Ron Wyden

Mr. WYDEN

Mr. WYDEN. Mr. President, all children should have access to a quality education, regardless of whether they have disabilities. The importance of the Individuals With Disabilities Education Act [IDEA] is that it enables parents to acquire special educational assistance for their children who may be fully capable of becoming productive members of society, but may need some extra help along the way. I am pleased that Members of Congress on a bipartisan, bicameral basis have worked out a compromise that allows us to reauthorize this important piece of legislation. While I generally support the compromise on the IDEA bill that is before us today, I want to touch briefly on an issue that some school nurses have raised with regard to this legislation. I have heard from many Oregon school nurses about the importance of including nurses in the individual education program [IEP] development process. Under current IDEA regulations, school nurses are considered qualified health professionals and are considered fully capable of assessing a student's disabilities during the IEP process. The school nurses had asked to be mentioned specifically in the statute as ``related service providers'' in a disabled child's multidisciplinary team. While this could not be worked out, I understand that the committee report addresses this issue, and I want to convey my support for the inclusion of school nurses as part of the IEP process. In this country we frequently underestimate the excellent quality of care provided by this Nation's nurses. School nurses have the training and provide the supervision to safely deliver specialized health services. For children with chronic or special health care needs, the school nurse is often a crucial member of the multidisciplinary team that enables children with disabilities to participate fully in their educational program. As long as they are fully qualified to make an assessment of a child's disability, there should be no reason that localities should discriminate against nurses. Again, I complement my colleagues for breaking through the logjam on this important reauthorization, and I want to reemphasize my support for the school nurses who play such an important role in the care of children with disabilities. personnel standards

Mr. WYDEN

Mr. WYDEN. Mr. President, I thank the Senator from New Mexico, and want him to know I very much appreciate the chance to join him and Senator Ashcroft on this bipartisan bill. Mr. President, I say to my colleagues, it is very clear that the juvenile justice system today in our country is very much like a revolving door. A young person can commit a violent crime, a series of violent crimes, be apprehended, visit the juvenile justice system--and that is really an appropriate characterization--and be back on the street virtually immediately. In fact, in our newspaper, the Oregonian, it was recently reported that a child committed 52 crimes, 32 of which were felonies, before the juvenile justice system took action to protect the community. I felt--and I think this is the focus of the legislation that the Senator from New Mexico, the Senator from Missouri and I bring to the floor today--that there should be three principles for the new juvenile justice system for the 21st century. The first ought to be community protection; the second should be accountability; and the third should be restitution. The principle of accountability is especially important with young people. I even see it with my own small kids, a 7-year-old and a 13-year-old. If they act up, there needs to be some consequences. I am particularly pleased that the legislation the Senator from New Mexico brings to the floor today puts a special focus on trying to deal with offenses perpetrated by young people that have not yet risen to that level of violent crime and, in effect, try to send a message to young people that there will be consequences. The last point that I will make, because I know time is short and we have much to do today, is that this legislation is particularly important in such areas as recordkeeping. We have found across the country that it has not even been possible to keep tabs on the violent juveniles, because there are so many gaps in the recordkeeping in the States. Both the Senator from New Mexico and the Senator from Missouri have done yeoman work in this regard. This is a balanced bill; it is a bipartisan bill. It moves to update the laws dealing with juveniles for the 21st century. I thank my friend from New Mexico and the Senator from Missouri for allowing me to be part of this bipartisan coalition. They included a number of provisions that are important to our State in the drafting that went on in the last week. I thank the Senator from New Mexico.

