Arlen Specter

Mr. SPECTER

Mr. SPECTER. Since Medicare was established in 1965, people are living longer and living better. Today Medicare covers more than 40 million Americans, including 35 million over the age of 65 and nearly 6 million younger adults with permanent disabilities. Congress now has the opportunity to modernize this important Federal entity to create a 21st century Medicare Program that offers comprehensive coverage for pharmaceutical drugs and improves the Medicare delivery system. The proposal before the Senate would make available a voluntary Medicare prescription drug plan for all seniors. If enacted, Medicare beneficiaries have access to a discount card for prescription drug purchases starting in 2004. Projected savings from cards for consumers would range between 10 to 25 percent. A $600 subsidy would be applied to the card, offering additional assistance for low-income beneficiaries defined as 160 percent or below the Federal poverty level. Effective January 1, 2006, a new optional Medicare prescription drug benefit would be established under Medicare Part D. This bill has the potential to make a dramatic difference for millions of Americans living with lower incomes and chronic health care needs. Low-income Medicare beneficiaries, who make up 44 percent of all Medicare beneficiaries, would be provided with prescription drug coverage with minimal out-of-pocket costs. For these seniors, copayments would not exceed 20 percent of the cost of the drugs. For medical services, Medicare beneficiaries will have the freedom to remain in traditional fee-for-service Medicare for drug coverage, or to enroll in Health Maintenance Organizations (HMOs) or Preferred Provider Organizations (PPOs), also called MedicareAdvantage, which offers beneficiaries a wide choice of health care providers, while also coordinating health care effectively, especially for those with multiple chronic conditions. MedicareAdvantage health plans would be required to offer at least the standard drug benefit, available through traditional fee-for-service Medicare. The legislation which is pending has been worked on, now, for many years. I congratulate the chairman of the committee, Senator Grassley, and the ranking member, Senator Baucus, for the outstanding work which they have done. This is an extraordinarily complex subject, and it is a very complex bill. We already know that there are many criticisms directed to this bill at various levels. Many would like to see the prescription drug program cover all of the costs without deductibles and without copays. There has been allocated in our budget plan $400 billion for prescription drug coverage. That is, obviously, a very substantial sum of money. There are a variety of formulas which could be worked out to utilize this funding. The current plan, depending upon levels of income, provides a deductible, then a copay, then what is called a donut hole where the recipient pays the entire costs of their drug coverage, and when it gets to a certain high level, it is catastrophic and there is coverage that pays almost all of it. As I have reviewed these projections and these analyses, it is hard to say where the line ought to be drawn. It is a value judgment as to what deductibles ought to be, and for whom, and what the copays ought to be and for whom. I am seriously troubled by the so-called donut hole. But it is calculated to encourage people to take the medical care they really need, and at lower levels of income to have certain copays, which it is projected will be affordable. Then, when the costs move into the so-called catastrophic range, to have the plan pay for nearly all of the medical costs. I think passage by the Senate would be a significant step forward. The House of Representatives, as usual, has a different plan--as is customary, with our bicameral legislative approach. Then the bill can be improved in conference. The legislative process has the committee turning out a bill, and then many amendments, which generally are not known to Members in advance of brief debate and then votes. It is in the conference, after the bill is analyzed, that another fresh look is taken at the bill to produce the best legislative product in the public interest. Amendment No. 983 I have already offered an amendment relating to end of life directives, number 983, which was adopted by unanimous consent. Commenting on it very briefly, we find statistically that nearly 30 percent of Medicare expenditures occur during a person's last year of life. We find, beyond the last year of life, a tremendous percentage of medical costs occur in the last month, in the last few weeks, in the last week, or in the last few days. Nobody should decide for anybody else what that person should have by way of end-of-life medical care. What care ought to be available is a very personal decision. The living wills would give an individual an opportunity to make that judgment, to make a decision as to how much care he or she wanted near the end of his or her life and that is, to repeat, a matter highly personalized for the individual. But if that decision was made to eliminate some of the very high costs at the very end of life, there would obviously be substantial savings to our medical system. As long as that comports with the will of the individual, that is something which ought to be considered. The amendment directs the Secretary of Health and Human Services to include in its annual ``Medicare And You'' handbook, to be provided to each beneficiary, a section that specifies information on advanced directives and details on living wills, durable powers of attorney for health care, and directs the Secretary of HHS, in the introductory letter to the ``Medicare And You'' handbook, to reference the inclusion of advanced directives. Amendment No. 1085 I have also submitted an amendment which is pending at the desk, amendment No. 1085, which has not yet been acted upon but which I will call up at an appropriate time. This is an amendment which would update the Medicare physician fee formula. It is a sense-of-the-Senate resolution. The projections from the Medicare payment formula called for a 4.4-percent reduction on March 1, which would have been very problematic. The fact is, the Center for Medicare and Medicaid Services, CMS, now projects a Medicare conversion factor figure of 4.2 percent will be projected for the year 2004. This reduction threatens to destabilize an important element of the Medicare Program; namely, physician participation and willingness to accept Medicare payments. This instability is a result of the sustainable growth rate, a system of annual spending which targets physicians' services under Medicare. This sense-of-the-Senate amendment would provide that the conferees on Medicare reform and prescription drug legislation should include in the conference agreement a provision to establish a minimum percentage update in physician fees for the next 2 years, and should consider adding provisions which would mitigate the swings in payment, such as establishing multiyear adjustments to recoup the variance and creating tolerance corridors for variations around the updated target trend. Amendment No. 1118 I have also submitted an amendment designated as amendment No. 1118, which provides for a lifestyle modification program demonstration. This is projected on the factor that heart disease kills some 500,000 Americans each year. The costs of coronary disease currently relate to an expenditure of some $58 billion annually. There has been a test program of the Medicare lifestyle modification program operating in some 12 States which has been demonstrated to reduce the need for coronary procedures by 88 percent. This program could reduce cardiovascular expenditures by as much as $36 billion annually. Lifestyle choices such as diet and exercise affect heart disease and heart disease outcomes by 50 percent or greater. This program has also been applied to men with prostate cancer, who have shown significant improvements in prostate cancer markers using a similar approach in lifestyle modifications. My amendment expresses the sense of the Senate that the Secretary of Health and Human Services should carry out the lifestyle modification program demonstration at the national level and then provide it on a permanent basis, and include as many Medicare beneficiaries as would like to participate in the project on a voluntary basis. I have submitted one additional amendment, which is No. 1128 and which relates to State pharmaceutical assistance programs for the elderly and disabled. Currently, 18 States have comprehensive pharmacy assistance programs which provide prescription drug coverage for more than 1.1 million older and disabled Americans. In my own State, Pennsylvania's Pharmaceutical Assistance Contract for the Elderly, known as PACE, established in 1984 provides prescription drug coverage to 230,000 Medicare beneficiaries, the vast majority of whom have incomes below 160 percent of the Federal poverty level. This enrollment is comprised largely of 70- and 80-year-old widows who have multiple diseases and limited educational background who have been enrolled in the PACE program for more than a decade. There is a serious concern that if there is not a coordinated program, people will not be informed as to how to move from PACE to another program. This affects not only Pennsylvania but, as I stated, 17 other States. The pending bill does not provide for coordination of benefits between State pharmaceutical programs and private insurers. Without a coordination of benefits for State plans to facilitate enrollment in private plans, many of these State program beneficiaries will be unable to assess the new Medicare drug benefit. This amendment provides for coordination of benefits between States and private insurance companies and facilitates the enrollment of State pharmacy assistance beneficiaries in the private plans. Without this amendment, the majority of seniors enrolled in their State pharmacy programs will not be able to effectively access private plans. I note the presence of other Senators who are seeking recognition. I attempted to be brief in my general statement about the bill and also in my descriptions of these four amendments, one of which has already been adopted. I ask unanimous consent that at the conclusion of my remarks, there be printed in the Record a summary of the end-of-life directive amendment, a summary of the updating of the Medicare physician fee formula, a summary of the lifestyle modification program, and a summary of the State pharmaceutical assistance programs for the elderly and disabled, and also printed in the Record at this point the amendments themselves.

