Paul Sarbanes

Mr. SARBANES

Mr. SARBANES. I commend the Senator from Illinois. We have a marvelous opportunity at this point, having come out of this deficit box as a consequence of the fiscal policies pursued by this administration, to reduce the national debt for the first time in a great number of years. Indeed, if we maintain proper discipline, we can in effect eliminate the national debt for the first time since the first part of the 19th century. All of that is at risk of loss, as the Washington Post says, because of the ``egregious recklessness of the Republican proposal'' which goes way out to the extreme. I ask unanimous consent that this editorial be printed at the end of this discussion.

Mr. SARBANES. Will the Senator yield?

Mr. SARBANES

Mr. SARBANES. Mr. President, I commend my very able colleague from Illinois for his very eloquent remarks about this tragedy, and I associate myself with his remarks. Our hearts do go out to both families, the Kennedy family and the Bessette family. The Bessette family has lost two children. My State has been fortunate to be blessed by the extraordinary leadership of the next generation of the Kennedy family in terms of Kathleen Kennedy Townsend, who now serves as our lieutenant governor. So I have a direct sense of the strong responsibility of dedicated public service which has marked this family from the very beginning. All of us are deeply struck by this tragedy. Our hearts reach out to the families. We extend them our very heartfelt sympathies. We feel very deeply about our colleague, Senator Kennedy, who, of course, has assumed the family leadership responsibilities. We have to press on, but it really comes as a very saddening tragedy for all of us. I thank my colleague for yielding.

Mr. SARBANES

Mr. SARBANES. Mr. President, I rise today to recognize Robert Tobias for his distinguished service at the National Treasury Employees Union, including four terms as its president. Admired by his friends and adversaries alike, Bob Tobias has garnered respect as an effective advocate and constructive mediator during his tenure at the NTEU. Bob and his wife Susan reside in Bethesda, MD, and we are very proud to have them as residents of our State. However, Bob is a native of Michigan and received a bachelor's degree, as well as a master's degree, in business administration from the University of Michigan. Bob completed his education at George Washington University, where he received a law degree. He built upon his formal education with substantial legal experience as a labor relations specialist for General Motors Corporation in Detroit and with the Internal Revenue Service. When Bob first joined the NTEU in 1968, he became its second staff employee. During his 31-year tenure at NTEU, Bob served the organization in numerous capacities and saw the staff grow to more than 100 members with seven field offices across the country. Now representing more than 150,000 Federal employees at the Internal Revenue Service, Customs Service, and other agencies, NTEU is a strong voice for public servants on Capitol Hill and with the other branches of Government. Starting at NTEU as a staff attorney, Bob later served as general counsel and executive vice president, supervising a staff of 45 attorneys and field representatives nationwide, as well as the litigation and negotiations staff in the NTEU training program. His dedicated and skillful performance in these positions led to his election as President of NTEU in 1983 and his subsequent reelection on three occasions. Under Bob's guidance, NTEU has been an influential voice for Federal employees and has waged many successful battles on their behalf. From challenging the line-item veto, to securing the right to picket for Federal employees, to obtaining the payment of over a half billion dollars in back pay from the Nixon administration, Bob Tobias has achieved wide-ranging victories for our public servants. In addition to his talent for successful litigation, Bob Tobias has worked with the Government and its agencies to improve the status of Federal employees and to enhance their ability to serve the public. For example, he is credited with wide-ranging IRS reforms, rendering the tax-collecting organization a more efficient and responsive public agency. He is credited with instituting the first negotiated alternate work schedule for employees and the first cooperative labor management program for onsite child care. Because of his extensive interaction with the agencies that employ Federal workers, Bob is highly regarded as an expert on how to improve Government. Many different organizations have sought out his expertise on these matters and, among others, Bob is now a member of the President's National Partnership Council, the Federal Advisory Committee on Occupational Safety and Health, the Executive Committee of the Internal Revenue Service, and the American Arbitration Association. Because of his dedicated leadership on behalf of our Federal workers, his consensus-building approach to Government reform, and the highly professional manner in which he carried out his work, Bob Tobias leaves a powerful and enduring legacy as President of the NTEU. I am pleased that he will continue in the public realm since he is planning a career in public policy teaching and writing. Again, I congratulate Bob Tobias on his outstanding service at NTEU and his terrific record as a public servant on behalf of the American people, and I wish him all the best in the years ahead. Mr. President, I yield the floor. Mr. DURBIN addressed the Chair.

