Olympia Snowe

Ms. SNOWE

Ms. SNOWE. I thank the Senator. It does obviously represent the legislation that I introduced on this issue. I appreciate the Senator's forceful advocacy. Obviously, the issue is concerning scope at this point in time. I might agree with him on what he is attempting to do, but obviously there is a big difference in our legislative approaches with respect to scope. There are differences. Perhaps that ultimately can be worked out on the whole issue of clinical trials, and I hope it is. I believe it is that important. We were left in the position, given the scenario that has been developed on both sides, because I think this is so important, of having to offer it at this point in time or I lost the opportunity. We think it is important to add this language to the Republican substitute. We lost an opportunity yesterday, to be honest with you, with the amendment that was offered to the Democrat's plan. We are left in this parliamentary process at this point in time.

Ms. SNOWE. Mr. President, I thank Senator Jeffords for his comment and for yielding time. I want to clarify a few points that were made earlier because I do think it is important it does not get lost in the debate. The amendment I am offering is not the amendment that was offered yesterday. The language is not identical. I thought I had made that abundantly clear. It is different from the D'Amato-Feinstein-Snowe legislation passed in the last Congress. It is different from the Snowe-Feinstein legislation offered in this Congress. It is different from the Feinstein-Snowe legislation because medical necessity is not defined, and that is the issue. Secondly, the Robb amendment did not have a second opinion for cancer patients. That is included in this legislation. This amendment is offered to the Republican legislation; that is, the substitute that was offered by the minority leader. That is the process that has been developed on a bipartisan basis and on unanimous agreement. The Republican substitute does not have this language. The option was to offer this amendment at this point in time. I should also make it clear the amendment that was offered yesterday by the Senator from Virginia was restated in the language that was already included in the Democratic legislation. So it is just restating a fact. We are in a position to offer this legislation to the Republican substitute, language that has not been included in the Republican substitute. This is the process that has been agreed to. Therefore, that is why this amendment is being offered at this time. I had hoped we could have worked on it yesterday, but the Robb amendment was offered to the Democratic plan yesterday, and that was a second-degree amendment. We had no ability to perfect that amendment.

Ms. SNOWE. Mr. President, I have an amendment at the desk.

Ms. SNOWE. Do I still have the time?

Ms. SNOWE. I appreciate and applaud the leadership of Senator Dodd on clinical trials, and I wholeheartedly agree----

Ms. SNOWE. Thank you. I thank Senator Frist for his leadership on obviously what is a very challenging and very difficult issue. I think even in spite of the debate that has occurred on some of these issues where there may be apparent differences on how to approach this problem, there is no disagreement on the fact that we need to bring much needed reform to the managed care system in America today. Mr. President, I rise today to submit an amendment to the Patients' Bill of Rights that will ensure that appropriate medical care--not a bureaucrat's bottom line--will dictate how long a woman stays in the hospital after undergoing a mastectomy. This amendment that I am introducing, along with my colleague from Michigan, Senator Abraham, and Senators Fitzgerald, Crapo, Collins, Jeffords, and Hutchison, is based on bipartisan legislation that I was pleased to introduce at the beginning of this year with bipartisan cosponsors. I have been in Congress for 20 years--10 of those years in the House when I served as cochairman of the Congressional Caucus on Women, which addressed issues that affected women and families in America on a bipartisan basis. Throughout that time, I fought long and hard to advance women's health issues, women's health research, and protection for patients who are facing life-threatening diagnoses of breast cancer. I feel justified in saying that I come to this debate not only with strong feelings about the issue but with a long history of involvement and close familiarity with the problem. It is in that light, I believe, that the amendment I am submitting today, along with Senator Abraham and my other colleagues, is the most effective approach to address the issue of those individuals who are faced with breast cancer. Our amendment is straightforward. First, it says that the inpatient coverage with respect to the treatment of a mastectomy, regardless of whether the patient's plan is regulated by ERISA or State regulations-- in other words, all plans will be provided for a period of time--will be determined by the attending physician in consultation with the patient as medically necessary and appropriate. Second, it allows any person facing a cancer diagnosis of any type to get a second opinion on their course of treatment. Imagine having a life-threatening disease and not having access to the best possible advice. A diagnosis of breast cancer is something that every woman dreads. But for an estimated 175,000 American women, this is certainly the fear that they have to realize. The fact is that one in nine women will develop this terrible disease during their lifetime, and for women between the ages of 35 and 54, there is no other disease which claims more lives. So it is not hard to understand why the words, ``You have breast cancer,'' are some of the most frightening words in the English language, because for the woman who hears them, everything changes from that moment. No wonder the diagnosis is not only accompanied by fear but also by uncertainty: What will become of me? What will they have to do to me? What will I have to endure? What is the next step? For many women, the answer to that question is mastectomy or lumpectomy. Despite the medical and scientific advances made, despite advances in early detection technology, and more and more often the need for radical surgery, it still remains a fact of life that at the end of the 20th century these procedures can be the most prudent options in attacking and eradicating cancer found in a woman's breast. These are the kinds of decisions that come with the breast cancer diagnosis. These are the kinds of questions women must answer. And they must endure some of the most difficult and stressful circumstances imaginable. The last question a woman should have to worry about at a time like this is whether or not her health insurance plan will pay for appropriate care after a mastectomy. A woman diagnosed with breast cancer in many ways already feels she has lost control of her life. She should not feel as though she has also lost control of her own treatment. All too often that is exactly what happens. Imagine a patient who just had one or both of her breasts removed in the wake of a cancer diagnosis, and she agrees in consultation with her physician that it would be best if she stayed in the hospital for another day or so. Maybe it is because she still needs to learn how to take care of herself. Maybe there are concerns about the possible complications, like infections or uncontrolled bleeding. Let's remember that this is a very complicated surgical procedure we are talking about. What other reason is the decision based on than medical advice from doctors who are likely involved with hundreds of thousands of these kinds of operations? Yet in many instances, because of the decisions made by accountants and insurance actuaries--none of whom have ever witnessed such operations, let alone go to medical school--that same woman cannot afford to follow her doctor's advice. She is not covered by her plan because whoever wrote her plan already decided that she didn't need inpatient care. Instead, that charge for that extra day in the hospital will come out of her own pocket, and unless it is an awfully deep pocket, she is just as likely to take her chances at home. That is just plain unacceptable. If we are talking about patients' rights, I can't think of a more appropriate place to start than right here. That is why I appreciate that my Democratic colleagues raised this vital issue. As I have said, no one is more concerned about this issue than I am. I looked carefully at the amendment and watched the debate very closely. But when all was said and done on this issue, and despite the good intentions of the amendment, I could not support the amendment that was offered yesterday by our colleague, Senator Robb. Let me tell you why. The Robb amendment relied on the phrase ``generally accepted" medical standard to instruct insurance companies as to what constitutes a ``medical necessity'' that requires coverage. What exactly does that mean, ``generally accepted'' medical standard? That is a good question. The fact is that we are not exactly sure what it means. In fact, the problem is that it means different things in different places. Moreover, there has never been a consensus concerning the definition of ``medical necessity,'' though it has not been for lack of trying. The most recent Federal attempt, as a matter of fact, was in 1993 when the Clinton health care working group tried and failed. But they didn't give up. Instead, they decided to leave the definition of this crucial term not to physicians and their patients but to a national administrative board. Perhaps that working group would have been better served if they looked to 1989 when Medicare tried to define ``medical necessity'' and Medicare failed. Medicare failed. Why did it fail? Because terms like ``medical necessity'' and ``appropriateness'' cannot be defined for an entire nation, and they certainly can't be defined by Congress. The standards change with time, they change with individual patients, they change depending on the illness or disease, and they should change because medicine is marching forward. Likewise, trying to define ``generally accepted medical standard'' is like hitting a moving target, and a low target at that. ``Generally accepted medical practices'' will vary tremendously among communities, hospitals, and even among doctors. Just look at the chart behind me that was used yesterday by my colleague, Senator Frist. It is a good chart because I think it illustrates the point on the very treatment prescribed for breast cancer patients. In some cases they use ``lumpectomy'' more sparingly than they do ``mastectomy.'' It obviously varies across regions and States. Looking at the percentages using lumpectomy versus mastectomy treatments, very few were performed in South Dakota; but in the Northeast, including parts of New York, there is a higher degree of the use of lumpectomy versus mastectomy. Obviously, the treatment varies. Obviously, the treatment is complicated. It is a very complicated treatment and set of options for a woman facing a mastectomy. As the chart shows, in the United States of America, the treatments vary all across the land. We cannot prescribe the status quo; we cannot prescribe uniformity. We have to allow the doctors and patients to have the latitude to determine what is best for the individual patient. We hear over and over again that the patient has choices. Let the patient have choices. This is allowing the patient to have choices as to what is in her best interest. This chart illustrates very graphically the differences and the variations across the country in mastectomy and lumpectomy surgeries. What is generally accepted in one area is not generally accepted or performed in another area. That is the way it should be. Should we be telling a woman who can be treated with a smaller, less invasive and less traumatic lumpectomy, Sorry, in your community, the generally accepted medical standard is a mastectomy? Of course not. And the reverse is true. Should a woman have a mastectomy without knowing that she can have a lumpectomy first, to determine whether or not it is necessary to go to the more invasive surgery? How can we say what is generally acceptable for a 31-year-old athlete in Oregon is generally acceptable for a 78-year-old grandmother in Maine? The phrase ``generally accepted medical standard,'' far from representing the cutting edge of medicine, is nothing more than the medical community status quo, a status quo that simply cannot keep up with the pace of medical science and new technologies. What we are talking about in this amendment is offering the best practice, the best standards, the best quality care. Think how far we have come in the past decade. Mastectomies were once virtually the only option. Today, we have a whole host of alternatives available, depending on the woman's circumstance. If a mastectomy is a generally accepted medical standard, there are other options a woman may be missing out on in making her decision. The web site of NIH shows a variety of options available to a woman to determine for herself, with her doctors, what is best, depending on the progress of her cancer. She could have a lumpectomy; she could have a segmental mastectomy, a modified radical mastectomy, or, if necessary, even a radical mastectomy. The fact is, hardly a day passes when we don't hear of a promising new treatment or a research breakthrough. Parties need to be able to take advantage of these advancements now. They can't wait for generally accepted medical standards to catch up with the times. Under this amendment, they will not have to. In contrast, my amendment dictates coverage in terms of medical standards. If a doctor and a patient agree on a course of treatment of care and an insurance plan refuses to allow that treatment, the patient has a right to appeal to an independent medical expert in that field of medicine. In turn, that expert can take into account all pertinent information in determining what is medically necessary and appropriate based on the relevant scientific and clinical evidence. That includes evidence offered by the patient and her doctor, expert consensus of peer review literature. Not only does this put the patient first, but it also ensures we are not lowering the bar of coverage by handcuffing the physicians in their ability to employ the best strategy, the latest medical technology, with respect to their specific patient. If anything, this amendment raises the bar precisely because the ultimate decisions will be driven by physicians and patients, not lawyers and regulators. Let me add another point. I heard over and over again that the language offered in the amendment yesterday was the language offered in my bill and the bill offered by Senator D'Amato in the last Congress. Let me state for the record, the D'Amato-Feinstein-Snowe legislation offered in the last Congress was legislation that said it was medically appropriate--medically appropriate. It did not use the definition of generally acceptable medical standards and practices. The legislation offered by myself and Senator Feinstein uses the word ``medically appropriate.'' The point I am making is, all of the bills that have been addressed in recent years on the issue of breast cancer treatment and whether or not the length of stay is to be determined by the doctor and patient have been using the words ``medically necessary,'' ``medically appropriate,'' not defining ``medical necessity.'' This would be the first time we are dealing with a definition of ``medical necessity'' which heretofore has not been practiced by Medicare, by the President's health care group, when developing a health care plan, not by CHAMPUS, not by the VA, not by Medicaid, not by legislation introduced on a bipartisan basis over the last few years. Finally, my amendment will also include the ability to provide full coverage for secondary consultations with a specialist whenever any type of cancer has been diagnosed or a treatment recommended. Imagine being given a life-threatening diagnosis and not being able to get another doctor's opinion. Patients cannot afford to forgo second opinions when it comes to cancer of any kind--from lung cancer, to leukemia, to breast cancer, to prostate cancer. Under this amendment, they will not have to. That is important because we all know, when it comes to cancer, time is of the essence and making the right decision in terms of treatment is paramount. So often there are no second chances when it comes to taking the best course of action. Our amendment will allow the possibility of having that second opinion and making sure people are getting the right treatment so we can reduce senseless deaths resulting from false diagnosis, empowering individuals to seek the most appropriate treatment available. The evidence for the need of this amendment is especially important when it comes to the so-called drive-through mastectomies. It is more than just allegorical, more than symbolism. We have heard time and time again antecdotal evidence that speaks for itself. Between 1986 and 1995, the average length of stay for mastectomies dropped from about 6 days to 2 to 3 days. Thousands of women across the country undergo radical mastectomies on an outpatient basis and are being forced out of hospitals before they or their doctors think is reasonable or prudent. I recall the story of one woman from the State of Washington named Linda Schrier. Linda was a registered nurse who worked in the postoperative recovery room for 18 years before she underwent a mastectomy. Linda was doing well after the operation. The pain was under control. She opted to go home instead of staying overnight. Today, she believes that was a big mistake. When Linda woke up at home the next day without the benefit of the IV pain medication she had in the hospital, she was in excrutiating pain. She also had tremendous difficulty caring for her wound. Keep in mind, this is someone who worked in the medical profession. Today, she feels, very strongly, based on her own experience as a nurse and as a patient, that no one should go home the day of their mastectomy. She also believes that no insurance company should tell a woman how long her hospital stay should be. It should be up to a woman and her doctor. I could not agree more. I know we all could not agree more. This decision must be returned to physicians and their patients. All Americans who face the possibility of a cancer diagnosis must be able to make informed decisions about the appropriate and necessary medical care. As we debate the Patients' Bill of Rights this week, let us not forget the women and men across the country who are battling cancer. Let's do the right thing for all of them. I yield back my time.

