Arlen Specter

Mr. SPECTER

Mr. SPECTER. Mr. President, I have sought recognition to introduce legislation that will honor the importance of the steel industry in the Commonwealth of Pennsylvania and the nation by creating the ``Steel Industry National Historic Park'' to be operated by the National Park Service in southwestern Pennsylvania. The importance of steel to the industrial development of the United States cannot be understated. A national park devoted to the history of the steel industry will afford all Americans the opportunity to celebrate this rich heritage, which is symbolic of the work ethic endemic to this great nation. There is no better place for such a site than in southwestern Pennsylvania, which played a significant role in early industrial America. I have long supported efforts to preserve and enhance this historical steel-related heritage through the Rivers of Steel Heritage Area, which includes the City of Pittsburgh, and seven southwestern Pennsylvania counties: Allegheny, Armstrong, Beaver, Fayette, Greene, Washington and Westmoreland. I have been very pleased with congressional support for the important work within the Rivers of Steel Heritage Area expressed through appropriations levels of $1 million annually since Fiscal Year 1998. I am hopeful that this support will continue however, more than just resources are necessary. That is why I am introducing this important legislation today. It is important to note why southwestern Pennsylvania should be the home to the national park that my legislation authorizes. The combination of a strong workforce, valuable natural resources, and Pennsylvania's strategic location in the heavily populated northeastern United States allowed the steel industry to thrive. Today, the remaining buildings and sites devoted to steel production are threatened with further deterioration or destruction. Many of these sites are nationally significant and perfectly suited for the study and interpretation of this crucial period in our nation's development. Some of these sites include the Carrie Furnace complex, the Hot Metal Bridge, and the Unites States Steel Homestead Works, which would all become a part of the Steel Industry National Historic Park under my legislation. Highlights of such a national park would commemorate a wide range of accomplishments and topics for historical preservation and interpretation from industrial process advancements to labor-management relations. It is important to note that the site I seek to become a national park under this bill includes the location of the Battle of Homestead, waged in 1892 between steelworkers and Pinkerton guards. The Battle of Homestead marked an important period in our nation's workers' rights movement. The Commonwealth of Pennsylvania, individuals, and public and private entities have attempted to protect and preserve resources such as the Homestead battleground and the Hot Metal Bridge. For the benefit and inspiration of present and future generations, it is time for the federal government to join this effort to recognize their importance with the additional protection I provide in this bill. I would like to commend my colleague, Representative Mike Doyle, who has been a longstanding leader in this preservation effort and who will sponsor the companion legislation in the House of Representatives. I look forward to working with southwestern Pennsylvania officials and Mr. August Carlino, Executive Director of the Steel Industry Heritage Corporation, in order to bring this national park to fruition. I urge my colleagues in the United States Congress to cosponsor this legislation and I will work for its swift passage. I ask unanimous consent that the bill be printed in the Record.

Mr. SPECTER

Mr. SPECTER. Mr. President, today I am pleased to submit a resolution along with fifty-one of my colleagues to designate March 25, 2001, as ``Greek Independence Day: A Celebration of Greek and American Democracy.'' One hundred and eighty years ago, the Greeks began the revolution that would free them from the Ottoman Empire and return Greece to its democratic heritage. It was, of course, the ancient Greeks who developed the concept of democracy in which the supreme power to govern was vested in the people. Our Founding Fathers drew heavily upon the political and philosophical experience of ancient Greece in forming our representative democracy. Thomas Jefferson proclaimed that, ``to the ancient Greeks . . . we are all indebted for the light which led ourselves out of Gothic darkness.'' It is fitting, then, that we should recognize the anniversary of the beginning of their efforts to return to that democratic tradition. The democratic form of government is only one of the most obvious of the many benefits we have gained from the Greek people. The ancient Greeks contributed a great deal to the modern world, particularly to the United States of America, in the areas of art, philosophy, science and law. Today, Greek-Americans continue to enrich our culture and make valuable contributions to American society, business, and government. It is my hope that strong support for this resolution in the Senate will serve as a clear goodwill gesture to the people of Greece with whom we have enjoyed such a close bond throughout history. Similar resolutions have been passed by the Senate since 1984 with overwhelming support. Accordingly, I urge my Senate colleagues to join me in supporting this important resolution.

Mr. SPECTER

Mr. SPECTER. Mr. President, I have sought recognition today to introduce, with my distinguished colleague, Senator Harkin, an important resolution calling for increased funding for the National Institutes of Health, to keep us on track to double NIH funding by fiscal year 2003. Specifically, the resolution calls for the fiscal year 2002 budget resolution to include an additional $3.4 billion in the health function, to be allocated for biomedical research at the National Institutes of Health. As chairman of the Appropriations Subcommittee for Labor, Health and Human Services, Education, and Related Agencies, I have said many times that the National Institutes of Health is the crown jewel of the Federal Government--perhaps the only jewel of the Federal Government. When I came to the Senate in 1981, NIH spending totaled $3.6 billion. Today, funding is $20.3 billion. This money has been very well spent, given that the advances realized by the National Institutes of Health has spawned tremendous breakthroughs in our knowledge and treatment for diseases such as cancer, Alzheimer's disease, Parkinson's disease, severe mental illnesses, diabetes, osteoporosis, heart disease, and many others. It is clear that a substantial investment in the NIH is paying off and that it is crucial that increased funding be continued in order to convert these advances into treatment and cures. The effort to double NIH began on May 21, 1997, when the Senate passed a sense-of-the-Senate resolution stating that funding for the National Institutes of Health be doubled over five years. Regrettably, even though the resolution was passed by an overwhelming vote of 98 to nothing, the Budget Resolution contained a $100 million reduction for health programs. That led to the introduction of an amendment to the resolution by myself and Senator Harkin to add $1.1 billion to carry out the expressed sense of the Senate to increase NIH funding. Our amendment, however, was defeated 63-37. We were extremely disappointed that, while the Senate had expressed its druthers on a resolution, they were simply unwilling to put up the actual dollars to accomplish this vital goal. The following year, during debate on the fiscal year 1999 budget resolution, Senator Harkin and I again introduced an amendment to the budget resolution which called for a $2 billion increase for the National Institutes of Health. While we gained more support on this vote than in the previous year, our amendment was again defeated by a vote of 57-41. Not to be deterred, Senator Harkin and I again went to work with our Subcommittee and we were able to add an additional $2 billion to the NIH account for fiscal year 1999. In fiscal year 2000, Senator Harkin and I again offered an amendment to the budget resolution to add $1.4 billion to the health accounts, over and above the $600 million increase which had already been provided by the Budget Committee. Despite this amendment's defeat by a vote of 47-52, we were able to provide in the appropriations bill a $2.3 billion increase for fiscal year 2000. Last year, Senator Harkin and I yet again offered an amendment to the budget resolution to increase funding for health programs by $1.6 billion. This amendment passed by a vote of 55-45. This victory brought the NIH increase to $2.7 billion for FY'01. However, after late night negotiations with the House, the funding for NIH was cut by $200 million below that amount. This brief history of defeats and victories brings us to where we are today. The amount necessary to keep us on our track to double NIH funding will require $3.4 billion for fiscal year 2002. I believe that this goal can be achieved if we make the proper allocation of our resources. Our investment has resulted in tremendous advances in medical research. A new generation of AIDS drugs are reducing the presence of the AIDS virus in HIV infected persons to nearly undetectable levels. Death rates from cancer have begun a steady decline. With the sequencing of the human genome, we will begin, over the next few years, to reap the benefits in many fields of research as analysis continues. And if scientists are correct, stem cell research could result in a veritable fountain of youth in replacing diseased cells. I anxiously await the results of all of these avenues of remarkable research. I, like millions of Americans, have benefited tremendously from the investment we have made in the National Institutes of Health. That is why we offer this resolution today--to call upon the Budget Committee to include the additional $3.4 billion to the health accounts so we can carry forward the important work of the National Institutes of Health.

Mr. SPECTER

Mr. SPECTER. Mr. President, I have sought recognition today to honor my colleague, Congressman Bud Shuster, who retired from Congress last week after serving fifteen terms in the United States House of Representatives. I am grateful to have had the opportunity to serve with Congressman Shuster since 1981, when I first came to the United States Senate. Bud Shuster has worked tirelessly on behalf of his constituents in the 9th Congressional District of Pennsylvania, the entire state, and the nation. During his time in office, Congressman Shuster consistently reached across party lines to work with his colleagues on the other side of the aisle to pass some of the most important public works bills in our nation's history. Over the years he built up a remarkable level of clout in Congress, affording him a great deal of success in enacting his legislative priorities. The name Bud Shuster is synonymous with transportation, and I have worked closely with Congressman Shuster on a number of transportation challenges facing Pennsylvania and the nation, including the ISTEA and TEA-21 highway authorization bills, the effort to take the highway trust fund off-budget, and the AIR-21 airport authorization bill. As Chairman of the Committee on Transportation and Infrastructure, he brought a level of insight and tenacity into infrastructure, highways and airports that was really remarkable. Congressman Shuster's expertise in the field of transportation and public works projects was second to none, and I valued his advice and counsel on a number of issues over the years. Few may know that Congressman Shuster graduated Phi Beta Kappa from the University of Pittsburgh, holds an MBA from Duquesne University and a Ph.D. in business from the American University. While these academic accomplishments have suited him well in his role as a legislator, they have also served him in his role as an accomplished author, penning two acclaimed novels about life in small-town Pennsylvania. Bud Shuster's legislative skill and almost thirty years of dedicated service to his constituency will be sorely missed in Pennsylvania and in America. We will be hard pressed to replace such a distinguished public servant and I wish him the best of luck in his future.

Mr. SPECTER

Mr. SPECTER. Mr. President, I intend to vote for Mr. Robert Zoellick for U.S. Trade Representative. I believe he brings excellent credentials to this position. I do believe the new President, President George W. Bush, is entitled to discretion but, in any event, this is a qualified man. I would like to take a moment or two to talk about the enforcement of U.S. trade laws, especially as they relate to a very serious situation in my State with respect to the steel industry. Steel has been victimized in the United States by illegal trade practices, trade practices which violate U.S. law and trade practices which violate international law. We have had a surge of dumping in the United States which has cost the steel workers, in the past two decades, a reduction in employment from close to half a million steel workers to now less than 160,000 workers, and a situation where many steel corporations today are on the verge of bankruptcy. We need to see to it that dumping is not permitted in this country. Simply stated: Dumping is where steel, for example, is sold in the United States at a lower price than it is sold in the country from which it is exported. I have introduced legislation in the past and intend to reintroduce it this year which would provide for a private right of action, which would enable the corporation or the injured workers and the union to go to Federal court and to get injunctive relief. That relief can be obtained very promptly. It is possible, under the Federal Rules of Civil Procedure, to get a temporary restraining order on an ex parte basis on the filing of affidavits--there has to be a hearing within 5 days, evidence can be put into the record, equity actions can be tried very promptly, and that is an effective way to see to it that U.S. trade laws are enforced and that they are consistent with international trade laws. Last year we legislated on a matter on a bill introduced by Senator DeWine of Ohio and backed by quite a number of us in the Senate steel caucus, a caucus which I chair, with the cochair being Senator Jay Rockefeller of West Virginia. Then through the leadership of Senator Robert Byrd of West Virginia, with my concurrence in the Appropriations Committee, we put that bill into effect last year which provides that where duties are imposed for violations of U.S. trade laws, that those duties are paid to the injured parties instead of going into the U.S. Treasury. Obviously, it is desirable to have funds go into the Treasury, but where it can be ascertained that the illegal foreign trade practices resulted from a violation of U.S. trade law and can be traceable to damages to specific companies and individuals, that is where those duties ought to be paid. A question has arisen as to whether the United States will fight to retain that legislation against complaints by some of the foreign countries where infractions have been found. I do hope our new Trade Representative will enforce that legislation which was passed by the Congress and was signed by the President under an appropriations bill last year. I make these comments because U.S. jobs, U.S. industrial interests ought not to be sacrificed for foreign policy or for defense policy. Not too long ago, when we were anxious to back up the Russian economy, we permitted tremendous dumping of steel by Russia in the United States. While I am concerned about the stability of the Russian economy, I am candidly more concerned about the stability of the Pennsylvania economy and the U.S. economy. But fair is fair. When the laws are on the books, they ought to be enforced and they ought not to be sacrificed for collateral U.S. interests on foreign policy or on defense policy. I make these comments with the hope that our new Trade Representative will be a vigorous enforcer of U.S. trade laws and that my colleagues will consider the legislation, which I will introduce later in this session, which will provide for that private right of action. I yield the floor and suggest the absence of a quorum.

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

Mr. SPECTER

Mr. SPECTER. Mr. President, I have sought recognition to voice my support for the nomination of John Ashcroft, of Missouri, to be U.S. Attorney General. I think it is important to focus on the standard for a Cabinet nomination, which is fundamentally different from a judicial appointment, which is a lifetime appointment, and focus on the latitude which is customarily accorded the President of the United States in making a selection on a Cabinet nominee. I do support former Senator Ashcroft for attorney general. And I do so, in substantial measure, because of the record he has compiled as an elected official in Missouri and because of my personal knowledge of him. He was twice elected attorney general of Missouri, he was twice elected governor of Missouri, he was elected Senator of Missouri. And Missouri is a moderate state, I think very much like my own state, Pennsylvania: two big cities, a lot of farmland. The characteristics of the electorate in Missouri, who have elected him five times to major offices, I think, speaks well of Senator Ashcroft in rejecting the notion that he is an extremist. The John Ashcroft whom I have known for six years in the United States Senate is not an extremist. He sat a couple of seats down from me on the Judiciary Committee. Although we did not agree on many items, I always felt he was exercising his honest judgement. He was a candidate for President, and it may be that in the course of that candidacy, expressed some views, as candidates sometimes do, which try to appeal to a constituency. But from what I have seen, on this committee and in the Senate, he is not an extremist. He and I had a very sharp disagreement on a judicial nominee, Philadelphia Common Please Judge Massiah-Jackson. And she was, in effect, rejected by the committee, and withdrew her nomination. She was challenged as being soft on crime because of her record on sentences. At the end of a very long, difficult and contentious proceeding, including a hearing before the Judiciary Committee, as I say, she did withdraw. But at the end of the process, it was my view that John Ashcroft had expressed his own judgement about it which differed from mine. I bring in the Judge Massiah-Jackson case because of some similarities which it has to the case involving Missouri Supreme Court Justice White. I said in the hearing that I thought that we did not accord Judge White the kind of consideration that should have been accorded, because our practices are to rely principally on staff, the ABA recommendation, the FBI investigation, without individual Senators paying as much attention to the district court nominees as we might. I intend on proposing a rule change that in the event someone is going to speak adversely about a nominee, that there be an opportunity for the nominee to respond, and the committee should focus specifically on any charges which are brought. But I do think that, at the conclusion, Senator Ashcroft expressed his own honest views. I think it is important to note that when Judge White appeared before the committee, he did not ask that Senator Ashcroft be rejected, he raised the question as to whether Senator Ashcroft had the qualities to be an attorney general and left it up to the committee to decide. Senator Ashcroft made a number of important commitments to the committee. We questioned him at great length on the difference between a legislator and a member of the executive branch who enforces the law. He said categorically that he would not choose to change Roe v. Wade but would be bound to enforce the law as it stood. He spoke emphatically about his commitment to enforce access to abortion clinics. And it was worth noting that, while in the Senate, on a vote on whether someone who had a judgment against them for damaging an abortion clinic and there was one case where there was an enormous judgment in excess of $100 million that the individuals' debt ought not to be dischargeable in bankruptcy, which I think is an indication as to his sentiments on that important subject. Senator Ashcroft also made very firm commitments on recognizing the distinction between church and state and committed that, to the extent he was involved, there would be no litmus test on the selection of Supreme Court nominees. There were challenges made to what Senator Ashcroft had done as attorney general on the segregation cases. Former Senator Danforth appeared during the nomination hearing and spoke about his evaluation of John Ashcroft being a vigorous advocate. There was a question raised as to whether as state attorney general of Missouri Senator Ashcroft used the litigation process inappropriately. He was not held in contempt. He was not sanctioned under the federal rules, which he could have been. So on the basis of that issue and the other objections which have been raised, it seems to me that this is a nomination and a nominee where we ought to accord the traditional latitude to the President of the United States. I intend to vote for Senator Ashcroft's nomination to be Attorney General of the United States.

Mr. SPECTER

Mr. SPECTER. Mr. President, I have sought recognition to introduce legislation which seeks to modernize Federal election voting procedures throughout the United States. The 2000 election saga is now over and, in the words of President John F. Kennedy, ``Our task now is not to fix the blame for the past, but to fix the course for the future.'' I believe that had we studied our country's voting and monitoring procedures after President Kennedy's election, we would have in place today a uniform Federal election system that would have avoided the very problem presented in Florida. The presidential election of the year 2000 has drawn attention to several issues relating to current voting technologies. The central question is, how can we ensure fair, reliable, prompt and secure voting procedures? In this electronic age--in a nation that has put a man on the moon and an ATM machine on every corner --we have no excuse not to ensure that we have an accurate voting system in which every person's vote counts. Thousands of my Pennsylvania constituents raise similar questions relating to the paradox of the ``Internet age'' and antiquated voting procedures. In order to move the voting process to the point we expect in the 21st century, we must establish a system that will improve the integrity of elections and facilitate faster, more accurate results and overcome the weaknesses of older election technology. It is not really practical for someone to layout an entire bill with the precise procedures to implement these objectives, but it seems to me that it will be useful to establish a Commission which would take up the question of how to reform our Federal election procedures. On November 14, 2000, the first legislative day following the presidential election, I introduced legislation addressing the issue of modernizing our voting procedures. Today, I am reintroducing essentially the same bill with my distinguished colleague, Senator Harkin, as the lead cosponsor. This bill would establish a Commission for the Comprehensive Study of Voting Procedures which would take up the very question of the best methods to ensure accurate, electronic, and timely reporting of vote counts. The Commission would then submit a report to the President and Congress which would include recommendations to reform or augment current voting procedures for Federal elections. Further, this bill would authorize matching grants for States and localities to implement the Commission's recommendations in relation to Federal elections. Congress should address this issue as least as to Federal elections, leaving the matters of State and local elections to State officials under Federalist concepts. Specifically, my bill would create a 6 member Commission with the President, Senate Majority Leader, Senate Minority Leader, Speaker of the House, and House Minority Leader each appointing one member; and the Director of the Office of Election Administration of the Federal Election Commission serving as a advisory, non-voting member. The Commission would conduct a thorough study of all issues relating to voting procedures in Federal, State, and local elections, including the following: (1) Voting procedures in Federal, State, and local government elections; (2) Current voting procedures which represent the best practices in Federal, State, and local government elections; (3) Current legislation and regulatory efforts which affect voting procedures; (4) Implementing standardized voting procedures, including technology, for Federal, State, and local government elections; (5) Speed and timeliness of reporting vote counts in Federal, State, and local government elections; (6) Accuracy of vote counts in Federal, State, and local government elections; (7) Security of voting procedures in Federal, State, and local government elections; (8) Accessibility of voting procedures for individuals with disabilities and the elderly; and (9) Level of matching grant funding necessary to enable States and localities to implement the recommendations of the Commission for the modernization of State and local voting procedures. The details of this bill are incorporated in the attached section-by-section analysis. Studies have shown that more than half of the nation's registered voters are currently using outdated voting systems. A recent USA Today article noted that most voters across our country still punch paper ballots, even though experts say that system is more vulnerable to voter error than any other. In addition, approximately 20% of voters use mechanical-lever machines that are no longer manufactured, while more than 25% of voters fill in a circle, square, or arrow next to their choice of candidates on a ballot. My bill is necessary to prevent a recurrence of the problems that threatened the 2000 presidential election whose problems could have been avoided if we had modernized voting and monitoring procedures. Voting is the fundamental safeguard of our democracy and we have the technological power to ensure that every person's vote does count. The time is now to repair the problems of our patchwork system in order to restore the faith of American voters in our Federal election process. Mr. President, I ask that the full text of the bill and a section by section analysis be printed in the Record.

Mr. SPECTER

Mr. SPECTER. Mr. President, I have sought recognition to introduce legislation which seeks to modernize Federal election voting procedures throughout the United States. The 2000 election saga is now over and, in the words of President John F. Kennedy, ``Our task now is not to fix the blame for the past, but to fix the course for the future.'' I believe that had we studied our country's voting and monitoring procedures after President Kennedy's election, we would have in place today a uniform Federal election system that would have avoided the very problem presented in Florida. The presidential election of the year 2000 has drawn attention to several issues relating to current voting technologies. The central question is, how can we ensure fair, reliable, prompt and secure voting procedures? In this electronic age--in a nation that has put a man on the moon and an ATM machine on every corner --we have no excuse not to ensure that we have an accurate voting system in which every person's vote counts. Thousands of my Pennsylvania constituents raise similar questions relating to the paradox of the ``Internet age'' and antiquated voting procedures. In order to move the voting process to the point we expect in the 21st century, we must establish a system that will improve the integrity of elections and facilitate faster, more accurate results and overcome the weaknesses of older election technology. It is not really practical for someone to layout an entire bill with the precise procedures to implement these objectives, but it seems to me that it will be useful to establish a Commission which would take up the question of how to reform our Federal election procedures. On November 14, 2000, the first legislative day following the presidential election, I introduced legislation addressing the issue of modernizing our voting procedures. Today, I am reintroducing essentially the same bill with my distinguished colleague, Senator Harkin, as the lead cosponsor. This bill would establish a Commission for the Comprehensive Study of Voting Procedures which would take up the very question of the best methods to ensure accurate, electronic, and timely reporting of vote counts. The Commission would then submit a report to the President and Congress which would include recommendations to reform or augment current voting procedures for Federal elections. Further, this bill would authorize matching grants for States and localities to implement the Commission's recommendations in relation to Federal elections. Congress should address this issue as least as to Federal elections, leaving the matters of State and local elections to State officials under Federalist concepts. Specifically, my bill would create a 6 member Commission with the President, Senate Majority Leader, Senate Minority Leader, Speaker of the House, and House Minority Leader each appointing one member; and the Director of the Office of Election Administration of the Federal Election Commission serving as a advisory, non-voting member. The Commission would conduct a thorough study of all issues relating to voting procedures in Federal, State, and local elections, including the following: (1) Voting procedures in Federal, State, and local government elections; (2) Current voting procedures which represent the best practices in Federal, State, and local government elections; (3) Current legislation and regulatory efforts which affect voting procedures; (4) Implementing standardized voting procedures, including technology, for Federal, State, and local government elections; (5) Speed and timeliness of reporting vote counts in Federal, State, and local government elections; (6) Accuracy of vote counts in Federal, State, and local government elections; (7) Security of voting procedures in Federal, State, and local government elections; (8) Accessibility of voting procedures for individuals with disabilities and the elderly; and (9) Level of matching grant funding necessary to enable States and localities to implement the recommendations of the Commission for the modernization of State and local voting procedures. The details of this bill are incorporated in the attached section-by-section analysis. Studies have shown that more than half of the nation's registered voters are currently using outdated voting systems. A recent USA Today article noted that most voters across our country still punch paper ballots, even though experts say that system is more vulnerable to voter error than any other. In addition, approximately 20% of voters use mechanical-lever machines that are no longer manufactured, while more than 25% of voters fill in a circle, square, or arrow next to their choice of candidates on a ballot. My bill is necessary to prevent a recurrence of the problems that threatened the 2000 presidential election whose problems could have been avoided if we had modernized voting and monitoring procedures. Voting is the fundamental safeguard of our democracy and we have the technological power to ensure that every person's vote does count. The time is now to repair the problems of our patchwork system in order to restore the faith of American voters in our Federal election process. Mr. President, I ask that the full text of the bill and a section by section analysis be printed in the Record.