Mr. SARBANES

Mr. SARBANES. Mr. President, I am pleased to join with my colleagues, Senators Robb, Warner and Mikulski, as an original co-sponsor of these two measures providing the additional financing necessary for the replacement of the Woodrow Wilson Bridge. The proposed $600 million in new funding authorized in these measures, combined with the $900 million already made available under the Transportation Equity Act for the 21st Century (TEA-21), will enable us to move ahead with constructing this vital link in our region's and nation's transportation system. Mr. President, everyone who commutes to work in the Washington Metropolitan area or who travels on Interstate 95 knows what a serious traffic and safety problem we have in the area of the Woodrow Wilson Bridge. The bridge is one of the worst bottlenecks on the interstate system. It is carrying traffic volumes far in excess of its designed capacity. Originally constructed in 1961 to carry 70,000 vehicles per day, the bridge now averages 176,000 vehicles daily. It is rapidly approaching the end of its service life. In fact in 1994, the Federal Highway Administration determined that due to the age of the facility, the structural deterioration and traffic demand, the existing bridge would not last much beyond 2004 even with additional repairs. The substandard condition of the bridge and resulting congestion means accidents-- at a rate of twice that for other segments of the Capital Beltway--and significant delays for commuters, interstate truckers, tourists, businesses and employers alike. With traffic volumes in the area projected to nearly double in the next 20 years, there has been a clear need to address this problem. In 1996, after many years of intensive study, the Wilson Bridge Coordination Committee, comprised of federal, state and local officials, recommended a 12-lane drawbridge and reconstructing approaches and adjacent interchanges as the preferred alternative for the replacement structure, at an estimated cost of $1.6 billion. Since then, there has been much discussion and debate about the size and cost of the facility as well as how the new bridge would be paid for and I would like to make several points: First, the project is a federal responsibility. The bridge is owned by the Federal government. In fact, it is the only federally-owned bridge on the interstate system. Funding provided for it should be commensurate with the federal ownership of the bridge. Second, the replacement bridge must be built in accordance with the same standards as applied to bridges owned by state jurisdictions. Just replacing the existing structure is not an acceptable option because it would continue the current bottleneck at the bridge and because it would not meet the Federal Highway Administration's own guidelines which require states in building new structures to meet projected future carrying capacity needs. This means the replacement structure must be able to accommodate current as well as projected future traffic growth and that the related interchanges and approaches to the bridge should match the new bridge. It should also provide for pedestrian and bicycle access as well as accommodate future transit useage. What is needed is not a quick fix that we will have to revisit in several years, but a long term solution that will carry us well into the next century. Third, we should not lose sight of the fact that if a replacement is not undertaken in the very near future, it will be necessary to impose significant restrictions on the use of the existing bridge and this will have enormous economic and transportation related consequences throughout the entire region. Last year we took a significant step forward in replacing the Woodrow Wilson Bridge by authorizing $900 million in new contract authority in TEA-21. The legislation which we are introducing today, when enacted, will help ensure that the federal responsibility to this bridge is met, and that it will meet the region's needs as we move into the next century. I want to commend Secretary Slater and his staff at the Department of Transportation for their support and assistance in developing this legislation and I urge my collegues to join me in supporting this measure.