Mr. SPECTER

Mr. SPECTER. I thank the chairman for his willingness to work with me on this issue as the Prescription Drug and Medicare Improvement Act moves forward.

Mr. SPECTER. Mr. President, I have sought recognition today to engage the distinguished chairman of the Finance Committee in a colloquy regarding concerns about the adequacy of Medicare payments to physicians. Each year, Medicare payments to physicians are adjusted through use of a ``payment update formula'' that is based on the Medicare Economic Index, MEI, and the sustainable growth rate, SGR. This formula has a number of flaws that create inaccurate and inappropriate payment updates that do not reflect the actual costs of providing medical services to the growing number of Medicare patients. As discussed above, the formula has resulted in numerous payment cuts to Medicare physicians. Earlier this year, Congress passed legislation as part of the fiscal year 2003 omnibus appropriations bill, H.J. Res. 2, that avoided an impending 4.4-percent cut in the Medicare conversion factor. This was accomplished by adding 1 million previously missed Medicare beneficiaries to the mix and recalculating the appropriate formulas. Although this change resulted in a welcomed 1.6-percent increase in the Medicare conversion factor for 2003, the Centers for Medicare and Medicaid Services', CMS, preliminary Medicare conversion factor figure predicts a 4.2-percent reduction for 2004. The reason for this latest reduction stems from the fact that the current formula that originally resulted in the need to fix the 2003 conversion factor cut, is flawed. The latest scheduled round of payment cuts will make Pennsylvania's Medicare practice climate untenable. In its March 2003 report, the Medicare Payment Advisory Commission, MedPac, stated that if ``Congress does not change current law, then payments may not be adequate in 2003 and a compensating adjustment in payments would be necessary in 2004.'' We owe it to America's physicians to fix the system so that they can continue to provide Medicare beneficiaries with the vital care they need. With 17 percent of its population eligible for Medicare, the Pennsylvania Medical Society has calculated that Pennsylvania's physicians have already suffered a $128.6 million hit, or $4,074 per physician, as a result of the 2002 Medicare payment reduction. If not corrected, the flawed formula will cost Pennsylvania physicians another $553 million or $17,396 per physician for the period 2003-2005. They simply cannot afford these payment cuts. I know you have worked very hard in preparing a bipartisan Medicare bill that represents a good solid beginning to improving our Nation's health care system. However, I firmly believe this is an issue that Congress must address.