Ms. SNOWE. Mr. President, I ask unanimous consent that reading of the amendment be dispensed with.

Ms. SNOWE

Ms. SNOWE. Mr. President, I rise today to express my sincere appreciation to my colleagues for joining me in honoring the more than two million veterans of the Veterans of Foreign Wars, VFW, of the United States as we pass legislation I introduced earlier this year, S.J. Res. 21, to designate September 29, 1999, as Veterans of Foreign Wars of the United States Day. September 29, 1999 marks the centennial of the VFW. As veterans of the Spanish American War and the Philippine Insurrection of 1899 and the China Relief Expedition of 1900 returned home, they drew together in order to preserve the ties of comradeship forged in service to their country. They began by forming local groups to secure rights and benefits for the service they rendered to our country. In Columbus, OH, veterans founded the American Veterans of Foreign Service. In Denver, Colorado, veterans started the Colorado Society of the Army of the Philippines. In 1901, the Philippine War Veterans organization was started by the Philippine Veterans in Altoona and Pittsburgh, Pennsylvania. In 1913, these varied organizations with a common mission joined forces as the Veterans of Foreign Wars of the United States. I am honored to salute this proud organization. Mr. President, when many of us think about war veterans, we think about the tremendous sacrifices these defenders of freedom made to safeguard the democracy we cherish, especially those who made the ultimate sacrifice. S.J. Res. 21 recognizes those contributions and sacrifices. It also recognizes the contributions that VFW members continue to make day-in and day-out in our communities--the youth activities and scholarships programs, the Special Olympics, homeless assistance initiatives, efforts to reach out to fellow veterans in need, and national leadership on issues of importance to veterans and all Americans. Over the last 100 years, members of the VFW have contributed greatly to our nation both in and out of uniform in ways too numerous to enumerate. I have nothing but the utmost respect for those who have served their country. With this legislation, we honor the men and women and their families who have served this country with courage, honor and distinction. They answered the call to duty when their country needed them, and this is but a small token of our appreciation. The centennial of the founding of the VFW will present all Americans with an opportunity to honor and pay tribute to the more than two million active members of the VFW and to all veterans, as well as to the ideals for which many made the ultimate sacrifice. I thank my colleagues for joining me in a strong show of support and an expression of thanks to the VFW and all veterans. Mr. President, I yield the floor.