Mr. SARBANES

Mr. SARBANES. Mr. President, I am pleased to join with my colleagues, Senators Robb, Warner and Mikulski, as an original co-sponsor of these two measures providing the additional financing necessary for the replacement of the Woodrow Wilson Bridge. The proposed $600 million in new funding authorized in these measures, combined with the $900 million already made available under the Transportation Equity Act for the 21st Century (TEA-21), will enable us to move ahead with constructing this vital link in our region's and nation's transportation system. Mr. President, everyone who commutes to work in the Washington Metropolitan area or who travels on Interstate 95 knows what a serious traffic and safety problem we have in the area of the Woodrow Wilson Bridge. The bridge is one of the worst bottlenecks on the interstate system. It is carrying traffic volumes far in excess of its designed capacity. Originally constructed in 1961 to carry 70,000 vehicles per day, the bridge now averages 176,000 vehicles daily. It is rapidly approaching the end of its service life. In fact in 1994, the Federal Highway Administration determined that due to the age of the facility, the structural deterioration and traffic demand, the existing bridge would not last much beyond 2004 even with additional repairs. The substandard condition of the bridge and resulting congestion means accidents-- at a rate of twice that for other segments of the Capital Beltway--and significant delays for commuters, interstate truckers, tourists, businesses and employers alike. With traffic volumes in the area projected to nearly double in the next 20 years, there has been a clear need to address this problem. In 1996, after many years of intensive study, the Wilson Bridge Coordination Committee, comprised of federal, state and local officials, recommended a 12-lane drawbridge and reconstructing approaches and adjacent interchanges as the preferred alternative for the replacement structure, at an estimated cost of $1.6 billion. Since then, there has been much discussion and debate about the size and cost of the facility as well as how the new bridge would be paid for and I would like to make several points: First, the project is a federal responsibility. The bridge is owned by the Federal government. In fact, it is the only federally-owned bridge on the interstate system. Funding provided for it should be commensurate with the federal ownership of the bridge. Second, the replacement bridge must be built in accordance with the same standards as applied to bridges owned by state jurisdictions. Just replacing the existing structure is not an acceptable option because it would continue the current bottleneck at the bridge and because it would not meet the Federal Highway Administration's own guidelines which require states in building new structures to meet projected future carrying capacity needs. This means the replacement structure must be able to accommodate current as well as projected future traffic growth and that the related interchanges and approaches to the bridge should match the new bridge. It should also provide for pedestrian and bicycle access as well as accommodate future transit useage. What is needed is not a quick fix that we will have to revisit in several years, but a long term solution that will carry us well into the next century. Third, we should not lose sight of the fact that if a replacement is not undertaken in the very near future, it will be necessary to impose significant restrictions on the use of the existing bridge and this will have enormous economic and transportation related consequences throughout the entire region. Last year we took a significant step forward in replacing the Woodrow Wilson Bridge by authorizing $900 million in new contract authority in TEA-21. The legislation which we are introducing today, when enacted, will help ensure that the federal responsibility to this bridge is met, and that it will meet the region's needs as we move into the next century. I want to commend Secretary Slater and his staff at the Department of Transportation for their support and assistance in developing this legislation and I urge my collegues to join me in supporting this measure.

