Paul Simon

Mr. SIMON

Mr. SIMON. So what we will be doing if we pass Davis-Bacon is depressing the wages of those who already are losing in our society.

Mr. SIMON. Then where, if we pass the repeal of Davis-Bacon, does it have its impact?

Mr. SIMON. If my colleague will yield for just a series of questions. If we repeal Davis-Bacon, does that, in any way, depress the wages of that top 20 percent that has already gone up 18 percent?

Mr. SIMON. If I may reclaim my time and respond to my friend from Rhode Island, who on most things is very rational and reasonable, he has strayed on this one. I remember way back when taking a course in logic at Dana College, a small liberal arts college in Nebraska, and one of the things you set up is a series. There is an animal that has four legs. A horse has four legs; therefore, that animal is a horse. Well, it turns out that animal is a cat and not a horse, but you start off with some premises that are not accurate. Do we want to have the free system? Yes, we want the free system. On that I agree with him. When he says the prevailing wage is the union wage, then the Senator from Rhode Island is off base. Only 11.8 percent of the nongovernmental employees in this Nation are union workers. The Senator from Massachusetts is here and I am sure will bear me out on this. Of the wages that are considered for prevailing wages, only--and if I may have the attention of my colleague from Rhode Island--of the wages that are considered for determining prevailing wages, only 29 percent are union workers. Of the rest, 48 percent are nonunion and then some mixed situations. What Davis-Bacon says is go in and find out what the average wage is in Jones County, RI, or whatever the county is in Illinois or Arizona and do not let the Federal Government be the source for depressing wages for the workers of our country. I think that is sound. That is what Davis-Bacon is all about. And then let businesses that pay the prevailing wage compete. Let the free market system work. Do not let it work by depressing people who are really struggling for a living. I hope we will do the sensible thing and not repeal Davis-Bacon. I see the presence of the senior Senator from Massachusetts, and I yield the floor, Mr. President.

Mr. SIMON. I would be pleased to. I am sure at the end of the discussion the Senator from Rhode Island will agree that we should not repeal Davis-Bacon.

Mr. SIMON. Mr. President, let me also digress for just a moment to say to the Presiding Officer, and to the Senator from Michigan, the only good thing about the Republicans taking over the Senate is Republicans have to preside and Democrats do not have to preside anymore. So I welcome the Republicans presiding up there. But again, I say to my friends from Rhode Island, Arizona, and Michigan, and elsewhere, the evidence is just overwhelming that all we are going to do is depress wages. We are not going to reduce costs in highway construction if we repeal Davis-Bacon. The statistics show that. I do not know why we should want to pass legislation that depresses wages for people in this country. You are talking about frequently very low-wage wages at the present time. Senator Kennedy had a chart yesterday showing Davis-Bacon wages for carpenters in Tennessee, $6 an hour. That is not high wages. Some of you spend that much per hour for a babysitter.

