 50,000 disabled West Virginians. For example, more and more employers are cutting costs by cutting back on their retirees' health benefits. Between 1993 and 1995, the number of large employers who provided retiree health benefits dropped by 5 percent. When retirees lose employer-sponsored health benefits, they are forced to go to the private market and purchase individual coverage. If they have any type of preexisting medical condition, they will be lucky to find an insurance company who will sell them a Medigap policy without a lengthy pre-existing condition limitation. Others will not be so lucky. They won't find an insurer willing to sell them a policy at any price. Mr. President, our bill gives Medicare beneficiaries an opportunity to try a managed care plan without worrying about losing their ability to return to fee-for-service medicine. Our legislation would give Medicare beneficiaries a 12-month trial period to try a Medicare managed care option. Understandably, many seniors are very nervous about enrolling in a managed care organization if it means losing access to their lifelong doctor. Our bill lets Medicare beneficiaries see if a managed health care plan suits them and gives them a way back to fee-for-service medicine, if that is their personal preference. Mr. President, my preference would be to allow continuously insured Medicare beneficiaries to freely switch types of policies--fee-for- service versus managed care--and insurers, on an annual basis. This would allow seniors the ability to switch insurers for customer service reasons or any other personal preference. But because the insurance companies are especially opposed to any type of continuous or annual open enrollment policy for Medigap insurance--even for individuals who are continuously insured--we have to have our bill aim for the more modest improvements in portability that we think we have a better chance of enacting. Our legislation bans insurance companies from imposing any preexisting condition limitation during the 6-month open enrollment period for Medigap insurance when a person first qualifies for Medicare. This makes the rules for Medigap policies consistent with the recently enacted Kassebaum-Kennedy bill, and with Medicare coverage which begins immediately, regardless of preexisting conditions. For the disabled, this bill is a big improvement over current law. In 1990, Congress mandated that insurers must sell a Medigap policy to any senior wishing to buy coverage when that individual first becomes eligible for Medicare. The disabled were left out at that time because of insurance company-generated concerns about potentially huge premium hikes for current Medigap policyholders. Since then, at least 10 States went ahead and required insurers to issue policies to all Medicare beneficiaries in their States, including the disabled. My staff called those States, and not one State reported large hikes in premiums as a result of their new laws requiring access to Medigap for the disabled. The Health Care Financing Administration [HCFA] has also estimated that Medicare's average per-person cost for the disabled is actually less than Medicare's average per-person cost for the aged. So, Mr. President, I believe we can put concerns about large premium hikes to rest, and move to guarantee the disabled access to private Medigap policies. This bill will help people like a 44-year-old man from Capon Bridge, WV, who qualifies for Medicare because of a disability. He earns too much money to qualify for Medicaid and is unable to buy a private Medigap policy because of a chronic medical condition. Medigap insurers in West Virginia refuse to sell him a policy because of his medical condition. A 47-year-old woman from Slanesville, WV, is in a similar situation. She was uninsured before qualifying for Medicare because of a chronic kidney disease that requires dialysis. Her husband and she have too many assets to qualify for Medicaid and they cannot afford the $300 a month, or $3,600 a year premium for health insurance provided through her husband's job. The average cost of a Medigap policy ranges from $700 to $1,000 a year. Access to a Medigap policy would be a more affordable option for this family. Mr. President, our bill also includes a section to help seniors choose the right health plan for them by ensuring that they get good information on what plans are available in their area. It allows them to compare different health plans based on results of consumer satisfaction surveys, and will include information on benefits and costs. Our bill does not directly address affordability. Just as the Kassebaum-Kennedy bill was not able to take that step, we leave it to the States to consider ways to promote affordable Medigap premiums. But Congress has some history in the Medigap market, with legislation passed in 1980, and again in 1990, to guarantee at least a minimal level of value across all Medigap policies. Under the current law that I helped enact back in 1990, individual and group Medigap policies must spend at least 65 percent and 75 percent, respectively, of all premium dollars collected, on benefits. If a Medigap plan fails to meet these minimum loss ratios, they must issue refunds or credits to their customers. Mr. President, while Federal loss ratio standards help assure a minimum level of value, they do not prevent insurance companies from annually upping premiums as a senior ages. This practice--known as attained age-rating--results in the frailest and the lowest income seniors facing large, annual premium hikes as they age. I would hope that more States would follow the lead of at least five other States who have banned attained age-rating. This would vastly improve the affordability of Medigap for the oldest and frailest of our seniors. Mr. President, our bill is a targeted, modest bill. But if and when we enact it, it will provide very real, very significant help to the seniors who, year in and year out, pay out billions of dollars in premiums in order to have the extra protection of Medigap protection. It is wrong and unfair when senior and disabled citizens in West Virginia and across the country are suddenly dropped by insurers or denied a Medigap policy just because they move to another State, or their employer cuts back on promised retiree health benefits, or because they're disabled. In the bipartisan and practical spirit of the Kassebaum-Kennedy bill, we now propose the same kind of commonsense, consumer protections and reforms, to help over 33 million senior citizens and almost 5 million disabled Americans. It is a great honor to be presenting this bill with the Senator from Rhode Island, someone who is responsible for many of the country's most important achievements in health care. I urge my colleagues to cosponsor this bill, and to help us extend the health care peace of mind that older and disabled Americans ask for and deserve.