Mr. WYDEN. Mr. President, last month, I talked about the importance of the innovative ``Community Justice'' model for juvenile justice being developed in Deschutes County and Multnomah County, OR. Today, Senators Domenici and Ashcroft and I are introducing legislation that incorporates many important pieces of this Oregon model and also represents an effort to bring some new, bipartisan thinking to the issue of juvenile justice. Oregon's idea is that the juvenile justice system should weave the community into the very fabric of juvenile justice. This entails treating the victim as a customer of the juvenile justice system and realizing that when a crime is committed the whole community is the victim. There is a reciprocal obligation in communities--first, to give children the values and tools to ensure that youth crime is prevented and second, to look for at-risk children and try to form a net of services to keep these children from getting into trouble. However, once a young person steps over the line and commits a crime, part of the reciprocity involves the youth making the community whole through restitution and community service. I was pleased to work with Senators Domenici and Ashcroft to include some of these Oregon ideas into this bill. In particular, I think that the second tier of incentive grants will help encourage States to come up with ways to integrate the community into the juvenile justice process. In particular, the bill promotes consideration for victims and restitution for all crimes. It will also ensure that this restitution is collected. The legislation encourages States to look at mentorship programs, parent accountability, and ways to bring together service providers to form a network of information sharing to prevent juvenile crime. One of the key aspects of the Deschutes County model that is so impressive is the coordination between schools, juvenile justice services, child protection services, police, district attorneys, judges, and others. Not only does this build a broad base of support for the juvenile justice system, but it allows these agencies to identify the most at-risk youth early, to see whether efforts to divert them from delinquency are effective and to concentrate resources on them. When I began working on this issue in 1995, I laid out three principles for a new juvenile justice system: community protection, accountability, and restitution. We need to keep our streets safe, punish criminals, and make sure victims--including the community itself--are repaid. This legislation will encourage States to develop systems based on these principles and to add to the the important ingredient of community involvement in the juvenile justice system. I thank the Senators from Missouri and New Mexico for their bipartisan effort to develop juvenile justice legislation that takes a balanced approach to juvenile justice.

Mr. WYDEN

Mr. WYDEN. Mr. President, last month, I talked about the importance of the innovative ``Community Justice'' model for juvenile justice being developed in Deschutes County and Multnomah County, OR. Today, Senators Domenici and Ashcroft and I are introducing legislation that incorporates many important pieces of this Oregon model and also represents an effort to bring some new, bipartisan thinking to the issue of juvenile justice. Oregon's idea is that the juvenile justice system should weave the community into the very fabric of juvenile justice. This entails treating the victim as a customer of the juvenile justice system and realizing that when a crime is committed the whole community is the victim. There is a reciprocal obligation in communities--first, to give children the values and tools to ensure that youth crime is prevented and second, to look for at-risk children and try to form a net of services to keep these children from getting into trouble. However, once a young person steps over the line and commits a crime, part of the reciprocity involves the youth making the community whole through restitution and community service. I was pleased to work with Senators Domenici and Ashcroft to include some of these Oregon ideas into this bill. In particular, I think that the second tier of incentive grants will help encourage States to come up with ways to integrate the community into the juvenile justice process. In particular, the bill promotes consideration for victims and restitution for all crimes. It will also ensure that this restitution is collected. The legislation encourages States to look at mentorship programs, parent accountability, and ways to bring together service providers to form a network of information sharing to prevent juvenile crime. One of the key aspects of the Deschutes County model that is so impressive is the coordination between schools, juvenile justice services, child protection services, police, district attorneys, judges, and others. Not only does this build a broad base of support for the juvenile justice system, but it allows these agencies to identify the most at-risk youth early, to see whether efforts to divert them from delinquency are effective and to concentrate resources on them. When I began working on this issue in 1995, I laid out three principles for a new juvenile justice system: community protection, accountability, and restitution. We need to keep our streets safe, punish criminals, and make sure victims--including the community itself--are repaid. This legislation will encourage States to develop systems based on these principles and to add to the the important ingredient of community involvement in the juvenile justice system. I thank the Senators from Missouri and New Mexico for their bipartisan effort to develop juvenile justice legislation that takes a balanced approach to juvenile justice.

Mr. WYDEN. Mr. President, I thank the Senator from New Mexico, and want him to know I very much appreciate the chance to join him and Senator Ashcroft on this bipartisan bill. Mr. President, I say to my colleagues, it is very clear that the juvenile justice system today in our country is very much like a revolving door. A young person can commit a violent crime, a series of violent crimes, be apprehended, visit the juvenile justice system--and that is really an appropriate characterization--and be back on the street virtually immediately. In fact, in our newspaper, the Oregonian, it was recently reported that a child committed 52 crimes, 32 of which were felonies, before the juvenile justice system took action to protect the community. I felt--and I think this is the focus of the legislation that the Senator from New Mexico, the Senator from Missouri and I bring to the floor today--that there should be three principles for the new juvenile justice system for the 21st century. The first ought to be community protection; the second should be accountability; and the third should be restitution. The principle of accountability is especially important with young people. I even see it with my own small kids, a 7-year-old and a 13-year-old. If they act up, there needs to be some consequences. I am particularly pleased that the legislation the Senator from New Mexico brings to the floor today puts a special focus on trying to deal with offenses perpetrated by young people that have not yet risen to that level of violent crime and, in effect, try to send a message to young people that there will be consequences. The last point that I will make, because I know time is short and we have much to do today, is that this legislation is particularly important in such areas as recordkeeping. We have found across the country that it has not even been possible to keep tabs on the violent juveniles, because there are so many gaps in the recordkeeping in the States. Both the Senator from New Mexico and the Senator from Missouri have done yeoman work in this regard. This is a balanced bill; it is a bipartisan bill. It moves to update the laws dealing with juveniles for the 21st century. I thank my friend from New Mexico and the Senator from Missouri for allowing me to be part of this bipartisan coalition. They included a number of provisions that are important to our State in the drafting that went on in the last week. I thank the Senator from New Mexico.