Ms. SNOWE

Ms. SNOWE. Mr. President, I rise today with my colleague, Senator Ted Kennedy, to introduce legislation that will play a critical role in the advancement of education as we prepare for the demands of the 21st Century. Specifically, the ``Educating America's Girls Act of 1999'' will ensure that our nation's children--and young women in particular-- will be prepared for the job market of the coming millenium, while also ensuring that the unique needs of girls are properly addressed in our nation's schools and classrooms. Given the critical role of education in preparing our children for the future, it is understandable that there is heightened interest in ensuring that the highest academic standards and best practices are incorporated in our nation's schools and classrooms. As Congress undertakes the reauthorization of the Elementary and Secondary Education Act (ESEA) of 1965, the provisions of the ``Educating America's Girls Act'' will ensure that the varying educational needs of all students, and young girls in particular, are recognized and addressed--and ultimately ensure that our efforts to reform and improve education are realized. Mr. President, due to the changes adopted in 1994, gender equity is a major theme throughout the ESEA. Specifically, the needs of girls are addressed in current law by requiring professional development activities to meet the needs of diverse students, including girls; encouraging professional development and recruitment activities to increase the numbers of women math and science teachers; including sexual harassment and abuse as a focus of the Safe and Drug-Free Schools Act; broadening dropout prevention activities to address the needs of pregnant and parenting teens; and reauthorizing the Women's Educational Equity Act (WEEA), which funds research and programs to achieve educational equity for women. During the ESEA reauthorization process, we should not only work to maintain the important gender equity provisions that were included in the 1994 law, but also to prepare girls for the future by adding the following provisions: ensure education technology programs are targeted in a manner that addresses the unique needs of all students, including girls; provide schools with resources to combat sexual harassment and abuse; collect data on high school athletic participation by girls; keep pregnant and parenting teens in school; and reauthorize WEEA. Accordingly, the ``Educating America's Girls Act'' contains provisions that will address all of these needs, so I urge that my colleagues support this legislation and these additions during the upcoming reauthorization of the ESEA. Mr. President, with the growing demand for technological skills in the workplace--including six out of 10 jobs requiring technological skills--the need to incorporate technology in the classroom cannot be understated. Accordingly, the utilization of education technology in the classroom is an arena in which we must ensure that all students, including girls, are not put at a disadvantage. Of note, a 1998 report by the American Association of University Women, Gender Gaps: Where Our Schools Still Fail Our Children, found that girls, when compared to boys, are at a significant disadvantage as technology is increasingly incorporated into the classroom. Specifically, girls tend to come to the classroom with less exposure to computers and other technology, and girls believe that they are less adept at using technology than boys. As a result, girls tend to have a more ``circumscribed, limited, and cautious'' interaction with technology than boys, as highlighted in the report. Schools can assist girls in developing a confident relationship to technology by integrating digital tools into the curriculum so girls can pursue their own interests. Unfortunately, current law lacks assurances that federal education programs will compensate for girls' different learning styles and different exposures to technology. Accordingly, provisions in the ``Educating America's Girls Act'' will ensure that the different learning styles of girls and other students will be taken into consideration when monies are awarded for a variety of existing K-12 programs. Furthermore, it also includes the ``High Technology for Girls Act'' (High-Tech Girls), legislation I have already introduced that will ensure young girls are encouraged to pursue degrees and demanding careers in math, science, engineering, and technology--fields that are critical in the increasingly technologically-driven workplace. Mr. President, as we seek to ensure that the unique technological needs of girls are addressed in the classroom, we also cannot ignore that sexual harassment and abuse is another issue of importance as we seek to educate our nation's children. While comprehensive research should be done on the pervasiveness of sexual harassment in schools--and ``Educating America's Girls Act'' will ensure that such a study is completed--various studies have found that the vast majority of secondary school students experience some form of sexual harassment during their school lives. For instance, the AAUW Educational Foundation's 1993 survey of 8th through 11th grade students on sexual harassment in schools, Hostile Hallways: The AAUW Survey on Sexual Harassment in America's Schools, found that the vast majority of secondary school students experienced some form of sexual harassment and that girls are disproportionately affected. While data on the incidence of sexual harassment is scant, Hostile Hallways found that 85 percent of girls experienced some form of sexual harassment; 65 percent of girls who have been harassed were harassed in the classroom; and 73 percent of girls who have been harassed were harassed in the hallway of their school; a student's first experience of sexual harassment is most likely to occur in the middle school/junior high years of 6th to 9th grade; and 81 percent of girls who have been harassed do not report it to adults. A 1996 University of Michigan study showed that sexual harassment can result in academic problems such as paying less attention in class and Hostile Hallways found that 32 percent of girls do not want to talk as much in class after experiencing harassment. Furthermore, thirty-three percent of girls do not want to go to school at all due to the stress and anxiety they suffered as a result of the sexual harassment, and nearly one in four girls say that harassment caused them to stay home from school or cut a class. We know little else about the extent of sexual harassment or even the nature and extent of more serious sexual crimes in schools. The Safe and Drug-Free Schools and Communities Act (SDFSCA) requires the National Center for Education Statistics (NCES) to collect data on violence in elementary and secondary schools in the United States. However, these reports provide only a very limited picture of sexual offenses in schools because they only capture data on rape or sexual battery reported to police. Further, school crime victimization surveys do not include questions on threats or abuse that are sexual in nature. Sexual harassment in schools is illegal, a form of sexual discrimination banned under Title IX of the Education Amendment of 1972. Unfortunately, on the 25th anniversary of Title IX, a report by the National Coalition for Women and Girls in Education (NCWGE) found that less progress was made in the area of sexual harassment than in any other gender equity issue in education. NCWGE concluded that few schools have sexual harassment policies, or effectively enforce them. Therefore, in addition to calling for more intensified Office of Civil Rights enforcement, NCWGE called on schools to adopt comprehensive policies and programs addressing sexual harassment. The reauthorization of the ESEA gives us an opportunity to greatly reduce the incidence of sexual harassment by gathering data on these often hidden offenses and providing programs to prevent sexual harassment and abuse. Accordingly, the ``Educating America's Girls Act'' ensures that this data will be compiled and that schools are provided with resources to combat sexual harassment. Of importance, because the definition of sexual harassment in elementary and secondary schools can be contentious, the legislation ensures that local schools will have the sole authority to define the forms of sexual harassment that will be addressed, and the sole authority to determine the types of programs that will be undertaken to address it. Mr. President, equal access to education for girls also means equal access to opportunities for athletic participation in our schools, particularly our high schools. Unfortunately, nationwide data measuring the participation of girls in physical education and high school athletics programs is very limited. Participation in high school athletic programs is important for girls because research has shown that it improves girls' physical and mental health. For instance, a study by the President's Council on Physical Fitness and Sports recently found that girls playing sports have better physical and emotional health than those who do not. The study also found that higher rates of athletic participation were associated with lower rates of sexual activity and pregnancy. Other studies link physical activity to lower rates of heart disease, breast cancer, and osteoporosis in later life. Sports build girls' confidence, sense of physical empowerment, and social recognition within the school and community. In addition, many girls who participate in high school athletics programs receive college scholarships. Therefore, by participating in high school athletics programs, girls increase their chances at receiving a college scholarship--which may be the only way that some young women will be able to pursue a higher education. Because of the lack of data on girls' participation in physical education and athletics during grades K-12, the ``Educating America's Girls Act'' will ensure that this data is collected and reported. Ultimately, this assembling of information will allow us to determine if girls are fully participating in these activities, and if further steps should be taken to increase their involvement. Mr. President, education is ultimately the means for all girls, including pregnant and parenting teens, to achieve economic self- sufficiency. Yet despite our strides to make education accessible to girls, dropping out of school remains a serious problem that should be addressed in the reauthorization of the ESEA. Five out of every 100 young adults enrolled in high school in 1996 left school without successfully completing a high school program. In October of 1997, 3.6 million young adults, or 11 percent of young adults between the ages of 16 and 24 in the United States, were neither enrolled in a high school program nor had they completed high school. Of note, girls who drop out are less likely than boys to return and complete school. Twenty-five years after the enactment of Title IX, pregnancy and parenting are still the most commonly cited reasons why girls drop out of school, and the United States has the highest teen pregnancy rate of any industrialized nation. In fact, almost one million teenagers become pregnant each year and 80 percent of these pregnancies are unintended. Pregnancy and parenting account for half the female dropout rate and one fourth of the dropout rate for all students. Two-thirds of girls who give birth before age 18 will not complete high school, and the younger the adolescent is when she becomes pregnant, the more likely it is that she will not complete high school. The last reauthorization of ESEA broadened the dropout prevention program to address the needs of pregnant and parenting teens. Because this problem remains so pervasive, the ``Educating America's Girls Act'' contains provisions to strengthen the ESEA's support for programs that keep pregnant and parenting teens in school, including the utilization of mentoring programs. Finally, Mr. President, the Women's Educational Equity Act (WEEA) represents the federal commitment to helping schools eradicate sex discrimination from their programs and practices and to ensuring that girls' future choices and success are determined not by their gender, but by their own interests, aspirations, and abilities. Since the program's inception in 1974, the WEEA has funded research, development, and dissemination of curricular materials; training programs; guidance and testing activities; and other projects to combat inequitable educational practices. Because of the important role that the WEEA has played in addressing sex discrimination over the past 25 years, the ``Educating America's Girls Act'' reauthorizes the WEEA so that it can continue to address the needs of women for many years to come. Mr. President, the bottom line is that the reauthorization of the ESEA provides us with a unique opportunity to address the numerous needs of our nation's students as we prepare for the 21st Century. I believe that the provisions of the ``Educating America's Girls Act'' will address a variety of these needs--and the unique needs of girls in particular--and urge that my colleagues support this legislation accordingly during the months ahead.