Mr. SPECTER

Mr. SPECTER. Mr. President, I have sought recognition to speak in support of the nomination of Governor Tommy Thompson to be Secretary of Health and Human Services. Governor Thompson brings an extraordinary record to Washington, DC, and he has accomplished a great deal as Governor of the State of Wisconsin. He began his political life in the Wisconsin State Assembly in 1966. He was elected to an unprecedented third term in Wisconsin, and then he broke his own record by being elected to a fourth term--of course again unprecedented. He has had remarkable accomplishments in the field of education, and tax cuts, where the tax rolls in Wisconsin have been very substantially reduced, in crime control, and perhaps his greatest achievement has been in welfare reform in Wisconsin. While Governor, Wisconsin got more waivers from the Department of Health and Human Services than any other State. Now it will be interesting to see how, in his capacity as Secretary of the Department, he will function to create policies in a climate where the Federal Government can articulate and implement policies which will not require States to seek waivers, as he was so successful at doing. His reform of the welfare system in Wisconsin has received national acclaim. He initiated the program called ``Learnfare.'' He was able to change the approach in Wisconsin to have work instead of welfare--all enormous accomplishments. When I looked at the record of Governor Thompson, candidly, I wondered why he did not run for President with those accomplishments behind him. I know some consideration had been given by Governor Thompson to that. It is an onerous road, considering all the difficulties. Perhaps foremost was the formidable candidacy of Gov. George Bush of Texas, who is now our President. So we have done very well indeed on the Presidency, and on the designation of Secretary Thompson for Health and Human Services. He will be facing some very difficult problems. One of the problems he will be facing is the controversial issue of stem cells, where I and others have introduced legislation to remove the ban on Federal funding for the extraction of stem cells from embryos. This has been a controversial matter because I think it is really not understood that the embryos from which the stem cells are extracted are to be discarded. They had been created for in vitro fertilization and are not to be used. So, instead of discarding them, it seems most appropriate to use them to save lives. The stem cells are a veritable Fountain of Youth, with stem cells already having been very useful in efforts to cure Parkinson's and spinal cord injuries. There is great promise for stem cells on Alzheimer's, perhaps in heart ailments to replace cells in the circulatory system and in the heart, and perhaps even on cancer. That is an issue which Senator Lott, our distinguished majority leader, has promised listing on a free-standing bill. Governor Thompson will also be a key player in implementing the distribution of organ transplants. We will, perhaps, call on him to implement a system which has been put into effect that he personally disagreed with as Governor of Wisconsin but now, as a national officeholder looking after the interests of 50 States, there is obviously going to be a different perspective. In Wisconsin, there had been great success in encouraging people to donate organs so there was an abundance of organs. Perhaps those techniques can be implemented by the new Secretary of Health and Human Services to create a national response, to have more organs donated so we need not have the controversy we have on the distribution of organs. As the chairman, for the past two Congresses, of the subcommittee on Labor, Health, Human Services and Education, I have had the role of working on the legislation of organ transplants, which we finally have worked out. It is my hope we will retain the policy which we have in effect.

Mr. SPECTER

Mr. SPECTER. Mr. President, in the absence of any other Senator on the floor, I think this would be an appropriate time to report on some foreign travel which I recently undertook for a 2-week period in late December and early January, accompanied on part of the trip by Senator Voinovich. Our trip took us to the Mideast, where we had the opportunity to confer with Egyptian President Mubarak, and then in Israel, Prime Minister Barak, and Minister Ariel Sharon, who was contesting for the post of Prime Minister in an election to be held in Israel on February 6; and also former Foreign Minister Shimon Peres. I then continued on to Aqaba in Jordan and had the opportunity to meet with King Abdullah in Jordan. We found the Mideast to be very tense, with the exacerbation of violence inspired by Palestinian youth. The Palestinian Authority has not observed their obligation under the Oslo accords to have an educational system which omits the traditional incitement to violence of youngsters. Their educational materials in the sixth grade, seventh grade, ninth grade and beyond, urges the young people to engage in violence--a holy jihad for the glory of Allah--encouraging acts which result in their own deaths as martyrs. That has set into motion a sequence of events in the area where the violence has just been extraordinary. I think we are really looking at a generational problem--perhaps more than a generational problem--until there is some recognition that the Israelis and Palestinians can live side by side under the terms of the Oslo accords and the implementation, as may be worked out. When we were there, and to this day, the atmosphere was heavy with doubts as to whether a peace treaty could be reached. I have complimented President Clinton privately and publicly, and I do so again today, for the efforts he maintained right to the end of his term in office. Now the new administration, I know, will pick up this very difficult issue and will work as best they can to implement the peace process and try to bring stability to that region. Before traveling to Egypt and Israel, Senator Voinovich and I visited Belgrade in Yugoslavia and made a trip into Bosnia. We were enormously impressed with the U.S. military presence in Bosnia, and U.S. soldiers helping to maintain a very fragile peace in that area of the world. In Yugoslavia, we met the new leaders, who are very impressive men who are carrying forward. The problem of former President Milosevic is a very big issue in Yugoslavia. The new Yugoslav leaders say they want to try him in Yugoslavia, as he has committed horrendous crimes against the people of Yugoslavia--embezzlement which is estimated as high as $1 billion, and stealing the election on election fraud. But at the same time, there are competing demands from the War Crimes Tribunal at The Hague. On my return trip, after Senator Voinovich had departed in Israel, I had the chance to meet with the chief prosecutor of the International Criminal Tribunal for the former Yugoslavia, Carla del Ponte, at The Hague. She is insistent on bringing Milosevic to trial at The Hague. Under the U.N. resolution, there is a priority status accorded to The Hague to try Milosevic. Perhaps these interests can be reconciled by trying Milosevic first in Yugoslavia, but before he serves a sentence if one is imposed, he goes to The Hague for trial. Ms. del Ponte was concerned that there not be a long interval because the War Crimes Tribunal is a temporary institution. There have been some suggestions that Milosevic be tried by the War Crimes Tribunal in Belgrade, Yugoslavia, but that remains to be worked out. One thing which must be accomplished, in my judgment, is that Milosevic must be tried and brought to justice. It is enormously important that a head of state be tried. I note my distinguished colleague, Senator Grassley, has arrived on the floor, so I will conclude these remarks with a comment or two on the discussions which were held with the leaders in India and in Pakistan where there has been a problem of nuclear confrontation and the dispute in Kashmir. There were also discussions on the persecution of Christians, which is a very rampant problem. Mr. President, on December 28, Senator Voinovich and I departed from Andrews Air Force Base and flew across the Atlantic landing late in the evening in Munich, Germany. Consul General Bob Boehme and Economic Officer John McCaslin met us in Munich. The two shared with us their thoughts on a wide variety of subjects ranging from a potential U.S. missile defense system to the current refugee situation in Germany. The next morning we had a working breakfast with representatives of the German/American business community. Our discussions ranged form lack of an educated workforce in Germany resulting in the need for skilled immigrants to staff many of their high-tech companies to harmonization of a European defense force with NATO to the ever-evolving situation in the Balkans. After our breakfast we departed Munich and arrived in Belgrade, Yugoslavia on Friday December 29. My first visit to Yugoslavia was in 1986, when I visited with then President Moisev. I was last in Belgrade in August 1998 in an attempt to visit then President Slobodan Milosevic to urge him to turn over indicted war criminals. Yugoslavia today is a country undergoing dramatic changes. Recently and most notably is the formation of a democratic form of government. The greatest political achievement of the Serbian people was a peaceful democratic revolution. Public protests usually happen before elections are held when the political tensions are at their greatest. In Yugoslavia, the opposite happened. Mass protests were the only way to guarantee that the popular will expressed at the polls was to be respected by former President Milosevic. The transfer of power following the electoral victory has not been simple, primarily because of Mr. Milosevic's attempts to falsify obvious electoral results. With widespread support from the citizens, the Democratic Opposition of Serbia secured the recognition of the electoral results and Dr. Kostunica was declared head of state on October 5, 2000. However, full legal transfer of power was not fully accomplished by this proclamation. President Kostunica has insisted on a strict observance of the rule of law. The immediate challenge ahead for President Kostunica and the Federal Government includes dealing in a clear and transparent way with relations in the Yugoslav federation and, in Serbia, resolving the political and security issues related to Kosovo. After my discussions with the various officials from the Serbian and Yugoslav Government, it was clear there is a strong desire for Mr. Milosevic to be tried by the Serbian government and be held to pay for what he has done to the Serbian people before they were willing to turn him over to the officials at The Hague. We were met at the airport by U.S. Ambassador Bill Montgomery and proceeded to our first meeting with Mr. Vojislav Kostunica, President of the Federal Republic of Yugoslavia. Sen. Voinovich and I were the first Congressional leaders to meet with the newly elected President and we congratulated him on his monumental victory. President Kostunica proudly told us that after the recent December 23 elections, democratic party candidates won 176 out of 250 seats in Parliament, Yugoslavia was now ready to push forward with reform. Unfortunately, the new democratic Yugoslavia is now having to pay for ten years of corruption and mismanagement under the Milosevic regime. Basic public services and health care are lacking as well as energy production resulting in rolling blackouts in Belgrade during the time of our visit. Another internal problem facing the Federal Republic of Yugoslavia is a political problem--dealing with the integration of Serbia and Montenegro. President Djukanovic of Montenegro has declared that Montenegro should be a separate state loosely aligned with Yugoslavia while Mr. Zoran Djindjic of Serbia, expected to be Prime Minister, desires a more traditional federal alliance with the Federal Republic of Yugoslavia. During our discussion, I told President Kostunica that I thought Slobodan Milosevic should be turned over to the prosecutors at the International Criminal Tribunal for the former Yugoslavia at The Hague for prosecution. President Kostunica told me that while he agreed that Slobodan Milosevic should be held accountable, the Serbian people should first be given the opportunity to prosecute Mr. Milosevic for his many transgressions against them, such as stealing the September elections and stealing approximately $1 billion from the coffers of the Yugoslav government. President Kostunica was quick to point out that he welcomed the office of The Hague Tribunal, which had recently reopened in Belgrade, as the first step in the eventual investigation and prosecution of Mr. Milosevic and also other indicted war criminal who were seeking safe harbor in Yugoslavia. We then met with Professor Miroljub Labus, the Federal Deputy Prime Minister in charge of economic policy as well as Mr. Bozidar Djelic, the Serbian Minister of Finance. Professor Labus as well as Minister Djelic, both were emphatic in their desire to bring pro market, transparent transactions to the economy of both the federal republic of Yugoslavia as well as Serbia. Two of the major moves the federal government had undertaken that week was to cut defense spending in order to direct more money into infrastructure repairs which had been badly neglected under the Milosevic regime and deregulate foreign trade in order to attract more overseas investment. Both felt that while the new democratic government had a good deal of support of the people behind them, they only had about 3 to 6 months to help get the government on the right track since the people were expecting to demand results soon. We next met Mr. Zoran Djindic who won his election only 6 days prior to our arrival. He told us that while he had won the political battle, the battle to undertake the reforms the people of Serbia demanded was just beginning. He said that for the past 50 years the government of Serbia had been a facade and that he intended to have a transparent, functioning democratic government. When we discussed Mr. Milosevic being tried at The Hague, he said Mr. Milosevic was merely a small time criminal but had been in the position to have the opportunity to commit big time crimes. He further said the will of the Serbian people was to try Mr. Milosevic in the Serbian courts first. On the topic of Montenegro, he said that integration into the Federal Republic of Yugoslavia was imperative for the establishment of joint institution of government so that Yugoslavia could begin to slowly move towards gaining membership into the EU. On the morning of December 30, we met with His Holiness Paul, Patriarch of the Serbian Orthodox Church. The elderly Patriarch was a distinguished looking gentleman who served as a priest in Kosovo for 34 years. The Patriarch felt that while the Serbians had done many things wrong during the recent conflicts, others did as well, and the unfortunate result was that many ancient churches and mosques were senselessly and unnecessarily destroyed. The Patriarch stated that he felt that the Church had assisted in highlighting moral issues during the elections and the Church had always advocated peaceful solutions and a peaceful transfer of power. After our meeting with the Patriarch we flew to Bosnia to meet soldiers from the multinational peace keeping force in Tuzla. Major General Sharp, Commander of the 3rd Infantry Division, headquartered in Tuzla, Bosnia met us at the airport. General Sharp commands over 3900 American soldiers, which help constitute a combined force of over 6700 soldiers including those from Russia, Denmark, Poland, Estonia, Finland, Latvia, Lithuania, Sweden and Turkey. We discussed his soldier's mission, which was supporting implementation of the Dayton Peace Accords and maintaining force protection awareness in the region. We discussed the problem of war criminals and he said that he knew of no indicted war criminals in his area of responsibility but that the orders for his division were to detain and hold any of the personnel that had been indicted for war crimes. We also discussed the increasing role of the National Guard in the peacekeeping role in the Balkans and the fact that Pennsylvania's 29th Infantry Division will be taking over that critical peace keeping mission there in 2002. We then flew by UH-60 Blackhawk helicopters from Tuzla to Camp Dobol to visit with some of the soldiers who are stationed there. During lunch we discussed many issues with the soldiers ranging from the need to continue to reform Tri-Care to the transferability of a soldiers GI bill to his family members. After having lunch we departed in Humvee's and went on a patrol through the towns of Flipovici and Katonovici with the soldiers of the 3rd Infantry Division. Upon returning from Tuzla late in the afternoon, we met with Yugoslav Minister of Justice Momcilo Grubac who told us that the new Yugoslav state would be formed under the rule of law and the massive legal reform was just beginning. The Minister told us that they were working on harmonizing existing Yugoslav law with EU law in order to comply with international standards and to attract overseas investment and provide legal and economic stability. When we discussed the trial of Mr. Milosevic, the Minister of Justice felt strongly that Milosevic should first be tried and held accountable in the Federal Republic of Yugoslavia before being turned over and tried in The Hague. The Minister of Justice said a new prosecutor for the City of Belgrade would be responsible for trying Milosevic. The current DA was a holdover from a Milosevic government and until December parliamentary elections could not have been removed. The Minister anticipated that in late January or early February the DA would be replaced with one that would be able to prosecute Milosevic. Later that evening we met with Professor Dragoljub Micunovic, the President of the Federal Parliaments Chamber of Citizens ``the Republic's Upper Body'' and his colleagues. We met in the same Parliament building that we all saw on CNN only a few months earlier being stormed by citizens demanding fair counting of the elected results. These same citizens then were hanging out of windows waving the Yugoslav flag after they were successful in forcing Mr. Milosevic to declare President Kostunica the rightful winner of the federal elections. The Parliamentarians told us that they felt they had laid a successful groundwork for reform and that now it was time for them to deliver. They, like all the other officials we talked to in Yugoslavia, felt that Mr. Milosevic should be first tried in Yugoslavia. We were told that they were sure that the prisons in Serbia were much less comfortable that those in The Hague and thus Mr. Milosevic would face a much harsher sentence in Serbia. After serving his time in Serbia, they agreed it would be possible for him to go to The Hague to be tried. On New Years Eve we departed Belgrade for Cairo, Egypt. In Cairo that evening, we met with Ambassador Daniel Kurtzer to discuss the status of the negotiations between Israel and the Palestinians. My first meeting with Ambassador Kurtzer occurred on January 7, 1998, his second day in Egypt. On New Years Day we visited with President Mubarak at Itihadiya Palace in Heiliopolis. As always, the President was gracious as he rearranged his busy schedule in order to meet with our delegation. President Mubarak and I discussed the negotiations between Chairman Arafat, Prime Minister Barak and President Clinton. When we asked President Mubarak when the Egyptian Ambassador would be returned to Israel, he said the withdrawal of his did not lessen diplomatic contacts between Egypt and Israel and should not be construed as his lack of support for comprehensive peace between the Palestinians and the Israelis. President Mubarak said he felt that there was no pressure to conclude talks because of President Clinton's departure or because of Prime Minister Barak's upcoming election. I asked President Mubarak if he would be willing to participate at the negotiations in Washington. President Mubarak said that he did not feel that it would be helpful to negotiate along-side Chairman Arafat, Prime Minister Barak and President Clinton as the issues really need to be resolved between Barak and Arafat on their own. President Mubarak said that the younger leaders in the region--The King of Jordan, the King of Morocco, and Crown-prince of Bahrain--were all bright stars on the horizon in the region and could be counted on to be supportive of the peace process. We discussed the problem of persecution of religious minorities with President Mubarak. Egypt, a Muslim country, also has a large vocal Christian community which is comprised of Copts and Evangelicals. I had previously discussed the plight of religious minorities with President Mubarak in February of 1998, in January of 1999, and again in September of 1999. I was informed on my previous trips as well as back in Washington that both the Copts and other religious minorities faced wide-spread discrimination and persecution sometimes rising to the level of violence. President Mubarak assured Senator Voinovich and me that the Egyptian government would not tolerate such activity. We discussed the International Religious Freedom Act of 1998 with President Mubarak who downplayed the significance of the Act in Egypt. He said there was no need for its application because his government would not tolerate religious persecution and that any incidents that did occur were undertaken on an isolated basis and investigated by the government. At mid morning on New Years day, we departed from Cairo and flew to Tel Aviv. Upon reaching Jerusalem, we were briefed by Ambassador Martin Indyk and headed off to our first meeting at the Kennesset with former Prime Minister Shimon Peres. Former Prime Minister Peres was under the impression that there was not sufficient time to conclude the compressive negotiations between the Palestinians and Israelis before the upcoming elections in Israel on February 6 and the end of President Clinton's term. In Prime Minister Peres' opinion, there was not enough focus on the economic issues surrounding a comprehensive peace plan. The former Prime Minister held the common opinion that the major stumbling blocks to the current negotiations were Jerusalem, the holy sites and the Palestinian claim to a right of return. He emphasized that there could be no Israeli concession on the right of return without endangering the continuation of a ``Jewish state'' which was the fundamental reason for the creation of Israel after the Holocaust. Our next meeting was with Prime Minister Barak whose frustration with negotiations was palpable. Barak stated that he had been very flexible in his negotiations with Arafat and that Arafat had taken no risks in the positions he was articulating. He stated that the continuing violence between the Palestinians and Israeli's lead to unrest in the region and did not help the current peace with Egypt and Jordan. The Prime Minister reminded us that last year was the best year in the history of Israel for Israel's economy. Prime Minister Barak stated that the only reason he had not already ended his negotiations with Arafat was to give President Clinton, who had personally invested so much in the negotiations, one last chance to broker peace in the region. Our final meeting on New Years day was with Minister Ariel Sharon. Minister Sharon said that his much maligned visit to the Temple Mount served only as an excuse for the Palestinians by which to mount violence against the Israeli people. He stated that he had visited the Temple Mount a number of times in the past without incident. Minister Sharon told us, if elected as Prime Minister on February 6, he would be willing to immediately talk to Arafat about continued negotiations. Minister Sharon said he was astounded that Prime Minister Barak was willing to ``give away'' Jerusalem and the holy sites without any debate or discussion with the people of Israel. He felt that the problems of Jerusalem, ensuring there are adequate security zones inside Israel, and the return of refugees were the major stumbling blocks to peace. Minister Sharon said although he was a General, he was committed to peace, not war. He recounted how he started as a young private in the Israeli Defense Force and rose to the level of General, fighting in every battle in the history of the State of Israel. He said that he had experienced all the horrors of war that he had seen many of his friends killed and wounded and was in fact twice wounded himself and therefore he understood, perhaps more than most, the importance of peace. However, he said, negotiating peace for Israel was almost as painful as war because peace means security for Israel and it was something that he was not going to undertake lightly. At the conclusion of that day after meeting with President Mubarak, Prime Minister Barak, former Prime Minister Peres and Minister Sharon, Senator Voinovich and I decided to send telefaxes to the leaders of Jordan, Saudi Arabia, Morocco and Tunisia, as well as President Mubarak, urging them to publicly express their support for President Clinton's proposal. The letter stated: We are advised that you think President Clinton's suggested parameters for the Israeli-Palestinian peace negotiation is a reasonable proposal and should be accepted by both sides. If that is true, we urge you to say so publicly to demonstrate there is support in the Arab world to encourage Chairman Arafat to give President Clinton an affirmative reply promptly. Later that evening I departed Tel Aviv and flew to Aqaba, Jordan. Senator Voinovich stayed in Israel and had a separate schedule for the balance of his trip. I met with King Abdullah in his summer palace on January 2. I had previously met with the King's father for many years. King Abdullah said that he had found President Clinton's peace proposals to be very reasonable and that he had encouraged Chairman Arafat to use the proposal as a framework from which to build a comprehensive peace. The King and I discussed whether or not he believed that Chairman Arafat had control of the street violence and protest in Israel, and King Abdullah opined that he believed that at the outset of the Intifada, Arafat had more control but recently the influence of the Islamic Jihad and Hamas were on the rise. I discussed with the King the possibility of other Arab countries using their influence to publicly persuade Arafat that the Clinton peace proposal was something that should be seriously considered. King Abdullah stated that President Mubarak had by far the most influence on Chairman Arafat. King Abdullah thought that he along with the Crown Prince of Bahrain, President Ben-Ali of Tunisia, President Mubarak of Egypt, and King Mohamed of Morocco would consider publicly supporting the Clinton peace proposal. Later that afternoon we departed for New Delhi. We arrived in New Delhi at 10:15 p.m. and Albert Thibault, the Deputy Chief of Mission and Paul Mailhot, First Secretary, met us at the airport. The following morning we had a working breakfast meeting with members from the U.S. Embassy. At the briefing, we discussed the current issues that were of concern to India including the signing of the Comprehensive Test Ban Treaty (CTBT), India-Pakistan relations, and the future of U.S.