Mr. ROCKEFELLER

Mr. ROCKEFELLER. Mr. President, I join my colleague from Rhode Island, Senator Chafee, in introducing a bill that aims at taking another significant step in extending the kind of health care security we want for all Americans. I believe the recent enactment of the Kassebaum-Kennedy health reform bill confirms that those of us who want to expand health care access, coverage, and quality for Americans have every reason to press on. And the Senator from Rhode Island and I have very deliberately adopted the same principles of bipartisanship and pragmatism in crafting this new bill to take the next steps forward in health reform. Our bill responds to a clear need among Medicare's beneficiaries, especially the 4 million disabled Americans who rely on Medicare, to be able to count on supplemental insurance when they seek it. As important as Medicare is, it covers less than one-half of beneficiaries' total health care costs. As a result, almost 80 percent of all Medicare beneficiaries buy private, supplemental insurance that gives them extra coverage and financial relief. But it turns out that seniors and the disabled are having all kinds of difficulties in obtaining or holding onto this supplemental insurance. Our bill solves some of these problems, by making Medigap policies portable, more reliable, and more accessible in different situations. Specifically, our bill requires insurers to issue a Medigap policy to a Medicare beneficiary who loses his or her Medigap coverage because he or she moves out of a plan's service area; because an HMO or managed care plan goes out of business or withdraws from the market; or because an employer drops, or substantially cuts back, retiree health benefits. This legislation responds to changes we are seeing that are hurting older and disabled Americans, which includes 50,000 disabled West Virginians. For example, more and more employers are cutting costs by cutting back on their retirees' health benefits. Between 1993 and 1995, the number of large employers who provided retiree health benefits dropped by 5 percent. When retirees lose employer-sponsored health benefits, they are forced to go to the private market and purchase individual coverage. If they have any type of preexisting medical condition, they will be lucky to find an insurance company who will sell them a Medigap policy without a lengthy pre-existing condition limitation. Others will not be so lucky. They won't find an insurer willing to sell them a policy at any price. Mr. President, our bill gives Medicare beneficiaries an opportunity to try a managed care plan without worrying about losing their ability to return to fee-for-service medicine. Our legislation would give Medicare beneficiaries a 12-month trial period to try a Medicare managed care option. Understandably, many seniors are very nervous about enrolling in a managed care organization if it means losing access to their lifelong doctor. Our bill lets Medicare beneficiaries see if a managed health care plan suits them and gives them a way back to fee-for-service medicine, if that is their personal preference. Mr. President, my preference would be to allow continuously insured Medicare beneficiaries to freely switch types of policies--fee-for- service versus managed care--and insurers, on an annual basis. This would allow seniors the ability to switch insurers for customer service reasons or any other personal preference. But because the insurance companies are especially opposed to any type of continuous or annual open enrollment policy for Medigap insurance--even for individuals who are continuously insured--we have to have our bill aim for the more modest improvements in portability that we think we have a better chance of enacting. Our legislation bans insurance companies from imposing any preexisting condition limitation during the 6-month open enrollment period for Medigap insurance when a person first qualifies for Medicare. This makes the rules for Medigap policies consistent with the recently enacted Kassebaum-Kennedy bill, and with Medicare coverage which begins immediately, regardless of preexisting conditions. For the disabled, this bill is a big improvement over current law. In 1990, Congress mandated that insurers must sell a Medigap policy to any senior wishing to buy coverage when that individual first becomes eligible for Medicare. The disabled were left out at that time because of insurance company-generated concerns about potentially huge premium hikes for current Medigap policyholders. Since then, at least 10 States went ahead and required insurers to issue policies to all Medicare beneficiaries in their States, including the disabled. My staff called those States, and not one State reported large hikes in premiums as a result of their new laws requiring access to Medigap for the disabled. The Health Care Financing Administration [HCFA] has also estimated that Medicare's average per-person cost for the disabled is actually less than Medicare's average per-person cost for the aged. So, Mr. President, I believe we can put concerns about large premium hikes to rest, and move to guarantee the disabled access to private Medigap policies. This bill will help people like a 44-year-old man from Capon Bridge, WV, who qualifies for Medicare because of a disability. He earns too much money to qualify for Medicaid and is unable to buy a private Medigap policy because of a chronic medical condition. Medigap insurers in West Virginia refuse to sell him a policy because of his medical condition. A 47-year-old woman from Slanesville, WV, is in a similar situation. She was uninsured before qualifying for Medicare because of a chronic kidney disease that requires dialysis. Her husband and she have too many assets to qualify for Medicaid and they cannot afford the $300 a month, or $3,600 a year premium for health insurance provided through her husband's job. The average cost of a Medigap policy ranges from $700 to $1,000 a year. Access to a Medigap policy would be a more affordable option for this family. Mr. President, our bill also includes a section to help seniors choose the right health plan for them by ensuring that they get good information on what plans are available in their area. It allows them to compare different health plans based on results of consumer satisfaction surveys, and will include information on benefits and costs. Our bill does not directly address affordability. Just as the Kassebaum-Kennedy bill was not able to take that step, we leave it to the States to consider ways to promote affordable Medigap premiums. But Congress has some history in the Medigap market, with legislation passed in 1980, and again in 1990, to guarantee at least a minimal level of value across all Medigap policies. Under the current law that I helped enact back in 1990, individual and group Medigap policies must spend at least 65 percent and 75 percent, respectively, of all premium dollars collected, on benefits. If a Medigap plan fails to meet these minimum loss ratios, they must issue refunds or credits to their customers. Mr. President, while Federal loss ratio standards help assure a minimum level of value, they do not prevent insurance companies from annually upping premiums as a senior ages. This practice--known as attained age-rating--results in the frailest and the lowest income seniors facing large, annual premium hikes as they age. I would hope that more States would follow the lead of at least five other States who have banned attained age-rating. This would vastly improve the affordability of Medigap for the oldest and frailest of our seniors. Mr. President, our bill is a targeted, modest bill. But if and when we enact it, it will provide very real, very significant help to the seniors who, year in and year out, pay out billions of dollars in premiums in order to have the extra protection of Medigap protection. It is wrong and unfair when senior and disabled citizens in West Virginia and across the country are suddenly dropped by insurers or denied a Medigap policy just because they move to another State, or their employer cuts back on promised retiree health benefits, or because they're disabled. In the bipartisan and practical spirit of the Kassebaum-Kennedy bill, we now propose the same kind of commonsense, consumer protections and reforms, to help over 33 million senior citizens and almost 5 million disabled Americans. It is a great honor to be presenting this bill with the Senator from Rhode Island, someone who is responsible for many of the country's most important achievements in health care. I urge my colleagues to cosponsor this bill, and to help us extend the health care peace of mind that older and disabled Americans ask for and deserve.