Mr. WYDEN

Mr. WYDEN. Mr. President, I want to congratulate those Members who have spent a good part of the last 2 days in search of a compromise on this question of how we make sure that these emergency efforts are not unreasonably hindered by compliance with the Endangered Species Act. I have serious reservations about this compromise. This amendment includes a provision that seeks to clarify the phrase ``reasonable and prudent measures'' in the context of the Endangered Species Act. Reasonable and prudent measures are those things that the Fish and Wildlife Service or NMFS may require in order to protect fish and wildlife from the adverse effects of, in this case, a specific repair or reconstruction project. The language directs that these measures be scaled to the scope and effect of the specific repair or reconstruction project. We are told by the amendment sponsors that their intent is to simply re-state existing law. This raises two important procedural questions: First, if the intent is simply to express a concept that is already in the law, then I see no reason to include it here. Second, the question of how we define the scope of section 7 consultations under the ESA is a major issue in our work to reauthorize the Act. It strikes me as imprudent for the Senate to go on record on this question in this disaster supplemental, when at the same time the same issue is under intense negotiation in the Environment and Public Works Committee. Having said that, there are several basic reasons to oppose the bill's existing provision allowing a broad exemption of all facilities with flood control functions from the requirements of the Endangered Species Act. First, the financial resources that this legislation brings to bear on the extensive damages caused by this year's disastrous flooding are immediately threatened and unreasonably delayed by using the bill as a vehicle to broadly amend the Endangered Species Act. It seems clear to this Senator that the bill would be vetoed and we would be back to the drawing board in trying to direct Federal resources toward the people who have faced awesome difficulties in dealing with this year's flood waters. Second, I firmly believe there is precious little support on either side of this issue for continuing to seek slam dunk, back door riders as a method of changing basic environmental laws. Reauthorization of the Endangered Species Act is already a complex and difficult chore, and we should set about that business within the regular committee process. And third, I am convinced that this provision is a case of Washington trying to fix a problem that simply does not exist. Let me talk more about this third concern. We have shown in Oregon--which has no shortage of endangered species issues--that we can get the dredges and cranes going quickly in response to the widespread damage we suffered in this extraordinary flood year. And we did it without sweeping aside the law. We went down an almost identical road here in Congress in responding to last year's flooding. We provided emergency funding to address major problems, and that effort, I'm pleased to report, was successful. Since Oregon's 1996 floods, literally thousands of actions have been taken to repair flood damage and restore natural resources. These include more than 400 emergency projects of the Natural Resources Conservation Service, more than 150 projects of the BLM, and more than 350 Forest Service projects on the Mt. Hood National Forest alone. None of these has been stopped or significantly delayed by the Endangered Species Act or other environmental laws. Oregon's experience once again is a model for the rest of the Nation. In fact, I'm told that it was Oregon's experience that has led to the much more efficient response to the floods in Idaho this year. The record in my State is clear: when we need an emergency response to flood damage, we can do it efficiently under current statutory authority. I want to talk for a moment about one example of our innovation--the cooperation with the U.S. Fish and Wildlife Service that ensured that these 1996 reconstruction projects went forward in a way that protects fisheries and aquatic resources. Early coordination with the Service led to the preparation of a manual that guided early project design work. We got the Service some extra money last year to put staff directly on the reconstruction projects. These efforts allowed the various agencies to essentially pre-approve various flood projects that may be funded by this year's supplemental flood response request. The bottom line is, of course, that the process enabled the highest care to be taken in protection of fish and wildlife, but without delay to the projects. Idaho has now benefitted from the Oregon experience. Already this year, I'm told that the Natural Resources Conservation Service in Idaho has processed three times the volume of flood repair projects as were done in all of last year in that State. Finally, I believe the interests of the American people are advanced best when we address major issues in their proper forum and context. All of us support an appropriate streamlining of the Endangered Species Act to ensure the efficient reconstruction and maintenance of critical river facilities damaged by this extraordinary flooding. This is not the time to begin a major overhaul of the Endangered Species Act. This bill would waive Endangered Species Act compliance in a broad range of nonemergency situations, including the routine operation and maintenance of Federal flood control facilities--flood control being one of the many benefits provided by virtually every dam, levee, and dike along our rivers. I cannot imagine that we now want to take a sledgehammer to the requirements that Federal river facilities comply with the act and operate in a manner that is as protective as possible of the various salmon species that are in real trouble in our region.