-India relations under the Bush Administration. President Clinton visit in March of 2000 was the first Presidential visit since President Carter's visit to India. The main focus of our discussions was the relationship between India and Pakistan. My first meeting that morning was with Foreign Secretary Lalit Mansingh. I congratulated Foreign Secretary Mansingh on his designation as the next Indian ambassador to the U.S. We spoke briefly about the elections in the U.S. and the Foreign Secretary asked me if I thought that the election would result in some momentum for reform of our system of voting. I responded that reform was on the horizon but that the electoral college would not be eliminated. On the issue of the CTBT, the Foreign Secretary expressed his sentiment that the U.S. should not expect India to sign a Treaty that the U.S. itself perceives as flawed. He went on to state that the Indian neighborhood was getting more dangerous and that India had no choice but to ``go nuclear'' to protect itself against both China and Pakistan ``but we want to convince you that India is a responsible country.'' I then posed the question to him of what his assessment was of the likelihood was that a nation, excepting those classified as so-called rogue nations, would launch an attack against another country. The foreign secretary promptly responded that unless there was an ``act of madness'', one does not anticipate nuclear attacks from democratic regime. India, he said, is producing thousands of graduates every year, whereas Pakistan is producing thousands of terrorists each year. He went onto expressed his concern about the role of Pakistan in fostering religious fervor, which manifested themselves into acts of terrorism. The Foreign Secretary stressed that India shared the United States commitment to reducing nuclear weapons, but have not always agreed in how to reach this common goal. The United States believes that India should forego nuclear weapons. India believes that it needs to maintain a credible minimum nuclear deterrent in keeping with its own assessment of its security needs. Nonetheless, he said, India would be prepared to work with the U.S. to build upon the bilateral dialogue already underway. Next, I asked the Foreign Secretary the impact of the religious persecution legislation that was enacted in law in 1998. He responded that the legislation had no impact because there is no real problem with discrimination in India. When I asked him what steps the Indian government had taken to protect minority communities and prosecute offenders, the Foreign Secretary responded that there had been isolated incidences in the remote tribal areas of Orissa and Gujarat and that the Government had strongly condemned these murders. Prime Minister Vajpayee had committed that reducing communal violence was one of the main goals of his government and in that light he had spent last week in the state of Kerala focuses on the issue. He went onto note that many religious minorities held seats in Parliament including Defense Minister George Fernandes. That afternoon, Ambassador Celeste hosted a luncheon at his residence with leaders from the business, civil, political and philanthropic communities. We discussed a wide range of issues ranging from brain drain in India to the middle-east peace process. My next meeting that afternoon was with the Leader of the Opposition in the Upper House of Parliament Dr. Manmohan Singh. Dr. Manmohan Singh was also Finance Minister under former Prime Minister Narashima Rao and the architect of India's economic reform program in the early 1990's. We discussed topics ranging from the continued strengthening of U.S.- India ties under the Bush Administration to the perseverance of India's economic liberalization. When Dr. Singh asked me about my general views on South Asia, I told him that I believed that with a population of over 1 billion, one fifth of the world's population, India has a lot of unrealized potential. I told him that I applauded India's move from a socialist economy to a free market economy and its achievements in science and technology. He said that India is committed to economic expansion and reform--especially in the emerging knowledge-based industries and high-technology areas, and it is determined to bring the benefits of economic growth to all its people. My final meeting that evening was with K. Natwar Singh, who is the chief foreign policy advisor to Congress Party President Sonia Gandhi. Mr. Singh also served as foreign minister under Prime Minister Rajiv Gandhi, Sonia Gandhi's late husband. We met in the room that used to serve as the late Prime Minister Indira Gandhi's office. Mr. Singh took me to the memorial, which marked the spot that on October 31, 1984, while walking to her office from her nearby residence, Indira Gandhi was assassinated. We discussed issues ranging from the middle east peace process to the balance of power in the newly elect 50-50 Senate to India-Pakistan relationship. Mr. Singh expressed the belief of his party that reestablishing a bilateral dialogue with Pakistan is critical if any progress is to be made in the Kashmir region. I told him that following my visit to the subcontinent in 1995, I wrote a letter to President Clinton summarizing my meetings with then Prime Minister Rao and Prime Minister Bhutto and suggesting that it would be very productive for the United States initiate and broker discussions between India and Pakistan regarding nuclear weapons and missile delivery systems. When I raised the issue of persecution of religious minorities, he responded that there is no state sponsored discrimination, but there had been isolated case by case incidents. Mr. Singh expressed to me that these were isolated incidents and that the government had strongly condemned the attacks. He informed me that Prime Minister Vajpayee personally was distressed over these attacks and had just returned from meeting with a group of Christian Bishops in the state of Kerala. The following day I attended a luncheon meeting with the Confederation of Indian Industry. Approximately 40 business leaders participated in a lively question and answer session where I responded to wide array of questions about from bipartisanship in the newly elected Senate, the U.S. economy, China PNTR and the Comprehensive Test Ban Treaty. I left the luncheon and arrived at the Mother Child Welfare Center in Chanakyapuri, New Delhi. This Welfare Center also serves as the local polio immunization clinic. Launched in 1988, the global Polio Eradication Initiative is spearheaded by the U.S. Center for Disease Control and Prevention, WHO, Rotary International, National Governments and UNICEF. The Governments of the United States, Denmark, Germany, Italy, Japan, UK, the European Commission, Bill & Melinda Gates Foundation, and the UN Foundation and the World Bank have all been supporting the effort to eradicate polio in India by 2002. This would be only the second disease to be eradicated after small pox. Here, I had the opportunity to hold and administer the polio vaccine drops to the infants at the clinic. Later that afternoon, I met with Foreign Minister Jaswant Singh. We discussed India signing the CTBT, FMCT--Fissile Material Production Treaty which would end the production of nuclear materials--India's nuclear weapons program, Kashmir, the problems in Afghanistan with the Taliban. He told me that India was committed towards any hostility in the region and that the CTBT was a meaningless Treaty in their eyes because they have already taken on a voluntary moratorium. He went on to stress that India recently signed a treaty with Pakistan that recently no aggressive use of nuclear weapons. The next morning we departed for Udaipur. That afternoon I met with Professor P.C. Bordia, an expert on India's licit opium production program. India is the world's largest source of opium for pharmaceutical use. However, located between Afghanistan and Burma, the two main world sources of illicitly grown opium, India is a transit point for heroin. Opium is produced legally in India under strict licensing and control, and the Government of India tries to extract every gram from the cultivators. The United States and India signed an agreement in June 2000 to jointly survey and study samples of licit opium poppy crop. Professor Bordia explained to me the methodology of the three year study. This collaborative DEA funded project seeks to produce reliable data on the yields of opium gum from India's poppy cultivation, which would help the Government of India to maintain tight control over its licit poppy production to prevent diversion and ensure an adequate supply to meet the international medical and scientific needs. The project is scheduled to begin in mid-January 2001 with the visit of two U.S. scientists, Drs. Basil and Mary Acock. Later that afternoon, my staff toured the Udaipur Solar Observatory GONG project--Global Oscillation Network Group--which has been funded by the National Science Foundation for the last nine years. The GONG project is an international project conducting a detailed study of the internal structure and motions of the Sun using helioseismology. The U.S. National Observatory developed GONG stations in six stations all over the world. These are in Hawaii, California, Chile, Canary Island, India and Australia, and the National Solar Observatory in Tucson, Arizona. Dr. Arvind Bhatnagar and Dr. S.C. Tripathy explained that this project enables surveillance of the Sun 24 hours a day. My staff saw first hand the working of the sophisticated $1.5 million state of the art telescope that has been installed in Udaipur under this project. This telescope monitors the Sun automatically, and takes digital velocity images of the sun every minute. This data is then combined with the data from the other five sites at the central facility located in Tucson. Dr. Bhatnagar explained to my staff with tremendous enthusiasm that the GONG project promises to unravel several fundamental problems of solar interior and general astrophysics. On Sunday, January 7, prior to departing for Islamabad from New Delhi, I met with the Station Chief and agents in-charge of the FBI and DEA in New Delhi. That same morning I also met with Dr. John Fitzsimmons and Dr. Gary Hlady to discuss the National Polio Surveillance Project and to see what might be done to expand that program to cover other illnesses such as measles, rubella, tetanus etc. They told me that polio eradication within Asia was within reach by the year 2002 and that measles was on the horizon. We also discussed ways in which Congress could assist the CDC and NIH to develop programs targeted at eradicating these diseases. It was apparent by comments in both India and Pakistan that the Senate's 1999 vote against ratifying the CTBT was closely watched and that the vote diluted our power to persuade nations like India and Pakistan to support the CTBT. In my discussions with officials, it became evident that securing compliance with the CTBT by these two nations without U.S. ratification would be problematic. We departed New Delhi on the morning of January 7 traveled to Islamabad, Pakistan. I last visited Pakistan in 1995 meeting with then Prime Minister Benezir Bhutto who is now living abroad in exile and facing corruption charges in Pakistan. Upon our arrival, the Charge, Michele Sison, met me at the airport and we departed for our first meeting. General Musharraf, the Chief Executive and current political leader of Pakistan as well as the foreign minister, were out of the country on foreign travel. Our first meeting was with the Foreign Secretary, Inam ul-Haq. Secretary Ul-Haq is Pakistan's highest-ranking career diplomat having previously been posted as Pakistan's Ambassador to the United Nations and as Pakistan's Ambassador to China. Our meeting began with a discussion of Pakistan's nuclear tests and the Comprehensive Test Ban Treaty (CTBT). The Foreign Secretary told me that General Musharraf and the current government was in favor of ratification of the CTBT. However, I was told that there was a very vocal group in Pakistan which was opposed to Pakistan's ratification of the Treaty and that the Foreign Minister was personally working on persuading opponents of the Treaty and its benefits. The foreign secretary informed me that the Pakistani government closely followed the limited debate and vote in the U.S. Senate regarding the CTBT and that ratification by the U.S. would be very helpful in Pakistan's internal debate on the issue. I next discussed the procedure by which General Musharraf came to be the current political leader of Pakistan. I was told that after the General's ouster of Prime Minister Nawaz Sharif and ascension to power, a lawsuit was filed against the General in the Supreme Court challenging the legitimacy of his actions. When I asked if the outcome of that suit was predetermined, the foreign secretary informed me that there was a similar situation when a previous General had ousted a previous Prime Minister and a lawsuit was filed challenging the legitimacy of the action. The Supreme Court in that case found the General's actions to be unjustified and returned the Prime Minister to power. I told the Foreign Secretary of the great concern in the United States Congress regarding the return of democracy to Pakistan and that I was hopeful General Musharraf would honor the October 2002 Supreme Court deadline for restoring democracy. Our discussion then turned to Kashmir and the ongoing conflict there. The Foreign Secretary stated that his government was pleased with the easing of tensions and was hopeful, but not optimistic, that the Indian government would engage in dialogue regarding Kashmir. I asked the Foreign Secretary what could or should be done with the Taliban and Osama Bin Laden in Afghanistan. The Foreign Secretary told me that Undersecretary of State Pickering had conducted meetings with officials from the Taliban and that they were very grateful for the support of the U.S. provided during their war with the former Soviet Union. The Foreign Secretary felt that the U.S. should continue to provide humanitarian aid to Afghanistan and that perhaps through dialogue with the Taliban some solution regarding Osama Bin Laden could be reached. The Foreign Secretary thought that more sanctions would do more harm than good. The Foreign Secretary told me that Pakistan suffered from more terrorist attacks than any other country and that combating terrorism in Afghanistan worked to Pakistan's benefit as well. Finally, we discussed the situation facing religious minorities in Pakistan. Pakistan is a predominately Muslim country with roughly 90 percent of its population belonging to that religion. The remaining religious minorities are roughly 3 percent Hindu, 6 percent Christian and 1 percent Sikh. The major problem facing non-Muslims in Pakistan is the blasphemy law, which allows for the death of anyone who blasphemes the Prophet Mohammed. I was told that the interpretation of the law is very liberal and mere attendance of mass by Catholics is a sufficient basis on which to charge someone for the crime. I urged the Foreign Secretary to have his government repeal this law and play a more active role in the protection of religious minorities. After my meeting with the foreign secretary, we attended a working reception at the Charge's home in Islamabad. The attendee's at the reception were leaders from the Government, the Academy, various NGOs, religious and American communities. During the course of the evening, we engaged in spirited debate on topics such as the CTBT, missile defense, religious tolerance and the importance of democracy. The next morning I had the opportunity to sit down with Mr. Shahbaz Bhatti, Founder and President of the Christian Liberation Front of Pakistan whom I had met in Philadelphia earlier this year. His group is an umbrella organization whose self described mission is the ``liberation of the oppressed from social subjugation, economic deprivation, religious discrimination, religious intolerance and expression.'' Mr. Bhatti and I discussed Pakistan's blasphemy law, which he told me is broadly interpreted, and states that anyone who blasphemes the Prophet Mohammed is to be sentenced to death. Mr. Bhatti told me that there were many individuals currently being detained in Pakistani jails under the law and he provided me with a list of names. I asked Mr. Bhatti if he thought that the religious persecution act the Congress had passed had any effect on his situation in Pakistan. He told me that he thought the Act was a useful instrument for the enhancement of interfaith harmony and religious tolerance, not only in Pakistan, but also all over the world. Mr. Bhatti told me that he felt that the U.S. State Department needed to be more focused on persecution in Pakistan in the coming year. Mr. Bhatti said that while he had met with the U.S. Ambassador when he had visited Pakistan and that he had met with the Ambassador again in Washington, he felt that Pakistan should be elevated to a country of special concern in the State Department's annual report. Mr. Bhatti felt that Islamic militants inside Pakistan were pressuring the government to be even less tolerant of religious minorities. Mr. Bhatti told me that he had received telephonic threats at his home and that vandals had done property damage to his office. He told me that he had a meeting with General Musharraf to discuss religious tolerance and while the General seemed to be genuinely concerned about the plight of the religious minorities, he told Mr. Bhatti that he had to deal with a constituency, which did not share his tolerant views. After my discussion with Mr. Bhatti I called the Foreign Secretary to discuss the plight of the religious minorities and the detention of certain individuals under the blasphemy law. The Foreign Secretary told me that he would look into the matter and I told him I would send him a list of those imprisoned because of their religion which Mr. Bhatti provided me. We departed Islamabad and arrived into Istanbul on the night of January 8. The next morning we had a working breakfast with the Ambassador, his wife, Station Chief and the regional head of the DEA. Our discussions at breakfast covered a wide range of issues from resolution of Turkey's long-standing conflict with Cyprus, Syrian- Turkish relations, Turkey's entry into the European Union, and the strong political and military ties between Turkey and the United States. After departing Istanbul, we traveled to Mons, Belgium to meet with General Ralston, the Supreme Allied Commander of all NATO forces in Europe. General Ralston and I discussed the United State's proposed National Missile Defense System and the views our European allies had of that plan. General Ralston told me that he felt that the European's felt vulnerable to strategic missile attack under the U.S. plan which just proposed to protect the United States. We discussed the stand- alone European Defense force in addition to NATO. General Ralston had high praise NATO's new members, Czech Republic, Poland and Hungary and in fact was headed to the Czech Republic that afternoon. General Ralston told me that his forces were ready, willing and able to assist the International Criminal Tribunal for the former Yugoslavia (ICTY) in effectuating the arrest and return to The Hague of persons indicted for war crimes as soon as his political leadership instructed him to do so. After our meeting with General Ralston, we traveled to The Hague to meet with the Chief Prosecutor of the ICTY, Carla del Ponte, and some of her staff. She expressed her strong sentiment to me that Slobodan Milosevic must be returned to The Hague for trial at the ICTY before standing trial in Belgrade. Madam del Ponte felt very strongly about Milosevic being brought to trial in Belgrade for a number of reasons. First of all, she said, the ICTY had a clear mandate and enjoyed primacy over domestic courts--this was a Security Council mandate. Secondly, she expressed her fear that the Milosevic regime would still retain some power--even behind the scenes--for a long time; Further, she stressed that The Federal Republic of Yugoslavia must first establish its credibility before it takes on the daunting task of judging a former President. She said that the whole basis of the ICTY was to tackle those difficult, painful cases for which domestic courts are ill-equipped. I told the Chief Prosecutor that I shared her desire to have Mr. Milosevic prosecuted at The Hague but was doubtful that Mr. Milosevic would be turned over to The Hague after my recent meeting in Belgrade. The Chief Prosecutor and I also discussed the ongoing negotiations to establish an International Criminal Court and the concerns surrounding such a body. I told her that there were concerns in the United States Congress regarding the vulnerability of U.S. servicemen of being subjected to charges that are purely politically motivated and had no basis in fact. We discussed her consideration of requests by Russia and Yugoslavia under Milosevic to charge NATO officials with war crimes. Madam del Ponte told me that as a prosecutor she had no discretion in the matter and that, as a matter of course, she had to investigate the charges which she eventually deemed to be without merit. I asked Madam del Ponte if the ICTY needed any additional resources. She told me that resources continued to be tight--stressing that there was a great deal of work to do collecting evidence of the war crimes and that additional resources would be beneficial. My next meeting was with ICTY Judge Patricia Wald who resigned from the federal judiciary to serve at The Hague. We discussed the functioning and legal rules of the ICTY. Judge Wald informed me that the ICTY bench consists of members from the U.S., England, France, Australia, Portugal, Italy, China, Vienna, Malaysia, Zambia, Colombia, Jamaica and Egypt. My meetings with Chief Prosecutor Carla del Ponte and Judge Pat Wald, following on my earlier meetings in Belgrade, supported my notion that bringing Milosevic to justice at The Hague rather than in Yugoslavia would prove to be complicated. The new Yugoslavian democratic government's persistence on trying Milosevic in Serbia and the ICTY's insistence that it had primacy over Milosevic established the complexity of the issue. The concept on an International Criminal Court arose because of the failure of national courts to bring individuals like Milosevic to trial. On one hand, to permit Yugoslavia to try Milosevic, at least first, would encourage national courts to deal with such issues. On the other hand, Madam del Ponte's adamance that the ICTY had primacy granted under U.N. Resolutions and should not have to negotiate. She further expressed her concern that Yugoslavia could not be trusted to prosecute Milosevic due to problems of witness intimidation and the Milosevic regime still retaining influence in the Justice system. It is a difficult problem with no easy solution. I yield the floor.