Mr. ROCKEFELLER

Mr. ROCKEFELLER. Mr. President, I want to pay tribute to a special West Virginian, Jerome R. ``Coach'' VanMeter. For more than 50 years, he was a high school football and basketball coach from Beckley. He is known throughout southern West Virginia as a man who not only has won many high school sporting events, but also as someone who has touched the lives of many young people. It is in this month of August that Mr. VanMeter celebrates his 96th birthday. Mr. VanMeter received numerous awards during his long tenure as a coach. He was named Coach of the Year from 1948 until 1951 and was later selected to the West Virginia Sports Hall of Fame in 1963. Being one of the founders of the West Virginia High School Coaches Association is another one of Mr. VanMeter's crowning achievements. He was also proud to serve on many State selections committees responsible for choosing outstanding basketball and football players throughout the State. Coach VanMeter has achieved much more than just personal awards. He has coached many of his teams to great success. His football teams won three state championships while his basketball teams won six. Four of those six State basketball championships were won consecutively, still a State record for the longest consecutive State basketball tournament wins. Mr. VanMeter has not only contributed on the field and court, but has also been deeply involved in community endeavors. While living in Beckley, he served as president of the local Kiwanis Club later becoming lieutenant governor of the West Virginia District. In addition, Mr. VanMeter has also contributed some of his precious skills to the Raleigh County Education Association and the Heber Street Methodist Church as chairman of the board of trustees. Furthermore, he volunteered his time to serve on the junior and senior chamber of commerce for several years. Jerome ``Coach'' VanMeter's numerous accomplishments merit notice and praise. His enthusiasm and concern for the many athletes he coached and his commitment to his community provide a model we should all strive to attain.

Mr. ROCKEFELLER

Mr. ROCKEFELLER. Mr. President, I want to take a moment to pay tribute to a group of very special people. During the last weekend in this month of September, the 91st Chemical Mortar Battalion of the 3d Army will be celebrating their 51st reunion in the fine town of Wheeling in my State of West Virginia. These men gather each year in their respective States to celebrate their outstanding efforts in the Second World War. While this Nation has many fine heroes from those years, these men are very unique because they are part of the Allied Forces who served under Gen. George S. Patton and fought in the Battle of the Bulge. As we all know, that battle is very important because it was the last German offensive on the Western Front during World War II. It gets its distinct name from the bulge or wedge of Germans that drove into Allied lines in December 1944 and January 1945. The Battle of the Bulge became an unsuccessful attempt to push the Allies back from German home territory. By January 8, 1945, the Germans made an orderly withdrawal having used all their resources they could afford trying to regain the west. These men kept the force and prevented Hitler from repossessing lands that were not his. They even assisted in the liberation of Hitler's labor camps and saw the faces of those who survived. The Battle of the Bulge was one of great magnitude and as a result there were 77,000 Allied and 130,000 German casualties. These heroes should be proud to celebrate and tell their stories. These men caused the height of General Patton's career as they made the dramatic sweep in his 3d Army across northern France in the summer of 1944. Under Patton, these men played a strategic role in defending Bastogne, Belgium in the Battle of the Bulge in December of that year. By January 1945, they had reached the German frontier and the United States counteroffensive began. George Patton was an outstanding practitioner of mobile tank warfare in World War II. His strict discipline, toughness, and sacrifice were well known within his ranks, leading to his being referred to by his men as ``Old Blood-and-Guts.'' Mr. President, I just wanted to take this time to have us all reflect and think about those men who fought for world peace during World War II. As the ranking member of the Senate Veteran's Affairs Committee, I hold a special place in my heart for every man and woman who serves our country. While every veteran of war is unique and deserves our Nation's honor, these 80 or so men gathered in Wheeling, WV, this month merit a special tribute. It is now 1996 and there is no more Hitler, there are no more concentration camps, and Patton no longer lives. These men fought and lived in a time that has now become history. May they meet, share their stories, and rejoice for who they are and what they have done. Let us all be proud to have these men come to West Virginia and celebrate their 51st reunion as the 91st Chemical Mortar Battalion of the 3d Army.