Mr. SPECTER

Mr. SPECTER. Mr. President, I have sought recognition to express my support for increased funding for rural hospitals. Pennsylvania is a geographically and demographically diverse State, and the health care needs of the communities across the Commonwealth differ significantly. But there is one constant--access to appropriate health care is critical, and if we are not prudent in making wise health care policy decisions now, we may jeopardize our citizens' ability to get the right care, in the right setting, at the right time. We must be aware of the pressures and challenges that constantly weaken the foundation of the health care system--the medical liability insurance crisis, inadequate State and Federal reimbursements, workforce shortages, growing uncompensated care costs, rising costs of technology and pharmaceuticals, bioterrorism planning and training, and a growing elderly population. As we look at restructuring a segment of the Medicare Program, we have the opportunity to strengthen that foundation. Improving our prescription drug benefits will not help the senior citizens of this country if health care providers cannot meet their needs. We must also remember that our actions here in the Senate and by our colleagues in the House have implications not only for the quality and stability of our health care system but for our economic health as well. A recent study completed by the Penn State Cooperative Extension and the Pennsylvania Office of Rural Health shows that the State's hospitals are the largest component of the health services sector, generating more than $33.9 billion to the State's economy. This includes 260,000 full- and part-time jobs, a payroll exceeding $9.3 billion, and a ripple effect that provides another 179,400 jobs and $5.4 billion in additional employee compensation. In many counties, the hospital is the No. 1 employer. Furthermore, the State's research hospitals have been identified as an integral component of biotechnology clusters, serving as an engine of growth in the new economy. Given all of these dynamics, we must support a legislative plan that adequately funds hospital and health systems. This plan must recognize that our rural communities face a unique set of challenges because they are often the only provider of health care in a vast geographic region and they have greater difficulty recruiting health care workers and physicians in today's health care climate. Such a plan should also include two major rural provisions dealing with the standardized rate amount and a change in the labor component to 62 percent. The standardized rate amount will allow rural hospitals to receive a Medicare standardized payment rate equal to the higher rate paid to urban areas. The adjustment of the labor component from 71 percent to 62 percent for rural hospitals will allow rural hospitals, which traditionally have low labor costs, to base a larger portion of their Medicare reimbursement on nonlabor provisions, thereby receiving a higher reimbursement from Medicare. I urge my colleagues to join in making sound health care policy decisions to ensure we are strengthening the foundation of our health care delivery system in those areas in which it is most vulnerable. I yield the floor and suggest the absence of a quorum.

Mr. SPECTER

Mr. SPECTER. I also thank the chairman.

Mr. SPECTER. Mr. President, I rise as a cosponsor of the amendment offered by my colleague Senator Santorum that would provide airports with increased flexibility in the use of their Passenger Facility Charge funds. As Senator Santorum mentioned, we are working hard to assist US Airways and to keep the company's large presence in Pennsylvania with its hubs in both Pittsburgh and Philadelphia. Earlier this week I hosted a meeting with US Airways CEO David Siegel in my office that included Governor Rendell, Senator Santorum, most of our delegation from the House of Representatives, as well as local elected officials. The purpose of this meeting was to work with US Airways to make our Pennsylvania hubs in Pittsburgh and Philadelphia more cost competitive so that those airports can remain critical assets to US Airways. If enacted, proposals such as our amendment will be of great help to Pennsylvania and will be available for use by other airports throughout the Nation.

Mr. SPECTER

Mr. SPECTER. Mr. President, the second-degree amendment proposed by the Senator from Mississippi is an improvement over where the record stands at the present time, however, I think it does not go far enough. When he states that he does not know the consequences of my amendment, I would disagree with him. The amendment provides that there will be standards on the level of inspection, which are of the same type as now promulgated by the Federal Aviation Administration. So if you have that level of inspection, which they have now, there is no question as to its not being onerous, or at least if it is onerous, it is onerous now, however, it is the same. We should have drug and alcohol testing as a very minimal requirement so we know specifically what is involved there. We know people who are drug addicts or who are unduly influenced by alcohol to be carrying on these inspections. When it comes to the third factor, security, the amendment I have proposed calls for ensuring the security of maintenance and repair work conducted on U.S. aircraft and components at foreign repair stations by the Under Secretary in consultation with the Administrator. Those security arrangements are going to be determined by the Department of Transportation. We certainly can rely on them. I think the issue has been joined. I think we understand what is involved. I ask for the yeas and nays on the pending amendment.