Mr. SARBANES

Mr. SARBANES. Mr. President, twenty-five years ago on this day, Turkish troops began their brutal assault on the people of Cyprus, forcing hundreds of thousands to flee their homes and villages. Less than a month later, after a cease-fire had been accepted and negotiations toward peaceful resolution of the conflict were proceeding under United Nations auspices, Turkey sent another, even larger occupation force of 40,000 troops and 200 tanks, seizing more than a third of the island. For the last quarter of a century, Turkish military forces have illegally occupied the northern part of the island, forcibly dividing it. Communities have been splintered, lives shattered, a nation deprived of its cultural heritage and the opportunity to live in peace. The events of 1974 took a harsh toll on the people of Cyprus that remains with us to this day. Hundreds of thousands of Cypriots who fled advancing troops remain refugees in their own land, unable to return to the homes and the communities they inhabited for generations. Others have been stranded in tiny enclaves, deprived of the most basic human rights, forbidden to travel or worship freely. The beautiful coastal resort of Famagusta lies emply, bearing silent witness to what once was an economic and cultural center of the island. The Green Line runs like a jagged scar across the face of Cyprus. An entire generation has grown up in the shadow of military occupation, knowing only division and despair. It is time for the world to recognize, however, that the Cyprus problem is more than just a humanitarian tragedy. As we have seen in Bosnia and Kosovo, when the suffering of a people puts peace and stability at risk, we also have a strategic interest in facilitating a negotiated settlement. And as long as the Cyprus problem divides not only a country, but two of our key NATO allies, the United States must work to help find a solution. The success of the UN peacekeepers should not for a minute obscure the real threat of conflict in the region. Cyprus can be either a spark to confrontation or the starting point for reconciliation, and we have a hard-headed security interest in seeing it resolved. In one of the tragic ironies of this situation, the man who ordered the invasion is once again Prime Minister of Turkey. On this sad anniversary, we ask the President to call upon Mr. Ecevit to assume the mantle of statesmanship and acknowledge that the status quo is not acceptable. The Turkish government must demonstrate its willingness to help rectify this continuing injustice and to participate in good faith in U.S. and U.N.-mediated efforts to resolve it. The current situation hurts not only Greek and Turkish Cypriots but Turkey itself, and its relations with the United States and the international community. I am pleased to say that the Clinton administration has kept the Cyprus issue high on the international agenda, raising it at every appropriate opportunity and assigning some of their most capable diplomats to work toward a settlement. I would particularly like to recognize the work of Dick Holbrooke and Tom Miller in this regard. Although Tom has just been sworn in as our new Ambassador to Bosnia- Herzegovina and Dick, I hope, will soon be confirmed as our Permanent Representative to the United Nations, they have played an invaluable role in demonstrating the seriousness of this administration in bringing peace and justice to this troubled island. In recent weeks there has been increased international attention focused on the Cyprus problem, and a greater sense of urgency in bringing the two sides together. The G-8 for the first time has dealt with the Cyprus problem in a direct and substantive way, urging the UN Secretary General, in accordance with relevent Security Council resolutions, to invite the leaders of the two sides to comprehensive negotiations without preconditions in the fall of 1999. Unfortunately, thus far, Mr. Denktash, the leader of the Turkish-Cypriot community, has sent a negative message on his participation in such talks. Less than a month ago the UN Security Council endorsed the G-8 leaders' appeal and reaffirmed its position that ``a Cyprus settlement must be based on a State of Cyprus with a single sovereignty and international personality and a single citizenship, with its independence and territorial integrity safeguarded, and comprising two politically equal communities as described in the relevant Security Council resolutions, in a bi-communal and bi-zonal federation, and that such a settlement must exclude union in whole or in part with any other country or any form of partition or secession.'' Such a resolution, according to the G-8, ``would not only benefit all the people of Cyprus, but would also have a positive impact on peace and stability in the region.'' Mr. President, the division of Cyprus has gone on far too long. I want to take this opportunity to commend the thousands of friends and supporters of a free and unified Cyprus who joined hands around the Capitol today. As we commemorate this tragic anniversary, let us salute their courage and redouble our own efforts to help bring an end to this terrible and continuing injustice.