Mr. SIMON. Mr. President, I would point out to my colleagues, because I know Senator Warner is a chief architect of this, I have great respect for Senator Warner. If I were to give an award of courage for the last 2 years in the U.S. Senate to any single Senator, it would be an award of courage to Senator Warner for how he has conducted himself in a very difficult situation in the State of Virginia. I greatly respect what he has done. He has handled himself with class. But even the best of Senators can be wrong once in awhile. I believe Senator Warner has erred in moving to repeal Davis-Bacon, in terms of highway construction. It is interesting that the National Alliance for Fair Contracting has come up with highway construction costs in low- wage States versus high-wage States. Listen to this. Total costs per mile on highway construction--and I assume this is State and interstate highways rather than local roads--total cost per mile in the low-wage States, $1,141,000. Total costs of highway construction per mile in high-wage States, $1,017,000 per mile. The reason, in part anyway--and I have not looked at these statistics in detail. I do not know how they were arrived at. But one of the things that every study shows is that if you pay people well they are more productive workers. Davis-Bacon does not only apply to union workers, but the Harvard studies and others also show that union workers are more likely to be satisfied and more likely to be highly productive. My hope is that we would not repeal Davis-Bacon. I think the reality is that if you repeal Davis-Bacon you do depress the wages of people who are struggling, people who are in the middle class or people who are trying to move up to the middle class. When you see somebody out holding a flag because there is highway construction, that man or woman is not paid an awful lot of money; paid really probably above the minimum wage but not a great deal above the minimum wage. To depress that person's wage, which is what we would do if we pass this bill, I do not think is a direction the American people want us to go. We ought to be talking about lifting the wages of people. We ought to be talking about raising the minimum wage, not depressing wages. Yet, that is what we are really asked to do in the legislation that is before us. Does Davis-Bacon need to be modified? There is no question that it should be modified. I had an amendment that Senator Kennedy was a cosponsor of in the Labor and Human Resources Committee which applied to Davis-Bacon across the board, not simply to highway construction, which Senator Warner says is about 38 percent of the application of Davis-Bacon. It would raise the threshold for coverage from $2,000 to $100,000. It would raise the threshold for repair work or alteration compared to new construction to $50,000. The current act, which is sometimes called the Copeland Act, is an--incidentally, Congressman Bacon, who was a cosponsor of Davis-Bacon, was a Republican Member of the House--but the Copeland Act currently requires weekly submission of payroll by contractors. We change that. So we reduce paperwork. And on contracts between $50,000 and $100,000 they would not be required to submit payrolls at all, simply a statement that they are complying with the law. And for the contracts over $100,000, instead of submitting a weekly payroll, they could submit a monthly payroll. I think those kinds of changes are the changes that we need. I think they make sense. I hear reports that Senator Hatfield may be coming up with a modification, something like the one that I offered in committee, and I hope that he does. I hope that somehow we move to a more sensible answer than simply repealing the Davis-Bacon legislation. Again, I see nothing to be gained for the country in highway construction costs, and in terms of what we are doing for our country to lift our people by repealing Davis-Bacon. When people say, ``Well, if you pay less, should not we have to pay less for highways?'' The answer comes in productivity or it comes in profits. It is interesting to me. I was contacted as I walked into this body today by someone speaking in behalf of highway contractors who did not want to have Davis-Bacon repealed. I am not saying that he speaks in behalf of all highway contractors. But I was surprised to have someone contact me in behalf of highway contractors. Labor costs per mile, according to the study in low-wage States, $216,000; labor costs per mile in high-wage States--my colleagues from Michigan and Rhode Island will be interested in this--in high-wage States costs per mile of labor costs are $241,000. Let me just repeat that because I know my colleagues from Michigan and Rhode Island would be persuaded by what I have to say on this now. The study shows in low- wage States the labor costs per mile are $216,000, in high-wage States the labor costs per mile are $241,000, and yet the total cost per mile, wages, everything--$1.141 million in a low-wage State, $1.17 million in a high-wage State. (Mr. KYL assumed the chair)

Mr. SIMON. If I could just respond very briefly to my friend from Michigan. First of all, I think we have to be very careful. We go through this litany that higher taxes have caused depressed wages. Very interesting. As late as 1986, the average American industrial wage per hour was the highest in the world. Today, 13 nations have higher average wages per manufacturing hour than we do, and every one of them has higher taxes than we do. We have to be careful about these kinds of economic myths that are going on out there. Now, there are some reasons. Frankly, both political parties share some guilt. One is the deficit. We just had the Concord Coalition economic study that said if it were not for the deficit in the last two decades, the average family income today would be $15,000 a year higher. The University of Michigan economics professor made a study and said the average family income, if it were not for the deficit, would be 25 percent higher. I do not know whose figure is right, but they are huge figures. Both parties share the blame on this. The Reagan tax cut, as Howard Baker said, was a riverboat gamble. And it was a gamble that did not pay off. It was tragic. Democrats voted for it. I was not one of them. But Democrats voted for it, as well as Republicans. The 1986 tax bill, I think, has turned out to be a disaster. I am pleased to say I voted against that. Both parties share guilt on this. Part of this has nothing to do with either political party. That is just the economic trend. We demand more and more skills. Part of the reason for those changes are the unskilled, their wages are going down; the skilled, their wages are going up. That is the reason for Bob Reich's statement, ``If you are well prepared, technology is your friend; if you are not well prepared, technology is your enemy.'' There was, during the Reagan years, a Democratic Party, so both parties share blame. There was kind of euphoria because we were living on a credit card. It is fun living on a credit card. We spent more money than we took in. It went very, very well. Now, we have to face up to these things. That is why education, as part of that three-part program that Senator Wellstone is talking about, is so important. It all fits into this, because one of the trends in our country today is there is a shrinking middle class; not dramatic, but it is shrinking. There are few people moving up, and more people moving down. If we repeal Davis-Bacon, that trend will accelerate. That is not good for this country. What we need is to build the middle class. I intend to speak on that a little more later on. I think again we have to examine these economic statistics. Both parties have plenty of blame to share. We ought to be working together to try to rectify this. Mr. ABRAHAM addressed the Chair.

Mr. SIMON

Mr. SIMON. Mr. President, we have been without a Surgeon General now for 6 months. I was very pleased when Senator Dole mentioned he was going to meet with Dr. Foster. I hope that meeting can take place. I think the vote in our committee clearly illustrated there is a will on the part of this body to confirm Dr. Foster. I notice even those who voted against Dr. Foster had praise for his dedication and sincerity. I hope we can move soon on this Foster nomination. I think we have delayed enough. If he is going to be voted down, let us vote him down. But I think we will approve him. I think he should be approved. I think those of us who were on the committee who heard him testify were very impressed by what he had to say.