Mr. WYDEN

Mr. WYDEN. Mr. President, the people of Oregon have firsthand knowledge of the dangers of chemical weapons. Stored at the chemical weapons depot at Umatilla in the eastern part of my State are millions of pounds of chemical weapons. Mustard gas and nerve gas sit in concrete bunkers, a constant reminder of the need for action. We see and hear constant news reports about the dangers facing children in eastern Oregon every day those weapons sit in those stockpiles. There is no place in a civilized society for terror weapons like these, and it is not right to have stockpiles of these weapons that put our children at risk. Passing the Chemical Weapons Convention is the most important vote in this Congress for a safer future for our children. This is a time in my view for the United States to lead rather than to retreat. When Presidents Reagan and Bush negotiated this treaty, they fully understood that U.S. leadership was needed to complete it. They knew that full U.S. participation was essential for its work. Not only will failure to ratify this convention put us in the position of being followers on the world's stage but the provisions built into this treaty to isolate and in fact economically punish those nations which refuse to ratify the treaty are going to apply to the United States if the Senate does not ratify this treaty. In my State, we believe that we prosper from trade, cultural and other exchanges with the rest of the world and that there would be a threat if we failed to ratify this treaty. If the Senate allows America to become an outlaw nation, the effects would be felt by every farmer, software engineer, timber worker and fisherman who sell the fruits of their labor overseas. I would like to for just a brief few minutes review the arguments against this treaty. Some say that it represents a loss of sovereignty, but there is no greater threat to our sovereignty than to run away from our role as a world leader. Some say that this treaty would open our essential industries to espionage, but there is no question that the American chemical companies were consulted on this treaty. They worked closely on the key verification issues and there is enormous support, enormous support among those in the chemical industry to approve this treaty. Finally, there are those who say verification is unworkable because rogue nations will refuse to ratify it. But the fact is that ratification of the treaty gives our country new access to information about the chemical weapons programs of other nations. If we are denied access to this vital intelligence, then we will be forced to spend even more on our own intelligence to track the chemical weapons threat. The world is watching the Senate now, watching the greatest nation on Earth and hoping that we will lead the way to ridding our planet of these poisons. I urge my colleagues to join across party lines and approve this treaty, because when it is approved, our world will be a safer place. I yield the floor.