Mr. SPECTER

Mr. SPECTER. Mr. President, as the 107th Congress commences, those of us elected to serve in the most evenly divided Senate and House in history recognize that whatever our parties' differences may be, we have a new opportunity to make a positive impact on the lives of the American people. The narrow margins in both legislative bodies offer us a chance to learn from the past, determine how best to respond to the challenges that are before us, and forge important alliances which will enable us to pass legislation important to this nation. I believe it is clear that one of our first priorities must be additional incremental reforms of our health care system. There is no time to waste. Many of our nation's health care problems are getting worse, not better. In its April 2000 report, the Employee Benefit Research Institute (EBRI) analyzed the March 1999 Current Population Survey, a document generated yearly by the U.S. Census Bureau. EBRI's analysis tells us that in 1998, about 194.7 million working-age Americans derived their health insurance coverage as follows: approximately 65 percent from employer plans; 10.4 percent from Medicare and Medicaid within a total of 14.0 percent from public sources of coverage; and 7 percent from other private insurance. While this survey shows us where the insured are obtaining their coverage, it also details a troubling statistic: 43.9 million Americans, or 18 percent of Americans aged 18-64, were uninsured. While the rate of growth of the number of uninsured is slowing, our goal of actually reducing the number of people without access to health coverage and services remains clear. As I have said many times, we can fix the problems felt by uninsured Americans without resorting to big government and without completely overhauling our current system, one that works well for most Americans--serving 81.6 percent of our non-elderly citizens. We must enact reforms that improve upon our current market-based health care system, as it is clearly the best health care system in the world. Accordingly, today I am introducing the Health Care Assurance Act of 2001, which, if enacted, will take us further down the path of the incremental reforms started by the Health Insurance Portability and Accountability Act of 1996 (Kassebaum-Kennedy) and various health care provisions enacted during the 105th and 106th Congresses. I would note that the final version of Kassebaum-Kennedy contained many elements which were in S. 18, the incremental health care reform bill I introduced when the 104th Congress began on January 4, 1995. The bill I am introducing today is distinct from my longstanding efforts regarding managed care reform. During the 105th and 106th Congresses, I joined a bipartisan group of Senators to introduce the Promoting Responsible Managed Care Act of 1998 and 1999, balanced proposals which would ensure that patients receive the benefits and services to which they are entitled, without compromising the savings and coordination of care that can be achieved through managed care. The managed care debate, which aims to improve insurance coverage for those who already have it, stands in stark contrast to the Health Care Assurance Act of 2001. My bill is intended to provide access to insurance coverage for those who have never even had the option to purchase it--or who simply could not afford it--due to market constraints. Given the importance of enacting this type of legislation, it is worth reviewing recent history which has taught us that bipartisanship is crucial in accomplishing any goal. In particular, the debate over President Clinton's Health Security Act during the 103rd Congress is replete with lessons concerning the pitfalls that inevitably lead to legislative failure. Several times during the 103rd Congress, I spoke on the Senate floor to address what seemed to be the wisest course--to pass incremental health care reforms with which we could all agree. Unfortunately, what seemed obvious to me, based on comments and suggestions by a majority of Senators who favored a moderate approach, was not obvious at the time to the Senate's Democratic leadership. This failure to understand the merits of an incremental approach was demonstrated in April 1993, during my attempts to offer a health care reform amendment based on the text of S. 631, an incremental reform bill I had introduced earlier in the session. This bill incorporated moderate, consensus principles in a reasonable reform package. First, I attempted to offer the bill as an amendment to legislation dealing with debt ceilings. Subsequently, I was informed that the floor consideration of this bill would be structured in a way that precluded my offering an amendment. Therefore, I prepared to offer my health care bill as an amendment to the fiscal year 1993 Emergency Supplemental Appropriations bill. To my dismay, then Majority Leader Mitchell, and Senator Byrd, then Chairman of the Appropriations Committee, worked together to ensure that I could not offer my amendment by keeping the Senate in a quorum call, a parliamentary tactic used to delay and obstruct. I was unable to obtain unanimous consent to end the quorum call, and thus could not proceed with my amendment. Three years later, well after the behemoth Clinton health care reform bill was derailed, the Senate once again endured a lengthy political battle concerning the Kassebaum-Kennedy bill, which I was pleased to cosponsor. When enough Senators sensed the growing frustration of the American people, we achieved a breakthrough in August 1996, and Kassebaum-Kennedy's vital health insurance market reforms were finally passed. There is no question that Kassebaum-Kennedy made significant steps forward in addressing troubling issues in health care--such as increasing the ease of portability of health insurance coverage--but I continue to recognize that there is much more to be done. That bill's incremental approach to health care reform is what allowed it to generate bipartisan, consensus support in the Senate. We knew that it did not address every single problem in the health care delivery system, but it would make life better for millions of American men, women, and children. I urge my colleagues to note a most important fact: the Kassebaum- Kennedy bill was enacted only after Democrats abandoned their hopes for passing a nationalized, big government health care scheme, and Republicans abandoned their position that access to health care is not really a major problem in the United States that demands Federal action. Perhaps the greatest recent example of the power of bipartisanship took place during the 105th Congress, with the passage of the Balanced Budget Act of 1997. This historic bipartisan agreement between Congress and the White House to balance the budget by 2002 extended the life of the vital Medicare hospital trust fund by ten years, while expanding needed benefits for seniors. The new law created a National Bipartisan Commission on the Future of Medicare to address the implications of the retirement of the Baby Boom generation, and marked the first balanced Federal budget in thirty years. This landmark accomplishment clearly would not have occurred without all members of Congress and the Administration crossing party lines, compromising, and doing what was right for the American people regardless of political affiliations. Despite the historic nature of the Balanced Budget Act of 1997, however, many providers, hospitals, home health agencies, and insurers argued that the cuts went too deep, and that patient access and care were being compromised. In both the 105th and 106th Congresses, I supported bipartisan efforts to carefully relieve and infuse additional dollars into areas which suffered too greatly from Medicare cuts, without upsetting the delicate balance of the budget. We must realize that if we are to continue to be successful in meeting the nation's health care needs, the solutions to the system's problems must come from the political center, not from the extremes. I have advocated health care reform in one form or another throughout my 18 years in the Senate. My strong interest in health care dates back to my first term, when I sponsored S. 811, the Health Care for Displaced Workers Act of 1983, and S. 2051, the Health Care Cost Containment Act of 1983, which would have granted a limited antitrust exemption to health insurers, permitting them to engage in certain joint activities such as acquiring or processing information, and collecting and distributing insurance claims for health care services aimed at curtailing then escalating health care costs. In 1985, I introduced the Community Based Disease Prevention and Health Promotion Projects Act of 1985, S. 1873, directed at reducing the human tragedy of low birth weight babies and infant mortality. Since 1983, I have introduced and cosponsored numerous other bills concerning health care in our country. A complete list of the 31 health care bills that I have sponsored since 1983 is included for the Record. During the 102nd Congress, I pressed the Senate to take action on the health care market issue. On July 29, 1992, I offered an amendment to legislation then pending on the Senate floor, which included a change from 25 percent to 100 percent deductibility for health insurance purchased by self-employed individuals, and small business insurance market reforms to make health coverage more affordable for small businesses. Included in this amendment were provisions from a bill introduced by the late Senator John Chafee, legislation which I cosponsored and which was previously proposed by Senators Bentsen and Durenberger. When then-Majority Leader Mitchell argued that the health care amendment I was proposing did not belong on that bill, I offered to withdraw the amendment if he would set a date certain to take up health care, similar to an arrangement made on product liability legislation, which had been placed on the calendar for September 8, 1992. The Majority Leader rejected that suggestion and the Senate did not consider comprehensive health care legislation during the balance of the 102nd Congress. My July 29, 1992 amendment was defeated on a procedural motion by a vote of 35 to 60, along party lines. The substance of that amendment, however, was adopted later by the Senate on September 23, 1992, when it was included in a Bentsen/ Durenberger amendment which I cosponsored to broader tax legislation (H.R. 11). This amendment, which included essentially the same self- employed tax deductibility and small group reforms I had proposed on July 29th of that year, passed the Senate by voice vote. Unfortunately, these provisions were later dropped from H.R. 11 in the House-Senate conference. On August 12, 1992, I introduced legislation entitled the Health Care Affordability and Quality Improvement Act of 1992, S. 3176, that would have enhanced informed individual choice regarding health care services by providing certain information to health care recipients, would have lowered the cost of health care through use of the most appropriate provider, and would have improved the quality of health care. On January 21, 1993, the first day of the 103rd Congress, I introduced the Comprehensive Health Care Act of 1993, S. 18. This legislation was comprised of reforms that our health care system could have adopted immediately. These initiatives would have both improved access and affordability of insurance coverage and would have implemented systemic changes to lower the escalating cost of care in this country. S. 18 is the principal basis of the legislation I introduced in the last three Congresses as well as this one. On March 23, 1993, I introduced the Comprehensive Access and Affordability Health Care Act of 1993, S. 631, which was a composite of health care legislation introduced by Senators Cohen, Kassebaum, Bond, and McCain, and included pieces of my bill, S. 18. I introduced this legislation in an attempt to move ahead on the consideration of health care legislation and provide a starting point for debate. As I noted earlier, I was precluded by Majority Leader Mitchell from obtaining Senate consideration of my legislation as a floor amendment on several occasions. Finally, on April 28, 1993, I offered the text of S. 631 as an amendment to the pending Department of the Environment Act (S. 171) in an attempt to urge the Senate to act on health care reform. My amendment was defeated 65 to 33 on a procedural motion, but the Senate had finally been forced to contemplate action on health care reform. On the first day of the 104th Congress, January 4, 1995, I introduced a slightly modified version of S. 18, the Health Care Assurance Act of 1995 (also S. 18), which contained provisions similar to those ultimately enacted in the Kassebaum-Kennedy legislation, including insurance market reforms, an extension of the tax deductibility of health insurance for the self employed, and tax deductibility of long term care insurance. I continued these efforts in the 105th Congress, with the introduction of Health Care Assurance Act of 1997 (S. 24), which included market reforms similar to my previous proposals with the addition of a new Title I, an innovative program to provide vouchers to States to cover children who lack health insurance coverage. I also introduced Title I of this legislation as a stand-alone bill, the Healthy Children's Pilot Program of 1997 (S. 435) on March 13, 1997. This proposal targeted the approximately 4.2 million children of the working poor who lacked health insurance at that time. These are children whose parents earn too much to be eligible for Medicaid, but do not earn enough to afford private health care coverage for their families. This legislation would have established a $10 billion/5 year discretionary pilot program to cover these uninsured children by providing grants to States. Modeled after Pennsylvania's extraordinarily successful Caring and BlueCHIP programs, this legislation was the first Republican-sponsored child health insurance bill during the 105th Congress. I was encouraged that the Balanced Budget Act of 1997, signed into law on August 5, 1997, included a combination of the best provisions from many of the child health insurance proposals throughout this Congress. The new legislation allocated $24 billion over five years to establish State Child Health Insurance Programs, funded in part by a slight increase in the cigarette tax. On the first day of the 106th Congress, I again introduced the Health Care Assurance Act of 1999, also designated S. 24. This bill contained similar insurance market reforms, as well as new provisions to augment the new State Child Health Insurance Program, to assist individuals with disabilities in maintaining quality health care coverage, and to establish a National Fund for Health Research to supplement the funding of the National Institutes of Health. All these new initiatives, as well as the market reforms that I supported previously, work toward the goals of covering more individuals and stemming the tide of rising health costs. My commitment to the issue of health care reform across all populations has been consistently evident during my tenure in the Senate, as I have taken to this floor and offered health care reform bills and amendments on countless occasions. I will continue to stress the importance of the Federal government's investment in and attention to the system's future. As my colleagues are aware, I can personally report on the miracles of modern medicine. Seven and one half years ago, an MRI detected a benign tumor (meningioma) at the outer edge of my brain. It was removed by conventional surgery, with five days of hospitalization and five more weeks of recuperation. When a small regrowth was detected by a follow-up MRI in June 1996, it was treated with high powered radiation using a remarkable device called the ``Gamma Knife.'' I entered the hospital on the morning of October 11, 1996, and left the same afternoon, ready to resume my regular schedule. Like the MRI, the Gamma Knife is a recent innovation, coming into widespread use only in the past decade. In July 1998, I was pleased to return to the Senate after a relatively brief period of convalescence following heart bypass surgery. This experience again led me to marvel at our health care system and made me more determined than ever to support Federal funding for biomedical research and to support legislation which will incrementally make health care available to all Americans. My concern about health care has long pre-dated my own personal benefits from the MRI and other diagnostic and curative procedures. As I have previously discussed, my concern about health care began many years ago and has been intensified by my service on the Appropriations Subcommittee on Labor, Health and Human Services, and Education, which I now have the honor to chair. My own experience as a patient has given me deeper insights into the American health care system beyond my perspective from the U.S. Senate. I have learned: (1) our health care system, the best in the world, is worth every cent we pay for it; (2) patients sometimes have to press their own cases beyond doctors' standard advice; (3) greater flexibility must be provided on testing and treatment; (4) our system has the resources to treat the 43.9 million Americans currently uninsured, but we must find the way to pay for it; and (5) all Americans deserve the access to health care from which I and others with coverage have benefitted. I have long been convinced that our Federal budget of $1.8 trillion could provide sufficient funding for America's needs if we establish our real priorities. Over the past eight years, I believe we have learned a great deal about our health care system and what the American people are willing to accept from the Federal government. The message we heard loudest was that Americans do not want a massive overhaul of the health care system. Instead, our constituents want Congress to proceed at a slower pace and to target what is not working in the health care system while leaving in place what is working. As I have said both publicly and privately, I had been willing to cooperate with the Clinton Administration in solving the health care problems facing our country. However, I found many important areas where I differed with President Clinton's approach to solutions and I did so because I believed that the proposals would have been deleterious to my fellow Pennsylvanians, to the American people, and to our health care system as a whole. Most importantly, as the President proposed in 1993, I did not support creating a large new government bureaucracy because I believe that savings should go to health care services and not bureaucracies. On this latter issue, I first became concerned about the potential growth in bureaucracy in September 1993 after reading the President's 239-page preliminary health care reform proposal. I was surprised by the number of new boards, agencies, and commissions, so I asked my legislative assistant, Sharon Helfant, to make me a list of all of them. Instead, she decided to make a chart. The initial chart depicted 77 new entities and 54 existing entities with new or additional responsibilities. When the President's 1,342-page Health Security Act was transmitted to Congress on October 27, 1993, my staff reviewed it and found an increase to 105 new agencies, boards, and commissions and 47 existing departments, programs and agencies with new or expanded jobs. This chart received national attention after being used by Senator Bob Dole in his response to the President's State of the Union address on January 24, 1994. The response to the chart was tremendous, with more than 12,000 people from across the country contacting my office for a copy; I still receive requests for the chart nearly eight years later. Groups and associations, such as United We Stand America, the American Small Business Association, the National Federation of Republican Women, and the Christian Coalition, reprinted the chart in their publications-- amounting to hundreds of thousands more in distribution. Bob Woodward of the Washington Post later stated that he thought the chart was the single biggest factor contributing to the demise of the Clinton health care plan. And, as recently as the November 1996 election, my chart was used by Senator Dole in his presidential campaign to illustrate the need for incremental health care reform as opposed to a big government solution. With the history of the health care reform debate in mind and building on my previous efforts, I am again introducing an incremental bill which would provide quality health care without adversely affecting the many positive aspects of our health care system. It is more prudent to implement targeted reforms and then act later to improve upon what we have done. I call this trial and modification. We must be careful not to damage the positive aspects of our health care system upon which more than 194.7 million Americans justifiably rely. The legislation I am introducing today has three objectives: (1) to provide affordable health insurance for those now not covered; (2) to reduce health care costs for all Americans; and (3) to improve coverage for underinsured individuals, families, and children. This bill includes provisions to expand the Medicaid program to cover higher income individuals than currently allowed, to encourage the formation of small group insurance purchasing arrangements, to expand access to health insurance for children, to improve health benefits for individuals with disabilities, to strengthen preventive health benefits under the Medicare program, to increase access to prenatal care and outreach for the prevention of low birth weight babies, to strengthen patients' rights regarding medical care at the end of life, to expand access to primary and preventive health services, to reform the COBRA law, to enhance our investment in outcomes research, to reduce the incidence of medical errors, and to establish a national fund for health research as a supplement to the National Institutes of Health budget. Taken together, I believe the reforms proposed in the Health Care Assurance Act of 2001 will both improve the quality of health care delivery and will help ease the escalating costs of health care in this country. This new initiative, which was not contained in my previous version of this legislation, would guarantee coverage for individuals earning up to 133 percent of the Federal poverty level ($11,105 for a single/ $22,676 for a family of four) and would give states the option to cover individuals earning up to 200 percent of poverty ($16,700 for a single/ $34,100 for a family of four). This population is generally deemed undesirable by private insurers, and since these low-income individuals are ineligible for Medicaid, they currently remain uninsured. The provisions in this title advance the recent joint proposal by the Health Insurance Association of America and Families USA, two groups which have traditionally been on opposing ends of health policy debates. Recognizing the rising number of Americans who lack health insurance, these groups took the unprecedented step in crafting a set of basic policy goals on which Congress may build consensus and get something done for the uninsured. Currently, Medicaid only guarantees coverage for pregnant women and infants who earn up to 133 percent of the poverty level. Beyond that population, the Federal mandate varies across age, income, and disability status; for instance, there are different federal mandates for preschool age children than for school- age children and for disabled individuals. Further, current law does not allow any Federal contributions for coverage of people ages 16-18 or for adults with children. I recognize that states may certainly choose to establish programs to cover these and other categories of low-income people, but usually will not do so without Federal help. Title II of the bill builds on the State Child Health Insurance Program (SCHIP), the program established in the Balanced Budget Act of 1997, which allocated $24 billion over five years to increase health insurance coverage for children. The SCHIP program gives States the option to use federally funded grants to provide vouchers to eligible families to purchase health insurance for their children, or to expand Medicaid coverage for those uninsured children, or a combination of both. This title would increase the income eligibility to families with incomes at or below 235 percent of the Federal poverty level ($40,067 annually for a family of four). The Health Care Financing Administration reported that nearly two million children were enrolled in the SCHIP program during fiscal year 1999. The Administration's goal is to enroll five million more children in the program by the end of fiscal year 2002. This provision would allow eligibility for approximately another 850,000 uninsured children. Title III assists another of our Nation's most vulnerable populations by improving the delivery of care for individuals with long-term disabilities. This title would allow for Medicaid reimbursement for community-based attendant care services, as an alternative to institutionalization, for eligible individuals who require such services based on functional need, without regard to the individual's age or the nature of the disability. The most recent data available tell us that 6.64 million individuals receive care for disabilities under the Medicaid program. This title builds on S. 1935, legislation I introduced during the 106th Congress with Senator Tom Harkin of Iowa. Such a change in Medicaid law is desperately needed given the Supreme Court's recent ruling in Olmstead v. L.C., 119 S. Ct. 2176 (1999): the Americans with Disabilities Act (ADA) requires States, in some circumstances, to provide community-based treatment to persons with mental disabilities rather than placement in institutions. This decision and several lower court decisions have pointed to the need for a structured Medicaid attendant-care services benefit in order to meet obligations under the ADA. I am pleased to report that my fiscal year 2001 Labor, HHS, and Education Appropriations bill provided $50 million for ``Real Choice, Systems Change'' grants for states to fund initiatives for systems improvements and to provide long term services and supports, including community-based attendant care. In addition, $20 million was provided to continue demonstration projects on Medicaid coverage of community- based attendant care services. Title III of this bill expands and authorizes the programs we have been funding as demonstration projects in order to establish a permanent infrastructure for the new benefit. The next title contains provisions to make it easier for small businesses to buy health insurance for their workers by establishing voluntary purchasing groups. It also obligates employers to offer, but not pay for, at least two health insurance plans that protect individual freedom of choice and that meet a standard minimum benefits package. It extends COBRA benefits and coverage options to provide portability and security of affordable coverage between jobs. Specifically, Title IV extends the COBRA benefit option from 18 months to 24 months. COBRA refers to a measure which was enacted in 1985 as part of the Consolidated Omnibus Budget Reconciliation Act (COBRA '85) to allow employees who leave their job, either through a lay-off or by choice, to continue receiving their health care benefits by paying the full cost of such coverage. By extending this option, such unemployed persons will have enhanced coverage options, particularly when compared to what they would be able to buy in the individual insurance market. In addition, options under COBRA are expanded to include plans with lower premiums and higher deductibles of either $1,000 or $3,000. This provision is incorporated from legislation introduced in the 103rd Congress by Senator Phil Gramm and will provide an extra cushion of coverage options for people in transition. According to Senator Gramm, with these options, the typical monthly premium paid for a family of four would drop by as much as 20 percent when switching to a $1,000 deductible and as much as 52 percent when switching to a $3,000 deductible. This title also includes a provision which would extend to 36 months the time period for COBRA coverage for a child who is no longer a dependent under a parent's health insurance policy. Uninsured workers tend to be concentrated among those under age 35, although the average age of uninsured workers is increasing. EBRI statistics indicate that 24 percent of young adults between the ages of 18 and 24 were without coverage in 1998. This provision would allow those who are no longer dependents on their parents' plan to have a more secure safety net. With respect to the uninsured and underinsured, my bill would permit individuals and families to purchase guaranteed, comprehensive health coverage through purchasing groups. Health insurance plans offered through the purchasing groups would be required to meet basic, comprehensive standards with respect to benefits. My bill would also create health insurance purchasing groups for individuals wishing to purchase health insurance on their own. In today's market, such individuals often face a market where coverage options are not affordable. Purchasing groups will allow small businesses and individuals to buy coverage by pooling together to form purchasing groups, and choose from insurance plans that provide comprehensive benefits, with guaranteed enrollment, renewability, and equal pricing through community rating, adjusted by age and family size. Title IV of my bill also includes an important provision to give the self employed 100 percent deductibility of their health insurance premiums. The Kassebaum-Kennedy bill extended the deductibility of health insurance for the self employed to 80 percent by 2006. The Balanced Budget Act of 1997 and the Omnibus Appropriations Act for fiscal year 1999 both contained new phase-in scales for health insurance deductibility for the self-employed. Currently, self-employed persons may deduct 60 percent of their health insurance costs through 2002, to be fully deductible in 2003. My bill would speed up the phase- in: health insurance costs would be 70 percent deductible in 2001 and fully deductible in 2002, thereby giving the currently 3.1 million self-employed Americans who are uninsured a better incentive to purchase coverage. The provisions contained in this portion of my bill are vital, as EBRI statistics tell us that 60 percent of all uninsured workers in 1998 were either self-employed or were working in small private-sector firms. The disparity is further demonstrated by the fact that 31 percent of workers in private-sector firms with fewer than 25 employees were uninsured, compared with only 13 percent of workers in private- sector firms with 1000 or more employees. It is anticipated that the increased costs to employers electing to cover their employees as provided under Title IV in my bill would be offset by the administrative savings generated by development of the small employer purchasing groups. Such savings have been estimated at levels as high as $9 billion annually. In addition, by addressing some of the areas within the health care system that have exacerbated costs, significant savings can be achieved and then redirected toward direct health care services. Although our existing health care system suffers from serious structural problems, common sense steps can be taken to head off the remaining problems before they reach crisis proportions. Title V of my bill includes initiatives which will enhance primary and preventive care services aimed at preventing disease. Each year about 7.6 percent of babies born in the United States are born with a low birth weight, multiplying their risk of death and disability. Most of the deaths which do occur are preventable. Although the infant mortality rate in the United States fell to an all-time low in 1989, and the rate decreased by 28 percent between 1988 and 1998, too many babies continue to be born of low birth weight. The Executive Director of the National Commission To Prevent Infant Mortality put it this way: ``More babies are being born at risk and all we are doing is saving them with expensive technology.'' It is a human tragedy for a child to be born weighing 16 ounces with attendant problems which last a lifetime. I first saw one pound babies in 1984 when I was astounded to learn that Pittsburgh, Pennsylvania, had the highest infant mortality rate of African-American babies of any city in the United States. I wondered how that could be true of Pittsburgh, which has such enormous medical resources. It was an amazing thing for me to see a one pound baby, about as big as my hand. However, I am pleased to report that as a result of successful prevention initiatives like the federal Healthy Start program, Pittsburgh's infant mortality has decreased 20 percent. The Department of Health and Human Services has estimated that between $1.1 billion and $2.5 billion per year could be saved if the number of low birth weight children were reduced by 82,000 births. We know that in most instances, prenatal care is effective in preventing low birth weight babies. Numerous studies have demonstrated that low birth weight that does not have a genetic link is most often associated with inadequate prenatal care or the lack of prenatal care. The short and long-term costs of saving and caring for infants of low birth weight is staggering. In the most recent available study on the costs of low birth weight babies, the Office of Technology Assessment in 1988 concluded that $8 billion was expended in 1987 for the care of 262,000 low birth weight infants in excess of that which would have been spent on an equivalent number of babies born of normal birth weight, averted by earlier or more frequent prenatal care. To improve pregnancy outcomes for women at risk of delivering babies of low birth weight, my legislation would strengthen the Healthy Start program to reduce infant mortality and the incidence of low birth weight births, as well as to improve the health and well-being of mothers and their families, pregnant women and infants. Funds are awarded under this program with the goal of developing and coordinating effective health care and social support services for women and their babies. I initiated action that led to the creation of the Healthy Start program in 1991, working with the Bush Administration and Senator Harkin. As Chairman of the Appropriations Subcommittee with jurisdiction over the Department of Health and Human Services, I have worked with my colleagues to ensure the continued growth of this important program. In 1991, we allocated $25 million for the development of 15 demonstration projects. This number grew to 22 in 1994, to 75 projects in 1998, and the Health Resources and Services Administration expects this number to continue to increase. For both fiscal years 2000 and 2001, we secured $90 million for this vital program. Title V also provides increased support to local educational agencies to develop and strengthen comprehensive health education programs, and to Head Start resource centers to support health education training programs for teachers and other day care workers. Many studies indicate that poor health and social habits are carried into adulthood and often passed on to the next generation. To interrupt this tragic cycle, our nation must invest in proven preventive health education programs. Title V also expands the authorization of a variety of public health programs, such as breast and cervical cancer prevention, childhood immunizations, family planning, and community health centers. These existing programs are designed to improve public health and prevent disease through primary and secondary prevention initiatives. It is essential that we invest more resources in these programs now if we are to make any substantial progress in reducing the costs of acute care in this country. As Chairman of the Labor, HHS and Education Appropriations Subcommittee, I have greatly encouraged the development of prevention programs which are essential to keeping people healthy and lowering the cost of health care in this country. In my view, no aspect of health care policy is more important. Accordingly, my prevention efforts have been widespread. Specifically, I joined my colleagues in efforts to ensure that funding for the Centers for Disease Control and Prevention (CDC) increased $2.92 billion or 290 percent since 1989, for a fiscal year 2001 total of $3.92 billion. We have also worked to increase funding for CDC's breast and cervical cancer early detection program to $176 million in fiscal year 2001, almost one and a half times its 1993 total. I have also supported programs at CDC which help children. CDC's childhood immunization program seeks to eliminate preventable diseases through immunization and to ensure that at least 90 percent of 2 year olds are vaccinated. The CDC also continues to educate parents and caregivers on the importance of immunization for children under two years. Along with my colleagues on the Appropriations Committee, I have helped ensure that funding for this important program totaled $532.5 million for fiscal year 2001. The CDC's lead poisoning prevention program annually identifies about 50,000 children with elevated blood levels and places those children under medical management. The program prevents the amount of lead in children's blood from reaching dangerous levels and is currently funded at $36 million. In recent years, we have also strengthened funding for Community Health Centers, which provide immunizations, health advice, and health professions training. These Centers, administered by the Health Resources and Services Administration, provide a critical primary care safety net to rural and medically underserved communities, as well as uninsured individuals, migrant workers, the homeless, residents of public housing, and Medicaid recipients. For fiscal year 2001, these Centers received over $1.2 billion. As former Chairman of the Select Committee on Intelligence and current Chairman of the Appropriations Subcommittee with jurisdiction over non-defense biomedical research, I have worked to transfer CIA imaging technology to the fight against breast cancer. Through the Office of Women's Health within the Department of Health and Human Services, I secured a $2 million contract in fiscal year 1996 for a research consortium led by the University of Pennsylvania to perform the first clinical trials testing the use of intelligence technology for breast cancer detection. My Appropriations Subcommittee has continued to provide funds to continue these clinical trials. I have also been a strong supporter of funding for AIDS research, education, and prevention programs. Funding for Ryan White AIDS programs has increased from $757.4 million in 1996 to $1.6 billion for fiscal year 2001. Within the fiscal year 2001 funding, $65 million was included for pediatric AIDS programs and $589 million for the AIDS Drug Assistance Program (ADAP). AIDS research at the NIH totaled $742.4 million in 1989, and has increased to an estimated $2.1 billion in fiscal year 2001. The health care community continues to recognize the importance of prevention in improving health status and reducing health care costs. The Balanced Budget Act of 1997 and the Consolidated Omnibus Appropriations Act of fiscal year 2001 established new and enhanced preventive benefits within the Medicare program, such as flu shots, bone mass measurements, yearly mammograms, biennial pap smears and pelvic exams, and coverage of colonoscopy for high risk patients. However, some of these ``wellness'' benefits have cost obligations, such as copayments or deductibles. In this bill, I have also included provisions which refine and strengthen preventive benefits within the Medicare program, including coverage of yearly pap smears, pelvic exams, and screening and diagnostic mammography with no copayment or Part B deductible; and coverage of insulin pumps for certain Type I Diabetics. The proposed expansions in preventive health services included in Title V of my bill are conservatively projected to save approximately $2.5 billion per year or $12.5 billion over five years. It is clearly difficult to quantify today the savings that will surely be achieved when future generations of children are truly educated in a range of health-related subjects. Title VI of my bill would establish a federal standard and create uniform national forms concerning a patient's right to decline medical treatment. Nothing in my bill mandates the use of uniform forms. Rather, the purpose of this provision is to make it easier for individuals to make their own choices and determination regarding their treatment during this vulnerable and highly personal time. Studies have also indicated that advance directives do not increase health care costs. Data indicate that end-of-life costs account for 10 percent of total health expenditures and 28 percent of total Medicare expenditures. Loose projections indicate that a 10 percent savings made in the final days of life would result in approximately $10 billion of savings in medical costs per year, and about $4.7 billion in savings for Medicare alone. However, economic considerations are not and should not be the primary reasons for using advance directives. They provide a means for patients to exercise their autonomy over end-of-life decisions. A study done at the Thomas Jefferson University Medical College in Philadelphia cited research which found that about 90 percent of the American population has expressed interest in discussing advance directives. However, even more recent studies indicate that living wills would be used by many more Americans if they were better understood. My bill would provide information on an individual's rights regarding living wills and advanced directives, and would make it easier for people to have their wishes known and honored. In my view, no one has the right to decide for anyone else what constitutes appropriate medical treatment to prolong a person's life. Encouraging the use of advance directives will ensure that patients are not needlessly and unlawfully treated against their will. No health care provider would be permitted to treat an adult contrary to the adult's wishes as outlined in an advance directive. However, in no way would the use of advance directives condone assisted suicide or any affirmative act to end human life. The next title addresses the unique barriers to coverage which exist in both rural and urban medically underserved areas. Within Pennsylvania, such barriers result from a lack of health care providers in rural areas, and other problems associated with the lack of coverage for indigent populations living in inner cities. Title VII of my bill improves access to health care services for these populations by: (1) expanding Public Health Service programs and training more primary care providers to serve in such areas; (2) increasing the utilization of non-physician providers, including nurse practitioners, clinical nurse specialists and physician assistants, through increased reimbursements under the Medicare and Medicaid programs; and (3) increasing support for education and outreach. I believe these provisions will also yield substantial savings. A study of the Canadian health system utilizing nurse practitioners projected savings of 10 to 15 percent of all medical costs. While our system is dramatically different from that of Canada, it may not be unreasonable to project annual savings of five percent, or $57.5 billion, from an increased number of primary care providers in our system. Again, experience will raise or lower this projection. Outcomes research is another area where we can achieve considerable long term health care savings while also improving the quality of care. According to most outcomes management experts, it is estimated that about 25 to 30 percent of medical care is inappropriate or unnecessary. Dr. Marcia Angell, former editor-in-chief of the New England Journal of Medicine, also stated that 20 to 30 percent of health care procedures are either inappropriate, ineffective or unnecessary. I joined my colleagues in recognizing this important area of research by supporting passage of legislation reauthorizing the Agency for Healthcare Research and Quality (formerly the Agency for Health Care Policy and Research. The renamed agency, dubbed ``AHRQ,'' is authorized to expand outcomes research necessary for the development of medical practice guidelines and for increased access to consumer information. In order to boost funding for this vital area of research, title VIII of my bill would establish a trust fund for medical treatment outcomes research, capitalized by a .001 cent tax on total U.S. health insurance premiums collected. This trust fund would be specifically authorized for use by AHRQ to supplement its outcomes research mission. Based on the Health Care Financing Administration's 1998 health spending review, private health insurance premiums totaled $375 billion. As provided in my bill, a surcharge would generate $375 million for an outcomes research fund. Also included in this title is my ``Medical Errors Reduction Act,'' which I introduced in the 106th Congress with Senators Harkin and Inouye, in response to the November 29, 1999, Institute of Medicine (IOM) report, ``To Err Is Human: Building a Safer Health System.'' The report concluded that medical mistakes have led to numerous injuries and deaths, affecting an estimated three to four percent of all hospital patients. The IOM report also concluded that health care is a decade or more behind other high-risk industries in its attention to ensuring basic safety. According to the IOM, at least 44,000 Americans die each year as a result of medical errors, and the number may be as high as 98,000-- which catapults medical errors to the fifth leading cause of death nationwide. This total outnumbers deaths from motor vehicle accidents, breast cancer, and AIDS. Further, medical errors resulting in injury are estimated to cost the nation between $17 billion and $29 billion, including additional health care costs, lost income, lost household production, and disability costs. The IOM findings are startling and beg for national attention to determine ways to reduce the number of medical errors. On December 13, 1999, I chaired a hearing of the Labor, HHS, Education Appropriations Subcommittee to hear details of IOM's report findings. On January 25, 2000, I chaired a joint Labor, HHS, and Education Appropriations Subcommittee/Veterans' Affairs Committee hearing to consider mandatory and voluntary reporting requirements and to begin to determine ways to reduce medical errors. Specifically, my proposal would make grants available to states so they can establish their own error reporting systems and would establish 15 competitively-awarded research demonstration projects in rural and urban areas throughout the country. These projects would employ new and proven technologies and enhance staff training to determine ways to reduce errors. The provision also requires the Secretary of HHS to provide patient education programs to all individuals covered by Federal health plans. I am pleased to report that my Appropriations Subcommittee has already taken some critical first steps to reduce the incidence of deaths and injuries related to medical errors. In fiscal year 2001, $50 million has been provided to explore opportunities for a better understanding of the systemic problems in health care, in the hope that we can dramatically reduce the incidence of medical errors. The research initiatives include a focus on developing guidance to assist in States' development of data collection systems so that national trends can be determined and analyzed. In addition, the Committee has encouraged health care providers to explore the use of technologies and other methods in reducing medical errors. Nursing home care is another significant issue which must be addressed. Spending on long term care totaled $115 billion in 1997, and over 40 percent of that cost was borne by the Medicaid program. Despite these large public expenditures, the elderly face significant uncovered liability for long term care. Title IX of my bill would provide a tax credit for premiums paid to purchase private long-term care insurance. Other tax incentives and reforms provided in my bill to make long term care insurance more affordable include: (1) allowing employees to select long-term care insurance as part of a cafeteria plan and allowing employers to deduct this expense; (2) excluding from income tax the life insurance savings used to pay for long term care; and (3) setting standards for long term care insurance that reduce the bias that currently favors institutional care over community and home-based alternatives. The final title of my bill would create a national fund for health research within the Department of the Treasury, to supplement the monies appropriated for the National Institutes of Health. To capitalize this fund, health insurance companies would be required to contribute 1 percent of all health insurance premiums received. This creative proposal was first developed by my distinguished colleagues, Senators Mark Hatfield and Tom Harkin. Their idea is a sound one and ought to be adopted. To this end, Senator Harkin and I introduced the National Fund for Health Research Act on March 13, 1997 (S. 441) and August 5, 1999 (S. 1504). I look forward to continuing to work with Senator Harkin to enact a biomedical research fund this Congress. While precision is again impossible, my proposal could conceivably achieve a net annual savings of between $74 billion to $86 billion. The savings are totaled as follows: $9 billion in small employer market reforms coupled with employer purchasing groups; $2.5 billion for preventive health services; $17 to $29 billion for reducing costs associated with reducing medical errors; $10 billion from advanced directives; $57.5 billion from increasing primary care providers; and $2.9 billion by reducing administrative costs. The costs would be conservatively estimated to be $2.8 billion for long term care tax credits, approximately $15 billion for community-based attendant care services under Medicaid, and $7 billion for general Medicaid expansion. Experience and more detailed analysis of the affected populations will require modification of these projections, and I am prepared to work with my colleagues to develop implementing legislation and to press for further action in the important area of health care reform. The provisions which I have outlined today contain my ideas for a framework to provide affordable, high quality health care for all Americans. I am opposed to rationing health care. I do not want rationing for myself, for my family, or for America. In my judgment, we should not scrap, but rather we should build upon our current health delivery system. We do not need the overwhelming bureaucracy that President Clinton and other Democratic leaders proposed in 1993 to accomplish this. I believe we can provide care for the 43.9 million Americans who are now not covered and reduce health care costs for those who are covered within the currently growing $1.15 trillion in health care spending. Mr. President, the time has come for concerted action in this arena. I urge the Congressional leadership, including the appropriate committee chairmen, to move this legislation and other health care bills forward promptly. I ask unanimous consent that the full text of the bill, a summary, and a list of my health reform bills be printed in the Record.