Mr. ROCKEFELLER

Mr. ROCKEFELLER. Mr. President, I am really amazed to listen to the debate across the aisle, and the fervor, really, the fervor about an amendment which would actually end up saving a lot of money; a debate in which they are determined that these kids with spina bifida are not going to have any help. There is a real determination about this. This is not just a mild philosophical discussion. There is a sense of outrage that spina bifida kids could get this kind of help. I find that interesting. Maybe they could get some help from the 15- percent tax cut. I don't know. The Senator from Missouri used the phrase ``spinning out of control'' over costs that will come, in 1997, to $3.179 million for medical care--spinning out of control. Actually, the Senator from Missouri said $14 million. He is wrong. It is $3.179 million for medical care. Spinning out of control. This is very interesting. I say to my esteemed chairman that we have never done anything on Gardner. He talked about correcting Gardner. He is wrong about that. We have never corrected Gardner. Some said it could be done. It has not been done. That is a statement that is inaccurate, and my colleagues who are listening, and their staffs, I hope they will understand that. The Senator from Missouri was talking about Gardner, using Gardner money to take away from veterans benefits. You cannot use Gardner money for veterans benefits. Gardner money is not a cash benefit for veterans. It has only to do with potential Government liability. It is not a source of funding for veterans benefits, another mistake by the Senator from Missouri. ``Normal legislative process''--sacred all of a sudden--``normal legislative process.'' Some of us feel very strongly about Persian Gulf war veterans and some of the mysterious illnesses which are occurring in tens of thousands of people across this country. No, nobody has been able to really prove anything to this point, but there is no normal legislative process. In fact, there was no interest on the part of the majority in even taking up this matter over the past 2 years in the Veterans' Affairs Committee. This is a subject which has gotten a great deal of attention, but not in the Veterans' Committee. I, in fact, as the ranking member, held--it was not even a hearing, it was kind of a meeting, about the Persian Gulf war illnesses--and was chewed out up and down for doing something that would never again be allowed in the Veterans' Committee, for trying to come to the rescue of Persian Gulf war veterans. Incidentally, some of those veterans have kids who, in a sense, although the word ``entitlement'' is not exactly true, we have already established that the Department of Veterans Affairs will allow medical examinations for the deformed children of some of these Persian Gulf war veterans, and there are a lot of them. That has been established. That is now being done. That is now in the law. They will be carefully examined by the Department of Veterans Affairs. But there is not any normal legislative process because there is no interest. There is no interest in the deformed children. There is no interest in these Persian Gulf war mystery illnesses, which are no mystery to me. I don't care if anybody has proved it. You cannot take a 20-year-old, send him to the Persian Gulf, and do what they did over there--which I will not get into now--and the Defense Department denied all of it until they had to admit that when they blew up a group of chemical bombs, maybe one of the divisions had been exposed a little bit. But that was just a minor thing, according to the Department of Defense, and they said if they had to do it all over again, they would do it exactly the same way. That is what the head of health for the Department of Defense said, a very sensitive position. So what the Senator from Missouri and the Senator from Wyoming have to understand, which I thought they would, is that war has changed. We are not talking about missiles. We are not talking about neutron bombs. We are not talking about hand-to-hand combat. We are not talking about tank warfare. We are talking about what started back in the First World War with mustard gas, in a very small sense, and we were unprepared for that. And then the atomic experimentation, which we carried out as a country, and we were unprepared for that. Thousands of soldiers were radiated, and the Government refused to do anything about it. It said, ``You can't prove it.'' Then along comes agent orange. They say it is just incidental if you are getting cancer or anything of that sort. You happened to have been in Vietnam in an agent-orange-exposed area. We do not seem to be able to show that we can prove this is enough, although I think we could there. Admiral Zumwalt, and a lot of other people, were pretty firm on that. War is changing, and I hope the other side is noticing that. We are getting into the century of toxins, of chemicals. We do not have the big Russian bear anymore. We have the little horrendous dictators like Saddam Hussein and Muammar Qadhafi. They build their little bombs, and their little bombs are not filled with explosives, they are filled with chemicals and toxins that will destroy peoples' nervous systems. ``Spinning out of control,'' ``normal legislative process,'' ``first time we've ever had an entitlement''--the world is changing, I say to my colleagues; war is changing, and it would be a good thing to take notice of. I would like to have a hearing on this subject, the changing nature of war, but we will not have one. We will not have one this month. We will not have one next month if we are in session, I guarantee you that, because the chairman will not do it. No, I am sorry, the Gardner amendment was not corrected. And, yes, there are some of us over here who do want to help children, some of us over here who do have a bias toward children. If evidence is, by and large, 50-50, we will lean toward the children, particularly in the case of spina bifida. All of that, unfortunately, was just a prelude to my remarks. I felt a need to respond. Incidentally, if the Senator from Wyoming is so unhappy about the precedent which was set in the agent orange decision by the Congress in the Vietnam war, then why doesn't he introduce legislation to repeal it? He talks about it all the time. Why not then introduce legislation to repeal it and count the votes? If that was wrong, if the proof was not sufficient, then introduce legislation to repeal it. I applaud the Democratic leader and his amendment to provide help and monetary support to veterans' children with spina bifida. I am going to talk about it. This is a tragedy that cries out for normal legislative process, and if you can't get it, then faster action. It also cries out for acceptance of Government responsibility. Spinning out of control--spinning out of control, $3 million in 1997 for medical care for spina bifida children born to Vietnam veterans. I mean, you have about 1,500 to 4,000 of these spina bifida babies being born each year, but the number is going down because of improved maternal diet. It has been going down for the last decade. There are many arguments against, as the Senator from Missouri pointed out, amending an appropriations bill in this way. The minority leader made the same argument, and those are arguments I would be generally inclined to support. Being the junior Senator to the senior Senator from West Virginia, those are arguments I would almost be bound to support. But here is one Senator from West Virginia who is willing to give a great deal of leeway and the benefit of the doubt when a compelling need comes about, to meet our responsibility to a class in our society called children. That is what we are doing by this amendment of the minority leader. A little background. Under the agent orange law that we enacted in 1991, the Government assumed responsibility for health outcomes. If somebody does not like it, repeal it if they can, but that is what we did under the law. We assumed responsibility for health outcomes of that particular war, the Vietnam war, where there was at least a positive association of the war with the disease. That law required the VA to contract with the National Academy of Sciences--and here we are doing the same thing on this. The National Academy of Sciences was charged with reviewing ongoing research on illnesses resulting from agent orange exposure in Vietnam. I seriously doubt there are many Senators on either side of the aisle who really questioned whether there is a relationship between agent orange and cancer, and the other different perils that it caused. In March of this year, the National Academy of Sciences found limited or suggestive evidence for connecting service in Vietnam with a number of additional diseases, including spina