Mr. SPECTER. Mr. President, I am offering this amendment on behalf of myself and Senators Boxer, Durbin, and Dayton. Senator Inhofe had indicated some support, but I think he has a little different approach, so I am going to proceed with it on this basis. The amendment provides for foreign aircraft repair stations to be subject to the same provisions as domestic air stations. What we have at the present time is a very different set of standards for foreign repair stations than are in effect for domestic stations. In foreign stations, for example, there need not be drug and alcohol testing. In foreign stations, there are not the kinds of requirements and regulations as to the maintenance for safety, and there are no requirements as to security. I realize this kind of an amendment may result in some higher costs, however, I believe these costs are warranted in the interest of the traveling public so there is an adequate assurance of safety. If you do not have the kinds of requirements that are in effect by the FAA in the United States, then we do not have the maintenance of the same kind of safety standards. With respect to foreign competition, I think it is a fair requirement to say that you are not requiring ``Buy American,'' but you are saying that the people in the United States who provide these services ought to have the same sort of security standards, the same sort of maintenance standards, and the same sort of drug testing or alcohol testing as in foreign standards. So this goes beyond the idea of protectionism. These requirements that are in effect in the United States are to provide for the safety of the traveling public. If it costs X dollars to provide for the safety of the traveling public, then I think that is what we ought to do, and that is the gravamen and the thrust behind this amendment. I yield the floor.

Mr. SPECTER. I ask unanimous consent that Senator Santorum be added as an original cosponsor on the Lancaster amendment.

Mr. SPECTER. I ask unanimous consent that further reading of the amendment be dispensed with.

Mr. SPECTER. Mr. President, I call up amendment No. 905, which has been filed.

Mr. SPECTER. Mr. President, I supplement what the Senator from Nevada said. I have already given notice that I have another amendment. If I may inquire of the manager, the Senator from Arizona. I am prepared to proceed at this time with the amendment. If I may have the attention of the Senator from Arizona, is it agreeable that I may call up my amendment?

Mr. SPECTER. Mr. President, I associate myself with the last remarks of Senator Hollings. Like the Senator from South Carolina, I thank the Senator from South Carolina.

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

Mr. SPECTER. Mr. President, I send an amendment to the desk.

Mr. SPECTER. Mr. President, to complete the discussion here regarding giving these essential air services to Lancaster, they had one small airline that serviced Lancaster. They withdrew because, in the absence of a modest subsidy, they could not serve Lancaster anymore. In an era when we are helping airlines with loan guarantees and bailouts and so many other provisions, this is really minimal. This amendment, as provided, will take care of Lancaster. If I may say for the record--if I may have the attention of the Senator from Mississippi, the chairman of the subcommittee, who will be principal conferee--this provision will be fought for in conference. In the House, the matter has been handled by Congressman Joe Pitts, a very able Congressman who represents the area including Lancaster. I am sure Congressman Pitts will be amenable to this amendment, which gives further assurance and protection to Lancaster, Pennsylvania. So it is in the context of this assurance of our tough position in conference, which ought to prevail, that I have agreed to this accommodation. I thank the Senator from Mississippi and I thank the Senator from Arizona for working out this issue. I yield the floor.

Mr. SPECTER. Mr. President, this amendment is an accommodation and compromise worked out after discussion with the chairman of the committee and the chairman of the subcommittee. I have already filed amendment No. 904, which is part of the record. This amendment goes to the issue of providing essential air services to Lancaster, Pennsylvania. The existing law provides that essential air services shall be provided if there is a distance of 70 miles or more to the hub of a major airport. Lancaster is 66 miles from the Philadelphia International Airport, if you travel along Route 30, which is the old Lincoln Highway, where there is a traffic light every other block with the most extraordinary congestion. Nobody who travels from Lancaster to the Philadelphia Airport takes congested Route 30. The commonly used route is to take 222 to the turnpike and then to the Schuylkill Expressway, and that is a distance of some 80 miles. So the route that any rational person would use would be the 80-mile route, not the 66-mile route. We have worked with the Department of Transportation for several years in trying to work out this arrangement, but they have refused to listen to reason. The City of Lancaster took an expensive appeal to the Court of Appeals for the Third Circuit, and the Court felt bound to honor the discretion of the Secretary of Transportation, even though the discretion was very unwisely used. The Court found itself constrained to let the Secretary determine it. The amendment I had intended to offer, which has been denominated as 904, provides that the determination of the appropriate mileage would be determined by the Governor or by the Metropolitan Planning Organization. A concern was expressed as to that--to have the State make a determination as to what would be done with the Federal expenditure of funds. Well, that is not all the time, but I am not going to belabor that argument because we have an accommodation.

Mr. SPECTER. Yes.

Mr. SPECTER

Mr. SPECTER. Mr. President, reserving the right to object, I would like incorporated in the unanimous consent request 5 minutes. This amendment was offered as the Landrieu-Specter amendment.