Mr. SPECTER

Mr. SPECTER. Mr. President, as the 107th Congress commences, those of us elected to serve in the most evenly divided Senate and House in history recognize that whatever our parties' differences may be, we have a new opportunity to make a positive impact on the lives of the American people. The narrow margins in both legislative bodies offer us a chance to learn from the past, determine how best to respond to the challenges that are before us, and forge important alliances which will enable us to pass legislation important to this nation. I believe it is clear that one of our first priorities must be additional incremental reforms of our health care system. There is no time to waste. Many of our nation's health care problems are getting worse, not better. In its April 2000 report, the Employee Benefit Research Institute (EBRI) analyzed the March 1999 Current Population Survey, a document generated yearly by the U.S. Census Bureau. EBRI's analysis tells us that in 1998, about 194.7 million working-age Americans derived their health insurance coverage as follows: approximately 65 percent from employer plans; 10.4 percent from Medicare and Medicaid within a total of 14.0 percent from public sources of coverage; and 7 percent from other private insurance. While this survey shows us where the insured are obtaining their coverage, it also details a troubling statistic: 43.9 million Americans, or 18 percent of Americans aged 18-64, were uninsured. While the rate of growth of the number of uninsured is slowing, our goal of actually reducing the number of people without access to health coverage and services remains clear. As I have said many times, we can fix the problems felt by uninsured Americans without resorting to big government and without completely overhauling our current system, one that works well for most Americans--serving 81.6 percent of our non-elderly citizens. We must enact reforms that improve upon our current market-based health care system, as it is clearly the best health care system in the world. Accordingly, today I am introducing the Health Care Assurance Act of 2001, which, if enacted, will take us further down the path of the incremental reforms started by the Health Insurance Portability and Accountability Act of 1996 (Kassebaum-Kennedy) and various health care provisions enacted during the 105th and 106th Congresses. I would note that the final version of Kassebaum-Kennedy contained many elements which were in S. 18, the incremental health care reform bill I introduced when the 104th Congress began on January 4, 1995. The bill I am introducing today is distinct from my longstanding efforts regarding managed care reform. During the 105th and 106th Congresses, I joined a bipartisan group of Senators to introduce the Promoting Responsible Managed Care Act of 1998 and 1999, balanced proposals which would ensure that patients receive the benefits and services to which they are entitled, without compromising the savings and coordination of care that can be achieved through managed care. The managed care debate, which aims to improve insurance coverage for those who already have it, stands in stark contrast to the Health Care Assurance Act of 2001. My bill is intended to provide access to insurance coverage for those who have never even had the option to purchase it--or who simply could not afford it--due to market constraints. Given the importance of enacting this type of legislation, it is worth reviewing recent history which has taught us that bipartisanship is crucial in accomplishing any goal. In particular, the debate over President Clinton's Health Security Act during the 103rd Congress is replete with lessons concerning the pitfalls that inevitably lead to legislative failure. Several times during the 103rd Congress, I spoke on the Senate floor to address what seemed to be the wisest course--to pass incremental health care reforms with which we could all agree. Unfortunately, what seemed obvious to me, based on comments and suggestions by a majority of Senators who favored a moderate approach, was not obvious at the time to the Senate's Democratic leadership. This failure to understand the merits of an incremental approach was demonstrated in April 1993, during my attempts to offer a health care reform amendment based on the text of S. 631, an incremental reform bill I had introduced earlier in the session. This bill incorporated moderate, consensus principles in a reasonable reform package. First, I attempted to offer the bill as an amendment to legislation dealing with debt ceilings. Subsequently, I was informed that the floor consideration of this bill would be structured in a way that precluded my offering an amendment. Therefore, I prepared to offer my health care bill as an amendment to the fiscal year 1993 Emergency Supplemental Appropriations bill. To my dismay, then Majority Leader Mitchell, and Senator Byrd, then Chairman of the Appropriations Committee, worked together to ensure that I could not offer my amendment by keeping the Senate in a quorum call, a parliamentary tactic used to delay and obstruct. I was unable to obtain unanimous consent to end the quorum call, and thus could not proceed with my amendment. Three years later, well after the behemoth Clinton health care reform bill was derailed, the Senate once again endured a lengthy political battle concerning the Kassebaum-Kennedy bill, which I was pleased to cosponsor. When enough Senators sensed the growing frustration of the American people, we achieved a breakthrough in August 1996, and Kassebaum-Kennedy's vital health insurance market reforms were finally passed. There is no question that Kassebaum-Kennedy made significant steps forward in addressing troubling issues in health care--such as increasing the ease of portability of health insurance coverage--but I continue to recognize that there is much more to be done. That bill's incremental approach to health care reform is what allowed it to generate bipartisan, consensus support in the Senate. We knew that it did not address every single problem in the health care delivery system, but it would make life better for millions of American men, women, and children. I urge my colleagues to note a most important fact: the Kassebaum- Kennedy bill was enacted only after Democrats abandoned their hopes for passing a nationalized, big government health care scheme, and Republicans abandoned their position that access to health care is not really a major problem in the United States that demands Federal action. Perhaps the greatest recent example of the power of bipartisanship took place during the 105th Congress, with the passage of the Balanced Budget Act of 1997. This historic bipartisan agreement between Congress and the White House to balance the budget by 2002 extended the life of the vital Medicare hospital trust fund by ten years, while expanding needed benefits for seniors. The new law created a National Bipartisan Commission on the Future of Medicare to address the implications of the retirement of the Baby Boom generation, and marked the first balanced Federal budget in thirty years. This landmark accomplishment clearly would not have occurred without all members of Congress and the Administration crossing party lines, compromising, and doing what was right for the American people regardless of political affiliations. Despite the historic nature of the Balanced Budget Act of 1997, however, many providers, hospitals, home health agencies, and insurers argued that the cuts went too deep, and that patient access and care were being compromised. In both the 105th and 106th Congresses, I supported bipartisan efforts to carefully relieve and infuse additional dollars into areas which suffered too greatly from Medicare cuts, without upsetting the delicate balance of the budget. We must realize that if we are to continue to be successful in meeting the nation's health care needs, the solutions to the system's problems must come from the political center, not from the extremes. I have advocated health care reform in one form or another throughout my 18 years in the Senate. My strong interest in health care dates back to my first term, when I sponsored S. 811, the Health Care for Displaced Workers Act of 1983, and S. 2051, the Health Care Cost Containment Act of 1983, which would have granted a limited antitrust exemption to health insurers, permitting them to engage in certain joint activities such as acquiring or processing information, and collecting and distributing insurance claims for health care services aimed at curtailing then escalating health care costs. In 1985, I introduced the Community Based Disease Prevention and Health Promotion Projects Act of 1985, S. 1873, directed at reducing the human tragedy of low birth weight babies and infant mortality. Since 1983, I have introduced and cosponsored numerous other bills concerning health care in our country. A complete list of the 31 health care bills that I have sponsored since 1983 is included for the Record. During the 102nd Congress, I pressed the Senate to take action on the health care market issue. On July 29, 1992, I offered an amendment to legislation then pending on the Senate floor, which included a change from 25 percent to 100 percent deductibility for health insurance purchased by self-employed individuals, and small business insurance market reforms to make health coverage more affordable for small businesses. Included in this amendment were provisions from a bill introduced by the late Senator John Chafee, legislation which I cosponsored and which was previously proposed by Senators Bentsen and Durenberger. When then-Majority Leader Mitchell argued that the health care amendment I was proposing did not belong on that bill, I offered to withdraw the amendment if he would set a date certain to take up health care, similar to an arrangement made on product liability legislation, which had been placed on the calendar for September 8, 1992. The Majority Leader rejected that suggestion and the Senate did not consider comprehensive health care legislation during the balance of the 102nd Congress. My July 29, 1992 amendment was defeated on a procedural motion by a vote of 35 to 60, along party lines. The substance of that amendment, however, was adopted later by the Senate on September 23, 1992, when it was included in a Bentsen/ Durenberger amendment which I cosponsored to broader tax legislation (H.R. 11). This amendment, which included essentially the same self- employed tax deductibility and small group reforms I had proposed on July 29th of that year, passed the Senate by voice vote. Unfortunately, these provisions were later dropped from H.R. 11 in the House-Senate conference. On August 12, 1992, I introduced legislation entitled the Health Care Affordability and Quality Improvement Act of 1992, S. 3176, that would have enhanced informed individual choice regarding health care services by providing certain information to health care recipients, would have lowered the cost of health care through use of the most appropriate provider, and would have improved the quality of health care. On January 21, 1993, the first day of the 103rd Congress, I introduced the Comprehensive Health Care Act of 1993, S. 18. This legislation was comprised of reforms that our health care system could have adopted immediately. These initiatives would have both improved access and affordability of insurance coverage and would have implemented systemic changes to lower the escalating cost of care in this country. S. 18 is the principal basis of the legislation I introduced in the last three Congresses as well as this one. On March 23, 1993, I introduced the Comprehensive Access and Affordability Health Care Act of 1993, S. 631, which was a composite of health care legislation introduced by Senators Cohen, Kassebaum, Bond, and McCain, and included pieces of my bill, S. 18. I introduced this legislation in an attempt to move ahead on the consideration of health care legislation and provide a starting point for debate. As I noted earlier, I was precluded by Majority Leader Mitchell from obtaining Senate consideration of my legislation as a floor amendment on several occasions. Finally, on April 28, 1993, I offered the text of S. 631 as an amendment to the pending Department of the Environment Act (S. 171) in an attempt to urge the Senate to act on health care reform. My amendment was defeated 65 to 33 on a procedural motion, but the Senate had finally been forced to contemplate action on health care reform. On the first day of the 104th Congress, January 4, 1995, I introduced a slightly modified version of S. 18, the Health Care Assurance Act of 1995 (also S. 18), which contained provisions similar to those ultimately enacted in the Kassebaum-Kennedy legislation, including insurance market reforms, an extension of the tax deductibility of health insurance for the self employed, and tax deductibility of long term care insurance. I continued these efforts in the 105th Congress, with the introduction of Health Care Assurance Act of 1997 (S. 24), which included market reforms similar to my previous proposals with the addition of a new Title I, an innovative program to provide vouchers to States to cover children who lack health insurance coverage. I also introduced Title I of this legislation as a stand-alone bill, the Healthy Children's Pilot Program of 1997 (S. 435) on March 13, 1997. This proposal targeted the approximately 4.2 million children of the working poor who lacked health insurance at that time. These are children whose parents earn too much to be eligible for Medicaid, but do not earn enough to afford private health care coverage for their families. This legislation would have established a $10 billion/5 year discretionary pilot program to cover these uninsured children by providing grants to States. Modeled after Pennsylvania's extraordinarily successful Caring and BlueCHIP programs, this legislation was the first Republican-sponsored child health insurance bill during the 105th Congress. I was encouraged that the Balanced Budget Act of 1997, signed into law on August 5, 1997, included a combination of the best provisions from many of the child health insurance proposals throughout this Congress. The new legislation allocated $24 billion over five years to establish State Child Health Insurance Programs, funded in part by a slight increase in the cigarette tax. On the first day of the 106th Congress, I again introduced the Health Care Assurance Act of 1999, also designated S. 24. This bill contained similar insurance market reforms, as well as new provisions to augment the new State Child Health Insurance Program, to assist individuals with disabilities in maintaining quality health care coverage, and to establish a National Fund for Health Research to supplement the funding of the National Institutes of Health. All these new initiatives, as well as the market reforms that I supported previously, work toward the goals of covering more individuals and stemming the tide of rising health costs. My commitment to the issue of health care reform across all populations has been consistently evident during my tenure in the Senate, as I have taken to this floor and offered health care reform bills and amendments on countless occasions. I will continue to stress the importance of the Federal government's investment in and attention to the system's future. As my colleagues are aware, I can personally report on the miracles of modern medicine. Seven and one half years ago, an MRI detected a benign tumor (meningioma) at the outer edge of my brain. It was removed by conventional surgery, with five days of hospitalization and five more weeks of recuperation. When a small regrowth was detected by a follow-up MRI in June 1996, it was treated with high powered radiation using a remarkable device called the ``Gamma Knife.'' I entered the hospital on the morning of October 11, 1996, and left the same afternoon, ready to resume my regular schedule. Like the MRI, the Gamma Knife is a recent innovation, coming into widespread use only in the past decade. In July 1998, I was pleased to return to the Senate after a relatively brief period of convalescence following heart bypass surgery. This experience again led me to marvel at our health care system and made me more determined than ever to support Federal funding for biomedical research and to support legislation which will incrementally make health care available to all Americans. My concern about health care has long pre-dated my own personal benefits from the MRI and other diagnostic and curative procedures. As I have previously discussed, my concern about health care began many years ago and has been intensified by my service on the Appropriations Subcommittee on Labor, Health and Human Services, and Education, which I now have the honor to chair. My own experience as a patient has given me deeper insights into the American health care system beyond my perspective from the U.S. Senate. I have learned: (1) our health care system, the best in the world, is worth every cent we pay for it; (2) patients sometimes have to press their own cases beyond doctors' standard advice; (3) greater flexibility must be provided on testing and treatment; (4) our system has the resources to treat the 43.9 million Americans currently uninsured, but we must find the way to pay for it; and (5) all Americans deserve the access to health care from which I and others with coverage have benefitted. I have long been convinced that our Federal budget of $1.8 trillion could provide sufficient funding for America's needs if we establish our real priorities. Over the past eight years, I believe we have learned a great deal about our health care system and what the American people are willing to accept from the Federal government. The message we heard loudest was that Americans do not want a massive overhaul of the health care system. Instead, our constituents want Congress to proceed at a slower pace and to target what is not working in the health care system while leaving in place what is working. As I have said both publicly and privately, I had been willing to cooperate with the Clinton Administration in solving the health care problems facing our country. However, I found many important areas where I differed with President Clinton's approach to solutions and I did so because I believed that the proposals would have been deleterious to my fellow Pennsylvanians, to the American people, and to our health care system as a whole. Most importantly, as the President proposed in 1993, I did not support creating a large new government bureaucracy because I believe that savings should go to health care services and not bureaucracies. On this latter issue, I first became concerned about the potential growth in bureaucracy in September 1993 after reading the President's 239-page preliminary health care reform proposal. I was surprised by the number of new boards, agencies, and commissions, so I asked my legislative assistant, Sharon Helfant, to make me a list of all of them. Instead, she decided to make a chart. The initial chart depicted 77 new entities and 54 existing entities with new or additional responsibilities. When the President's 1,342-page Health Security Act was transmitted to Congress on October 27, 1993, my staff reviewed it and found an increase to 105 new agencies, boards, and commissions and 47 existing departments, programs and agencies with new or expanded jobs. This chart received national attention after being used by Senator Bob Dole in his response to the President's State of the Union address on January 24, 1994. The response to the chart was tremendous, with more than 12,000 people from across the country contacting my office for a copy; I still receive requests for the chart nearly eight years later. Groups and associations, such as United We Stand America, the American Small Business Association, the National Federation of Republican Women, and the Christian Coalition, reprinted the chart in their publications-- amounting to hundreds of thousands more in distribution. Bob Woodward of the Washington Post later stated that he thought the chart was the single biggest factor contributing to the demise of the Clinton health care plan. And, as recently as the November 1996 election, my chart was used by Senator Dole in his presidential campaign to illustrate the need for incremental health care reform as opposed to a big government solution. With the history of the health care reform debate in mind and building on my previous efforts, I am again introducing an incremental bill which would provide quality health care without adversely affecting the many positive aspects of our health care system. It is more prudent to implement targeted reforms and then act later to improve upon what we have done. I call this trial and modification. We must be careful not to damage the positive aspects of our health care system upon which more than 194.7 million Americans justifiably rely. The legislation I am introducing today has three objectives: (1) to provide affordable health insurance for those now not covered; (2) to reduce health care costs for all Americans; and (3) to improve coverage for underinsured individuals, families, and children. This bill includes provisions to expand the Medicaid program to cover higher income individuals than currently allowed, to encourage the formation of small group insurance purchasing arrangements, to expand access to health insurance for children, to improve health benefits for individuals with disabilities, to strengthen preventive health benefits under the Medicare program, to increase access to prenatal care and outreach for the prevention of low birth weight babies, to strengthen patients' rights regarding medical care at the end of life, to expand access to primary and preventive health services, to reform the COBRA law, to enhance our investment in outcomes research, to reduce the incidence of medical errors, and to establish a national fund for health research as a supplement to the National Institutes of Health budget. Taken together, I believe the reforms proposed in the Health Care Assurance Act of 2001 will both improve the quality of health care delivery and will help ease the escalating costs of health care in this country. This new initiative, which was not contained in my previous version of this legislation, would guarantee coverage for individuals earning up to 133 percent of the Federal poverty level ($11,105 for a single/ $22,676 for a family of four) and would give states the option to cover individuals earning up to 200 percent of poverty ($16,700 for a single/ $34,100 for a family of four). This population is generally deemed undesirable by private insurers, and since these low-income individuals are ineligible for Medicaid, they currently remain uninsured. The provisions in this title advance the recent joint proposal by the Health Insurance Association of America and Families USA, two groups which have traditionally been on opposing ends of health policy debates. Recognizing the rising number of Americans who lack health insurance, these groups took the unprecedented step in crafting a set of basic policy goals on which Congress may build consensus and get something done for the uninsured. Currently, Medicaid only guarantees coverage for pregnant women and infants who earn up to 133 percent of the poverty level. Beyond that population, the Federal mandate varies across age, income, and disability status; for instance, there are different federal mandates for preschool age children than for school- age children and for disabled individuals. Further, current law does not allow any Federal contributions for coverage of people ages 16-18 or for adults with children. I recognize that states may certainly choose to establish programs to cover these and other categories of low-income people, but usually will not do so without Federal help. Title II of the bill builds on the State Child Health Insurance Program (SCHIP), the program established in the Balanced Budget Act of 1997, which allocated $24 billion over five years to increase health insurance coverage for children. The SCHIP program gives States the option to use federally funded grants to provide vouchers to eligible families to purchase health insurance for their children, or to expand Medicaid coverage for those uninsured children, or a combination of both. This title would increase the income eligibility to families with incomes at or below 235 percent of the Federal poverty level ($40,067 annually for a family of four). The Health Care Financing Administration reported that nearly two million children were enrolled in the SCHIP program during fiscal year 1999. The Administration's goal is to enroll five million more children in the program by the end of fiscal year 2002. This provision would allow eligibility for approximately another 850,000 uninsured children. Title III assists another of our Nation's most vulnerable populations by improving the delivery of care for individuals with long-term disabilities. This title would allow for Medicaid reimbursement for community-based attendant care services, as an alternative to institutionalization, for eligible individuals who require such services based on functional need, without regard to the individual's age or the nature of the disability. The most recent data available tell us that 6.64 million individuals receive care for disabilities under the Medicaid program. This title builds on S. 1935, legislation I introduced during the 106th Congress with Senator Tom Harkin of Iowa. Such a change in Medicaid law is desperately needed given the Supreme Court's recent ruling in Olmstead v. L.C., 119 S. Ct. 2176 (1999): the Americans with Disabilities Act (ADA) requires States, in some circumstances, to provide community-based treatment to persons with mental disabilities rather than placement in institutions. This decision and several lower court decisions have pointed to the need for a structured Medicaid attendant-care services benefit in order to meet obligations under the ADA. I am pleased to report that my fiscal year 2001 Labor, HHS, and Education Appropriations bill provided $50 million for ``Real Choice, Systems Change'' grants for states to fund initiatives for systems improvements and to provide long term services and supports, including community-based attendant care. In addition, $20 million was provided to continue demonstration projects on Medicaid coverage of community- based attendant care services. Title III of this bill expands and authorizes the programs we have been funding as demonstration projects in order to establish a permanent infrastructure for the new benefit. The next title contains provisions to make it easier for small businesses to buy health insurance for their workers by establishing voluntary purchasing groups. It also obligates employers to offer, but not pay for, at least two health insurance plans that protect individual freedom of choice and that meet a standard minimum benefits package. It extends COBRA benefits and coverage options to provide portability and security of affordable coverage between jobs. Specifically, Title IV extends the COBRA benefit option from 18 months to 24 months. COBRA refers to a measure which was enacted in 1985 as part of the Consolidated Omnibus Budget Reconciliation Act (COBRA '85) to allow employees who leave their job, either through a lay-off or by choice, to continue receiving their health care benefits by paying the full cost of such coverage. By extending this option, such unemployed persons will have enhanced coverage options, particularly when compared to what they would be able to buy in the individual insurance market. In addition, options under COBRA are expanded to include plans with lower premiums and higher deductibles of either $1,000 or $3,000. This provision is incorporated from legislation introduced in the 103rd Congress by Senator Phil Gramm and will provide an extra cushion of coverage options for people in transition. According to Senator Gramm, with these options, the typical monthly premium paid for a family of four would drop by as much as 20 percent when switching to a $1,000 deductible and as much as 52 percent when switching to a $3,000 deductible. This title also includes a provision which would extend to 36 months the time period for COBRA coverage for a child who is no longer a dependent under a parent's health insurance policy. Uninsured workers tend to be concentrated among those under age 35, although the average age of uninsured workers is increasing. EBRI statistics indicate that 24 percent of young adults between the ages of 18 and 24 were without coverage in 1998. This provision would allow those who are no longer dependents on their parents' plan to have a more secure safety net. With respect to the uninsured and underinsured, my bill would permit individuals and families to purchase guaranteed, comprehensive health coverage through purchasing groups. Health insurance plans offered through the purchasing groups would be required to meet basic, comprehensive standards with respect to benefits. My bill would also create health insurance purchasing groups for individuals wishing to purchase health insurance on their own. In today's market, such individuals often face a market where coverage options are not affordable. Purchasing groups will allow small businesses and individuals to buy coverage by pooling together to form purchasing groups, and choose from insurance plans that provide comprehensive benefits, with guaranteed enrollment, renewability, and equal pricing through community rating, adjusted by age and family size. Title IV of my bill also includes an important provision to give the self employed 100 percent deductibility of their health insurance premiums. The Kassebaum-Kennedy bill extended the deductibility of health insurance for the self employed to 80 percent by 2006. The Balanced Budget Act of 1997 and the Omnibus Appropriations Act for fiscal year 1999 both contained new phase-in scales for health insurance deductibility for the self-employed. Currently, self-employed persons may deduct 60 percent of their health insurance costs through 2002, to be fully deductible in 2003. My bill would speed up the phase- in: health insurance costs would be 70 percent deductible in 2001 and fully deductible in 2002, thereby giving the currently 3.1 million self-employed Americans who are uninsured a better incentive to purchase coverage. The provisions contained in this portion of my bill are vital, as EBRI statistics tell us that 60 percent of all uninsured workers in 1998 were either self-employed or were working in small private-sector firms. The disparity is further demonstrated by the fact that 31 percent of workers in private-sector firms with fewer than 25 employees were uninsured, compared with only 13 percent of workers in private- sector firms with 1000 or more employees. It is anticipated that the increased costs to employers electing to cover their employees as provided under Title IV in my bill would be offset by the administrative savings generated by development of the small employer purchasing groups. Such savings have been estimated at levels as high as $9 billion annually. In addition, by addressing some of the areas within the health care system that have exacerbated costs, significant savings can be achieved and then redirected toward direct health care services. Although our existing health care system suffers from serious structural problems, common sense steps can be taken to head off the remaining problems before they reach crisis proportions. Title V of my bill includes initiatives which will enhance primary and preventive care services aimed at preventing disease. Each year about 7.6 percent of babies born in the United States are born with a low birth weight, multiplying their risk of death and disability. Most of the deaths which do occur are preventable. Although the infant mortality rate in the United States fell to an all-time low in 1989, and the rate decreased by 28 percent between 1988 and 1998, too many babies continue to be born of low birth weight. The Executive Director of the National Commission To Prevent Infant Mortality put it this way: ``More babies are being born at risk and all we are doing is saving them with expensive technology.'' It is a human tragedy for a child to be born weighing 16 ounces with attendant problems which last a lifetime. I first saw one pound babies in 1984 when I was astounded to learn that Pittsburgh, Pennsylvania, had the highest infant mortality rate of African-American babies of any city in the United States. I wondered how that could be true of Pittsburgh, which has such enormous medical resources. It was an amazing thing for me to see a one pound baby, about as big as my hand. However, I am pleased to report that as a result of successful prevention initiatives like the federal Healthy Start program, Pittsburgh's infant mortality has decreased 20 percent. The Department of Health and Human Services has estimated that between $1.1 billion and $2.5 billion per year could be saved if the number of low birth weight children were reduced by 82,000 births. We know that in most instances, prenatal care is effective in preventing low birth weight babies. Numerous studies have demonstrated that low birth weight that does not have a genetic link is most often associated with inadequate prenatal care or the lack of prenatal care. The short and long-term costs of saving and caring for infants of low birth weight is staggering. In the most recent available study on the costs of low birth weight babies, the Office of Technology Assessment in 1988 concluded that $8 billion was expended in 1987 for the care of 262,000 low birth weight infants in excess of that which would have been spent on an equivalent number of babies born of normal birth weight, averted by earlier or more frequent prenatal care. To improve pregnancy outcomes for women at risk of delivering babies of low birth weight, my legislation would strengthen the Healthy Start program to reduce infant mortality and the incidence of low birth weight births, as well as to improve the health and well-being of mothers and their families, pregnant women and infants. Funds are awarded under this program with the goal of developing and coordinating effective health care and social support services for women and their babies. I initiated action that led to the creation of the Healthy Start program in 1991, working with the Bush Administration and Senator Harkin. As Chairman of the Appropriations Subcommittee with jurisdiction over the Department of Health and Human Services, I have worked with my colleagues to ensure the continued growth of this important program. In 1991, we allocated $25 million for the development of 15 demonstration projects. This number grew to 22 in 1994, to 75 projects in 1998, and the Health Resources and Services Administration expects this number to continue to increase. For both fiscal years 2000 and 2001, we secured $90 million for this vital program. Title V also provides increased support to local educational agencies to develop and strengthen comprehensive health education programs, and to Head Start resource centers to support health education training programs for teachers and other day care workers. Many studies indicate that poor health and social habits are carried into adulthood and often passed on to the next generation. To interrupt this tragic cycle, our nation must invest in proven preventive health education programs. Title V also expands the authorization of a variety of public health programs, such as breast and cervical cancer prevention, childhood immunizations, family planning, and community health centers. These existing programs are designed to improve public health and prevent disease through primary and secondary prevention initiatives. It is essential that we invest more resources in these programs now if we are to make any substantial progress in reducing the costs of acute care in this country. As Chairman of the Labor, HHS and Education Appropriations Subcommittee, I have greatly encouraged the development of prevention programs which are essential to keeping people healthy and lowering the cost of health care in this country. In my view, no aspect of health care policy is more important. Accordingly, my prevention efforts have been widespread. Specifically, I joined my colleagues in efforts to ensure that funding for the Centers for Disease Control and Prevention (CDC) increased $2.92 billion or 290 percent since 1989, for a fiscal year 2001 total of $3.92 billion. We have also worked to increase funding for CDC's breast and cervical cancer early detection program to $176 million in fiscal year 2001, almost one and a half times its 1993 total. I have also supported programs at CDC which help children. CDC's childhood immunization program seeks to eliminate preventable diseases through immunization and to ensure that at least 90 percent of 2 year olds are vaccinated. The CDC also continues to educate parents and caregivers on the importance of immunization for children under two years. Along with my colleagues on the Appropriations Committee, I have helped ensure that funding for this important program totaled $532.5 million for fiscal year 2001. The CDC's lead poisoning prevention program annually identifies about 50,000 children with elevated blood levels and places those children under medical management. The program prevents the amount of lead in children's blood from reaching dangerous levels and is currently funded at $36 million. In recent years, we have also strengthened funding for Community Health Centers, which provide immunizations, health advice, and health professions training. These Centers, administered by the Health Resources and Services Administration, provide a critical primary care safety net to rural and medically underserved communities, as well as uninsured individuals, migrant workers, the homeless, residents of public housing, and Medicaid recipients. For fiscal year 2001, these Centers received over $1.2 billion. As former Chairman of the Select Committee on Intelligence and current Chairman of the Appropriations Subcommittee with jurisdiction over non-defense biomedical research, I have worked to transfer CIA imaging technology to the fight against breast cancer. Through the Office of Women's Health within the Department of Health and Human Services, I secured a $2 million contract in fiscal year 1996 for a research consortium led by the University of Pennsylvania to perform the first clinical trials testing the use of intelligence technology for breast cancer detection. My Appropriations Subcommittee has continued to provide funds to continue these clinical trials. I have also been a strong supporter of funding for AIDS research, education, and prevention programs. Funding for Ryan White AIDS programs has increased from $757.4 million in 1996 to $1.6 billion for fiscal year 2001. Within the fiscal year 2001 funding, $65 million was included for pediatric AIDS programs and $589 million for the AIDS Drug Assistance Program (ADAP). AIDS research at the NIH totaled $742.4 million in 1989, and has increased to an estimated $2.1 billion in fiscal year 2001. The health care community continues to recognize the importance of prevention in improving health status and reducing health care costs. The Balanced Budget Act of 1997 and the Consolidated Omnibus Appropriations Act of fiscal year 2001 established new and enhanced preventive benefits within the Medicare program, such as flu shots, bone mass measurements, yearly mammograms, biennial pap smears and pelvic exams, and coverage of colonoscopy for high risk patients. However, some of these ``wellness'' benefits have cost obligations, such as copayments or deductibles. In this bill, I have also included provisions which refine and strengthen preventive benefits within the Medicare program, including coverage of yearly pap smears, pelvic exams, and screening and diagnostic mammography with no copayment or Part B deductible; and coverage of insulin pumps for certain Type I Diabetics. The proposed expansions in preventive health services included in Title V of my bill are conservatively projected to save approximately $2.5 billion per year or $12.5 billion over five years. It is clearly difficult to quantify today the savings that will surely be achieved when future generations of children are truly educated in a range of health-related subjects. Title VI of my bill would establish a federal standard and create uniform national forms concerning a patient's right to decline medical treatment. Nothing in my bill mandates the use of uniform forms. Rather, the purpose of this provision is to make it easier for individuals to make their own choices and determination regarding their treatment during this vulnerable and highly personal time. Studies have also indicated that advance directives do not increase health care costs. Data indicate that end-of-life costs account for 10 percent of total health expenditures and 28 percent of total Medicare expenditures. Loose projections indicate that a 10 percent savings made in the final days of life would result in approximately $10 billion of savings in medical costs per year, and about $4.7 billion in savings for Medicare alone. However, economic considerations are not and should not be the primary reasons for using advance directives. They provide a means for patients to exercise their autonomy over end-of-life decisions. A study done at the Thomas Jefferson University Medical College in Philadelphia cited research which found that about 90 percent of the American population has expressed interest in discussing advance directives. However, even more recent studies indicate that living wills would be used by many more Americans if they were better understood. My bill would provide information on an individual's rights regarding living wills and advanced directives, and would make it easier for people to have their wishes known and honored. In my view, no one has the right to decide for anyone else what constitutes appropriate medical treatment to prolong a person's life. Encouraging the use of advance directives will ensure that patients are not needlessly and unlawfully treated against their will. No health care provider would be permitted to treat an adult contrary to the adult's wishes as outlined in an advance directive. However, in no way would the use of advance directives condone assisted suicide or any affirmative act to end human life. The next title addresses the unique barriers to coverage which exist in both rural and urban medically underserved areas. Within Pennsylvania, such barriers result from a lack of health care providers in rural areas, and other problems associated with the lack of coverage for indigent populations living in inner cities. Title VII of my bill improves access to health care services for these populations by: (1) expanding Public Health Service programs and training more primary care providers to serve in such areas; (2) increasing the utilization of non-physician providers, including nurse practitioners, clinical nurse specialists and physician assistants, through increased reimbursements under the Medicare and Medicaid programs; and (3) increasing support for education and outreach. I believe these provisions will also yield substantial savings. A study of the Canadian health system utilizing nurse practitioners projected savings of 10 to 15 percent of all medical costs. While our system is dramatically different from that of Canada, it may not be unreasonable to project annual savings of five percent, or $57.5 billion, from an increased number of primary care providers in our system. Again, experience will raise or lower this projection. Outcomes research is another area where we can achieve considerable long term health care savings while also improving the quality of care. According to most outcomes management experts, it is estimated that about 25 to 30 percent of medical care is inappropriate or unnecessary. Dr. Marcia Angell, former editor-in-chief of the New England Journal of Medicine, also stated that 20 to 30 percent of health care procedures are either inappropriate, ineffective or unnecessary. I joined my colleagues in recognizing this important area of research by supporting passage of legislation reauthorizing the Agency for Healthcare Research and Quality (formerly the Agency for Health Care Policy and Research. The renamed agency, dubbed ``AHRQ,'' is authorized to expand outcomes research necessary for the development of medical practice guidelines and for increased access to consumer information. In order to boost funding for this vital area of research, title VIII of my bill would establish a trust fund for medical treatment outcomes research, capitalized by a .001 cent tax on total U.S. health insurance premiums collected. This trust fund would be specifically authorized for use by AHRQ to supplement its outcomes research mission. Based on the Health Care Financing Administration's 1998 health spending review, private health insurance premiums totaled $375 billion. As provided in my bill, a surcharge would generate $375 million for an outcomes research fund. Also included in this title is my ``Medical Errors Reduction Act,'' which I introduced in the 106th Congress with Senators Harkin and Inouye, in response to the November 29, 1999, Institute of Medicine (IOM) report, ``To Err Is Human: Building a Safer Health System.'' The report concluded that medical mistakes have led to numerous injuries and deaths, affecting an estimated three to four percent of all hospital patients. The IOM report also concluded that health care is a decade or more behind other high-risk industries in its attention to ensuring basic safety. According to the IOM, at least 44,000 Americans die each year as a result of medical errors, and the number may be as high as 98,000-- which catapults medical errors to the fifth leading cause of death nationwide. This total outnumbers deaths from motor vehicle accidents, breast cancer, and AIDS. Further, medical errors resulting in injury are estimated to cost the nation between $17 billion and $29 billion, including additional health care costs, lost income, lost household production, and disability costs. The IOM findings are startling and beg for national attention to determine ways to reduce the number of medical errors. On December 13, 1999, I chaired a hearing of the Labor, HHS, Education Appropriations Subcommittee to hear details of IOM's report findings. On January 25, 2000, I chaired a joint Labor, HHS, and Education Appropriations Subcommittee/Veterans' Affairs Committee hearing to consider mandatory and voluntary reporting requirements and to begin to determine ways to reduce medical errors. Specifically, my proposal would make grants available to states so they can establish their own error reporting systems and would establish 15 competitively-awarded research demonstration projects in rural and urban areas throughout the country. These projects would employ new and proven technologies and enhance staff training to determine ways to reduce errors. The provision also requires the Secretary of HHS to provide patient education programs to all individuals covered by Federal health plans. I am pleased to report that my Appropriations Subcommittee has already taken some critical first steps to reduce the incidence of deaths and injuries related to medical errors. In fiscal year 2001, $50 million has been provided to explore opportunities for a better understanding of the systemic problems in health care, in the hope that we can dramatically reduce the incidence of medical errors. The research initiatives include a focus on developing guidance to assist in States' development of data collection systems so that national trends can be determined and analyzed. In addition, the Committee has encouraged health care providers to explore the use of technologies and other methods in reducing medical errors. Nursing home care is another significant issue which must be addressed. Spending on long term care totaled $115 billion in 1997, and over 40 percent of that cost was borne by the Medicaid program. Despite these large public expenditures, the elderly face significant uncovered liability for long term care. Title IX of my bill would provide a tax credit for premiums paid to purchase private long-term care insurance. Other tax incentives and reforms provided in my bill to make long term care insurance more affordable include: (1) allowing employees to select long-term care insurance as part of a cafeteria plan and allowing employers to deduct this expense; (2) excluding from income tax the life insurance savings used to pay for long term care; and (3) setting standards for long term care insurance that reduce the bias that currently favors institutional care over community and home-based alternatives. The final title of my bill would create a national fund for health research within the Department of the Treasury, to supplement the monies appropriated for the National Institutes of Health. To capitalize this fund, health insurance companies would be required to contribute 1 percent of all health insurance premiums received. This creative proposal was first developed by my distinguished colleagues, Senators Mark Hatfield and Tom Harkin. Their idea is a sound one and ought to be adopted. To this end, Senator Harkin and I introduced the National Fund for Health Research Act on March 13, 1997 (S. 441) and August 5, 1999 (S. 1504). I look forward to continuing to work with Senator Harkin to enact a biomedical research fund this Congress. While precision is again impossible, my proposal could conceivably achieve a net annual savings of between $74 billion to $86 billion. The savings are totaled as follows: $9 billion in small employer market reforms coupled with employer purchasing groups; $2.5 billion for preventive health services; $17 to $29 billion for reducing costs associated with reducing medical errors; $10 billion from advanced directives; $57.5 billion from increasing primary care providers; and $2.9 billion by reducing administrative costs. The costs would be conservatively estimated to be $2.8 billion for long term care tax credits, approximately $15 billion for community-based attendant care services under Medicaid, and $7 billion for general Medicaid expansion. Experience and more detailed analysis of the affected populations will require modification of these projections, and I am prepared to work with my colleagues to develop implementing legislation and to press for further action in the important area of health care reform. The provisions which I have outlined today contain my ideas for a framework to provide affordable, high quality health care for all Americans. I am opposed to rationing health care. I do not want rationing for myself, for my family, or for America. In my judgment, we should not scrap, but rather we should build upon our current health delivery system. We do not need the overwhelming bureaucracy that President Clinton and other Democratic leaders proposed in 1993 to accomplish this. I believe we can provide care for the 43.9 million Americans who are now not covered and reduce health care costs for those who are covered within the currently growing $1.15 trillion in health care spending. Mr. President, the time has come for concerted action in this arena. I urge the Congressional leadership, including the appropriate committee chairmen, to move this legislation and other health care bills forward promptly. I ask unanimous consent that the full text of the bill, a summary, and a list of my health reform bills be printed in the Record.