Mr. SARBANES

Mr. SARBANES. Mr. President, this week the Senate is finally addressing an issue that is vitally important to the American people-- managed health care reform. The number of Americans who receive health care through managed care organizations continues to increase at a rapid rate. Today, approximately 75 percent of those with employer-provided health insurance are covered by managed care plans. Although managed care was put forth as promoting both greater efficiency and higher quality health care, all too often the lure of greater profits has resulted in curtailing care to patients dependent on managed plans for their medical needs. The American people are rightly demanding more patient protections, and it is clearly time for Congress to act to guarantee all Americans certain fundamental rights regarding their health care coverage. The Democrats in both the House and Senate have worked hard to convince the Republican Majority of the need to establish safeguards for patients in managed care. For a long time the Majority chose to ignore the patients' plight and refused to acknowledge the need for any patient protections at all. Last Congress we proposed a comprehensive set of reforms designed to ensure that patients receive the care they have been promised and have paid for. I am proud to be an original co- sponsor of this Democratic bill again this Congress. After seeing how the public responded to this Democratic initiative, the Republican Majority did draft a managed care reform bill. But, unfortunately their bill calls for only the most minimal reforms; in many respects it is a sham. In addition, until this week, they persisted in blocking the issue from being brought up on the floor. However, the Democrats joined together in insisting that the needs of managed care patients be given careful consideration. After much hard work by the Minority leader and others, an agreement was reached under which patients' rights legislation could be brought up on the Senate floor this week. The debate which has taken place highlights the difference between the Democratic and the Republican approaches to this issue. The Democrats seek to provide comprehensive coverage and protections; the Republicans are minimalist in both respects. Let us look at some of the differences: the Democrats' bill would protect all 161 million Americans with private insurance; the Republican proposal ignores the over 113 million people who work for other than the large self-insured employers, or State or local governments, or who buy their own insurance. Our bill would guarantee basic patient protections to all consumers of private health insurance. The Republican proposal would cover only the employees of businesses that assume the risk of self-insuring their employees. Thus, the Republican bill leaves out more than 70 percent of the consumers of private health insurance. The Democrats' bill provides patients with access to specialists, whereas the Republican bill is woefully inadequate in this regard. For those who are seriously or chronically ill, receiving treatment from a qualified medical specialist can mean the difference between life and death. Our Patients' Bill of Rights would guarantee that patients with special conditions could go to providers with the expertise needed to treat their particular problems, even if the needed specialist was not a member of a plan's provider network. Under the Republican bill, patients are not guaranteed access to the specialists they need and could be charged exorbitant fees for going to an out-of-network provider--even if the plan may be at fault for not having access to appropriate specialists. The Democratic bill would prevent HMOs from arbitrarily interfering with doctors' treatment decisions whereas the Republican bill does not address this issue at all. The Republicans claim that our provision would allow doctors to order unnecessary care, but that is not the case. Under our bill, an insurer could still challenge a doctor's recommendation, but their denial of coverage would have to be based on medical facts not on their bottom line. The Democratic bill would restore patients' ability to trust that their health care provider's advice is driven solely by health concerns, not cost concerns. It would prohibit the coercive practices used by managed care companies to restrict which treatment options doctors may discuss with their patients. The Republican bill would allow HMOs to continue terminating health care providers for having frank and candid doctor-patient communications and would allow HMOs to continue using incentives to bias a doctor's medical decision-making. Managed care companies regularly refuse to pay for emergency room services without prior authorization. This unreasonable requirement has caused countless tragedies as people are forced to waste critical time finding an emergency room their HMO will pay for. One of my constituents recently experienced this shocking treatment from an HMO. While hiking in the Shenandoah Mountains, she fell off a 40-foot cliff. She sustained fractures to her arms, pelvis, and skull but was quickly airlifted to a hospital in Virginia. Her HMO refused to pay the over $10,000 in hospital bills because she failed to gain ``pre-authorization'' for her emergency room visit. For over a year, she challenged her HMO and faced personal bankruptcy. Ultimately, the Maryland Insurance Administration ordered the insurer to pay the hospital and fined them for refusing to pay from the outset. However, her struggles with the HMO were not yet over. Within a year, after follow-up surgery for her injuries, she found herself again in need of an emergency room. This time she called the HMO beforehand, but was told they would pay only for her screening fees because the visit was not considered a medical emergency. The Democratic Patients' Bill of Rights would guarantee that patients could go to the nearest emergency room during a medical emergency without having to call their health plan for permission first. Patients would have the right to receive the medical care they need without the limitations currently imposed by HMOs. The Republicans, on the other hand, would not guarantee patients access to the nearest emergency room and would not ensure that patients could receive full medical care without prior authorization. Our bill would also provide patients with meaningful recourse if they are harmed by a managed care plan's medical decision-making. Today, there is nothing to discourage HMOs from denying critically necessary care. Thus, our bill creates a fair, independent, and timely appeals process through which patients could challenge a plan's denial of care. Under the Republican bill, HMOs could delay the appeals process indefinitely and many HMO decisions could not be appealed at all. Furthermore, where the Republican bill is silent, our bill would enable those harmed by the medical-decision making of HMOs to hold those HMOs legally accountable for second-guessing the advice of a treating physician. The Republican plan would continue to shield HMOs from accountability for conduct that results in injury or death to patients. The American people need a meaningful Patients' Bill of Rights. That is why I strongly support the Democratic proposal put forward by Senator Daschle.

Mr. SARBANES

Mr. SARBANES. What is the purpose of their exercise? It is a pretense, is it not, to assert some sort of Patients' Bill of Rights to deal with problems people are having with HMOs and then not to cover the very people who are in the HMOs? That is a pretense, is it not?