Ms. SNOWE

Ms. SNOWE. Mr. President, I rise today to speak about Bread for the World, an organization which has dedicated itself to helping end hunger in the U.S. and throughout the world, and is celebrating its 25th Anniversary this year. I would like to take this opportunity to commend the members of Bread for the World on their 25 years of dedication to helping those less fortunate. Bread for the World began in 1974 with a small group of Protestants and Catholics who were concerned about hunger. This group of individuals has now become a national movement with 44,000 members representing 40 denominations. In its informational campaigns around the world, and here on Capitol Hill, Bread for the World is a non- partisan organization whose legislative initiatives serve the purpose of providing assistance to those in need and, no less important, a means to provide for oneself. Children and child nutrition programs have been a principal focus for Bread for the World. In addition, Bread for the World has advocated programs designed to help individuals in need to receive assistance and, ultimately, find a job. During my tenure here in the Senate, and earlier as a member of the House of Representatives, I have worked with Bread for the World on a number of initiatives related to these issues. Last year, the Congress passed and the President signed into law legislation backed by Break for the World, the Africa: Seeds of Hope Act, of which I was an original cosponsor. This law will redirect U.S. resources to small-scale farmers and struggling rural communities in Africa. It also established a revolving loan fund to provide food aid in response to emergency food crises throughout the world. As a member of the board, I am pleased to commend the people of this fine organization for 25 years of dedicated efforts on behalf of Americans and people around the world who suffer from hunger.

Ms. SNOWE

Ms. SNOWE. Mr. President, I rise today to introduce legislation that will ensure our nation's students, and young women in particular, are encouraged to pursue degrees and careers in math, science, engineering, and technology. Mr. President, if our children are to be prepared for the globally competitive economy of the next century, they must not only have access to the technologies that will dominate the workforce and job market that they will enter--but they should also be encouraged to pursue degrees in the fields that underlie these technologies. We simply cannot ignore that six out of ten new jobs require technological skills--skills that are seriously lacking in our workforce today. The impact of this technological illiteracy is devastating for our nation's businesses, with an estimated loss in productivity of $30 billion every year, and the inability of companies across the nation to fill an estimated 190,000 technology jobs in mid- to large-sized companies. In fact, these very job vacancies led to Congress passing legislation last year that increased the number of H1- B visas that could be issued to foreign workers to enter the United States. Furthermore, according to a 1994 report by the American School Counselors Association, 65 percent of all jobs will require technical skills in the year 2000, with 20 percent being professional and only 15 percent relying on unskilled labor. In addition, between 1996 and 2006, all occupations expect a 14 percent increase in jobs, but Information Technology occupations should jump by 75 percent. As this data implies, today's students must gain a different knowledge base than past generations of students if they are to be prepared for, and competitive in, the global job market of the 21st Century. Mr. President, even as we should seek to increase student access and exposure to advanced technologies in our nation's schools and classrooms through the E-rate and other programs, we should also seek to increase the interest of our students in the fields that are the backbone of these technologies: namely, math, science, engineering, and other technology- related fields. Clearly, if technology will be the cornerstone of the job market of the future, then it is vital that our nation's students-- who will be tomorrow's workers--be the architects that build that cornerstone. Accordingly, the legislation I am offering today is designed to ensure that our nation's students are encouraged to pursue degrees in these demanding fields. In particular, my legislation will ensure that young girls--who are currently less likely to enter these fields than their male counterparts--be encouraged to enter these fields of study. Mr. President, as was highlighted in the American Association of University Women report, ``Gender Gaps: Where Schools Still Fail Our Children,'' when compared to boys, girls might be at a significant disadvantage as technology is increasingly incorporated into the classroom. Not only do girls tend to come into the classroom with less exposure to computers and other technology, but they also tend to believe that they are less adept at using technology than boys. In light of these findings, it should come as no surprise that girls are dramatically underrepresented in advanced computer science courses after graduation from high school. Furthermore, it should come as no surprise that girls tend to gravitate toward the fields of social sciences, health services, and education, while boys disproportionately gravitate toward the fields of engineering and business. In fact, data gathered in 1997 on the intended majors of college- bound students found that a larger proportion of female than male SAT test-takers intended to major in visual and performing arts, biological sciences, education, foreign or classical languages, health and allied services, language and lierature, and the social sciences. In contrast, a larger portion of boys than girls intended to major in agriculture and natural resources, business and commerce, engineering, mathematics, and physical sciences. While all of these fields are invaluable--and students should always be encouraged to choose the fields of study and careers that interest them most--I believe it is critical that we ensure students do not balk at entering a particular field of study or career simply because it has typically been associated with ``males'' or ``females.'' Instead, all students should be aware of the multitude of opportunities that are available to them, and encouraged to enter those fields that they find of interest. Mr. President, young women should not shy away from technical careers simply because they are more often associated with men--and they should not avoid higher education courses that would give them the knowledge and skills they need for these jobs simply because they are more typically taken by young men. Accordingly, my legislation will ensure that fields relying on skills in math, science, engineering, and technology will be promoted to all students--and especially girls--to ensure that the numerous opportunities and demands of the job market in the 21st Century are met. Specifically, the ``High Technology for Girls Act'' will expand the possible uses of monies provided under the Elementary and Secondary Education Act (ESEA) of 1965 to ensure young women are encouraged to pursue demanding careers and higher education degrees in mathematics, science, engineering, and technology. As a result, monies provided for Professional Development Activities, the National Teacher Training Project, and the Technology for Education programs can be used by schools to ensure these fields of study and careers are presented in a favorable manner to all students. Of critical importance, schools will be able to use these monies for the development of mentoring programs, model programs, or other appropriate programs in partnership with local businesses or institutions of higher education. As a result, programs will be created that meld the best ideas from educators and the private sector, thereby improving the manner in which these fields are presented and taught-- and ultimately putting a positive ``face'' on fields that may otherwise be shunned by young women. Mr. President, as Congress moves forward in its effort to reauthorize the ESEA, I believe the provisions contained in this legislation would be a positive and much-needed step toward preparing our students for the jobs of the 21st Century. We cannot afford to let any of our nation's students overlook the fields of study that will be the cornerstone of the global job market of the future, and my legislation will help ensure that does not happen. Accordingly, I urge that my colleagues support the ``High Technology for Girls Act,'' and look forward to working for its adoption during the consideration of the Elementary and Secondary Education Act.