Mr. SPECTER. Mr. President. I have sought recognition to introduce legislation that will address the plight of our nation's cities. With 80 percent of the U.S. population living in metropolitan areas, there is an urgent need to improve our urban economies and the quality of life for the millions of Americans who live and work in cities. By simply making our cities an appealing place to live, work, and visit, urban areas can rebound to the vibrant economic centers they once were. There is a common perception that most urban areas are abandoned and stripped of their resources, burdened with poverty and crime. However, cities have a wealth of resources available to not only the urban dweller, but to cultural centers, business hubs, and some of the finest educational and medical institutions. The real problem is that we do not draw upon these riches or strive to better coordinate them to serve people, especially those in need. My proposal, the ``New Urban Agenda Act of 2001,'' is based on legislation which I have endeavored to enact into law since the 103rd Congress. The bill constitutes an effort to give our cities some much- needed attention, but reflects the federal budgetary constraints which govern our actions in Congress. This bill, based in significant part on suggestions by Former Philadelphia Mayor Edward G. Rendell and the League of Cities as well as current Philadelphia Mayor John Street and Pittsburgh Mayor Tom Murphy, offers aid to the cities while containing federal expenditures and re-instituting important cost-effective tax breaks. Urban areas remain integral to America's greatness as centers of commerce, industry, education, health care, and culture. Yet urban areas, particularly the inner cities which tend to have a disproportionate share of our nation's poor, also have special needs which must be recognized. We must develop ways of aiding our cities that do not require either new taxes or more government bureaucracy. With that in mind, I am pleased that Congress recognized included an initiative to aid our cities in the fiscal year 2001 Omnibus Appropriations Act. This initiative provides important incentives for businesses to invest and locate in our nation's cities by stimulating new private capital investments in economically distressed communities, expanding empowerment zones, increasing the low income housing tax credit, creating new market venture capital firms, and creating 40 Renewal Communities, which will provide additional key incentives to spur investment. I am particularly pleased that a close variation of a provision from my Urban Agenda bill was included as part of this initiative, which will provide a 60 percent exclusion for capital gains tax purposes for any gain resulting from targeted investments in small businesses located in urban empowerment zones, enterprise communities, or enterprise zones. A targeted capital gain will serve as a catalyst for job creation and economic growth in our cities by encouraging additional private investment in our urban areas. While all of these initiatives are an important first step in assisting our cities, I believe that there is still more that needs to be accomplished to revitalize America's metropolitan areas. If we are to address many of the serious social issues that we face-- unemployment, drug abuse, juvenile violence, welfare dependency, and other pressing issues--we cannot give up on our cities. We must continue to develop new strategies for dealing with the problems of urban America. The days of creating ``Great Society'' federal aid programs are clearly past, but that is no excuse for the national government to ignore the problems of the cities. As a Philadelphia resident, I have first-hand knowledge of the growing problems that plague our cities. I have long supported a variety of programs to assist our cities, such as increased funding for Community Development Block Grants and legislation to establish enterprise and empowerment zones. To encourage similar efforts, in April 1994, I hosted my Senate Republican colleagues on a visit to explore urban problems in my hometown. We talked with people who wanted to obtain work, but had discovered few opportunities. We saw a crumbling infrastructure and its impact on residents and businesses. We were reminded of the devastating effect that the loss of inner city businesses and jobs has had on our neighborhoods. What my Republican colleagues saw in Philadelphia is the urban rule across our country, not the exception. There are many who do not know of city life, who are far removed from the cities and would not be expected to have any key interest in what goes on in the big cities of America. I cite my own boyhood experience illustratively: Born in Wichita, Kansas, raised in Russell, a small town of 5,000 people on the plains of Kansas, where there is not much detailed knowledge of what goes on in Philadelphia, Pennsylvania, or other big cities like Los Angeles, San Francisco, New York, Miami, Pittsburgh, Dallas, Detroit or Chicago. Those big cities are alien to many in America. But there is a growing understanding that the problems of big cities contribute significantly to the general problems affecting our nation as a whole and have an economic impact, at the very least, on our small towns. For rural America to prosper, we need to make sure that urban America prospers and vice-versa. For example, if cities had more economic growth, taxes could be reduced on all Americans at the federal and state level because revenues would increase and social welfare spending would be reduced. There is indeed a domino effect from our cities to rural communities throughout the country. Lately, we have witnessed this in the violent behavior of adolescents. School violence, juvenile crime and drug abuse are no longer endemic to urban living. Take the Bloods and the Crips gangs from Los Angeles, California, and similar gangs; that are all over America. They are in Lancaster, Pennsylvania; Des Moines, Iowa; Portland, Oregon; Jackson, Mississippi, Racine, Wisconsin; and Martinsburg, West Virginia. They are literally everywhere, big city and small city alike. Additionally, while drug abuse among teens has historically been viewed solely as an inner city problem, recent statistics indicate that teen drug abuse in the suburbs is an increasing epidemic. According to an October 10, 1999 Philadelphia Inquirer article, in the seven county Philadelphia suburbs, the rate of youths in treatment for heroin jumped from 77 to 84 per 100,000 people between 1995 and 1998. In the Baltimore suburbs, 25 percent of teens admitted to drug treatment centers used heroin compared to 17 percent in inner city Baltimore. In the U.S. Department of Housing and Urban Development's 2000 report on the ``State of the Cities,'' findings show that large urban schools still deal with a higher concentration of violence, and the data only represents crimes which were serious enough to report to the police. An estimated 3 million crimes each year are committed in or near the nation's 85,000 public schools. During the 1996-97 school year alone, one-fifth of public high schools and middle schools reported at least one violent crime, such as murder, rape or robbery. More than half reported less serious crimes. Homicide is now the third leading cause of death for children age 10 to 14. For more than a decade it has been the leading cause of death among minority youth between the ages of 15 and 24. The School District of Philadelphia's most recent report on school violence shows that in the 1994-1995 academic year, students, teachers and administrators were the victims of 2,147 reported criminal incidents, up by almost 100% from the previous year. These included assault, robbery, rape, and students being stabbed or even shot. The school district also reported troubling news about abysmal attendance rates. On any given day, more than one in every four students are absent. In an effort to seriously address the problem of youth violence, during the summer of 1999, I convened three extensive roundtable discussions with experts from the Department of Education, Health and Human Services, Labor and Justice, who administer programs targeted at children from prenatal to age seventeen. On June 7, 1999, I chaired a discussion session on at-risk youth as part of the White House Conference on Mental Health. As a result of these meeting, $911 million in fiscal year 2000 and $1.6 billion in fiscal year 2001 have been reallocated across government agencies to tackle the problem of youth violence, focusing on the Safe and Drug Free Schools Program, mental health services for children, character education, and literacy programs. These programs pick up on the conclusion that Surgeon General Koop made in 1982--that juvenile violence is a national health problem. I am pleased to note that the HUD 2000 ``State of the cities'' report found that the national poverty rate declined from 13.7% in 1996 to 12.7% in 1998. Encouragingly, the poverty rate also decreased in central cities during this same period from 19.6% to 18.5%. However, despite the dramatic record of job gains, one in eight cities still faces high unemployment and significant population loss or high poverty rates. The report further found that the overall poverty rate in the cities remains twice that of the suburbs. In fact, there are 67 large cities that have an unemployment rate of 50% or higher than the U.S. rate. These facts emphasize the need for more efforts to be focused on strengthening our inner city businesses which, in turn, will boost local economies and serve to provide more jobs, reduce poverty and, hopefully, reduce crime. To facilitate economic development and job creation in the United States, I supported the Balanced Budget Act of 1995, which contained such provisions as the Job Training Partnership Act and the Targeted Job Tax Credit. As Congress put the final touches on that legislation, I circulated a joint letter with several Senators to then-Majority Leader Dole and Speaker Gingrich which recommended several new urban initiatives to spur job creation and economic growth in our cities such as a targeted capital gains exclusion, commercial revitalization tax credit, historic rehabilitation tax credit, and child care credit. In 1998, I introduced the ``Job Preparation and Retention Training Act,'' which was included in the Workforce Development act of 1998. My legislation authorized funding for States to enroll long-term welfare dependents into a training program to provide the necessary skills to locate and maintain gainful and unsubsidized employment. A number of jobs are becoming available in the high tech industry and high tech growth is a substantial contributor to recent economic gains in cities. According to the HUD 2000 ``State of the Cities'' report, high tech jobs account for 27% of new employment in cities. However, there is anew digital divide in high tech jobs between cities and suburbs. High tech job growth in suburbs is 30% faster than that of cities. In effort to bridge the digital divide, I was an original cosponsor with Senator Biden of the ``Kids 2000'' legislation, which would authorize $120 million to build computer technology centers in Boys and Girls Clubs nationwide and allow the funds to be used to pay for computer teachers, who are crucial to the success of this initiative. The federal funds would be complemented by donations from private sources. I have also been supportive of collaborative efforts like PowerUp, founded by America Online (AOL) Chief Executive Steve Case, which joins non-profit organizations, major corporations, and Federal agencies to help close the digital divide. The goal of this initiative is to help ensure that America's underserved youth acquire the skills, experiences, and resources they need to succeed in the digital age. Initiatives like Kids 2000 and PowerUp are steps in the right direction to provide American children with the skills necessary to compete in an increasingly technologically-advanced workforce. These initiatives offer training for those segments of the American population which currently have no opportunity to learn these technology-based skills, and thus offer extraordinary employment and earning possibilities. Each day, small business owners question whether they should remain in the city because they fear for the safety of their children, their employees, and, ultimately, their businesses. I have personally met and spoken with shop owners in the University City section of Philadelphia who tell me that they look desperately for reasons to stay, but it gets harder and harder. I have long supported efforts to encourage the growth of small business, as small businesses provide the bulk of the jobs in this country. To that end, I am again introducing legislation to provide targeted tax incentives for investing in small minority or women-owned businesses called ``Minority and Women Capital Formation Act.'' Many minority entrepreneurs, for instance, have told me that they are dedicated to staying in the cities to continue to provide employment opportunities, but continue to face difficulty in obtaining the necessary capital. My legislation would help remove the capital access barriers, thereby enabling these entrepreneurs to grow their businesses and payrolls. The economic problems our cities are facing are not easy to deal with or answer. Municipal leaders stress many of the same concerns that business people have voiced. Additionally, in a report by the National League of Cities entitled ``City Fiscal Conditions in 1996,'' municipal officials from 381 cities answered questions on the economic state of their cities. The report found that 21.7 percent of responding cities reduced municipal employment and 18.5 percent had frozen municipal employment due to state budgetary problems. Nearly six out of ten cities raised or imposed new taxes or user fees during the past twelve months. These numbers are of concern to me and I believe they highlight the need for federal legislation to enhance the ability of cities to achieve competitive economic status. An added concern is that city managers are forced to balance cuts in services or enact higher taxes. Neither choice is easy, and it often counteracts municipal efforts to retain residents or businesses. One issue in particular that is hurting many cities is the erosion of their tax bases, evidenced particularly by middle-class flight to the suburbs. Mr. Ronald Waiters, professor of Political Science at Howard University, in testimony before the Senate Banking Committee, stated that in 1950, 23 percent of American's lived outside central cities; by 1998, that number rose to 46 percent. The District of Columbia's population loss is among the worst in the nation, with a quarter of its population relocating to the suburbs since the 1970s. This trend of shrinking urban populations gives no sign of ending. Middle-class families continue to leave for the suburbs where there are typically better public services. According to the September 2000 General Accounting Office Report on Community Development, over 50 percent of U.S. cities reported that an inadequate tax base for supporting schools and services was among their top four growth related challenges. As America's cities struggle with the exodus of residents, businesses and industry, city, residents who remain are faced with problems ranging from increased tax burdens and lesser services to dwindling economic opportunities, leading to welfare dependence and unemployment assistance. The September 2000 General Accounting Office Report on Community Development also found that of the 2000 cities surveyed, 83 percent reported that revitalizing their downtown areas was their top priority. The federal government has attempted to revitalize our ailing urban infrastructure by providing federal funding for transit and sewer systems, roads and bridges. As a member of the Transportation Appropriations Subcommittee, I have been a strong supporter of public transit, which provides critically needed transportation services in urban areas. Transit helps cities meet clean air standards, reduce traffic congestion, and allows disadvantaged persons access to jobs. Federal assistance for urban areas, however, has become increasingly scarce as we grapple with the nation's deficit and debt. Therefore, we must find alternatives to reinvigorate out nation's cities so they can once again become economically productive areas providing promising opportunities for residents and neighboring areas. To address the need for reliable transportation systems in our nation's cities and to provide access to jobs for city residents, I introduced reverse commute and jobs access legislation, which was successfully included in the 1998 ``TEA-21'' highway and transit reauthorization bill. The bill authorized over five years access-to-jobs transit grants targeted at low-income individuals. Up to $10 million per year may be used for reverse commute projects to move individuals from cities to suburban job centers. In addition to support for infrastructure, I believe there are many other opportunities for Congress to assist the America's urban areas. Over the past few years, I have worked with Former Mayor Ed Rendell to develop a legislative package which contains many good ideas. I have taken many of these suggestions and have since added and revised provisions to take into account new developments at the federal, state and local levels to create the ``New Urban Agenda Act of 2001.'' First, recognizing that the federal government is the nation's largest purchaser of goods and services, my legislation would require that no less than 15 percent of federal government purchases be made from businesses and industries within designated urban Empowerment Zones, Enterprise Communities and Renewal Communities. Similarly, my bill would required that no less than 15 percent of foreign aid funds be redeemed through purchases of products manufactured in urban Empowerment Zones, Enterprise Communities and Renewal Communities. The General Services Administration would be required to submit to Congress its assessment of the extent to which federal agencies are committed to this policy, and in general, economic revitalization in distressed urban areas. The second major provision of this bill would commit the federal government to play an active role in restoring the economic health of our cities by encouraging the location, or relocation, of all federal facilities in urban areas. To accomplish this, all federal agencies would be required to prepare and submit to the President an Urban Impact Statement detailing the impact that relocation or downsizing decisions would have on the affected city. Presidential approval would be required to place a federal facility outside an urban area, or to downsize a city-based agency. The third critical component of this bill would revive and expand federal tax incentives that were eliminated or restricted in the Tax Relief Act of 1986. Until there is passage of legislation on the flat tax, which would provide benefits superior to all targeted tax breaks, I believe America's cities should have the advantages of such tax benefits. These provisions offer meaningful incentives to businesses to invest in our cities. I am calling for the restoration of the Historic Rehabilitation Tax Credit which supports inner city revitalization projects. According to the September 2000 GAO Report on Community Development, 32 percent of cities and 22 percent of counties surveyed strongly supported the extension of federal tax benefits to the rehabilitation of historic residential properties. The City of Philadelphia reports that there were 8,640 construction jobs involved in 356 projects in Philadelphia from 1978 to 1985 stimulated by the Historic Rehabilitation Tax Credit, which was eliminated in 1986. In Chicago, 302 projects prior to 1985 generated $524 million in investment and created 20,695 jobs. In St. Louis, 849 projects generated $653 million in investment and created 27,735 jobs. Nationally, according to National Park Service estimates for the 16 years before the 1986 Act, the Historic Rehabilitation Tax Credit stimulated $16 billion in private investment for the rehabilitation of 24,656 buildings and the creation of 125,306 homes which included 23,377 low and moderate income housing units. The 1986 Tax Act dramatically reduced the pool of private investment capital available for rehabilitation projects. In Philadelphia, projects dropped from 356 to 11 by 1988 from 1985 levels. During the same period, investments dropped 46 percent in Illinois and 92 percent in St. Louis. Another tool is to expand the authorization of commercial industrial development bonds. Under the Tax Reform Act of 1986, authorization for commercial industrial bonds was permitted to expire. Consequently, private investment in cities declined. For instance, according to the City of Philadelphia, from 1986--the last year commercial development bonds were permitted--to 1987, the total number of city-supported projects in Philadelphia was reduced by more than half. Industrial development or private activity bonds encourage private investment by allowing, under certain circumstances, tax-exempt status for projects where more than 10 percent of the bond proceeds are used for private business purposes. The availability of tax-exempt commercial industrial development bonds will encourage private investment in cities, particularly the construction of sports, convention and trade show facilities; parking facilities owned and operated by the private sector; air and water pollution facilities owned and operated by the private sector and industrial parks. My bill would also increase the small issue exemption, which provides a way to help finance private activity in the building of manufacturing facilities from $10 million to $50 million to allow increased private investment in our cities. A minor change in the federal tax code related to arbitrage rebates on municipal bond interest earnings could also free additional capital for infrastructure and economic development by cities. Currently, municipalities are required to rebate to the federal government any arbitrage--a financial term meaning interest earned in excess of interest paid on the debt--earned from the issuance of tax-free municipal bonds. I understand that compliance, or the cost for consultants to perform the complicated rebate calculations, is actually costing municipalities more than the actual rebate owed to the government. This bill would allow cities to keep the arbitrage earned so that they can use it to fund city projects and for other necessary purposes. A fourth provision of this legislation provides needed reforms to regulations and the financial challenges to obtaining affordable housing. My proposal provides language to study streamlining federal housing program assistance to urban areas into a block grant form so that municipal agencies can better serve local residents. Safe, clean, and affordable housing is not widely available to most low income families. According to the National Housing Law Project, in 1996, only one in four families was eligible to receive HUD assistance with a waiting period up to five years. This provision of the bill steers the Secretary of Housing and Urban Development to take a hard look at these conditions and determine what works and what does not in federally- subsidized housing and to consider alternatives that will provide suitable homes for America's families. I believe that as a nation we should work toward providing individuals and their families with more opportunities for home ownership which stabilizes a community and restores our cities. Urban home ownership, including middle-income home ownership, lags behind the suburbs. According to the Harvard University Joint Center for Housing Studies, city residents of all income levels are less likely to own a home than suburban residents with similar incomes. I hear time and time again from families starting out that they move out to the suburbs for better schools, because central cities lack the property tax base to provide a quality education. Home ownership is key to saving our cities, both socially and economically. A 1998 Fannie Mae national housing survey indicated that even though home ownership rates continued to increase in the late 1990s, six in every ten renters said that buying a home was a very important priority, if not their number- one priority in life. Yet for so many families financial barriers make that dream unattainable. That is why my legislation includes two provisions to restore the American dream of home ownership. First, my bill would amend the National Affordable Housing Act and the Community Development Block Act of 1974 to make municipal employees such as policemen, firemen, maintenance workers and teachers eligible for home ownership assistance. Municipal employees and teachers contribute to the health, safety and vitality of the communities in which they serve. However, escalating rent and housing prices due to the booming technology market and rising salaries have made it particularly difficult for teachers, police officers and city workers to live where they work. In a growing number of metropolitan areas, home buyers who make the median income in their region cannot afford its median-priced housing, and therefore, must live outside the community in which they work, resulting in longer commutes. According to the September 2000 GAO Report, the shortage of funding for affordable housing in urban areas has forced people to move to the fringes of metropolitan areas, where housing is typically less expensive. This provision would seek to remedy this situation by providing communities with the tools needed to increase home ownership opportunities for those who form the backbone of our cities and who are an integral component of our commitment to revitalize our urban areas. Second, my bill would provide a tax credit for income-eligible individuals and families to purchase homes in distressed areas. In the 1999 Taxpayer Relief Act, Congress approved such a tax credit for home buyers in the District of Columbia. While single family home sales can be attributed to a multitude of factors, such as historically low interest rates and a strong economy, it is important to note some interesting statistics related to home ownership since enactment of the tax credit in the District of Columbia. The Home Purchase Assistance Program through the District of Columbia's Office of Housing and Community Development helped 410 families purchase homes. Further, a group called the ``Washington Partners for Home ownership,'' a collaboration of realtors, banks, community and faith-based organizations, set a goal last year to create 1,000 new homeowners in the District of Columbia for each of the next three years. Remarkably, the Washington Partners reached that goal before the end of the first year. I believe that this country will reap extraordinary benefits if we expand such a credit on a national basis, as I propose in the ``New Urban Agenda Act of 2001.'' I believe that the revitalization of cities will require social and economic facets, but is also imperative that our cities are safe and clean. This last component of my bill helps urban areas to address their unique environmental challenges and reforms Superfund law. First, the legislation authorizes a federal brownfields program to help clean up idle or underused industrial and commercial facilities and waives federal liability for persons who fully comply with a state cleanup plan to clean sites in urban and other areas pursuant to state law, provided that the site is not listed or proposed to be listed on the National Priorities List. The Environmental Protection Agency currently operates this pilot program under general authority provided by the Superfund law. My legislation would make this a permanent program and substantially increase the funding levels to a $100 million authorized level for Fiscal Year 2002, $105 million for Fiscal Year 2003, and $110 million for Fiscal Year 2004. The EPA could expend funds to identify and examine potential idle or underused Brownfield sites and to provide grants to States and local governments of up to $200,000 per site to put them back to productive use. One such grant has been used to great success to Pittsburgh Mayor Tom Murphy, and I hope this provision will generate additional success stories of redeveloping urban brownfields. The Brownfields Program allows sites with minor levels of toxic waste to be cleaned up by State and local governments with federal and other funding sources. Companies and individuals who are interested in developing land into industrial, commercial, recreational, or residential use are often reluctant to purchase property with any level of toxic waste because of a fear of being saddled with cleanup liability under the Superfund law. Through expanded Brownfields grants, cleanup at such sites will be expedited and will encourage redevelopment of otherwise unusable property. My bill would also waive federal liability for persons who fully comply with a state cleanup plan to clean sites in urban or other areas pursuant to state law, providing that the site is not listed or proposed to be listed on the National Priorities List. Many states, including Pennsylvania, have developed their own toxic waste cleanup programs and have done good work to clean up many of these sites. Pennsylvania Governor Tom Ridge has developed an extensive plan, where contaminated sites are made safe based on sound science by returning the site to productive use through the development of uniform cleanup standards, by creating a set of standardized review procedures, by releasing owners and developers from liability who fully comply with the state cleanup standards and procedures, and by providing financial assistance. However, the efforts of states like Pennsylvania are often stifled because the federal government has not been willing to work with the States to release owners and developers from liability, even when they fully comply with the state plans. This section of my bill only applies to sites that are not on the National Priorities List. These are sites that the state has identified for which the state has created a comprehensive cleanup plan. If the federal government has concerns with the cleanup procedure or the safety of the site, then the government has full authority to place that site on the National Priority List. The plans, like that developed by Governor Ridge, deal with sites not controlled by the Superfund law. By not allowing the individual states to take the initiative to clean up these sites, and by not providing a waiver for federal liability to those who fully comply with the procedures and standards of the state cleanup, the federal government impedes the efforts of the states to work to clean up their own sites. This provision takes a significant step toward encouraging states to take the responsibility for their toxic waste sites and to encourage the effective cleanup of these sites in our nation's urban areas. Mr. President, we must take a comprehensive approach to reversing urban decay. My bill seeks to accomplish this by requiring increased federal and foreign aid purchases operating in urban zones, a restoring of the issuance of tax free industrial development bonds, facilitating home ownership in urban areas, and providing regulatory relief to redevelop brownfield sites. As one of a handful of United States Senators who lives in a big city, I have a special understanding of both the problems and the promise of urban America. I am committed to a new urban agenda which relies on market forces, not a welfare state, for urban revitalization. While the issues facing our nation's cities are indeed difficult, working together with my colleagues I believe we can fashion a strong plan of action to help cities face their pressing problems. I ask unanimous consent that my bill be printed in the Record.