Mr. SIMON

Mr. SIMON. Mr. President, today marks the 19th anniversary of the Soweto massacre where more than 100 black South African students-- children--were killed while protesting against the tyranny of South African apartheid. These children are martyrs to the cause of freedom and justice. Their sacrifices, along with those of many others, contributed to a far brighter future in South Africa than could have been foreseen at that time. And so, June 16 has been designated by the Organization of African Unity as the ``Day of the African Child.'' On this day, we not only mark the past, but we should also commit ourselves to creating a brighter future for the children of Africa. Our commemoration of the children of Soweto should be solemn, as we reflect on the loss of far too many African children to conflict and war, to disease, to famine, and to the neglect of a world that often cares more about amassing material wealth than about ensuring the health and well-being of all of its children. An African child deserves no less than any other child born anywhere else in the world. They deserve to be cared for, to be protected, to have adequate food, shelter, and health care, to have safe drinking water, to be educated, and to live in a peaceful world. Yet, a child born in sub-Saharan Africa has a life expectancy 20 years shorter than a child born in an industrialized country. An African child is 8 times less likely to survive infancy and 10 times less likely to survive beyond 5 years old than a child in an industrialized country. The mother of an African child is 29 times more likely to die in childbirth than the mother of a child in the industrialized country. As many as 30 percent of African children suffer from malnutrition. Only 45 percent of Africans have access to safe drinking water. Thanks to U.S. assistance, there has been progress in reducing the under-5 mortality rate, increasing child immunizations and increasing life expectancy over the last 30 years. But clearly, there is much work to be done. As we commemorate the Day of the African Child let us also recognize the very positive affect that our foreign assistance has on improving the prospects for Africa's children to have healthy, productive lives--to have no less than what we would want for our own children. The theme of this year's observance is ``Children in Armed Conflict.'' War has a devasting affect on children. Prior to 1945, most of the victims of war were soldiers. In the 160 wars and conflicts since 1945, 80 percent of the dead and wounded have been civilians-- most of them women and children. The effect of armed conflict on African women and children has been particularly devastating. Ninety- two percent of the war-related deaths in Africa are women and children. In the Sudanese war, children die at 14 times the rate of government and guerrilla soldiers combined. Most often, in conflict zones children die as a result of the dispersal that leads to malnutrition and disease. Child mortality rates are highest in those countries that are ravaged by armed conflicts. As we observe the Day of the African Child let us also commit ourselves to playing whatever positive role we can through diplomacy, support for U.N. peacekeeping operations, or whatever measures appropriate to help resolve those conflicts that still remain on the African Continent. There has been great progress in ending conflicts on the African Continent over the last decade. Much more has to be done. I join today with the Organization of African Unity, the United Nations Children's Fund and all those who care about the health and well-being of all the world's children in recognizing June 16 as the Day of the African Child. I salute the U.S. Committee for UNICEF for its hard work in organizing today's celebration. Let us resolve to do all that we can to provide hope for Africa's children that they may have the kind of future that each of us wants for our own children. Mr. President, on the topic of aid to Africa, I would like to share with my colleagues a letter I received from a young lady, Miss Julie Haronik, from Moline, IL. Julie is 13 years old and she wrote to me asking that we maintain the Development Fund for Africa. I have received many letters supporting foreign aid to Africa over the last month. Julie's letter demonstrated how a child can sometimes be wiser, more caring, and more compassionate than many adults far older than herself. Among Julie's reasons for supporting aid to Africa, she says that, ``If you cut off aid some projects in Africa that have been started recently may fall apart without aid [before] they can sustain themselves.'' In the last paragraph of Julie's letter she writes: You may wonder why a thirteen year old would be concerned about Africa. One reason is that I want society to be on equal terms with all people when I am an adult. Another reason is that if America ever needed an African resource I would hope Africa would help us in our time of need. I also hope for world peace which can be achieved only through kindness, recognizing fellow humans, and helping those in need. I am so proud of this young lady both for her world outlook and compassion for others, and for her willingness to write and participate in public debate on the political issues of the day. Mr. President, I ask that the full text of the letter be printed in the Record. The letter follows: Moline, IL. Senator Paul Simon, U.S. Senate, Washington, DC. Dear Senator Simon: Although you may not realize it Africa has come a long way, with outside aid. If you cut off aid some projects in Africa that have been started recently may fall part without aid until they can sustain themselves. Africa still has a way to go, but it is a place of hope. Please don't cut off aid to the Development Fund for Africa! The United States of America has a duty to itself and the rest of the world. That duty is to help all people whether they can repay debts or not. One tenth of one percent of the budget is not very much money to give to those in need. Africa doesn't just take aid from people it has been its own resources, which are scarce. The government's duty is to make sure Africa does not lose all aid, but develop enough not to need it. You may wonder why a thirteen year old would be concerned about Africa. One reason is that I want society to be on equal terms with all people when I am an adult. Another reason is that if America ever needed African resources I would hope Africa would help us in our time of need. I also hope for world peace which can be achieved only through kindness, recognizing fellow humans, and helping those in need. Thank you for your time. Sincerely, Julie Haronik.