Ms. SNOWE

Ms. SNOWE. Mr. President, I rise today to introduce legislation that will ensure our nation's students, and young women in particular, are encouraged to pursue degrees and careers in math, science, engineering, and technology. Mr. President, if our children are to be prepared for the globally competitive economy of the next century, they must not only have access to the technologies that will dominate the workforce and job market that they will enter--but they should also be encouraged to pursue degrees in the fields that underlie these technologies. We simply cannot ignore that six out of ten new jobs require technological skills--skills that are seriously lacking in our workforce today. The impact of this technological illiteracy is devastating for our nation's businesses, with an estimated loss in productivity of $30 billion every year, and the inability of companies across the nation to fill an estimated 190,000 technology jobs in mid- to large-sized companies. In fact, these very job vacancies led to Congress passing legislation last year that increased the number of H1- B visas that could be issued to foreign workers to enter the United States. Furthermore, according to a 1994 report by the American School Counselors Association, 65 percent of all jobs will require technical skills in the year 2000, with 20 percent being professional and only 15 percent relying on unskilled labor. In addition, between 1996 and 2006, all occupations expect a 14 percent increase in jobs, but Information Technology occupations should jump by 75 percent. As this data implies, today's students must gain a different knowledge base than past generations of students if they are to be prepared for, and competitive in, the global job market of the 21st Century. Mr. President, even as we should seek to increase student access and exposure to advanced technologies in our nation's schools and classrooms through the E-rate and other programs, we should also seek to increase the interest of our students in the fields that are the backbone of these technologies: namely, math, science, engineering, and other technology- related fields. Clearly, if technology will be the cornerstone of the job market of the future, then it is vital that our nation's students-- who will be tomorrow's workers--be the architects that build that cornerstone. Accordingly, the legislation I am offering today is designed to ensure that our nation's students are encouraged to pursue degrees in these demanding fields. In particular, my legislation will ensure that young girls--who are currently less likely to enter these fields than their male counterparts--be encouraged to enter these fields of study. Mr. President, as was highlighted in the American Association of University Women report, ``Gender Gaps: Where Schools Still Fail Our Children,'' when compared to boys, girls might be at a significant disadvantage as technology is increasingly incorporated into the classroom. Not only do girls tend to come into the classroom with less exposure to computers and other technology, but they also tend to believe that they are less adept at using technology than boys. In light of these findings, it should come as no surprise that girls are dramatically underrepresented in advanced computer science courses after graduation from high school. Furthermore, it should come as no surprise that girls tend to gravitate toward the fields of social sciences, health services, and education, while boys disproportionately gravitate toward the fields of engineering and business. In fact, data gathered in 1997 on the intended majors of college- bound students found that a larger proportion of female than male SAT test-takers intended to major in visual and performing arts, biological sciences, education, foreign or classical languages, health and allied services, language and lierature, and the social sciences. In contrast, a larger portion of boys than girls intended to major in agriculture and natural resources, business and commerce, engineering, mathematics, and physical sciences. While all of these fields are invaluable--and students should always be encouraged to choose the fields of study and careers that interest them most--I believe it is critical that we ensure students do not balk at entering a particular field of study or career simply because it has typically been associated with ``males'' or ``females.'' Instead, all students should be aware of the multitude of opportunities that are available to them, and encouraged to enter those fields that they find of interest. Mr. President, young women should not shy away from technical careers simply because they are more often associated with men--and they should not avoid higher education courses that would give them the knowledge and skills they need for these jobs simply because they are more typically taken by young men. Accordingly, my legislation will ensure that fields relying on skills in math, science, engineering, and technology will be promoted to all students--and especially girls--to ensure that the numerous opportunities and demands of the job market in the 21st Century are met. Specifically, the ``High Technology for Girls Act'' will expand the possible uses of monies provided under the Elementary and Secondary Education Act (ESEA) of 1965 to ensure young women are encouraged to pursue demanding careers and higher education degrees in mathematics, science, engineering, and technology. As a result, monies provided for Professional Development Activities, the National Teacher Training Project, and the Technology for Education programs can be used by schools to ensure these fields of study and careers are presented in a favorable manner to all students. Of critical importance, schools will be able to use these monies for the development of mentoring programs, model programs, or other appropriate programs in partnership with local businesses or institutions of higher education. As a result, programs will be created that meld the best ideas from educators and the private sector, thereby improving the manner in which these fields are presented and taught-- and ultimately putting a positive ``face'' on fields that may otherwise be shunned by young women. Mr. President, as Congress moves forward in its effort to reauthorize the ESEA, I believe the provisions contained in this legislation would be a positive and much-needed step toward preparing our students for the jobs of the 21st Century. We cannot afford to let any of our nation's students overlook the fields of study that will be the cornerstone of the global job market of the future, and my legislation will help ensure that does not happen. Accordingly, I urge that my colleagues support the ``High Technology for Girls Act,'' and look forward to working for its adoption during the consideration of the Elementary and Secondary Education Act.

Ms. SNOWE

Ms. SNOWE. Mr. President, I rise today with my colleague from Nevada, Senator Harry Reid, to reintroduce the Equity in Prescription Insurance and Contraceptive Coverage Act. We are back today, with the support of 30 Members of the Senate, to finish the work we began in the last Congress. Why are we back again this year? Because the need behind the Equity in Prescription Insurance and Contraceptive Coverage Act has not abated. There are three million unintended pregnancies every year--half of all pregnancies that occur every year in this country. And frighteningly, approximately half of all unintended pregnancies end in abortion. I am firmly pro-choice and I believe in a woman's right to a safe and legal abortion when she needs this procedure. But I want abortion to be an option that a woman rarely needs. So how do we prevent this? How do we reduce the number of unintended pregnancies? The safest and most effective means of preventing unintended pregnancies are with prescription contraceptives. And while the vast majority of insurers cover prescription drugs, they treat prescription contraceptives very differently. In fact, half of large group plans exclude coverage of contraceptives. And only one-third cover oral contraceptives--the most popular form of reversible birth control. When one realizes the insurance ``carve-out'' for these prescriptions and related outpatient treatments, it is no longer a mystery why women spend 68 percent more than men in out-of-pocket health care costs. No woman should have to forgo or rely on inexpensive and less effective contraceptives for purely economic reasons, knowing that she risks an unintended pregnancy. In last year's Omnibus Appropriations Bill, Congress instructed the health plans participating in the Federal Employees Health Benefit Plan--the largest employer-sponsored health insurance plan in the world--to provide prescription contraceptive coverage if they cover prescription drugs as a part of their benefits package. The protections we afford to Members of Congress, their staff, other federal employees and annuitants, and to the approximately two million women of reproductive age who are participating in FEHBP need to be extended to the rest of the country. Unfortunately, the lack of contraceptive coverage in health insurance is not news to most women. Countless American women have been shocked to learn that their insurance does not cover contraceptives, one of their most basic health care needs, even though other prescription drugs which are equally valuable to their lives are routinely covered. Less than half--49 percent --of all large-group health care plans cover any contraceptive method at all and only 15 percent cover the five most common reversible birth control methods. HMOs are more likely to cover contraceptives, but only 39 percent cover all five reversible methods. And ironically, 86 percent of large group plans, preferred provider organizations, and HMOs cover sterilization and between 66 and 70 percent of these different plans do cover abortion. The concept underlying EPICC is simple. This legislation says that if insurers cover prescription drugs and devices, they must also cover FDA-approved prescription contraceptives. And in conjunction with this, EPICC requires health plans which already cover basic health care services to also cover outpatient services related to prescription contraceptives. The bill does not require insurance companies to cover prescription drugs. What the bill does say is that if insurers cover prescription drugs, they cannot carve prescription contraceptives out of their formularies. And it says that insurers which cover outpatient health care services cannot limit or exclude coverage of the medical and counseling services necessary for effective contraceptive use. This bill is good health policy. By helping families to adequately space their pregnancies, contraceptives contribute to healthy pregnancies and healthy births, reduce rates of maternal complications, and reduces the possibility of low-birthweight births. Furthermore, the Equity in Prescription Insurance and Contraceptive Coverage Act makes good economic sense. We know that contraceptives are cost-effective: in the public sector, for every dollar invested in family planning, $4 to $14 is saved in health care and related costs. And all methods of reversible contraceptives are cost-effective when compared to the cost of unintended pregnancy. A sexually active woman who uses no contraception costs the health care provider an average of $3,225 in a given year. The average cost of an uncomplicated vaginal delivery in 1993 was approximately $6,400. And for every 100 women who do not use contraceptives in a given year, 85 percent will become pregnant. Why do insurance companies exclude prescription contraceptive coverage from their list of covered benefits--especially when they cover other prescription drugs? The tendency of insurance plans to cover sterilization and abortion reflects, in part, their long-standing tendency to cover surgery and treatment over prevention. Sterilization and abortion is also cheaper. But insurers do not feel compelled to cover prescription contraceptives because they know that most women who lack contraceptive coverage will simply pay for them out of pocket. And in order to prevent an unintended pregnancy, a woman needs to be on some form of birth control for almost 30 years of her life. The Equity in Prescription Insurance and Contraceptive Coverage Act tells insurance companies that we can no longer tolerate policies that disadvantage women and disadvantage our nation. When our bill is passed, women will finally be assured of equity in prescription drug coverage and health care services. And America's unacceptably high rates of unintended pregnancies and abortions will be reduced in the process. The philosophy behind the bill is that contraceptives should be treated no differently than any other prescription drug or device. It does not give contraceptives any type of special insurance coverage, but instead seeks to achieve equity of treatment and parity of coverage. For that reason, the bill specifies that if a plan imposes a deductible or cost-sharing requirement on prescription drugs or devices, it can impose the same deductible or cost-sharing requirement on prescription contraception. But it cannot charge a higher cost- sharing requirement or deductible on contraceptives. Outpatient contraceptive services must also be treated similarly to general outpatient health care services. Time and time again Americans have expressed the desire for their leaders to come together to work on the problems that face us. This bill exemplifies that spirit of cooperation. It crosses some very wide gulfs and makes some very meaningful changes in policy that will benefit countless Americans. As someone who is pro-choice, I firmly believe that abortions should be safe, legal, and rare. Through this bill, I invite both my pro- choice and pro-life colleagues to join with me in emphasizing the rare.