Mr. SPECTER

Mr. SPECTER. Mr. President, I have sought recognition today to summarize for my colleagues, and for the public, the activities and accomplishments of the Committee on Veterans' Affairs during the 106th Congress. I am pleased to report, as chairman of the committee, that this Congress has been one of significant accomplishment. When this Congress convened, it was determined that three veterans' priorities needed to be met. We had to increase the availability of Department of Veterans Affairs (VA)-provided health care services, particularly long-term care services, to World War II veterans. We had to improve educational assistance benefits--so-called Montgomery GI bill or MGIB benefits--made available by VA to veterans, principally young veterans, newly released from service. And we had to address and rectify vestigial elements of discrimination against women contained in veterans' statutes. With the assistance of the committee's ranking minority member, Senator John D. (``Jay'') Rockefeller IV, and in bipartisan partnership with all of the committee's members, we have achieved all three of these goals--and more. First, with the enactment of the Veterans Millennium Health Care and Benefits Act of 1999, Public Law 106-117 (Millennium Act), the Congress provided for the first time that the most deserving of veterans--those with severe service-connected disabilities--will be assured of receiving nursing home care should they need it--and so long as they need it. Under the terms of the Millennium Act, any veteran who needs nursing home care to treat a service-connected disability will get it. Similarly, any veteran who is rated as 70 percent disabled or higher by VA due to a service-connected cause will be provided with needed nursing home care--even if the condition which causes the need for such care is not itself service-connected. Further, all veterans who are enrolled for VA care--even those who do not have service-connected disabilities--will, under the terms of the Millennium Act, receive any and all non-institutional alternatives to inpatient long-term care-- services such as home health aide services, adult day health care services, and the like--as they might need to forestall the day on which they will have to resort to inpatient long-term care. Finally, the Millennium Act mandates that VA maintain the nursing home capacity that it now has, and that it initiate pilot programs to determine, first, the most cost-effective ways of providing more nursing home care to more veterans and, second, the feasibility of providing to veterans, and their spouses, assisted living services. With enactment last month of the Veterans Benefits and Health Care Improvement Act of 2000, Public Law 106-419, the other two priorities which had been identified at the outset of the 106th Congress were also met. Under that statute, a veteran who has served a three-year enlistment and who returns to school after service will be eligible to receive as much as $800 per month in assistance payments while he or she is in school. In January 1997, when I assumed the chairmanship of the committee, veteran-students could receive no more than $427 per month in Montgomery GI bill assistance; thus, in four years, assistance to full time veteran students has been increased by 87 percent. The Veterans Benefits and Health Care Improvement Act also addressed two issues of importance to women veterans: It provided that special compensation benefits--those provided to male veterans when they lose, due to a service-connected cause, a so-called creative organ--will also be afforded to women veterans who sustain the service-connected loss of a breast. And it provided--based on sound scientific evidence--that children with birth defects of women Vietnam veterans will be provided compensation, health care, and job training benefits. These three measures--addressing the disparate needs of older, younger, and women veterans--are not the only veterans-related legislative accomplishments of the 106th Congress. To the contrary, the list of other legislative achievements is long. In addition to providing the long-term care benefits I have already outlined, the Millennium Act also specifies that VA will itself provide, or reimburse the uninsured costs of, emergency care needed by any veteran enrolled for VA care. It mandates, further, that VA enhance the services it provides to homeless veterans, and to veterans with post-traumatic stress disorders, drug abuse disorders, and injuries from sexual trauma. It provides, in addition, that higher priority access to VA care will be provided to veterans who were wounded in combat and are, as a consequence, recipients of the Purple Heart. And, finally, it authorizes VA to provide enhanced care, as space is available, to active duty service personnel and military retirees (who normally receive care from their respective military services), and reauthorizes the provision of health care evaluations to the spouses and children of Persian Gulf war veterans. Further in the area of health care benefits, the Millennium Act and the Veterans Benefits and Health Care Improvement Act jointly enhance services provided to veterans by improving VA assistance to State-run veterans' nursing home facilities; by authorizing 13 major hospital construction projects; by improving provisions of law relating to nurse, dentist, and pharmacist pay and the recruitment of physician assistants, social workers, and medical support staff; by increasing VA incentives to collect reimbursements from non-service- disabled veterans' health insurance carriers--funds that are not remitted to the Treasury but are funneled back into VA hospitals; and by encouraging increased VA and Department of Defense cooperation in the procurement of pharmaceuticals and medical supplies. And last, but surely not least in the area of health care, VA's health care system received the two greatest increases ever in funding for fiscal years 2000 and 2001, increases of $1.7 billion and $1.4 billion respectively. The ranking member and I very much appreciate that the chairman and ranking member of the VA, HUD and Independent Agencies Appropriations Subcommittee, Senators Bond and Mikulski, heard our call for such funding increases. In the area of veterans' readjustment benefits and other non- healthcare-related benefits provided by VA, I have already outlined the significant increases in monthly Montgomery GI bill benefits that have been gained since 1997, and the improvements in women veterans' benefits. Beyond these accomplishments, there is a lengthy and strong record of accomplishment. In addition to increasing veterans' educational assistance allowances, the Veterans Benefits and Health Care Improvement Act also increased education assistance benefits provided to the widows and surviving children of persons who were killed in service or who died after service from service-connected causes. And these survivors' educational assistance benefits were, for the first time, ``indexed'' by the Veterans Benefits and Health Care Improvement Act so that they will keep pace with inflation. The Veterans Benefits and Health Care Improvement Act and the Millennium Act also improved VA educational assistance programs by allowing benefits to be paid to students taking test preparation courses and certification or licensing examinations, and by paying benefits to students during term breaks and, retroactively, to students who are veterans' survivors and who are deemed eligible for such benefits only after their educations have begun. In addition, those statutes also expanded eligibility standards applicable to post-Vietnam era veterans by allowing those who had participated in the less generous Veterans Educational Assistance Program or VEAP program of the late 1970's and early 1980's to convert to Montgomery GI bill eligibility. Finally, the Veterans Benefits and Health Care Improvement Act liberalized MGIB participation rules so that officer candidates and veterans serving second enlistments would not, due to technicalities in the law, be denied Montgomery GI bill eligibility. Benefits other than educational assistance benefits were also improved by the Veterans Benefits and Health Care Improvement Act, the Millennium Act, and other committee-approved legislation. Compensation benefits provided to radiation-exposed veterans were modified by the addition, under the Millennium Act, of bronchiolo-alveolar cancer to the listing of diseases that are presumed to be service-connected if they are contracted by radiation-exposed veterans. The Veterans Benefits and Health Care Improvement Act specifies that compensation will be provided, for the first time, to reservists who suffer heart attacks or strokes while on active duty and to veterans who are injured while participating in VA-sponsored compensated work therapy programs. In addition, that statute provides for a long-overdue increase in the net worth threshold at which compensation payments are suspended in certain cases involving veterans who are hospitalized on a long term basis, though I hasten to add that a repeal of this limitation--which, under current law, applies to mentally incompetent hospitalized veterans but not to other hospitalized veterans--will remain a top priority of mine. And benefits provided to veterans' widows were improved by liberalizing eligibility for survivors of former prisoners of war and widows who have remarried. In addition, the Veterans Claims Assistance Act of 2000, Public Law 106-475, reinstated and improved court-struck provisions of law requiring that VA assist veterans and other claimants--principally, widows and surviving children--in the preparation of their claims to VA for benefits. And Public Laws 106-118 and 106-413 increased VA compensation, survivors' benefits, and other cash-transfer benefits by 2.4 percent and 3.5 percent, respectively, thereby assuring that VA benefits keep pace with inflation. In the area of insurance benefits, the Veterans Benefits and Health Care Improvement Act increased the amount of life insurance available to service members from $200,000 to $250,000, and authorized insurance program participation by members of the Reserves. That statute also freezes premiums paid by certain insured veterans who have reached the age of 70. And, in the area of housing benefits, the Veterans Benefits and Health Care Improvement Act improved remodeling grant programs to assist disabled veterans in making their homes accessible, and the Millennium Act extended mortgage loan guarantee benefits to members of the Reserves. In order to assist veterans in gaining meaningful post-service employment, the Veterans Benefits and Health Care Improvement Act extends eligibility for Federal contractor outreach programs to recently-separated veterans. In addition, the Veterans Entrepreneurship and Small Business Development Act of 1999, Public Law 106-50, provides technical, financial, and procurement assistance to veteran-owned small businesses. Finally, in the area of memorial affairs, the Millennium Act mandates that VA establish six new national cemeteries in areas which VA had identified as being underserved. In addition, the Millennium Act facilitated last month's dedication of the World War II Memorial on the National Mall by authorizing the American Battle Monuments Commission to borrow funds needed to proceed now while World War II veterans remain alive to see the memorial they earned. Finally, the Veterans Benefits and Health Care Improvement Act extended eligibility for burial, and funeral expense and plot allowances, to certain U.S.- citizen Filipino veterans, improved VA assistance to States in establishing State cemeteries, and extended job-protection benefits to Reserve and Guard members who take leave from their civilian jobs to honor veterans by serving in burial details. Mr. President, I commend and thank the ranking minority member of the Veterans' Affairs Committee, and all of the committee's members, for their extraordinary diligence and cooperation in assisting me in pressing forward the numerous improvements to veterans programs that I have outlined in this statement. The Veterans' Affairs Committee operates in an unusually bipartisan way--a way that might be a model for constructive activity in the 107th Congress. We will continue to so act, and we anticipate that the 107th Congress will show a record of accomplishment similar to that which characterizes the 106th.