Mr. SPECTER. Mr. President, I am pleased to be the original, principal cosponsor, along with Senator Landrieu, on the Landrieu- Specter-Bingaman-Collins amendment. I am pleased to see that now the Senate is on the verge of taking a significant step, albeit a modest one, on petroleum conservation, a step long overdue in this country. Last year, I cosponsored, along with Senator Carper, an amendment which would have targeted reduction in oil consumption, and it was defeated on a tabling motion 57 to 42. A few days ago, I introduced S. 1169, which was a repeat of the Carper-Specter amendment. And today I am pleased to join with Senator Landrieu on a broader amendment which goes for reduction of oil dependency beyond transportation but calls on the President to set a standard for reduction of oil by 1 million barrels a day from a projected use of some 24 million barrels. This is a significant step, albeit a modest one. It is a first step. But it is very important for the United States that we reduce our dependence on foreign oil for many reasons. First of all, simply stated, we use too much foreign oil. Secondly, we are dependent upon the OPEC countries, especially upon Saudi Arabia, and it has an effect on influencing our foreign policies in ways which may well be undesirable. There have been very serious charges as to the Saudis on sponsoring al-Qaida and sponsoring terrorism. There is much yet that has to be proved on that subject, but we should not be tied to or dependent upon any nation, especially Saudi Arabia. The dependence on foreign oil results in a tremendous amount of our imbalance on foreign trade, with oil imports now accounting for one- third of the Nation's trade deficit which exceeded $400 billion in the year 2001. There is much we could do to reduce our dependence upon foreign oil. I am pleased to report on a $100 million grant by the Department of Energy to a plant in Pottsville, PA; a $612 million plant which will turn sludge into high-octane fuel is now moving forward. We have tremendous coal resources in this country, some 20 billion tons of bituminous coal alone in Pennsylvania, 7 billion tons of anthracite, and coal across this country which can be turned, with clean coal technology, into reducing our dependence on foreign oil. I am pleased to see the distinguished Senator from New Mexico, chairman of the Energy Committee, is now cosponsoring this amendment so that what you have, although slightly different than last year on a tabling at 57 to 42, is an amendment gaining very substantial momentum. That is a very good sign for conservation, a very good sign for the future of the American economy, and a very good sign for environmental protection. I yield the floor.

Mr. SPECTER

Mr. SPECTER. Mr. President, as Chairman of the Committee on Veterans' Affairs, I have today introduced, at the request of the Secretary of Veterans Affairs, S. 1213, a proposed bill to improve the benefits for Filipino veterans of World War II and survivors of such veterans and for other purposes. The Secretary of Veterans Affairs has submitted this proposed legislation to the President of the Senate by letter dated May 12, 2003. My introduction of this measure is in keeping with the policy which I have adopted of generally introducing--so that there will be specific bills to which my colleagues and others may direct their attention and comments--all Administration-proposed draft legislation referred to the Committee on Veterans' Affairs. Thus, I reserve the right to support or oppose the provisions of, as well as any amendment to, this legislation. I ask unanimous consent that the text of the bill be printed in the Record, together with the transmittal letter and a section-by-section analysis which accomplished it.