bifida, in children of those who served in Vietnam. Creating a new entitlement for dependents? Yes. Because when you get into this kind of toxic stuff, dependents are affected, like they were in the Persian Gulf war through the chemical combinations and toxins that were used there. Dependents are affected. Reproductive activities are affected. Women are affected. Kids are affected. Have you seen the pictures? Have you visited the kids? Has anybody on that side of the aisle visited the kids, visited the families, talked with them? I do not know. But this is extremely important. It is the National Academy of Sciences that made this finding, Mr. President, not the Congress, not the Veterans' Committee, not the House, not the Senate, not the President, not the VA. The National Academy of Sciences. The President immediately established a task force within the Department of Veterans Affairs to make recommendations to him based upon what the NAS--the National Academy of Sciences--had reported. The VA task force recommended, among other things, the enactment of legislation that is now provided by the Democratic leader's amendment. Everything sounds pretty much in order to me. On May 28, President Clinton announced that the Government would meet its responsibility to the children of Vietnam veterans. We did it with agent orange. Nobody has tried to repeal that that I am aware of. Now we have a new classification, new evidences, dependents, children showing up with problems. And the President said that he would send the Congress legislation to take care of Vietnam veterans' children who develop spina bifida. The decision for the Government to take responsibility for children of veterans exposed to these environmental hazards--toxic hazards of war--is precedent setting. It surely is. It absolutely is, because the nature of war is changing. It is not without controversy, as is clear on the floor this morning, but it is what I call a leadership decision. And I applaud the President for making that decision. The hazards of war are changing. It is so obvious. It is so obvious, Mr. President. It seems so obvious, but evidently it is not. Witness the great difficulty that the Government has had in discovering the causes of the vast array of illnesses that have followed service in the Persian Gulf war. The injuries of that war in the great majority of cases have not resulted, once again, from guns or missiles, but rather from environmental or other toxic exposures. Once again, we have not had a chance to have a hearing on this. The normal legislative process was not followed, which is the reason that the minority leader and some of us have had to resort to approaches of this sort. There are new types of dangers that our soldiers will increasingly face in future conflicts. That is assured. That is why, as chair and now ranking member of the Committee on Veterans' Affairs, I made and am making a significant effort to oversee the Government efforts regarding environmental exposures to our military men and women. And it has not been a pretty sight. The Defense Department, in one of the greatest stonewalls of all time, but in keeping with their record going all the way back to the First World War, denies any responsibility for anything happening to the soldiers that they are responsible for. Part of the bargain in the Vietnam war, and also the Persian Gulf war--but here we are talking about Vietnam with these children--yes, the soldiers, men and women, signed up and went over to serve, but it was not part of the bargain that the children which they might have upon return from service, who might potentially be affected, would be part of this deal. These children were not sent to Vietnam. They did not sign up for the risks of service. There seems to be benefit-of-the- doubt type evidence that they were harmed, however. So the question comes again, do we favor the $3 million expenditure in 1997 for medical care for the horrible consequences they suffered-- or do we ignore them, ignore them because it is a new type of entitlement or it has not followed the legislative process? I mean, this is a stunning difference between the two sides of the aisle. The question before us today is whether the Government owes responsibility to children born to those who served in an earlier war, children born with a disabling condition called spina bifida. Now let us talk a little bit about the problem. Mr. President, the problem can be immensely horrible, and it is in the case of spina bifida. It is not brought on by any action by the children. It is not brought on by any action by the parents. These are truly innocent victims. My colleagues may not want to hear some of the horrendous problems these children face, but they are going to, because we all need to understand a little bit about the nature of what is at stake here. Spina bifida, SB, means ``split spine.'' It is a defect of the neural tube, the embryonic structure that evolves into the brain and the spinal cord. It results from the failure of the spine to close properly in the first month of pregnancy. There are three types of spina bifida, the most common of which is occulta, which is not disabling and is not included in the amendment before us. What is covered in the proposed amendment are the two much more severe forms of spina bifida. In these forms, a cyst holding the spinal cord membranes, nerve roots of the spinal cord, or the cord itself, usually malformed, pokes through an open part of the spine; or there may be, in fact, no cyst, but only a fully exposed section of the spinal cord and the nerves. Affected babies are at a high risk of infection until the back is closed surgically, and varying degrees of other problems remain even if the surgery is successful. Estimates of the number of children born with spina bifida range from 1,500 to 4,000 each year. As I indicated before, that number is going down as maternal diet and pregnancy testing are improving. All of this has been declining over the last decade. The types of problems that these children develop vary, sometimes significantly, depending on the particular spinal nerves that are involved. But their conditions are serious, often severely disabling, and for all, lifelong. Curable? No. Lifelong? Yes. Now, there are three primary areas of disabling function: The central nervous system, which is the brain and the spinal cord; the urologic system, which are the kidneys and the bladder; and the musculoskeletal system, which are the bones and muscles. Common primary medical problems include hydrocephalus, which occurs when the cerebrospinal fluid is unable to drain normally and fluid collects around the brain, resulting in an enlarged head; serious bladder problems due to lack of muscle control--urinary tract infections are very common, and kidney problems can result; bowel control problems; orthopedic conditions, including partial or complete paralysis, depending on where the defect shows on the spinal cord; and a variety of problems involving dislocated joints, misshapen bones, bowed legs, and foot deformities. It is not a lot of fun. It is also very common for these children to develop a whole host of secondary medical problems as a result of this, including obesity, high blood pressure, heart disease, bone fractures, seizures, eye disorders--due to pressure on the optic nerve--and a life-threatening latex allergy. In addition, learning disabilities are a constant and lifelong reality for children with spina bifida. Now, remember, we have had learning through the school systems as it has been over the past couple of centuries; and we are now, after the deregulation of the telecommunication industry, entering into a whole new age where children are going to be expected to be able to handle much more complex learning procedures through computers and all the rest. So learning disabilities are going to be a horrible, lifelong reality for children with spina bifida, as they already are. Poor short-term memory, lack of organizational skills, lack of eye-hand coordination, needs for special education and other kinds of support are common. Finally, there are a plethora of social development and psychological problems which plague these children for all their lives. Put yourself in the condition that I have just described for the last 7 or 8 minutes. I invite my colleagues to put their children in that condition. We have all seen spina bifida kids. We all know what they look like, what happens. We all know the love they get from their parents, but we all know what a fundamentally incurable, horrible condition it is. I, as one Senator, want to say that I am willing to give these children a huge benefit of the doubt as we did in the agent orange bill. I turn to the controversy of determining the cause of these problems. Now, looking