Mr. SIMON

Mr. SIMON. Mr. President, I have been handed a note by the staff. On behalf of Senator Kennedy, I ask unanimous consent that Ross Eisenbrey, a fellow on the staff of the Labor Committee, be granted floor privileges during the pendency of this matter.

Mr. SIMON

Mr. SIMON. Mr. President, we have a serious problem in health care. We have almost 41 million now who do not have health care coverage. As the Presiding Officer knows, because he has now been designated to lead the effort for the Republican Party, and he and I last year had some discussions about what kind of a practical compromise could be made. This is a compromise. I would love to have universal coverage for everyone. This is a practical compromise that says ``Let's protect pregnant women and children 6 and under.'' It provides affordable, comprehensive, quality private health care coverage for these groups. The health of America's mothers and children is simply unacceptable. The U.S. is No. 1 in wealth; we are 22d in infant mortality; we are 18th in maternal mortality. Mr. President, 24 percent of the children of our country live in poverty. No other Western industrialized nation has anything like these figures. Many developing countries have much more coverage in terms of immunization. Mongolia is a country I have had a chance to visit. Very few Americans visit Mongolia. It is really remote. Talk about developing nations that have problems, and yet they have a higher percentage of their children immunized than we do. Mr. President, 22 percent of pregnant women do not have prenatal care in the first trimester. Uninsured children of the United States today, 11.1 million, or 1 out of 6, and it is getting worse. What is going to happen, whether the Clinton bill passes in terms of the budget or the Republican budget passes--and obviously it is more likely to be the Republican budget--what if the distinguished junior Senator from Utah were a hospital administrator and the amount you get for coverage for Medicare and Medicaid goes down, what happens is you shift the burden to the nonMedicaid/nonMedicare patient and health insurance premiums go up? As health insurance premiums go up, the percentage of employers providing insurance will go down. The estimate is the year 2002, somewhere between 17 million and 20 million children will not be covered. Incidentally, I would love to have a bill that covers all children, covers 18 and under. But I know, realistically, that does not have a chance of passage. But if we were to say let us at least cover pregnant women and children 6 and under, of the 1.1 million net increase in uninsured persons from 1992 to 1993, 84 percent, 922,000, were children. That is the increase for children. That is the increase for adults. Obviously, we are talking about the future of our Nation when we talk about the children. Guiding principles of this act, the Healthy Mothers, Healthy Children Act? Coverage is independent of family income, employment, or health status. Everyone can get insurance. This is a single-tier health care system for everyone. Coverage is affordable for all families. We have some flexibility here. Health services are comprehensive. And we ensure quality. Eligibility? All children under the age of 7 and pregnant women; replaces Medicaid for those groups. The States save money and the Federal Government would save money. And it calls for a report on possible future expansion. Enrollment? There would be a national open enrollment month; plus, if you go to the hospital, if you go to a physician, if you are not enrolled, you can enroll at that point. It is administratively simple. Plans must accept any eligible person, no preexisting conditions. And within the State, you would have competition among the insurers so we keep the rates down. Cost sharing is part of it. Our friends in Canada say they made a great mistake in not having all people contribute something. There is overutilization of the system when you do not have everyone contributing something. So we have all families contributing. Families receive premium subsidies ranging from 99 percent to 5 percent, depending on income. And there is a cap because even a family of upper income, if you have a devastating kind of an illness--we just heard Senator Chafee talk about someone who had a $3 million medical bill. State flexibility and accountability--States and plans are given maximum flexibility; States develop and administer the program; States and Federal Government and health plans are accountable for meeting certain objectives. There is a matching rate. The Federal matching rate is more generous than Medicaid. The national average would be 80 percent. That means very substantial savings for Illinois, for Utah, and for the other States. The maximum matching rate would be 90 percent. Comprehensive health care services, and there are some limits here, let me just say, because--which I will outline in a minute. Preventive health, ambulatory care, laboratory services, prescription drugs, hospital, and in-home services, mental health services, dental and vision care--this is an example where there are limitations. We do not cover orthodontia services. We do not cover cosmetic surgery. There are obviously limitations that have to be here. Long-term health care for children with disabilities and chronic health conditions, durable medical equipment, allied health services. Here is the way it would work. A family of four at 250 percent of poverty, that is $37,000 with one child under 7, the mother is pregnant, the father works in a small business, with no dependent health care coverage, they would have the option to enroll into this plan. They would receive comprehensive coverage for the mother and the child--not for the father, not for any children over the age of 6. With their income, they would receive a 40 percent premium subsidy. In other words, they would have to pay 60 percent of the costs and they would pay a maximum, during the course of the year, of $1,830 per year. Then, if their costs exceed that $1,830, the Federal Government would pay. Here is a lower-income family, a family of four at 100 percent of poverty, $15,000 with two children under 7, a single parent who works part time and is covered by Medicaid. Both children are automatically enrolled. Everyone who is on Medicaid is automatically enrolled into the Healthy Mothers, Healthy Children Act. The parent remains in Medicaid also, but we do not cover that parent. The Medicaid Program continues as is for that parent. They would have a choice of provider, get quality services, and coordination of care improves. They would receive a 90-percent subsidy. In other words, if they have a problem, they would have to pay 10 percent, even a poor