Mr. SPECTER

Mr. SPECTER. Mr. President, it is especially appropriate for members of the Court of Appeals for the Third Circuit to have a little special understanding of the needs of that court, and the Court of Appeals for the Third Circuit is very badly overworked at the present time and very much in need of judicial replacements. The court has served under the superb leadership of Chief Justice Edward R. Becker, and I know personally from my discussions with him and the new Chief Judge, Anthony Scirica, the tremendous backlog and tremendous pressures the court of appeals has for the very busy States of Pennsylvania, New Jersey, and Delaware. I am pleased to see that Michael Chertoff is now coming up for a vote before the Senate. He has an extraordinary record--Harvard undergraduate, Bachelor's degree, magna cum laude, 1975; Harvard Law School, again magna cum laude, in 1978. He has been engaged in the private practice of law. He has served as assistant U.S. attorney for the Southern District of New York, which is one of the toughest, most complicated jurisdictions. They handle very difficult cases. Then he became an assistant U.S. attorney for the District of New Jersey, moved up the ranks to be first assistant, and then later U.S. attorney for the District of New Jersey. Again, that is a jurisdiction which has very complicated cases. He has served as minority counsel for the Banking Committee. He has been the Assistant Attorney General in charge of the Criminal Division. He has had very wide experience in both civil and criminal law, and I think he comes to the position for the Court of Appeals for the Third Circuit with extraordinary qualifications. It is my hope the vote which we are having today on Michael Chertoff might be an indication the so-called logjam on filibusters will be broken. The Rules Committee last week held a hearing on a variety of ways to deal with the filibuster. It had been my hope during the 107th Congress, before the filibuster was tried, that we might find a protocol, which would work regardless of who controlled the White House, and regardless of who controlled the Senate. When President Clinton was in the White House and Republicans controlled the Senate, it was my view, stated on the floor at the time, that we should have handled President Clinton's nominations differently. We should have processed them in a more expeditious manner. Finally, we did handle quite a number of the judges who moved through after some judicial delays--Judge Berzon, and others. When the Democrats controlled the Senate in 107th Congress and President Bush was in the White House, the situation was reversed. It was my hope at that time we might find some protocol which I had proposed, one specifically which would establish a timetable: Sixty days after the nomination was submitted to the Senate there would be a hearing by the Judiciary Committee; Sixty days later there would be action by the Judiciary Committee voting up or down; Sixty days later there would be floor action in the Senate. Those timetables were not written in stone. They could have varied. They would be subject to a modification if cause was shown by the chairman of the committee upon notice to the ranking member or by the majority leader listing it for the full Senate action upon notice to the leader of the minority party. It was my view at that time that we had so many votes which were party line that if it was a party-line vote the matter would then go to the full Senate for resolution. That was before advent of the filibuster. The filibuster cut new ground. It was unprecedented in the Senate for a filibuster to be lodged against a Court of Appeals judge. Once before in the history of the Senate was there a filibuster, and that was when Associate Justice Abe Fortas was considered for Chief Justice of the United States. That was a bipartisan filibuster. There were integrity issues there which were very different from the filibusters which have been mounted during the 108th Congress where, as I say, this unprecedented action has been taken. That caused a good deal of consternation on this side of the aisle, and I think a good deal of consternation in the country. A number of options were considered where the rule might be changed. One proposal has been to have the first vote require 60 votes and on subsequent votes down to 51. My frank view is that is unlikely to be accepted because it isn't very difficult to have a series of cloture motions filed. For those who may be wondering and for anyone watching C-SPAN II, a cloture motion is a motion filed to cut off debate. The current rule requires 60 votes to cut off debate. When the logjam continues, there has been the suggestion of what we refer to colloquially as the ``nuclear option'' where there might be a ruling of the Chair that requires 60 votes, and that ruling could be challenged. On a 51-vote majority, that ruling could be overturned as a matter of Senate precedent. That has been done on occasion in the past. But it is an alternative which I think would be unwise and undesirable if any other alternative can be found. But if we were faced with the unprecedented cloture proceeding, the Senate may be driven to that alternative. What is really under consideration in many minds is whether the filibuster on the two circuit nominees pending is really a preliminary for a Supreme Court nominee. I think if that were to be the case it would be really most unfortunate for the judicial selection process and very unfortunate for the Senate, which really turns on collegiality for us to do our job--traditional collegiality which has been sorely tempted in the recent several years. If there had been an occasion for a filibuster on a Supreme Court nominee, I think that would have occurred with the nomination of Justice Clarence Thomas. And it was not attempted. I think it should not have been attempted. But that was the most hotly contested Supreme Court nomination during my tenure here, and I think perhaps the most hotly contested nomination short of the Fortas nomination in the history of the Court with the arguments which were raised during the hearings, with the arguments which were raised on the Senate floor, the delay, the second round of hearings, and the entire difficulties which surrounded that nomination. Had there been an occasion for a filibuster, I think that would have been the ultimate test. I repeat that I don't think a filibuster should have been attempted. None was. Justice Thomas was confirmed 52-48, which I think was a very firm imprimatur of regular procedure for the Senate not to filibuster but to vote on a majority vote. It is my hope that what we are doing here with Michael Chertoff will be a bellwether of a change of landscape and a sea change in the Senate, so that this confirmation is, I think, pretty much assured. I hope it will set the stage for affirmative votes in the Senate. I see other colleagues who have come to the floor with only 15 minutes before the scheduled vote. I yield the floor.