Mr. SPECTER

Mr. SPECTER. Mr. President, I rise to introduce legislation at this time which will put on the record factors which have been enormously harmful in the current violence which now occurs in Israel. This bill would prohibit assistance to the Palestinian Authority or Palestinian projects, unless and until certain conditions are met. The Oslo Interim Agreement of 1995 provided that the Palestinian Authority would: . . . ensure that their respective educational systems contribute to the peace between the Israeli and Palestinian peoples and to peace in the entire region, and will refrain from the introduction of any motifs that could adversely affect the process of reconciliation. Notwithstanding that commitment, the Palestinian Authority has filled the textbooks with the most vitriolic condemnation of Israel and the Jews. For example, the ninth graders are taught: One must beware of the Jews, for they are treacherous and disloyal. The ninth graders are further instructed: One must beware of civil war, which the Jews try to incite, and of scheming against the Muslims. There are some extraordinarily vitriolic comments which are inciting the young people, the Arabs, to turn to violence in the name of Allah, with the instruction directing them that they will be doing Allah's work, and if they are killed, they will go to heaven as Allah's messengers, as Allah's assistants. There are reports of 12-year-old boys who leave their homes telling their parents they are off to throw stones and otherwise incite violence. The parents permit this under a fatalistic attitude of ``what will be will be,'' and that it is something to be desired--incite to violence and be killed in doing Allah's work. The difficulties in the peace process are enormous. They are generational. There is absolutely no likelihood of success if the schoolchildren in the Palestinian Authority schools are going to be taught hatred and violence and the most extraordinary forms of misleading comment--about how to please Allah and how to go to heaven by getting themselves killed in the process of killing others and destroying the peace process. The United States and our allies have contributed very substantially to projects in the West Bank and Gaza. While the United States has not given aid directly to the Palestinian Authority since 1995, in fiscal year 2000, the United States allocated $485 million in development assistance to non-governmental organizations working in the West Bank and Gaza. Between 1995 and 1998, international aid provided by 21 countries and 4 international organizations amounted to almost $227 million. Between 1993 and 1999, the international community pledged a total of $5.7 billion for assistance in the West Bank and Gaza, and over $2.7 billion was disbursed by the end of 1999, according to the World Bank. I will go into the funding which the United States has provided and which our allies have provided in greater detail. This legislation would condition any assistance by the United States to the Palestinian Authority on changing those textbooks in accordance with their commitments under the Oslo agreement, ceasing to publish maps which omit Israel but instead refer only to Palestine, and changing the vitriol which appears on the state-sponsored television. These are absolutely minimal steps which have to be taken if there is to be any opportunity for success in the Mideast peace process. In 1995, Senator Shelby and I introduced legislation which was enacted which conditioned U.S. aid on the Palestinian Authority changing its charter which called for the destruction of Israel. That, in fact, did happen and perhaps our legislation was somewhat helpful in getting that done. The legislation also conditioned aid on maximum efforts of the Palestinian Authority and Chairman Arafat to restrain terrorists. For a time, I think there was a real effort by Chairman Arafat and many in the Palestinian Authority to do that, but that has totally broken down. Notwithstanding those grave difficulties, efforts must continue on the peace process to try to terminate the violence there. I note in this morning's press there are reports of additional meetings. I have both privately and publicly commended President Clinton for his efforts in trying to mediate the difficulties between the Israelis and the Palestinians. This business about teaching sixth graders, seventh graders, eighth graders, and ninth graders to hate and to incite violence is just absolutely intolerable if there is to be any chance at all for the peace process to succeed, and even in the next generation to find a way for people to live in peace with the Jewish State of Israel, the Palestinian Authority and the Arabs, who are citizens of Israel, for that matter. I am introducing this bill on what is probably going to be the last day of our session so that these educational tools may become better known. People will understand them and will join the fight to insist that they be terminated. Mr. President, to reinterate, I have sought recognition today to introduce legislation to condition aid to the Palestinian Authority upon the removal of all anti-Semitic and anti-Israel content from their school textbooks, and radio and television broadcasts at publically funded facilities. The Palestinian Authority deliberately and consciously disseminates messages filled with anti-Semitic and anti- Israel hatred with the clear aim of promoting violence against Israel and the Jewish people. This is a clear violation of the spirit of the peace process. A study by the Center for Monitoring the Impact of Peace, a Jerusalem-based non-governmental organization, found that there is not one example in the entire Palestinian school system of a positive reference to a Jew, Judaism, or to peace with Israel. I urge the passage of this legislation to send a clear signal to the Palestinian people that the international community will not accept the fostering of hatred in textbooks and broadcast media in the West Bank and Gaza. The United States provides assistance to the region in support of the peace process, and we must condition this assistance upon each party's fulfillment of the commitments made to bring peace to the region. Furthermore, we must vigorously press for our allies to do the same. In years past, Palestinian schools in the West Bank used Jordanian textbooks and the schools in Gaza used Egyptian textbooks. While the areas were under the control of the Israeli government, these books continued to be used but anti-Semitic and anti-Israel material was removed. As a result of the 1993 Oslo Accords, the responsibility for education in the West Bank and Gaza was transferred from the Israeli government to the Palestinian Ministry of Education. While beginning to develop their own curriculum, the Palestinian Ministry of Education continued to use Egyptian and Jordanian books, but failed to remove the anti-Israel and anti-Semitic material. Currently, the Palestinian Ministry of Education is directly supervising the production of new textbooks which are the first Palestinian-produced textbooks. As part of a pilot program, the first new textbooks were introduced in the first and sixth grades in September 2000, as part of the new curriculum which the Palestinian Authority plans to expand to cover the grades first through twelfth over the next fours years. Many Israelis and others hoped these books would promote the peace process and teach cooperation and tolerance among the Israelis and the Palestinians. Instead, the new Palestinian textbooks continue to contain anti-Israel material, such as a map denying the existence of Israel. The continued promotion of hatred by the Palestinian Authority is unacceptable, as it not only violates the spirit of the peace process but also the letter of the Oslo Accords. The United States and the rest of the international community must send a message to the Palestinian Authority that this will not be tolerated. By means of both the new and old textbooks in their schools, the Palestinian Authority is raising an entire generation of Palestinian children to despise Jews and Israel. These teachings foster an environment of hatred and violence, not peace and conciliation. Palestinian school children are actively taught that the Jewish people and Israel are the enemy in a broad range of contexts, and that Jews are not to be trusted. For example, on page 79 of the textbook entitled the Islamic Education for Ninth Grade, the book outlines lessons to be learned by the students. Specifically, it says ``One must beware of the Jews, for they are treacherous and disloyal.'' The book goes on to say on page 94, ``one must beware of civil war, which the Jews try to incite, and of scheming against the Muslims.'' Reinforcing this message, students read on page 182, ``The Jews . . . have killed and evicted Muslim and Christian inhabitants of Palestine, whose inhabitants are still suffering oppression and persecution under racist Jewish Administration.'' Another textbook, the Islamic Religious Education for Fourth Grade, on page 44, states ``. . . the Jews--as is their way--do not want people to live in peace. . .'' In the Reader and Literary Texts for Eighth Grade, on pages 96 through 99, students are taught ``The Jews have clear greedy designs on Jerusalem.'' Students are then asked to think about the following question: ``What can we do to rescue Jerusalem and to liberate it from the thieving enemy. . .?'' The authors of these textbooks clearly intended not to foster an environment of trust between the Palestinian people and their Jewish neighbors. Without a foundation of trust in the hearts and minds of the Palestinian people, the peace process is doomed to failure. The school books also include lessons equating Zionism with Nazism, Fascism, and racism. For example, the textbook entitled The Contemporary History of the Arabs and the World, on page 123, states ``The clearest examples of racist belief and racial discrimination in the world are Nazism and Zionism.'' Lessons such as this one are clearly not intended to support peace between the Palestinians and Israelis. More alarmingly, in addition to anti-Semitic material, these textbooks also teach children to pursue violence and the destruction of Israel. The calls to fight and eliminate Israel through Jihad, holy war, and martyrdom for Allah, appear frequently in the school textbooks. The need to fight Israel is portrayed as a religious imperative in the books. For example, a fifth grade textbook, Our Arabic Language for Fifth Grade on page 69 and 70, teaches children that ``there will be a Jihad and our country shall be freed. This is our story with the thieving conquerors. You must know, my boy, that Palestine is your grave responsibility.'' The book also teaches children to ``remember: The Arabs and the Muslims are fighting the Jews who fought against them and oppressed them and drove them from their homes unjustly. The final and inevitable result will be the victory of the Muslims over the Jews.'' The violent message continues in the seventh grade textbook, Islamic Education for Seventh Grade, on page 108, which states ``if the enemy has conquered part of its land and those fighting for it are unable to repel the enemy, then Jihad becomes the individual religious duty of every Muslim man and woman, until the attack is successfully repulsed and the land liberated from conquest and to defend Muslim honor. . .''. In addition to lessons on Jihad, students are instructed to adopt hostile attitudes on a particularly divisive topic--their responsibility regarding holy sites. The seventh grade textbook, Islamic Education for Seventh Grade, on page 184, states ``Muslims must protect all mosques. . . They must devote all their efforts and resources to repairing them and to protecting them and must wage a Jihad both of life and property to liberate al-Aqsa Mosque from the Zionist conquest.'' The inflammatory language is also included on page 50, ``The Muslim connects the holiness of al-Aqsa Mosque, and its precincts, with the holiness of the `Sacred Mosque' and Mecca. Therefore, any aggression against one is an aggression against the other and to defend them is to defend Islam. Disregard of the duty in respect of them is a crime for which Allah will punish every believer in Allah and His Prophet.'' The aggressive message clearly encourages the violence which is currently taking place in the Middle East. The same seventh grade book also teaches children to fight and conquer Israel's capital, Jerusalem. For example, the book contains a composition question which asks: ``How are we going to liberate our stolen land? Make use of the following ideas: Arab unity, genuine faith in Allah, most modern weapons and ammunition, using oil and other precious natural resources as weapons in the battle for liberation.'' It is this type of violent message which leads young children to take to the streets and engage in stone-throwing and other violence. However, this message is not limited to schoolbooks. The same hateful portrayal of Jews and Israel found in the school books is promoted regularly on Palestinian Television, which is also under direct control of the Palestinian Authority. For example, on May 14, 1998, Palestinian television broadcast statements such as ``The Jewish gangs waged racial cleansing wars against innocent Palestinians . . . large scale appalling massacres saving no women or children.'' On May 14, 1998, Zionism was presented as ``a cancer in the body of the nation.'' Palestinian television broadcasts a continuous flow of violent images with messages glorifying the children in the streets as martyrs participating in Jihad. For example, television stations around the world broadcast the image of Muhammad al-Durrah, the twelve year old boy who was killed while his father tried to shield him from the crossfire on September 30, 2000. However, the image of the young man, who had no intention when he left his house that day to become a martyr, was instantly the symbol used by Palestinian television of the continued victimization of the Palestinian people at the hands of the so-called Israeli ``occupiers.'' By continually referring to the occupation of their land, Palestinian television refuses to acknowledge the legitimacy of Israel. On May 19, 1998, Palestinian television reported `` . . . the war of 1948 brought about the establishment of the Zionist entity on Palestinian land.'' The television broadcasts also declared in May 1998: ``This is our Palestine. We defend it with blood.'' The hate-filled broadcasts further reinforce the anti-Israel and anti-Semitic messages found in the school textbooks and explicitly aim to incite violence. We cannot tolerate this behavior by a society that claims to be committed to pursuing the peace process. These teachings send a direct message to young children to pursue violence and the destruction of Israel, and the message appears to be reaching the children. On October 6, 2000, the New York Times reported on Muhammad Ibrahim, a Palestinian teenager engaged in the current violence in the streets. Muhammad joins his young friends on the streets and throws stones at Israeli soldiers, even though his father asked him ``not to go down that road'' and telling him ``we do not need another generation of victims.'' When asked why he engaged in the stone throwing, Muhammad plainly stated, ``You want to express your anger. You know your stone might not hit an Israeli soldier or might not even hurt him. But you want to feel you've done something for the homeland.'' Muhammad made clear where he learned these lessons when he said, ``I was raised with stories of how they kicked us off our land.'' The young people out on the streets today throwing stones have been raised on anti-Israel and anti-Semitic stories, which is formally reinforced in the textbooks used in the schools in the West Bank and Gaza and the television and radio broadcasts. If there is any hope for lasting peace in the region, the next generation of leaders must not be raised on lessons of hatred and violence. In signing the 1995 Interim Agreement on the West Bank and Gaza, the Israeli government and the Palestinian Authority agreed to use their respective educational systems to support the peace process. Specifically, Article XXII of the Israeli-Palestinian Interim Agreement on the West Bank and the Gaza Strip of 1995 declares that Israel and the Palestinian Authority will ``ensure that their respective educational systems contribute to the peace between the Israeli and Palestinian peoples and to peace in the entire region, and will refrain from the introduction of any motifs that could adversely affect the process of reconciliation.'' The Palestinian Authority should be held to the commitments made in the peace process, not the least of which is to educate the young people of the West Bank and Gaza with a curriculum that will contribute to peace between the Israeli and Palestinian peoples. The United States provides assistance to the region in support of the peace process, and it is imperative to condition this assistance upon the fulfillment of the commitments made to bring peace to the region. While the United States has not given aid directly to the Palestinian Authority since 1995, in fiscal year 2000 the United States allocated $485 million in development assistance to non-governmental organizations working in the West Bank and Gaza, including funds for educational programs. It is of the utmost importance that the United States conditions any aid to the Palestinian Authority on their commitment to the peace process, which must be demonstrated by the removal of the anti-Semitic and anti-Israel material from their textbooks and radio and television broadcasts. It is also imperative that the United States urge our allies to condition their aid to the Palestinian Authority on this issue. Between 1995 and 1998 international aid provided by twenty-one countries and four international organizations provided $226.9 million to educational projects in the Palestinian Territories. Between 1993 and 1999, the international community pledged a total of $5.7 billion in assistance for the West Bank and Gaza, and over $2.7 billion was disbursed by the end of 1999 according to the World Bank. From 1994 to 1999, the European Community committed over $600 million. Recently, on December 6, 2000, the World Bank also agreed to a grant to the Palestinian Authority in the amount of $12 million. The assistance to the Palestinian Authority, whether through international institutions or our allies, must include conditions which will compel the Palestinian Authority to remove this unacceptable material from the textbooks and the broadcast media. The assistance is given to the Palestinian Authority with the intent to support peace in the region, and therefore, the aid should be conditioned on the removal of material which undermines the peace process from the Palestinian educational system and broadcast media. I urge my colleagues to join me in supporting this legislation which sends a clear signal to the Palestinian Authority that the use of anti-Semitic and anti-Israel material in their schools and television and radio broadcasts will not be tolerated. Mr. President, I ask unanimous consent that the text of the bill be printed in the Congressional Record.

Mr. SPECTER

Mr. SPECTER. As you know, I have been a strong supporter of the LIHEAP program and I am aware of how essential the program becomes in times of high fuel prices. While I hope that a continuing resolution will not be necessary next year, I would certainly support including funding for the full winter season in the first continuing resolution for fiscal year 2002, if that is necessary. catholic social services

Mr. SPECTER. As I, too, have had a long-running interest in coal mining and health and safety matters, I thank the Senator for his interest in this important coal matter. Yes, I believe that it is important for a range of stakeholders to be involved in this study as well as to look at both the current and future issues related to coal waste impoundments.

Mr. SPECTER

Mr. SPECTER. I thank the distinguished Senator from New Jersey for yielding to me. I compliment him for his leadership on Amtrak generally and especially on this current plan for financing. I support Amtrak and believe the proposal to provide this additional funding is very much in the national interest. I think it is a very salutary thing, as some have already commented, that we have people extending their hands across the aisle on a matter of great national importance. The Senator from Delaware, I think, characterized the situation very aptly when he talked about federalism; and that is, one region helping another region. There is no doubt that those of us who live in the eastern corridor-- and I am a beneficiary of Amtrak. It is 1 hour and 37 civilized minutes from Washington, DC, to 30th Street Station in Philadelphia. But it is more than my convenience; it is the infrastructure of the country. I think this is very good for the country that we are going to be moving ahead with this legislation next year, and a very good sign for the 107th Congress that hands are being extended across the aisle to show bipartisanship. If this carries forward in the next year generally, it will be very good for the American people. I, again, thank my colleague from New Jersey.

Mr. SPECTER

Mr. SPECTER. Mr. President, I commend my distinguished colleague from Virginia for those fine remarks about Senator Robb. I associate myself with Senator Warner on his best wishes to Senator Robb, acknowledging his very distinguished service in the Senate for 12 years. I might add, his distinguished wife, Lynda Johnson Robb, was a regular at the Old Testament Bible class conducted in my office over the past decade, presided over by a very distinguished Biblical scholar, Naomi Rosenblatt. But Chuck and Lynda Robb will still be around and we will have the benefit of their company, although his Senate career, at least, is over at the moment.

Mr. SPECTER

Mr. SPECTER. Mr. President, I express my thanks to Senator Collins. We work very closely together with a very distinguished group of Senators--Senator Jeffords, Senator Snowe, and who is the fifth member? Yes, Senator Chafee, who is presiding. I thank the Chair and thank Senator Collins.

Mr. SPECTER. Mr. President, I again thank my distinguished ranking member, Senator Jay Rockefeller, who works collaboratively on veterans affairs matters and all members of the Veterans' Affairs Committee. It is a committee which has worked in a bipartisan way. It has a very excellent staff, with staff director Bill Tuerk. I thank the staff for their assistance and commend to the public and the Congressional Record the legislation which has been passed during the 106th Congress. I know my time has expired, and I note the presence on the floor of a distinguished Senator, Ms. Collins. I yield the floor. I was about to say ``another distinguished Senator,'' but I modified that to ``a distinguished Senator.''

Mr. SPECTER. Mr. President, I have sought recognition to comment about the pending appropriations bill on Labor, Health and Human Services, and Education, which comes from the appropriations subcommittee which I chair. There has been an extraordinarily rocky road for this bill this year. I think it is very regrettable that on December 15 we are still debating that bill and the entire package is as yet unsettled, although hopefully it will be resolved before the end of the day. But there have been many days when we have been hopeful about resolving matters before the end of the day and that has not occurred. Without going into the background on prior years, it has been a very difficult matter to get the bill on Labor, Health and Human Services, and Education to the President for signature and to resolve the controversies. This year, my ranking member on the subcommittee, Senator Tom Harkin, and I have worked as partners on this matter. When he chaired the subcommittee, I was ranking, or when I have chaired the subcommittee, he has been ranking. Both of us understand--and have for a long time--that if you want to get something done in Washington, you have to cross party lines. That is more true today than ever. It will be even more true in the 107th Congress when we have a 50-50 split. But we brought that bill to conclusion on the Senate vote on June 30 of this year, which tied the record going back to 1976. We completed a conference report on July 27, the last Thursday before we adjourned for the Republican convention and the August recess. We did that with a lot of extra effort, hard work by our staffs led by Bettilou Taylor on my staff, so we could get the bill to the President right after Labor Day. There is no use sending it in August, but we were prepared to submit it to the President the day after Labor Day. We had met the President's figure of $106 billion, which was a $10 billion increase over the program authority from last year. We did that because the experience in the past had been that when we quarreled with the President about the total figure, invariably there were add-ons at the end when the issue went beyond September 30 into October or November. Candidly, it was difficult to get the Republican caucus to agree to $106 billion in the Senate and in the House, but we did that. But in presenting the bill, the conference report, we had some priorities which were somewhat different from those of the President. We had, for example, added $2.7 billion for the National Institutes of Health because we thought that was a very high priority item. We had also made some changes on the $2.7 billion which the President had requested for school construction and additional teachers, giving him that money but adding a provision that if the local boards of education wanted to use the money for something else after fulfilling very stringent requirements, that they could use it for local control. When we sat down to negotiate with the White House, the President and the Democrats in the House upped the ante and asked for an additional $6 billion. From my way of thinking, that was totally unacceptable because we had provided the $106 billion which the President had initially requested. After all, it is the congressional prerogative to set the priorities on appropriations. That is spelled out in the Constitution. The President has to sign the bill but we have the lion's share of responsibility, in my view, to establish the priorities. Those negotiations degenerated--at least in my opinion--until there was an inclination by some in the conference to pay $114 billion. I refused to be a party to that amount of money because I had fought hard to raise the figure to $106 billion and I felt there would be no credibility in what I would present as chairman of the subcommittee if I would be a will-o'-the-wisp and raise it to any figure to satisfy the demands of the White House and the House Democrats. There was a tentative agreement of $114 billion and I declined to sign any conference report which reflected that figure. Ultimately that arrangement broke down. Now we have come to the point where the negotiations have produced a figure of $108.9 billion, which is still more than the $106 billion we had originally projected, but in the spirit of accommodation, trying to finish the business of the Congress, I am prepared to go along with that figure although very reluctantly. There have been changes in the bill which I find totally unacceptable. The National Institutes of Health has had an increase of $2.7 billion over fiscal year 2000, which had been in all along, now cut by $200 million to $2.5 billion. I believe that the National Institutes of Health is the crown jewel of the Federal Government. It may be the only jewel of the Federal Government. We have added almost $9 billion to the funding on NIH in the last five cycles. The Senate, in one of the first years under my chairmanship, came in at the figure of a $950 million increase. The House would not go along. We compromised out at $907 million. The next year we added $1 billion; the year after, $2 billion; the year after that, $2.3 billion, which was cut a little on an across-the-board cut. This year we put in $2.7 billion, now reduced to $2.5 billion. But we have a total of almost $9 billion added in these last five cycles and they have made tremendous strides on the most dreaded diseases--Parkinson's and Alzheimer's and cancer and heart ailments and the whole range. It is my hope in the future that whoever chairs the subcommittee will have better cooperation on all sides to present the bill to the President before the fiscal year ends. I think, had that been done, we could have mustered a very strong position that our priorities were superior to what the President had in mind, and that if he were going to veto the bill, we ought not to be fearful of his veto but we ought to accept it as his view and then take the case to the American public. I think, had the bill been submitted to the President on September 5, we would have won that fight. Or if we had not won it outright, we would have compromised in terms so we wouldn't be here on December 15, still arguing about this Labor-HHS-Education bill as the principal source of contention. (The remarks of Mr. Specter pertaining to the introduction of S. 3280 are located in today's Record under ``Statements on Introduced Bills and Joint Resolutions.'')

Mr. SPECTER

Mr. SPECTER. Mr. President, I ask unanimous consent that the Senate now turn to the consideration of the continuing resolution, H.J. Res. 125, funding the Federal Government through December 5, 2000; that the joint resolution be read the third time and passed, and the motion to reconsider be laid upon the table, all without any intervening action, motion, or debate.

Mr. SPECTER

Mr. SPECTER. I suggest the absence of a quorum.