Mr. SARBANES. As I understand this, we are dealing here with a Patients' Bill of Rights which is designed to, in effect, curb some of the practices of the HMOs. The proposal from the other side of the aisle by our Republican colleagues does not cover the bulk of the people who are in HMOs, is that correct?

Mr. SARBANES. Will the Senator yield further?

Mr. SARBANES. That is a total of 113 million people not covered. As I understand it, the only people covered in this Republican proposal are 48 million people covered through a self-funded employer plan, which is less than 30 percent of the total number of people about whom we should be concerned.

Mr. SARBANES. I think the Senator from New York has again emphasized an extremely important point. People watching this debate have to understand, we have had these amendments arguing about what practice should be covered--what practice should be covered. So we have an important difference there. But the fact of the matter is, under the Republican proposal, no matter what practice is covered, it is only going to reach less than 30 percent of the people. For the remainder, the other 70 percent, the 113 million, this debate for them is completely irrelevant because they are not going to be covered at all. So all of this other argument about whether you cover this procedure or that procedure--which I think are extremely important arguments in and of themselves, and important issues--but unless we deal with this issue of coverage, which is the sharpest contrast between the two proposals, well over 70 percent of the people are simply going to be left out altogether. Is that not correct?

Mr. SARBANES. As I understand the Senator's chart, there are 15 million people buying individual policies. Under the Republican proposal, they will not be covered, is that correct?

Mr. SARBANES. There are another 23 million people, State and local government workers, as I understand it, under the Republican bill, who will not be covered, but they will not receive any protections with respect to the practices of the HMOs, is that correct?

Mr. SARBANES. Furthermore, there are another 75 million people whose employers provide coverage through an insurance policy or an HMO, 75 million, and those people will not be covered, is that correct?

Mr. SARBANES. Will the Senator yield?

Mr. SARBANES. I did a fast calculation. As I calculate, more than 70 percent of the people who we are concerned about with respect to how they get their health care and the practices which are followed are excluded--not included, excluded--from the Republican proposal.

Mr. SARBANES. Will the Senator yield?

Mr. SARBANES

Mr. SARBANES. It becomes a highly relevant question, doesn't it?

Mr. SARBANES. Will the Senator yield on that point, please?

Mr. SARBANES. I yield to the chairman of the subcommittee.

Mr. SARBANES. Will the Senator yield for a question on that point?

Mr. SARBANES. The argument the Senator made about trying to move forward was responded to by the committee in the past with the Exim exception, with the OPIC exception, with the encouraging democracy exception, all of the provisions that provide some aid. Now the Senator wants to lift any limitations altogether. I think any chance of getting this situation resolved will simply be gone. I know the pressures that exist. The Silk Road strategy involves tremendous oil interests. We ought to put that out on the table, I guess. Someone ought to lay that out as an important consideration. But it ought not to result in overturning what has been an established policy in the way we are trying to do it today, particularly in a situation when, last fall, we thought we would be able to move this peace process. Had Azerbaijan participated in the peace process last fall, we would have been able to move forward. They refused to do so.

Mr. SARBANES. Mr. President, in light of the comments of the Senator from Texas, I want to reemphasize something I said earlier. Section 907 is not a sanction. There is no provision currently in place that prevents American companies from trading or doing commerce in Azerbaijan. The only thing section 907 limits is it doesn't allow foreign assistance direct from the U.S. Government to Azerbaijan unless Azerbaijan--listen to this --takes demonstrable steps to cease all blockades against Armenia and Nagorno-Karabakh. So it is an absolute misrepresentation of the current situation to assert that this is a sanction. There are no trade sanctions. In fact, as the chairman of the subcommittee indicated, there are a number of Government programs that are operating in Azerbaijan. The only thing not now permitted is direct foreign aid. There is not an entitlement to foreign aid. All we have said--I think, quite reasonably--is that you can't get any foreign aid unless you take demonstrable steps to cease all blockades against Armenia. That is what 907 provides. Why should we give them foreign aid and allow them to continue the blockade? We want the blockade to cease.