Ms. SNOWE

Ms. SNOWE. Mr. President, I rise today with my colleague from Nevada, Senator Harry Reid, to reintroduce the Equity in Prescription Insurance and Contraceptive Coverage Act. We are back today, with the support of 30 Members of the Senate, to finish the work we began in the last Congress. Why are we back again this year? Because the need behind the Equity in Prescription Insurance and Contraceptive Coverage Act has not abated. There are three million unintended pregnancies every year--half of all pregnancies that occur every year in this country. And frighteningly, approximately half of all unintended pregnancies end in abortion. I am firmly pro-choice and I believe in a woman's right to a safe and legal abortion when she needs this procedure. But I want abortion to be an option that a woman rarely needs. So how do we prevent this? How do we reduce the number of unintended pregnancies? The safest and most effective means of preventing unintended pregnancies are with prescription contraceptives. And while the vast majority of insurers cover prescription drugs, they treat prescription contraceptives very differently. In fact, half of large group plans exclude coverage of contraceptives. And only one-third cover oral contraceptives--the most popular form of reversible birth control. When one realizes the insurance ``carve-out'' for these prescriptions and related outpatient treatments, it is no longer a mystery why women spend 68 percent more than men in out-of-pocket health care costs. No woman should have to forgo or rely on inexpensive and less effective contraceptives for purely economic reasons, knowing that she risks an unintended pregnancy. In last year's Omnibus Appropriations Bill, Congress instructed the health plans participating in the Federal Employees Health Benefit Plan--the largest employer-sponsored health insurance plan in the world--to provide prescription contraceptive coverage if they cover prescription drugs as a part of their benefits package. The protections we afford to Members of Congress, their staff, other federal employees and annuitants, and to the approximately two million women of reproductive age who are participating in FEHBP need to be extended to the rest of the country. Unfortunately, the lack of contraceptive coverage in health insurance is not news to most women. Countless American women have been shocked to learn that their insurance does not cover contraceptives, one of their most basic health care needs, even though other prescription drugs which are equally valuable to their lives are routinely covered. Less than half--49 percent --of all large-group health care plans cover any contraceptive method at all and only 15 percent cover the five most common reversible birth control methods. HMOs are more likely to cover contraceptives, but only 39 percent cover all five reversible methods. And ironically, 86 percent of large group plans, preferred provider organizations, and HMOs cover sterilization and between 66 and 70 percent of these different plans do cover abortion. The concept underlying EPICC is simple. This legislation says that if insurers cover prescription drugs and devices, they must also cover FDA-approved prescription contraceptives. And in conjunction with this, EPICC requires health plans which already cover basic health care services to also cover outpatient services related to prescription contraceptives. The bill does not require insurance companies to cover prescription drugs. What the bill does say is that if insurers cover prescription drugs, they cannot carve prescription contraceptives out of their formularies. And it says that insurers which cover outpatient health care services cannot limit or exclude coverage of the medical and counseling services necessary for effective contraceptive use. This bill is good health policy. By helping families to adequately space their pregnancies, contraceptives contribute to healthy pregnancies and healthy births, reduce rates of maternal complications, and reduces the possibility of low-birthweight births. Furthermore, the Equity in Prescription Insurance and Contraceptive Coverage Act makes good economic sense. We know that contraceptives are cost-effective: in the public sector, for every dollar invested in family planning, $4 to $14 is saved in health care and related costs. And all methods of reversible contraceptives are cost-effective when compared to the cost of unintended pregnancy. A sexually active woman who uses no contraception costs the health care provider an average of $3,225 in a given year. The average cost of an uncomplicated vaginal delivery in 1993 was approximately $6,400. And for every 100 women who do not use contraceptives in a given year, 85 percent will become pregnant. Why do insurance companies exclude prescription contraceptive coverage from their list of covered benefits--especially when they cover other prescription drugs? The tendency of insurance plans to cover sterilization and abortion reflects, in part, their long-standing tendency to cover surgery and treatment over prevention. Sterilization and abortion is also cheaper. But insurers do not feel compelled to cover prescription contraceptives because they know that most women who lack contraceptive coverage will simply pay for them out of pocket. And in order to prevent an unintended pregnancy, a woman needs to be on some form of birth control for almost 30 years of her life. The Equity in Prescription Insurance and Contraceptive Coverage Act tells insurance companies that we can no longer tolerate policies that disadvantage women and disadvantage our nation. When our bill is passed, women will finally be assured of equity in prescription drug coverage and health care services. And America's unacceptably high rates of unintended pregnancies and abortions will be reduced in the process. The philosophy behind the bill is that contraceptives should be treated no differently than any other prescription drug or device. It does not give contraceptives any type of special insurance coverage, but instead seeks to achieve equity of treatment and parity of coverage. For that reason, the bill specifies that if a plan imposes a deductible or cost-sharing requirement on prescription drugs or devices, it can impose the same deductible or cost-sharing requirement on prescription contraception. But it cannot charge a higher cost- sharing requirement or deductible on contraceptives. Outpatient contraceptive services must also be treated similarly to general outpatient health care services. Time and time again Americans have expressed the desire for their leaders to come together to work on the problems that face us. This bill exemplifies that spirit of cooperation. It crosses some very wide gulfs and makes some very meaningful changes in policy that will benefit countless Americans. As someone who is pro-choice, I firmly believe that abortions should be safe, legal, and rare. Through this bill, I invite both my pro- choice and pro-life colleagues to join with me in emphasizing the rare.

Ms. SNOWE

Ms. SNOWE. Mr. President, I draw the attention of the distinguished Chairman of the Appropriations Committee to a funding provision of the FY 2000 Defense Authorization Bill that passed after the Appropriations Committee had completed its military budget mark-up last month. Title X of the Authorization Bill allows the Secretary of the Navy to expend no more than $190 million for the advance procurement of components to support the planned construction of DDG-51 Arleigh Burke-class destroyers in Fiscal Years 2002 and 2003. The Navy, as the Chairman knows, has already written to Congress that it will need $371 million for this purpose by FY 2001, but the obligation of some of this amount next fiscal year may reduce programmatic risks.

Ms. SNOWE. I thank the Chairman of the Appropriations Committee for his understanding and support of this critical shipbuilding amendment. procurement of a 20th large, medium speed roll on/roll off vessel

Ms. SNOWE

Ms. SNOWE. I rise to speak on behalf of an amendment I sponsored that was agreed to previously as part of the managers' package.