at the science and the law, opponents of providing health care to spina bifida children will honestly and genuinely argue that the scientific evidence of the connection between service in Vietnam and spina bifida is either lacking or flawed, or both. And for sure, there are those who argue against caring for any Vietnam veterans for agent orange exposure. But, Mr. President, I believe we in Congress are particularly ill- suited to be the determiners of what is and what is not ``good science.'' Those are debates and discussions best left to the scientists themselves, not to politicians. But the determination is great to replace scientific review with political debate and bias. The fact is that with only a few exceptions, the maladies previously identified by the National Academy of Sciences as statistically connected with service in Vietnam can also be statistically related to other causes, as well. The scientific proof, as I understand it, is not an open-and-shut case with regard to those earlier diseases and illness findings. I readily acknowledge it is not an open-and-shut case regarding spina bifida. However, Mr. President, this is, in fact, exactly what the 1991 agent orange law intended. We, as a Nation, decided then that we would give the benefit of the doubt to those who served our country in Vietnam. What we decided then was to task the NAS with the scientific determination as to the strength of the evidence of connection of a disease or illness. No more and no less. Based upon those NAS findings, we directed the Department of Veterans Affairs to make a determination of whether there was a ``positive association''--meaning at least 50 percent of the credible evidence supported a conclusion that a health outcome was related to Vietnam service. In fulfilling their job, the NAS established in 1993 four categories of the association of health outcomes. The minority leader referred to these. One, sufficient evidence of association. Two, limited or suggestive evidence. Three, inadequate or insufficient evidence. Four, limited or suggested evidence of no association. It was in the second category, ``limited or suggestive evidence,'' that the NAS earlier this year placed spina bifida in its report--for the first time. It is based upon this NAS finding that the VA task force concluded there was sufficient evidence to establish a positive association of military service and spina bifida. The question then becomes whether ``limited or suggested evidence of an association''--which the task force described as ``several studies [that] suggest apparent increases in risk in offspring of Vietnam veterans''--whether that is sufficient to support the Government's assuming financial responsibility. That is an appropriate question for debate, but one we have already answered in this body and in this Congress and in the law, by enactment of the 1991 agent orange law. What this amendment does today is fully in accordance with that law. Now, the legislation proposed by the Democratic leader, and as suggested by the Department of Veterans Affairs, would establish a health care program for children with spina bifida, and a three-tiered compensation program paying either $200, $700, or $1,200 a month, depending on the degree of disability. The compensation program would not, as I understand it, entail new costs, since it is offset by savings of other veterans' programs, and the health program's small cost would be absorbed in the VA medical care account. Because no one knows for sure how many children will qualify for the health care or monetary benefits, the costs are uncertain. Estimates range from 700 to 3,000 spina bifida children of a parent who served in Vietnam and where this positive association was established. CBO has informally advised--and they speak for us--that about 2,785 children probably would be eligible to participate--2,785 children--at a total cost of perhaps $4 million annually for health care. This is a real, real, budget buster. This is, in fact, a very small amount of money, when one considers that lifetime health care costs for those who have spina bifida range from $294,000--which comes from the Centers for Disease Control--to over $750,000--and that comes from the Spina Bifida Association--per child for comprehensive health care. But since many of the health care costs are in the early years of life, and the proposed amendment is not retroactive, the health care costs would be much, much less than these estimates. The monetary portion of the benefit is intended to offset the varied expenses that these children and their families face other than direct health care. One can well imagine that this would include such things as special education and training, lost wages or work limitations, or independent living needs. It is not very hard to imagine that. Under the Democratic leader's amendment, the Secretary of Veterans Affairs would establish, by regulation, three levels of disability, corresponding to the three tiers of payments intended to supplement other funds available to these children from either public or private sources. Again, CBO estimates that the compensation and vocational costs of the amendment would be fully offset and would, in fact, result in a net savings of $4.2 million in 1997 and $525 million through 2002. So I conclude, Mr. President, that the question we will answer today is whether we will honor the commitment we have often stated to our men and women in uniform. I am sure somebody will stand up and take that one apart with all kinds of anger, rage, and whatever else. But that is what we have committed to do. That is the mission statement above the door at the Department of Veterans Affairs office building. We are dealing with a new kind of precedent-setting entitlement, yes, because we have moved into a new era of warfare. I am sorry, but in the Persian Gulf, there are kids that are born with deformities. There is something called ``burning semen,'' what some Persian Gulf veterans' wives have called ``shooting fire,'' which nobody wants to talk about; wherein the soldier, be it a male, who served up front in the Persian Gulf war, when he is having sexual relations with his wife and some sperm maybe hits her in the leg, an enormous red welt develops. We have never had to talk about things like that before, but we do now because it is different now. Some of these kids from the Persian Gulf war are being born deformed. Have we done anything to really help them? No. Has the Defense Department admitted anything is wrong whatsoever? No, of course not, not since World War One have they ever done that. Now we are dealing with spina bifida, coming from the Vietnam war. Positive association was established, leaning toward the child, toward the veteran was established, by law, in 1991. So we will have this question answered today. There are those who want to go by normal legislative procedure, which would not happen, and who are, for whatever reason, incredibly reluctant to help children in a situation in which money would be saved by so doing. Spina bifida is horrible. I repeat, it is horrible. My wife and I have four children. None of them has that. I thank God that none of them do. I am overwhelmed with caring. One man I met on the subway yesterday whose child has spina bifida talked to me about her. It has nothing to do with Vietnam, but he talked about just the problems of that. So I come very close to my ending here. In that 1991 law, Mr. President, we decided that the scientific test of our commitment would not be a 100 percent, totally black or white, test of cause and effect. We decided that as a matter of law. It was not intended to be an absolute test of cause and effect. It was intentionally balanced in favor of our soldiers, which now includes their offspring, because the world and wars have changed. Those we have directed to make these decisions now tell us that there is evidence--albeit limited or suggestive evidence--of the causal connection for spina bifida in children and the service of their parents in Vietnam. As I understand it, the evidence is considered close to a 50-50 proposition; that is, the causal connection is as likely as not. In such cases, I am totally comfortable with giving a strong presumption in favor of the children of American service members, at least until such time as scientific evidence suggests a more positive association--or a less positive one, a negligible one, or a nonassociation. This is not an area of absolutes. But if I am to err, Mr. President, as I often have and surely will in the future, I choose to err on the side of assuming a responsibility, of assuming a benefit of the doubt, of assuming the care of the children of the war. I thank the Presiding Officer and yield the floor. Mr. WELLSTONE addressed the Chair.