Mr. SPECTER

Mr. SPECTER. Mr. President, I have sought recognition to introduce legislation that would reduce our Nation's dependence on imported oil. Last year, Senator Carper and I introduced this legislation as an amendment to the energy bill and I offer it today to begin a debate and dialogue in the Senate about the merits of this goal. During last year's energy bill consideration, I joined over 60 of my colleagues in voting for the Levin-Bond amendment regarding the Corporate Average Fuel Economy standards for cars, SUV's, and light trucks. Given the instability in the Middle East and our Nation's reliance on foreign oil, Senator Carper and I offered additional language to slow the growth of our dependency on oil in a measurable way on the energy bill. I supported the Levin-Bond amendment because, among other things, it would have invested Federal dollars in research and development of advanced technology vehicles. It would have harnessed the power of government to purchase and commercialize hybrid and fuel cell-powered vehicles. I also supported the amendment's accompanying tax incentives, which would further encourage the production and purchase of advanced, fuel-efficient vehicles. However, the Levin-Bond amendment fell short in one important area - it did not include a clear, measurable objective for oil savings. The issue is not just the Corporate Average Fuel Efficiency, CAFE, or Miles Per Gallon, MPG,--rather it is oil and our growing dependence on imports for 56 percent of what we use. The bill I am introducing today would implement the Levin-Bond requirement that the Secretary of Transportation issue new regulations setting forth increased average fuel economy standards and further require that the Secretary of Transportation issue regulations to reduce the amount of oil consumed in our passenger cars and light trucks in 2015 by 1,000,000 barrels per day compared to consumption without such regulations in place. Federal research has identified promising fuel technologies, including fuels developed from biomass, coal waste, and other sources that could play a role in reducing our dependence on traditional, foreign crude oil and facilitate a transition to advanced fuels. For example, one important effort that is happening in Pennsylvania involves a recent $100 million U.S. Department of Energy grant to build the first U.S. coal-waste-to-clean-fuel plant. This $612 million plant is expected to produce 5,000 barrels of sulfur-free diesel or other types of transportation fuel daily. This will have the multiple benefits of removing coal waste, reducing acid mine drainage, producing fuels that will reduce air pollution, and using a domestic energy supply, thus reducing the need to import foreign oil. The bill I am introducing today tasks the Department of Energy to work with the Department of Transportation to develop and encourage such technologies. America uses about 8 million barrels of oil daily to power the vehicles that we drive. The Department of Energy forecasts that this amount will climb to 10.6 million barrels per day by 2015, an increase of over 35 percent. I propose to limit that growth to 23 percent, or 9.6 million barrels. America's national security is jeopardized by our growing dependence on foreign oil. Oil imports now account for a third of our nation's trade deficit, which exceeded $400 billion in 2001. I will continue to raise the issue of the untenable position the United States is in by relying on oil from the Middle East. This is highlighted by the fact that we continue to see suicide bombings in Israel and new attacks in other Middle Eastern nations such as Saudi Arabia and Morocco. Additionally, the exhausts of our motor vehicles are the source of significant amounts of air pollution, including a quarter of the carbon dioxide emitted into our atmosphere, which is sited as a lead contributor to global climate change. To address these concerns, Congress need not attempt to micro manage a solution by setting higher CAFE levels. We should, however, set a clear, measurable objective--reducing the growth in oil consumption by at least a million barrels per day by 2015. We should then delegate to NHTSA, as the energy bill would have accomplished last year under the Levin-Bond amendment and my legislation does, the responsibility for working with the auto industry to achieve that objective. That approach will encourage American ingenuity and foster a public-private partnership that recognizes the interests of consumers and auto makers, as well as furthering public policy that will help relieve the very significant and dangerous policy of relying on our economy's lifeblood of oil from unstable regions. As this body considers energy legislation, I encourage my colleagues to consider the importance of taking appropriate steps to reduce our dependence on foreign sources of energy, particularly oil. I invite my colleagues to join me in this effort by cosponsoring this legislation.

Mr. SPECTER

Mr. SPECTER. Mr. President, I have sought recognition to introduce legislation that would reduce our Nation's dependence on imported oil. Last year, Senator Carper and I introduced this legislation as an amendment to the energy bill and I offer it today to begin a debate and dialogue in the Senate about the merits of this goal. During last year's energy bill consideration, I joined over 60 of my colleagues in voting for the Levin-Bond amendment regarding the Corporate Average Fuel Economy standards for cars, SUV's, and light trucks. Given the instability in the Middle East and our Nation's reliance on foreign oil, Senator Carper and I offered additional language to slow the growth of our dependency on oil in a measurable way on the energy bill. I supported the Levin-Bond amendment because, among other things, it would have invested Federal dollars in research and development of advanced technology vehicles. It would have harnessed the power of government to purchase and commercialize hybrid and fuel cell-powered vehicles. I also supported the amendment's accompanying tax incentives, which would further encourage the production and purchase of advanced, fuel-efficient vehicles. However, the Levin-Bond amendment fell short in one important area - it did not include a clear, measurable objective for oil savings. The issue is not just the Corporate Average Fuel Efficiency, CAFE, or Miles Per Gallon, MPG,--rather it is oil and our growing dependence on imports for 56 percent of what we use. The bill I am introducing today would implement the Levin-Bond requirement that the Secretary of Transportation issue new regulations setting forth increased average fuel economy standards and further require that the Secretary of Transportation issue regulations to reduce the amount of oil consumed in our passenger cars and light trucks in 2015 by 1,000,000 barrels per day compared to consumption without such regulations in place. Federal research has identified promising fuel technologies, including fuels developed from biomass, coal waste, and other sources that could play a role in reducing our dependence on traditional, foreign crude oil and facilitate a transition to advanced fuels. For example, one important effort that is happening in Pennsylvania involves a recent $100 million U.S. Department of Energy grant to build the first U.S. coal-waste-to-clean-fuel plant. This $612 million plant is expected to produce 5,000 barrels of sulfur-free diesel or other types of transportation fuel daily. This will have the multiple benefits of removing coal waste, reducing acid mine drainage, producing fuels that will reduce air pollution, and using a domestic energy supply, thus reducing the need to import foreign oil. The bill I am introducing today tasks the Department of Energy to work with the Department of Transportation to develop and encourage such technologies. America uses about 8 million barrels of oil daily to power the vehicles that we drive. The Department of Energy forecasts that this amount will climb to 10.6 million barrels per day by 2015, an increase of over 35 percent. I propose to limit that growth to 23 percent, or 9.6 million barrels. America's national security is jeopardized by our growing dependence on foreign oil. Oil imports now account for a third of our nation's trade deficit, which exceeded $400 billion in 2001. I will continue to raise the issue of the untenable position the United States is in by relying on oil from the Middle East. This is highlighted by the fact that we continue to see suicide bombings in Israel and new attacks in other Middle Eastern nations such as Saudi Arabia and Morocco. Additionally, the exhausts of our motor vehicles are the source of significant amounts of air pollution, including a quarter of the carbon dioxide emitted into our atmosphere, which is sited as a lead contributor to global climate change. To address these concerns, Congress need not attempt to micro manage a solution by setting higher CAFE levels. We should, however, set a clear, measurable objective--reducing the growth in oil consumption by at least a million barrels per day by 2015. We should then delegate to NHTSA, as the energy bill would have accomplished last year under the Levin-Bond amendment and my legislation does, the responsibility for working with the auto industry to achieve that objective. That approach will encourage American ingenuity and foster a public-private partnership that recognizes the interests of consumers and auto makers, as well as furthering public policy that will help relieve the very significant and dangerous policy of relying on our economy's lifeblood of oil from unstable regions. As this body considers energy legislation, I encourage my colleagues to consider the importance of taking appropriate steps to reduce our dependence on foreign sources of energy, particularly oil. I invite my colleagues to join me in this effort by cosponsoring this legislation.