Ms. SNOWE. Mr. President, this amendment imposes a straightforward but neglected requirement on the administration to seek multilateral economic embargoes as well as foreign asset seizures against governments with which the United States engages in armed hostilities. After one month of conflict in Kosovo, the Pentagon had announced that NATO had destroyed most of Yugoslavia's internal oil refining capacity. But the Secretary of State then acknowledged that the Serbians continued to fortify their hidden armored forces in the province with imported oil. And just three weeks ago, the allies first agreed to an American proposal to intercept petroleum exports bound for Serbia on the high seas but then declined to enforce the ban against their own ships! On May 1st, five weeks after the Kosovo operation had begun, the President finally signed an executive order imposing an American embargo against Belgrade on oil, software, and other sensitive products. Yet NATO and the United States have paid a steep price for failing to impose comprehensive economic sanctions on Serbia from the beginning of the air campaign in late March. As recently as May 13th, an anonymous U.S. government source told Reuters that the Yugoslavian Army continued to smuggle significant amounts of oil over land and water. At the end of April, General Wesley Clark, NATO's Supreme Commander, gave the alliance a plan for the interdiction of oil tankers streaming in the Adriatic towards Serbian ports. To justify this proposal, he cited the fact that through approximately 11 shipments, as this chronology shows, the Yugoslavians had imported 450,000 barrels containing 19 million gallons of petroleum vital to their war efforts. One Russian vessel alone deposited more than four million gallons of this amount. Unfortunately, Mr. President, it has been economic business as usual for the Serbians as our missiles try to grind their will. The President declared on March 24th the beginning of the NATO campaign and set a goal of deterring a bloody offensive against Moslem civilians. Less than four weeks later, with more than 400 planes flying over 400,000 internally displaced Kosovars, Belgrade reached the mid-point of receiving 11 shipments of oil from abroad. By the close of April, General Clark confirmed the destruction of Yugoslavia's oil production capacity. On the same day, however, the Serbs took in 165,000 barrels of imported fuel. And on May 1st, when the President signed the executive order banning U.S. trade with Yugoslavia, Milosevic had received the last of the 11 April oil shipments for a total of 450,000 barrels. As of three weeks ago, the number of displaced Kosovars had topped one million and NATO acknowledged the continuation of energy imports by the enemy. These imported energy reserves play a significant role in supporting Serbian ground operations. The U.S. Energy Information Agency estimates that Yugoslav forces consume about four thousand barrels of oil per day. This fact means that if Serbian armored units in Kosovo used only one-half of the imported fuel just from April, they could have operated for nearly two months. It took barely one month after the start of the NATO campaign, however, for President Milosevic to uproot the vast majority of the ethnic Albanian population of the province. So by the time frame that NATO had claimed to destroy Serbia's oil refining capacity, mid-to-late April, the Yugoslavians still managed to perpetrate Europe's worst humanitarian crisis since World War II. We now face the strategic and operational challenge of uprooting dispersed tank, artillery, and infantry units in Kosovo. This challenge confounds NATO because our military campaign ignored the offshore economic base sustaining the aggression that we had pledged to overcome. This example, Mr. President, teaches us that military victory involves more than the decisive application of force. It also demands, as Operation Desert Storm so dramatically illustrated, a coordinated diplomatic and economic enemy isolation effort among the United States and its allies. Iraq invaded Kuwait on August 1, 1990. Five days later, on August 6th, the United Nations Security Council, with only Cuba and Yemen in opposition, had passed a resolution directing ``all states'' to bar Iraqi commodity and product imports. This action first helped to freeze Saddam in Kuwait before he could move into Saudi Arabia. The wartime coalition subsequently faced the more manageable task of expelling this dictator from a small country rather than the entire Arabian Peninsula. We must always try to damage or destroy the offensive military apparatus of a hostile state. But as the Persian Gulf War taught us, it should also be starved of resources. Efforts to establish multilateral embargoes will always encounter resistance and lapses in enforcement. My amendment, however, puts the tyrants of the globe on notice that as a matter of policy, the United States will take immediate steps to deprive them of the finances and the imports to wage war should America and its international partners engage in hostilities against them. The language of this provision instructs the President to ``seek the establishment of a multinational economic embargo'' against an enemy government upon the engagement of our Armed Forces in hostilities. If the conflict continues for more than 14 days, the President must also report to Congress on the actions taken by the administration to implement the embargo and to publish any foreign sources of trade and revenue that sustain an adversary's war-making capabilities. This amendment will not constrain, but strengthen, future Presidents in organizing the international community against regional zealots like Milosevic. We must remember that the European Union states declined to enforce the Adriatic Sea embargo against the advice of the United States. But if we lend the force of law to administration's embargo efforts from the outset of a war, we could gain more allied partners to force an aggressor into military bankruptcy. As our Balkan campaign reveals, the foreign energy and assets at the disposal of dictators can provide their forgotten tools of aggression. But this seamless embargo amendment signals that the United States will not only remember these tools, but take decisive action to break them. It signals that we should not bomb only so the enemy can trade and hide. To enforce greater clarity in our strategies of isolating the nation's armed adversaries of tomorrow, Mr. President, I urge the Senate's unanimous support for this amendment. nato's mission

Ms. SNOWE. Mr. President, Members of the Senate, last night the Senate did pass an amendment I drafted establishing a policy that would require the President to establish a multinational embargo against adversary nations once our Armed Forces have become engaged in hostilities. I thank the chairman of the Senate Armed Services Committee, Senator Warner, and Senator Levin, as well as minority and majority staffs of the Armed Services Committee and the Foreign Relations Committee for working with me on this initiative. This amendment would impose a requirement on Presidents to seek multilateral economic embargoes, as well as foreign asset seizures, against governments with which the United States engages in armed hostilities. After 1 month of conflict in Kosovo, the Pentagon had announced that NATO had destroyed most of Yugoslavia's interior oil-refining capacity. At approximately the same point in time, we had the Secretary of State acknowledging that the Serbians had continued to fortify with imported oil their hidden armed forces in the province. Just 3 weeks ago, the allies first agreed to an American proposal, one which had been put forward by this administration, to intercept petroleum exports bound for Serbia but then declined to enforce the ban against their own ships. On May 1, 5 weeks after the Kosovo operation had begun, the President finally signed an Executive order imposing an American embargo against Belgrade on oil, software, and other sensitive products. Yet, NATO and the United States have paid a steep price for failing to impose a comprehensive economic sanction on Serbia from the beginning of the air campaign, which started in March. As recently as May 13, a Government source told Reuters that the Yugoslavian Army continued to smuggle significant amounts of oil over land and water. At the end of April, General Clark gave the alliance a plan for the interdiction of oil tankers coming into the Adriatic towards Serbian ports. To justify this proposal, he cited the fact that through approximately 11 shipments, the Yugoslavians had imported 450,000 barrels containing 19 million gallons of petroleum vital to their war effort. Let me repeat: 450,000 barrels, containing 19 million gallons of oil, that supported the war effort. Half of those 19 million gallons of oil would support them for 2 months; half of the 19 million gallons of oil supported the Serbian war effort for 2 months, yet we allowed 11 shipments to come through since the beginning of this air campaign. Unfortunately, it has been economic business as usual for the Serbians as our missiles try to grind their will. The President declared on March 24 the beginning of the NATO campaign and set a goal of deterring a bloody offensive against the Moslem civilians. We know what happened. I have a chart that illustrates a chronology of the situation when it comes to economic business as usual. We started the air campaign March 24. Then on April 13, while we were adding more aircraft to the engagement, Serbia had reached the midpoint of receiving 11 shipments of oil from abroad. Of course, on April 27, General Clark announced: We have destroyed his oil production capacity. NATO estimates of displaced Kosovars rise to 820,000. Serbia receives 165,000 barrels of imported fuel over a 24-hour period. While we were adding more aircraft, it now had been a month later since the campaign began, we find they are still bringing in more oil. A month after the start, they were at the midpoint of receiving 450,000 barrels of oil. By the close of April, General Clark confirmed the destruction of Yugoslavia's oil production capacity. On the same day, however, the Serbs took in 165,000 barrels of imported oil. As I mentioned earlier in this chronology, while we are still bringing in the aircraft, they are still bringing in the oil. Interestingly enough, just today, in the Financial Times of London, General Wesley Clark was understood to have expressed concern about the oil issue when he briefed NATO ambassadors yesterday on the progress of the 9-week-old air campaign. He has expressed disappoint that U.S. proposals for using force to support the embargo, at least in the Adriatic, were rejected by other allies--notably France. NATO is still working out how the details of a voluntary ``visit and search'' regime under which the alliance warships would check on ships sailing up the Adriatic Sea. Let me repeat, they are still working out the details of a voluntary visit and search regime. Now we are in the ninth week of the campaign, well over 400 aircraft, 23, 24 Apache helicopters, the President has called up 33,000 reservists, and they have yet to establish procedures for an oil embargo. They are still working out the details. The article goes on to say the North Atlantic Council agreed this week to introduce the regime but has to approve the rules of engagement. It is clear that the air campaign is still being operated, and, obviously, the oil embargo, according to committee. On May 1, when the President signed the Executive order barring oil and software receipts, there were 11 foreign oil shipments of 450,000 barrels. Milosevic has now received the last of the 11 April oil shipments, for a total of 450,000 barrels on the day when the President signed the Executive order barring the oil and software imports. As of 3 weeks ago, the number of displaced Kosovars had topped 1 million, and NATO acknowledges the continuation--as we have certainly learned today in the most recent news updates--of energy imports by the enemy. These imported energy reserves play a significant role in supporting Serbian ground operations. The U.S. Energy Information Agency estimates that Yugoslavian forces consume about 4,000 barrels of oil per day. This fact means that if Serbian armored units in Kosovo used only one half of the imported fuel just from the month of April alone, they could have operated for nearly 2 months, just half the amount they imported in April, yet as we well know, the air campaign began on March 24. It took nearly 1 month after the start of the NATO campaign, however, for Milosevic to uproot the vast majority of the ethnic Albanian population of the province. By the timeframe that NATO had claimed to destroy Serbia's oil refining capacity, which was mid to late April, as we have seen here when General Clark announced it on April 27, the Yugoslavians still managed to perpetrate Europe's the worst humanitarian crisis since World War II. We now face the strategic and operational challenge of uprooting dispersed tank, artillery and, infantry units in Kosovo. This challenge confounds NATO because our military campaign ignored the offshore economic base sustaining the aggression that we had pledged to overcome. This example teaches us that military victory involves more than the decisive application of force. It also demands, as Operation Desert Storm so dramatically illustrated, a coordinated diplomatic and economic enemy isolation effort among the United States and its allies. Iraq invaded Kuwait on August 1, 1991. Five days later, on August 6, the United Nations Security Council, with only Cuba and Yemen in opposition, passed a resolution directing ``all States'' to bar Iraqi commodity and product imports. This action first helped to freeze Saddam in Kuwait before he could move into Saudi Arabia. The wartime coalition subsequently faced the more manageable task of expelling this dictator from a small country rather than the entire Arabian peninsula. The point is, during Operation Desert Storm the President of the United States had worked in concert with the allies to establish an embargo. That was effective. What is difficult to understand is why the President and the NATO alliance did not agree to this at the outset? Why, at a time when we were conducting--initiating an air campaign, this oil embargo was not in place? We must always try to damage or destroy the offensive military apparatus of a hostile State, but as the Persian Gulf war taught us, it should also be starved of its resources. No law can mandate an immediate multinational embargo. But this amendment that will be included in this reauthorization will make it more difficult for future Presidents to repeat President Clinton's mistake, the alliance's mistake of waiting a month--and actually it is even more than that, because we do not have it in full force. There is no immediate impact of a voluntary embargo currently, as we have obviously heard today with General Clark's concerns about this issue that continues to fortify Milosevic's defenses. So we do not want future Presidents to repeat the mistake of waiting a month, waiting longer to allow the enemy to conserve fuel, to get more fuel and to be able to become more entrenched on the ground as we have seen Milosevic has done in Kosovo, and to cloud the prospects for victory. The United States, as a matter of standing policy, should pursue an international embargo immediately. In fact, that should have been done even before the campaign had been initiated. That should have been part of the planning process. It should not have been an afterthought. It should not have been ad hoc. It should not have been a few days later we will get to it. In this case, obviously, it was more than a month and it is still running. It should be done immediately. If we are willing to place our men and women and weaponry in harm's way in the middle of a conflict, in the midst of hostilities, then at the very least the ability of any adversaries to reinforce their military machine should cease. Dictators, tyrants, would further know in advance that we would wage a parallel diplomatic and trade campaign next to the military one to disable their war machinery. This amendment is not micromanaging policy, but it provides increased assurances of victory and averts a delay in the interception of war materiel. In the case of Kosovo, the administration and the alliance admits this was helpful to the enemy. We keep seeing that time and time again. We keep hearing it is helpful. That should have been done long ago. It does beg the question why this was not considered as part of the planning process before we initiated the air campaign. It seems to me it would be very logical. This amendment will not constrain but strengthen future Presidents in organizing the international community against regional zealots like Milosevic. We must remember the European Union states declined to enforce the Adriatic Sea embargo, against the advice of the United States. Obviously, that is what General Clark is stating, in terms of his concerns. Obviously, the NATO alliance does not have the rules of engagement for even doing a voluntary search and seizure process. So I think this amendment will be helpful to lend the force of law to future Presidents in order to strengthen their hand in implementing an embargo and to seek international agreement with those countries with whom we are engaged in a military effort so we can force an aggressor into military and economic bankruptcy. As our Balkan campaign reveals, the foreign energy and assets at the disposal of dictators can provide their forgotten tools of aggression. But this amendment signals that the United States will not only remember these tools, but take decisive action to break them. It signals we should not bomb only so the enemy can trade and hide and can conduct business as usual. It has been business as usual for Mr. Milosevic, regrettably. So I hope this amendment will enforce greater clarity in our strategies of isolating our adversaries of tomorrow. I am pleased the Senate has given its unanimous support of this amendment. I yield the floor.