Mr. ROCKEFELLER

Mr. ROCKEFELLER. Mr. President, today I offer a bill that is very important to my State of West Virginia, and can benefit the entire Nation. This very small bill will have a very big impact on the ability of small oil and gas producers in my State and across the Nation to compete. The bill creates a new tax incentive, modeled on the old section 29 tax credit, to help small marginal well drillers. I offer this with a measure of frustration, based on the fact that while Congress managed to incorporate a great number of narrowly targeted amendments into the small business tax bill passed today, the final bill did not include this provision that I propose today. I am pleased that the tax package includes an extension of the part of section 29 dealing with facilities that manufacture gas from biomass and coal. That is helpful to a variety of States, including West Virginia. But for less than one tenth the cost of that provision, we could and should have done something to help drillers get gas from devonian shale and other nonconventional sources. The original section 29 credit for drilling expired in 1992 after some of the larger gas companies in this country put emphasis on getting relief from the alternative minimum tax instead of renewing section 29. They got that, but it didn't help a lot of the smaller drillers, which happen to include most of the gas producers in West Virginia. Mr. President, I'd like the record to show that since the credit expired, drilling for margin gas wells in West Virginia has dropped off by more than 30 percent. In 1992, the last year of the credit, 760 wells were drilled in West Virginia. By 1995, that number had fallen to 530 wells. In that same timeframe, the number of rigs actively drilling wells in the Appalachian basin declined from 73 to 45--a 48-percent decline. That translates directly into jobs, as the average rig employs about 25 people. When you add to that all the jobs associated with a well (from transportation to bookkeeping), you have a job loss of more than 1,500 in the Appalachian Basin, which stretches from New York to Kentucky, and from Ohio to Virginia. Mr. President, this is about more than jobs. I have spoken in the past of the great problem our Nation has with oil dependency. Following the oil shocks of the 1970's, Congress made a concerted effort to help ease our dependency on foreign energy sources. That effort showed much success in the 1980's when imports fell by more than 40 percent from 1970's highs. However, the 1990's have seen import totals steadily rise, to today when more than 50 percent of our oil is imported. In fact, Mr. President, the biggest 1-year rise in imports since 1986 came in the year following the expiration of section 29, in 1993. The Senate knows well the problem raised by energy dependency. The Gulf war was fought largely to protect our foreign oil sources in the Middle East, and 19 brave American soldiers died in June for that very same cause. Our energy dependency, in addition to years of cheap oil and an exceptionally harsh winter, also led to the outrage earlier this spring when gas prices at the pump rose steeply. For all these reasons, Mr. President, it is important that we foster the development of new sources of domestic energy. Gas in my State, and many others, is hard to get at. It is locked in rock formations that yield their fuel much more slowly, and at lower profits, than wells in the oil patch out West. This bill is specifically designed to offer a very modest incentive to those producers, when the price of natural gas gets so low that they can't make a profit from their wells. Unlike the original section 29, the credit will be available only for the first 10 million cubic feet of gas produced each year by each well. Additionally, the credit will only be available to wells that produce less than 100 million cubic feet of gas per year. Mr. President, I have intentionally limited the scope of this bill so that it is only available to smaller wells, and only there, for a limited amount of gas. The idea behind this bill is not to have a big giveaway for big oil and gas producers. But instead, it is designed to give a little bit of insurance to risk-taking drillers who make their living tilling nonconventional sources for fuel. This is a modest bill, but one that can make a big difference in certain places that have the potential for more prosperity, more job growth, and more economic growth like West Virginia. Reviving and revising section 29 will put an incentive in place to seize more of this potential while reducing the entire country's dependence in foreign oil. I urge the Senate to find a way to make this bill a reality--the sooner, the better.