family. So we do not have overutilization. But they would pay a maximum of $80 per year. For a family that is on the poverty level or below, that is still a sizable amount of money but it is a restraining factor. But then the Federal Government picks the tab up after that. An upper-income family, a family of four, at 500 percent of poverty, $75,000, with two children under 7, one parent works for a large company and has a health plan through the employer but no coverage for preexisting conditions. They have the option of staying with the company plan or enrolling in this plan. They receive complete coverage, including preexisting conditions. They receive only a 5 percent premium subsidy. They would have to pay 95 percent. Obviously, at $75,000 a year, they can afford that. But they can pay a maximum of $6,000 per child for a year. So if you have a child who is a diabetic, who has a serious problem--if you have the kind of problem that Senator Chafee just mentioned, with somebody who had a $3 million expenditure--that would be covered. Financing sources? Medicaid funds, that we have right now. Here is the tough one. We increase the tax on a package of cigarettes by $1.50. There is no question that is going to be tough. Some of our colleagues are going to resist it strongly. I add, even if we were not providing any benefits for anybody, [[Page S8504]] we would have a healthier America if we increase the tax on cigarettes $1.50 per pack. Young people, particularly, like these pages--if I may pick on them here-- they are very price sensitive. That really would make a difference. The State has to match. They will not have to match as much as they have been. The States would save some money; some employers would save some money. The family has to contribute. I think that is proper. There would be savings from elimination and reduction of duplicative programs. In controlling costs, they are controlled by market competition. They have to bid within the State. Premium subsidies are based on the lowest-priced plan. Obviously, quality has to be there. The funding increases to States limited to the national rate of inflation. If, for example, in Utah you have a plan and it increases the cost 20 percent while the national average is 5 percent, we say to Utah: Sorry, you can only have a 5-percent increase. So there is that limitation. Specific options for reducing program costs to ensure financial integrity of the program. Then, finally, a quote from this radical by the name of Herbert Hoover. Herbert Hoover said: The greatness of any nation, its freedom from poverty and crime, its aspirations and ideals are the direct quotient of the care of its children. There should be no child in America that is not born and does not live under sound conditions of health. That is not the case today. We ought to make Herbert Hoover's dream for America a reality. So I have this bill. I think it is appropriate that the two Members on the Republican side who are here right now are Senator Bennett and Senator Chafee. Senator Chafee provided excellent leadership last session. We were not able to put the package together. Senator Bennett now has that mantle on the Republican side. We ought to do something. My proposal is let us provide coverage for pregnant women and children 6 and under. That would be a great initial step for the future of our country, and would protect 11 million children in our country today. I hope we take a look at this. At some point, whether the Finance Committee approves this idea or not, I am going to offer it as an amendment on the floor so we get a vote on it. My instinct is you have to be pretty hardhearted to vote against coverage for pregnant women and children 6 and under. I think this might be politically acceptable. I certainly know the American people would favor it. So I am introducing this bill today. I hope we will consider it. I commend it to my colleagues who have done more work in the health care field on the other side of the aisle than any others--Senator Chafee and Senator Bennett. The purpose of this act is to ensure that affordable, comprehensive, high quality private health care coverage is available through State- based programs for all children, initially for those under seven, and for all uninsured pregnant women. Mr. President, friends, yesterday was Flag Day. A day for all Americans to reflect upon our country, where we've been and where we are heading. When I think about the future of this country, I realize that the future is already here--in our children. What should be our national direction? Let me share with you my vision for our children. I suggest that we move towards a society where every child at least has adequate health care, receives a good education, lives in a caring family, and grows up in a safe community. the poor health of america's mothers and children How are we doing in fulfilling that vision? My friends, I have to tell you that we as a country are failing to properly care for our children. We are the wealthiest Nation in the world. But if our wealth was measured by the health status of mothers and children, we fall well behind the other major industrialized nations. Despite the highest per capita spending on health care of any country, we currently rank 22d in infant mortality and 18th in maternal mortality. Approximately 24 percent of all our children live in poverty. Many developing countries including Albania, Malawi, Mongolia, and Turkmenistan, have higher childhood immunization rates than we do. In addition, approximately 22 percent of mothers did not receive prenatal care in the first trimester. We can do better. lack of health insurance among children and pregnant women is increasing What about health care coverage? Unfortunately, the lack of insurance among children and pregnant women is unacceptable and is getting worse. A recent report by the Employee Benefit Research Institute shows that between 1992 and 1993, the number of uninsured people increased by 1.1 million or 17.8 percent to 40.9 million. The most alarming finding is that children accounted for the largest proportion of the net increase in the number of the uninsured: Of the 1.1 million net increase between 1992 and 1993, 922,500 or 84 percent, were children under 18. In 1993, 11.1 million or one of every six children did not have health insurance or publicly-financed health care, up from 10.2 million or 15 percent in 1992. Despite recent expansions in Medicaid, 22 percent of all poor children were uninsured, and approximately 500,000 pregnant women did not have health insurance in 1992. In addition, if this Congress significantly reduces the Medicaid budget as proposed under the current Senate and House budget resolutions, it is estimated that between