Mr. SPECTER

Mr. SPECTER. Mr. President, I have sought recognition to explain briefly the provisions of the ``Department of Veterans Affairs Long- Term Care and Personnel Authorities Enhancement Act of 2003,'' a bill that I have introduced today. Title I of the bill would extend through calendar year 2008 authorities that now specify that the Department of Veterans Affairs, VA, will provide to veterans enrolled for VA medical care outpatient- based long-term care services, such as Adult Day Health Care, Home Health Aide assistance, Non-Institutional Respite Care, and Home-based Primary Care. These services provide alternatives to institutional care and, in many cases, they obviate the need for institutional care by allowing veterans to remain in their own homes with care-giving assistance provided by VA. In addition, this bill would lower, from 70 percent to 50 percent, the threshold level of service-connected disability that would qualify a veteran for highest-priority for institutional care should he or she need it. VA currently provides highest-priority access to hospital and outpatient clinic-based care to veterans who have suffered a service- connected disability rated by VA as 50 percent disabling or higher. Highest-priority access to inpatient-based long-term care services, however, is only granted by law to veterans who are 70 percent or more disabled, unless such care is needed specifically to treat a less- disabling service-connected disability. When this provision of law was enacted in 1999, Congress set the threshold for priority access to nursing home care at 70 percent, rather than at 50 percent, due primarily to concerns that a lower threshold--which was actively considered--might cause VA to be faced with an unforeseen level of demand that could not be met. Since then, however, VA has reported that ``there was only a small increase in the numbers of veterans 70 percent service-connected or greater who were estimated to need nursing home care but who actually received that care from VA.'' In light of that, I see no compelling reason to continue distinguishing between nursing home care and all other types of care that are made available to 50 percent or higher service-connected veterans on a highest-priority basis. This bill would provide, in effect, that hospital care, outpatient clinic-based care, and nursing home care will equally be made available to all such enrolled veterans. Title I of the bill would also make technical changes to VA authority to contract for nursing home and adult day health care services by allowing VA to enter into agreements with providers under standards similar to those allowed by Medicare. According to VA, these changes will allow a greater number of smaller community-based providers to contract with VA by reducing the regulatory burdens placed upon them as a condition to contracting eligibility. Title II of the bill authorizes major construction for long-term care facilities in Beckley, WV and Lebanon, PA. Each of these states has a substantial elderly population and each is need of expansion to their VA long-term care programs. Title III of the bill would change current law to allow VA to more easily hire and retain certain clinical staff members. Under current law, VA hires many clinical professionals, such as physicians and nurses, under streamlined authorities set forth in title 38 of U.S. Code. But other key clinical professionals, such as clinical social workers, psychologists, and pharmacists, may only be hired through the standard ``civil service'' authorities specified in Title 5, U.S. Code. Further, members of such professions may only be paid and promoted in accordance with the standard civil service General Schedule, GS, pay scale. The process of hiring staff under these procedures is arduous and lengthy, consuming three months or more and placing VA at great competitive disadvantage in securing the services of best qualified candidates. This bill would convert many of these positions into ``hybrid Title 38'' status and permit VA greatly increased hiring and promotion flexibility, and compensation at special, locally-based, pay scales. Such clinicians, however, would retain their standard civil service grievance, vacation, and discipline protections. Title III of the bill also contains provisions to correct a long- standing inequity relating to retirement benefits for certain part-time VA nurses; to expand a successful pilot program allowing for contract- physician disability compensation medical examinations; and to afford certain wage-grade canteen workers an opportunity to compete favorably for VA employment. I urge my colleagues to support this legislation. Mr. President, I ask unanimous consent that the text of this bill be printed in the Record.