Mr. ROCKEFELLER

Mr. ROCKEFELLER. Mr. President, today I offer a bill that is very important to my State of West Virginia, and can benefit the entire Nation. This very small bill will have a very big impact on the ability of small oil and gas producers in my State and across the Nation to compete. The bill creates a new tax incentive, modeled on the old section 29 tax credit, to help small marginal well drillers. I offer this with a measure of frustration, based on the fact that while Congress managed to incorporate a great number of narrowly targeted amendments into the small business tax bill passed today, the final bill did not include this provision that I propose today. I am pleased that the tax package includes an extension of the part of section 29 dealing with facilities that manufacture gas from biomass and coal. That is helpful to a variety of States, including West Virginia. But for less than one tenth the cost of that provision, we could and should have done something to help drillers get gas from devonian shale and other nonconventional sources. The original section 29 credit for drilling expired in 1992 after some of the larger gas companies in this country put emphasis on getting relief from the alternative minimum tax instead of renewing section 29. They got that, but it didn't help a lot of the smaller drillers, which happen to include most of the gas producers in West Virginia. Mr. President, I'd like the record to show that since the credit expired, drilling for margin gas wells in West Virginia has dropped off by more than 30 percent. In 1992, the last year of the credit, 760 wells were drilled in West Virginia. By 1995, that number had fallen to 530 wells. In that same timeframe, the number of rigs actively drilling wells in the Appalachian basin declined from 73 to 45--a 48-percent decline. That translates directly into jobs, as the average rig employs about 25 people. When you add to that all the jobs associated with a well (from transportation to bookkeeping), you have a job loss of more than 1,500 in the Appalachian Basin, which stretches from New York to Kentucky, and from Ohio to Virginia. Mr. President, this is about more than jobs. I have spoken in the past of the great problem our Nation has with oil dependency. Following the oil shocks of the 1970's, Congress made a concerted effort to help ease our dependency on foreign energy sources. That effort showed much success in the 1980's when imports fell by more than 40 percent from 1970's highs. However, the 1990's have seen import totals steadily rise, to today when more than 50 percent of our oil is imported. In fact, Mr. President, the biggest 1-year rise in imports since 1986 came in the year following the expiration of section 29, in 1993. The Senate knows well the problem raised by energy dependency. The Gulf war was fought largely to protect our foreign oil sources in the Middle East, and 19 brave American soldiers died in June for that very same cause. Our energy dependency, in addition to years of cheap oil and an exceptionally harsh winter, also led to the outrage earlier this spring when gas prices at the pump rose steeply. For all these reasons, Mr. President, it is important that we foster the development of new sources of domestic energy. Gas in my State, and many others, is hard to get at. It is locked in rock formations that yield their fuel much more slowly, and at lower profits, than wells in the oil patch out West. This bill is specifically designed to offer a very modest incentive to those producers, when the price of natural gas gets so low that they can't make a profit from their wells. Unlike the original section 29, the credit will be available only for the first 10 million cubic feet of gas produced each year by each well. Additionally, the credit will only be available to wells that produce less than 100 million cubic feet of gas per year. Mr. President, I have intentionally limited the scope of this bill so that it is only available to smaller wells, and only there, for a limited amount of gas. The idea behind this bill is not to have a big giveaway for big oil and gas producers. But instead, it is designed to give a little bit of insurance to risk-taking drillers who make their living tilling nonconventional sources for fuel. This is a modest bill, but one that can make a big difference in certain places that have the potential for more prosperity, more job growth, and more economic growth like West Virginia. Reviving and revising section 29 will put an incentive in place to seize more of this potential while reducing the entire country's dependence in foreign oil. I urge the Senate to find a way to make this bill a reality--the sooner, the better.

Mr. ROCKEFELLER

Mr. ROCKEFELLER. Mr. President, today hope is restored as we turn the desire for health care reform into reality. When the Kassebaum-Kennedy bill is signed into law, which will happen very soon, some of the most maddening, often cruel problems with America's health care system will begin to get fixed. When you look at all the hard work that went into getting this bill hammered out and on the brink of enactment, we could fill Olympic Stadium with the people who deserve some of the credit. But two individuals win the health reform gold medals in achieving this victory for millions and millions of Americans. The senior Senators from Kansas and Massachusetts have been true champions in leading what turned into a legislative marathon for health care reform. On behalf of the people of my State, and from my own heart, I thank both colleagues for their incredible feat. Over the past few years, Americans had every reason to wonder if Congress would ever be capable of doing anything ever again about the health care problems that cause them so much pain. When the fight for comprehensive health reform failed, it was hard to see how we could ever get out of the ditch of partisan politics, special interests, and fear that did us in. But while plenty of special interests and politicians wanted health care reform to die, millions of Americans were still waiting desperately for something to be done. The Senators from Kansas and Massachusetts realized that we had to take a different tack. We had to target just a few of the most serious problems in the health care system, and offer solutions that made obvious sense. It took persistence, patience, cooperation, and compassion to get this bill to this point today. With this legislation, millions of Americans will be able to get the health insurance they desperately want and need--or I should say that this will happen soon, since one of the compromises was that the insurance reforms won't be effective until July of next year. When that date is reached, the rules will change. Working Americans will be freed from the trap that locks them into jobs and situations solely because a change will mean losing their health insurance. Preexisting conditions will no longer mean an endless nightmare for the millions of children and adults who have some illness or medical problem that's the very reason they need health care. Small employers won't be shut out from the health insurance marketplace. When I talk about the Kassebaum-Kennedy bill, I can picture the West Virginians--parents, children, small business owners, health care professionals--who have begged for help. Now, I can report back to the West Virginian who shared his agony over not being able to get coverage for his cancer, because it was branded a pre-existing condition, that the law will soon require an insurance company to sell him that coverage. Now, I can send word to West Virginians who want to switch jobs, move to a different community, or even start their own business that they can hold onto their health insurance while they pursue any of these goals for themselves and their families. And most importantly, now I can tell all West Virginians, and we can tell all Americans, that health care reform is not dead, it's not code for gridlock, and it's not a pipedream. The Kassebaum-Kennedy bill also represents the art and necessity of compromise. Some proposals that would have helped numerous families were dropped, because opposition just couldn't be overcome. And one proposal, to open the door for medical savings accounts, worries me. It is labeled a ``demonstration,'' and I just hope that Congress will be honest and responsible about taking a true look at how people do when they turn from conventional insurance to tax breaks and catastrophic-only coverage. I know that most people don't plan on getting sick or having an accident or developing a serious disease, and I fear that an MSA will go from being a financial benefit into an overwhelming burden for many Americans when the unexpected happens. But I also know that we won't achieve any positive health reforms without making concessions. And the work will always be difficult. There are too many insurance companies that want to chase after healthy customers, and avoid the sick. There will always be ideology that gets in the way of telling the private sector to do anything differently, no matter how many families are hurting. There will always be fear of the unknown, no matter how many problems exist in the present. Today, however, let's celebrate what is getting done. And then tomorrow, let's move on to the next round of health care reform. Today, let's thank Senator Kassebaum and Senator Kennedy for their gift to at least 25 million Americans, and many thousands of West Virginians. And then tomorrow, let's be inspired by their leadership to get even more done for millions more who still suffer because they can't get or afford decent health care.