Ms. SNOWE

Ms. SNOWE. Mr. President, I ask unanimous consent that the reading of the amendment be dispensed with.

Ms. SNOWE. Mr. President, I ask unanimous consent the Senate now proceed to the consideration of Calendar No. 17, H.R. 435.

Ms. SNOWE. Mr. President, Senator Roth has a substitute amendment at the desk. I ask for its consideration.

Ms. SNOWE. I ask unanimous consent the bill be considered read a third time and passed as amended, the motion to reconsider be laid upon the table, and that any statements relating to the bill appear in the Record.

Ms. SNOWE

Ms. SNOWE. Mr. President, I rise today to reintroduce legislation that will standardize coverage for bone mass measurement for people at risk for osteoporosis under the Federal Employee Health Benefits Program. This legislation is similar to my bill which was enacted as part of the Balanced Budget Act to standardize coverage of bone mass measurement under Medicare. The bill I reintroduce today guarantees the same uniformity of coverage to Federal employees and retirees as Congress provided to Medicare beneficiaries two years ago. Osteoporosis is a major public health problem affecting 28 million Americans, who either have the disease or are at risk due to low bone mass; 80 percent of its victims are women. This devastating disease causes 1.5 million fractures annually at a cost of $13.8 billion--$38 million per day--in direct medical expenses. In their lifetime, one in two women and one in eight men over the age of 50 will fracture a bone due to osteoporosis. Amazingly, a woman's risk of a hip fracture is equal to her combined risk of contracting breast, uterine, and ovarian cancer. Osteoporosis is largely preventable and thousands of fractures could be avoided if low bone mass were detected early and treated. Though we now have drugs that promise to reduce fractures by 50 percent and new drugs have been proven to actually rebuild bone mass, a bone mass measurement is the only way to diagnose osteoporosis and determine one's risk for future fractures. And we have learned that there are some prominent risk facts: age, gender, race, a family history of bone fractures, early menopause, risky health behaviors such as smoking and excessive alcohol consumption, and some medications all have been identified as contributing factors to bone loss. But identification of risk factors alone cannot predict how much bone a person has and how strong bone is--experts estimate that without bone density tests, up to 40 percent of women with low bone mass could be missed. Unfortunately, coverage of bone density tests under the Federal Employee Health Benefit Program (FEHBP) is inconsistent. Instead of a comprehensive national coverage policy, FEHBP leaves it to each of the nearly 500 participating plans to decide who is eligible to receive a bone mass measurement and what constitutes medical necessity. Many plans have no specific rules to guide reimbursement and cover the tests on a case-by-case basis. Some plans refuse to provide consumers with information indicating when the plan covers the test and when it does not and some plans cover the test only for people who already have osteoporosis. Mr. President, we owe the people who serve our Government more than that. We know that osteoporosis is highly preventable, but only if it is discovered in time. There is simply no substitute for early detection. My legislation standardizes coverage for bone mass measurement under the FEHBP and I urge my colleagues to support this legislation.

Ms. SNOWE

Ms. SNOWE. Mr. President, I rise today to reintroduce legislation that will standardize coverage for bone mass measurement for people at risk for osteoporosis under the Federal Employee Health Benefits Program. This legislation is similar to my bill which was enacted as part of the Balanced Budget Act to standardize coverage of bone mass measurement under Medicare. The bill I reintroduce today guarantees the same uniformity of coverage to Federal employees and retirees as Congress provided to Medicare beneficiaries two years ago. Osteoporosis is a major public health problem affecting 28 million Americans, who either have the disease or are at risk due to low bone mass; 80 percent of its victims are women. This devastating disease causes 1.5 million fractures annually at a cost of $13.8 billion--$38 million per day--in direct medical expenses. In their lifetime, one in two women and one in eight men over the age of 50 will fracture a bone due to osteoporosis. Amazingly, a woman's risk of a hip fracture is equal to her combined risk of contracting breast, uterine, and ovarian cancer. Osteoporosis is largely preventable and thousands of fractures could be avoided if low bone mass were detected early and treated. Though we now have drugs that promise to reduce fractures by 50 percent and new drugs have been proven to actually rebuild bone mass, a bone mass measurement is the only way to diagnose osteoporosis and determine one's risk for future fractures. And we have learned that there are some prominent risk facts: age, gender, race, a family history of bone fractures, early menopause, risky health behaviors such as smoking and excessive alcohol consumption, and some medications all have been identified as contributing factors to bone loss. But identification of risk factors alone cannot predict how much bone a person has and how strong bone is--experts estimate that without bone density tests, up to 40 percent of women with low bone mass could be missed. Unfortunately, coverage of bone density tests under the Federal Employee Health Benefit Program (FEHBP) is inconsistent. Instead of a comprehensive national coverage policy, FEHBP leaves it to each of the nearly 500 participating plans to decide who is eligible to receive a bone mass measurement and what constitutes medical necessity. Many plans have no specific rules to guide reimbursement and cover the tests on a case-by-case basis. Some plans refuse to provide consumers with information indicating when the plan covers the test and when it does not and some plans cover the test only for people who already have osteoporosis. Mr. President, we owe the people who serve our Government more than that. We know that osteoporosis is highly preventable, but only if it is discovered in time. There is simply no substitute for early detection. My legislation standardizes coverage for bone mass measurement under the FEHBP and I urge my colleagues to support this legislation.