five and seven million children in addition to the 12.6 million children already projected to be uninsured under the current health care system, will not have health coverage by the year 2002. It is important to note that lack of health insurance is not solely a problem of poverty. A large proportion of children in middle class families are uninsured. For example, among children in families with incomes between 100 and 199 percent of poverty, 25 percent are uninsured. And among children in families with incomes between 200 and 399 percent of poverty, 12 percent lack insurance. My friends, we can do better. We must do better. investing in the health of mothers and children Given the state of the Federal deficit, some of you may question whether the Government should be expanding health coverage for children. You may ask, ``Is this a proper role for government?'' I think the words of Abraham Lincoln are helpful. He said: ``The legitimate object of government, is to do for a community of people, whatever they need to have done, but cannot do, at all, or cannot, so well do, for themselves--in their separate, and individual capacities.'' Children do not have the capacity to ensure their health. Yes, families have primary responsibility for ensuring that their children receive medically necessary care. The Government's role is to ensure that health coverage is accessible and affordable for all. It is clear that the private sector has been unable to accomplish this goal. There are more reasons why we should invest in our children's health. Investing in health services for children substantially increases their potential to be productive members of society and averts more serious or more expensive conditions later in life. Similarly, ensuring that all pregnant women receive adequate prenatal care is cost saving to society. Ensuring coverage for children is also relatively inexpensive: In 1993, the Medicaid program spent an average of $1,012 per child compared to $8,220 per elderly adult. Therefore, if the question to me is ``Can we afford to invest in the health of our children?,'' I reply by asking you, ``How can we afford not to?'' guiding principles for the healthy mothers, healthy children act In developing the Healthy Mothers, Healthy Children Act, I considered 10 fundamental guiding principles that I believe should be the basis for any national health care program for children and pregnant women. They are: First, coverage is independent of family income, employment, or health status; Second, there is a single-tier health care system; Third, coverage is affordable for all families; Fourth, health services are comprehensive; Fifth, ensuring quality is a primary goal; [[Page S8505]] Sixth, everyone shares responsibility for mothers and children; Seventh, health, not just health care, is emphasized; Eighth, States and health plans have maximum flexibility and accountability; Ninth, administrative costs and complexity are minimized; and Tenth, program costs and fraud and abuse are controlled. summary of the healthy mothers, healthy children act Let me summarize the legislation I am introducing: A national trust fund is established to support state-based programs that involve private health plans. Participation is voluntary for states, health plans, and families. All children under age seven are eligible, regardless of family income, employment, or insurance status. Pregnant women without employer-based coverage are eligible. Medicaid-eligible children and pregnant women are brought into the program to enhance their choice of providers and to avert a multi-tier health care system. There is no impact on the Medicaid program for nonparticipating States for noneligible children seven years of age and older. Every 2 years, if sufficient funds are available and the public is supportive of the program, the Secretary will increase eligibility to older children on a national basis. A State that has achieved universal coverage for children under seven in their State can extend coverage to older children before such children are eligible on a national basis. In my legislation, children are enrolled during a national open enrollment period. States ensure that the enrollment process is simple and is not a barrier to care. Participating plans must accept any eligible person who wishes to enroll and cannot deny coverage for pre- existing conditions or any other reason. All families contribute according to their ability to pay and receive a premium subsidy, ranging from 99 percent to 5 percent, based on a sliding scale of income. There is a cap on annual family medical expenses and a required $5 copayment for most services, except for preventive services. The legislation is based on a management by objectives approach: States and health plans are given maximum flexibility to determine how they will meet program objectives, but are also fully accountable for results. States develop and administer the program, and are evaluated on an annual basis regarding their progress in achieving program objectives. State funds are matched by Federal funds at a rate based on the State per capita income that is more generous than the State's current Medicaid matching rate. The average Federal matching rate for all States is 80 percent with a maximum matching rate of 90 percent. Health services in the Healthy Mothers, Healthy Children Act are provided by private health plans. States certify health plans and negotiate premium rates with all interested plans. Participating plans compete to deliver the highest quality care at the lowest price. There are a series of standards to prevent adverse selection and discrimination, ensure access to primary and specialty care, and ensure that all participating plans compete on a ``level playing field.'' The program encourages innovation by existing plans and formation of new health plans. All participating health plans must provide a comprehensive package of services. The services will be specified by the Secretary and health professional groups. In general, services include: preventive health, ambulatory care, laboratory services, prescription drugs, hospital and in-home services, mental health services, dental and vision care, long- term health care for children with disabilities and chronic health conditions, durable medical equipment, and allied health services. Because I believe that we must emphasize quality and accountability, the bill includes a series of standards to ensure quality at the health plan, State, and Federal levels. National guidelines for quality assessment and improvement, utilization review, and other programs are developed in consultation with private health plans and other nongovernmental organizations. All participating States must have a program for preventing, monitoring, and controlling fraud and abuse. As a check and balance, nongovernment advisory council provides program oversight and advises the Secretary on program administration and modifications. A national maternal and child health information system and a national childhood immunization database are established to monitor program quality and to increase childhood immunization rates. How would employers be affected by this bill? Experience from the last Congress demonstrates that the issue of the role of employers in health care reform is extremely difficult to resolve. I propose that employers who drop coverage of employee-dependent children as a result of this Act must pay a temporary (5-year) annual maintenance of effort fee equivalent to 50 percent of health coverage costs for their employees' children. To discourage dropping of coverage, families whose coverage is dropped by their employers are not eligible for the program for 6 months. In my legislation, there is a strong emphasis on prevention. Up to 5 percent of trust monies can be used to fund activities by States and nonprofit organizations to improve the health of mothers and children. Eligible activities include: supporting school-based clinics, increasing the use of telecommunications and computer technology to increase health care access, supporting biomedical and health-related research, enhancing core public health functions, and supporting health promotion and disease prevention activities. To minimize duplicative programs, existing Federal and State maternal and child health programs are integrated and coordinated under the bill. Controlling health care costs is crucial. Therefore, I have several mechanisms designed to control costs in the program. Costs are controlled by market competition and delivery of care primarily through management care plans. Because premium subsidies for families are based on the lowest priced plan in an area, plans have an incentive to control costs. Because annual funding increases to the States are limited to the average increase in medical care costs for children and pregnant women on a national basis, states have an incentive to control program costs. There are also mechanisms in the bill that allow the Secretary to reduce program costs or request additional funds as necessary to ensure the financial integrity of the program. I am asking the Congressional Budget Office to score the bill. How will we pay for the program? Funding sources for my legislation include shifting of Federal Medicaid funds for targeted groups, increase in Federal excise taxes on cigarettes of $1.50/pack, state matching funds, partial premiums from families, savings from elimination/reduction of duplicative Federal and State programs, and charitable contributions. Perhaps I can best summarize my legislation by illustrating how it affects different families. First, let's take the example of a middle class family of four at 250 percent of poverty with one child under seven, a pregnant mother, and a father who works in a small business that does not offer dependent coverage. In this situation, the mother and child may be enrolled into the Healthy Mothers, Healthy Children Program. They would receive comprehensive health care coverage and 40 percent of the cost would be subsidized. The family would pay a maximum of $1,830 per year for total medical expenses for the mother and child. Now let's look at a lower income, single parent family at 100 percent of poverty with two children under 7, the parent works part time and the family is covered by Medicaid. In this case, the children would be automatically enrolled into the Healthy Mother, Healthy Children program. Under this program, the choice of provider, quality of care, and coordination of care would improve. Ninety percent of the cost of the coverage would be subsidized, and the family would pay a maximum of $80 per year for total medical expenses for both children. Finally, what about higher income families? Let's consider a family at 500 percent of poverty with two children under 7, one parent works in a large company that provides family coverage but does not cover the children's preexisting conditions. This family may [[Page S8506]] elect to stay with their coverage or enroll their children into the Healthy Mothers, healthy Children program. The children would receive comprehensive health coverage including for pre-existing conditions. The family would also receive a 5 percent premium subsidy, and pay a maximum of $6,000 per year for total medical expenses for the mother and child. toward a healthy future for our nation Mr. President, I am introducing this bill today as a starting point for discussions towards a bipartisan bill to ensure that the most vulnerable members of our society have a chance to lead productive lives regardless of the circumstances of their birth. I urge all of my colleagues who are concerned with our Nation's future to join me and further develop my proposal. As Congress revisits health care reform this year, it is likely that we will agree to at least provide for portability of coverage for employed individuals and limit exclusions for pre-existing conditions. These insurance reforms will improve access for some, but such reforms unfortunately fall far short of what we should and can do to expand coverage for children and pregnant women. We can do better. There is a health care crisis in this country. Should we accept a society where children in many neighborhoods have better access to drug and handguns than to doctors? A society that ensures health care for all prisoners but does not extend that guarantee to all children? I recognize that health care reform is complex. We must move cautiously and incrementally. A sensible approach is to start by at least ensuring that every child under seven and all uninsured pregnant women have affordable, comprehensive, high quality health care coverage. In accepting the Republican nomination for President in 1928, Herbert Hoover said ``* * * the greatness of any nation, its freedom from poverty and crime, its aspirations and ideals are the direct quotient of the care of its children.'' And that ``* * * there should be no child in America that is not born and does not live under sound conditions of health * * *'' Sixty-seven years later, we are the only developed Nation that does not ensure that all children and pregnant women have health coverage as part of national maternal and child health policy. I know we can do better. There is a saying that children will treat us as they have been treated. I urge that we, our society, start treating them well. Mr. President, I ask unanimous consent that a summary of the bill be printed in the Record.

Mr. SIMON

Mr. SIMON. Mr. President, I call up my amendment No. 1283.

Mr. SIMON. Mr. President, I ask unanimous consent to speak as if morning business for 2 minutes.

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

Mr. SIMON

Mr. SIMON. The ceiling would go, as I recall, to $100,000. I will have the full information on this tomorrow. We offered this in committee. We checked this out with a number of contractors. We think the proposal that we have makes a great deal of sense. I will have a chance to discuss that tomorrow.

Mr. SIMON. Mr. President, I would like to deal with this tomorrow. I would say to the Senator from Rhode Island that what we do is raise the ceiling. We also deal with the problems that contractors say they have with Davis-Bacon. I think it is a practical bill that answers the fundamental problems.

Mr. SIMON

Mr. SIMON. Mr. President, if I may have the attention of my colleagues, the present FCC rule says one entity can own 20 AM stations and 20 FM stations, or a total of 40. Right now, the maximum owned by any one entity is 27. This bill takes the cap off completely. My amendment says we will put a cap of 50 AM, 50 FM, a 150-percent increase, but do not take the cap off completely. We should not concentrate media ownership in this country. It is not a healthy thing for the future of our country. I hope Members will resist the motion to table my amendment.

Mr. SIMON. Mr. President, parliamentary inquiry. My understanding is that before these next two amendments are voted on, the supporters get 1 minute, and the opposition gets 1 minute to explain.

Mr. SIMON. Mr. President, if no one wishes the floor, I question the presence of a quorum.

Mr. SIMON. I would like to just speak very briefly on an amendment that I have in. The present practice of the FCC is to limit radio station ownership by any one entity to 20 AM and 20 FM stations. The most any one entity now has is 27 total. The bill, without my amendment, takes the cap off completely. My amendment says let us put a cap of 50 AM, 50 FM, far more than we have now by any one entity. It is a 150-percent increase. But let us not move to the day when we have too much concentration of the media. I think that is not a healthy thing. One of my colleagues speaking against my amendment says this is what is happening in the newspaper business. It is. It is not healthy in the newspaper business. But we do not have any control over that. We do have control through Federal licensing of radio stations and television. My amendment goes further than some people would want. I say let us increase that 40 limit now to 100. But let us not let anyone who wants control of the radio stations of this Nation to have unlimited ability to get those radio stations. I hope my amendment will be approved.

Mr. SIMON. Mr. President, I take 3 minutes of my time on my amendment. I first want to comment on what Senator Byrd just had to say. I think in general we can say there are rare occasions when we take too much time on a bill. There are too many occasions when we take too little time on a bill, as far as legislative process. Amendment No. 1283, as Modified

Mr. SIMON. Does the Senator want to speak on this amendment?

Mr. SIMON. I yield 5 minutes to the Senator from North Dakota [Mr. Dorgan].

Mr. SIMON

Mr. SIMON. Mr. President, I just learned talking to the pages they are going to be leaving tomorrow. One of the things that we do around here is we [[Page S8424]] do not thank people enough. And the pages have just been terrific. We are very proud of you, and I am sure some of you are going to be Senators someday in the future. But it is not only the pages. It is the people who take the Record; it is the people at the front desk who tolerate us when we come up and say, ``How did Coats vote on this? How did Pressler vote on this?'' It is the people who are waiters and waitresses downstairs--all of the people, the people who watch the doors. I am going to get back in good graces with someone here--it is the people who write out our amendments. It is the people who provide the thousand-and-one little services that we just neglect to thank people for. So I just wanted to get up and say we thank everyone, and wish the pages the very best. They are a fine group of young people with a bright future. We wish them the very best. Mr. President, I see the Senator from Montana on the floor. He may wish the floor at this point. I yield the floor.