Mr. WYDEN

Mr. WYDEN. Mr. President, and colleagues, watching Ms. Shea enter the Chamber today makes me feel very proud. It is a good day for the Senate because ensuring equal access to opportunity is what the U.S. Senate is all about. Ms. Shea has been assisting my office in a number of matters, particularly nuclear waste legislation and legislation with respect to the rights of the disabled. Yesterday, I attempted to bring Ms. Shea on to the Senate floor to assist me in debate on the nuclear waste bill. Ms. Shea is a respected economist and energy policy expert who has worked for the Federal Government for more than 20 years. She was denied access to the Senate floor yesterday because she requires the use of a guide dog as a result of a genetic condition which significantly impairs her vision. Today, Mr. President and colleagues, I thank the majority and minority leaders as well as the chairman and ranking member of the Rules Committee for moving so expeditiously to ensure that this body extend equal opportunity to citizens who are visually impaired. Today, a resolution was offered by the majority and minority leaders and referred to the Senate Rules Committee that seeks to permanently address this issue so that an individual with a visual impairment will not need to seek case-by-case approval just to use their talents on this Senate floor. I intend to work with Members on both sides of the aisle and with Ms. Shea to make certain that the U.S. Senate provides appropriate access to those citizens with disabilities and that the access complies with the spirit of the Americans with Disabilities Act. It seems to me, Mr. President, that what the Senate is saying today is that a double standard will not be allowed here. In the private sector, for example, Federal law is very clear. In the private sector where you have an individual with Ms. Shea's talents and abilities, and if a guide dog or a white cane is needed to carry out those duties in the private sector, Ms. Shea would have a legal right to have that guide dog with her. Now, I close by thanking several of our colleagues for their help in rectifying this situation. I particularly thank Senator Reid of Nevada, the lead cosponsor of my resolution, as well as chairman Frank Murkowski for his support yesterday. In addition, Senators Wellstone and Bryan and, in fact, all Members of the Senate who were on the floor yesterday during discussion of this issue moved to be cosponsors of this legislation. I thank Senator Ford who also, for years, has worked for the rights of the disabled. Finally, I thank our Sergeant at Arms, Mr. Greg Casey. He has been extraordinarily patient and conscientious in working with myself and our staff. I thank him for helping to bring justice to the floor of the Senate. Mr. President, the U.S. Senate has done the right thing today by standing up for full legal rights and equal opportunity for those like Ms. Shea who have a visual impairment. The Senate is sending a message across this country that we are not going to leave our citizens behind. I am very proud that the Senate has taken this action. I yield the floor.

Mr. WYDEN. I thank my colleague.

Mr. WYDEN

Mr. WYDEN. Given this development, Mr. President, I ask unanimous consent that my staffer, Ms. Moira Shea, be granted access to the floor of the United States.

Mr. WYDEN. Mr. President, I rise today to express my appreciation to the bipartisan leadership for responding so quickly to an issue that cries out for justice. With strong and responsive action from the leadership today, the U.S. Senate said that those who have a visual impairment will be able to fully utilize their talents on this Senate floor. A resolution was accepted today in the Senate which allows persons requiring a guide dog, a wheelchair, or a cane to be considered on a case-by-case basis for entry to the floor. Pursuant to this resolution, the Sergeant at Arms has determined that for Ms. Moira Shea, a staffer in my office, that her guide dog is necessary and appropriate to the performance of her duties. Privilege of the Floor

Mr. WYDEN

Mr. WYDEN. Mr. President, I ask unanimous consent to speak for 15 minutes as in morning business.

Mr. WYDEN

Mr. WYDEN. Mr. President, I ask unanimous consent that Ms. Moira Shea, a congressional fellow in my office who is visually impaired, be granted floor access during the course of debate on S. 104, the Nuclear Waste Policy Act, and that Ms. Shea's guide dog also be granted floor access during the course of debate on S. 104.

Mr. WYDEN. Mr. President, I thank the Senator from Minnesota for yielding me time. Transportation of defense- and commercial-grade nuclear fuel and high-level radioactive waste is a great concern to the people of Oregon. Virtually every shipment to and from the Department of Energy's Hanford site requires at least 200 miles of transport on the roads in our State. As we have heard these past several days, the transportation of spent nuclear fuel and high-level radioactive waste is a major concern to many Senators on both sides of the aisle in this debate with respect to how to handle nuclear waste in the next century. During the Energy Committee markup on S. 104, my amendment on transportation safety of spent nuclear fuel and high-level radioactive waste was adopted. A key component of that amendment is the no shipments if no training provision. It literally means what it says, that there will be no shipment of spent nuclear fuel or high-level radioactive waste through the jurisdiction of any State or reservation lands of any Indian tribe eligible unless technical assistance and funds to implement procedures for the safe routing transportation are available for at least 3 years prior to any shipments. This provision was carefully crafted to ensure safe transportation while also preventing anyone from using this provision to obstruct shipment by refusing to accept the grants or by failing to use the grants for training. Senator Wellstone's amendment further tightens this requirement, and, it seems to me, Mr. President, that our Government, built on checks and balances, ought to be ensuring this kind of mechanism, the kind of mechanism envisaged by the Senator from Minnesota, to ensure accountability and to ensure public safety. I also point out that it is not necessary to reinvent the wheel to transport spent nuclear fuel or high-level radioactive waste. What this amendment does, as did the amendment that I offered in committee, is to essentially build on the good system already in place to provide for the safest method possible for the transportation of spent nuclear fuel and high-level radioactive waste. That is the system now being used for the transportation of plutonium from the Hanford nuclear reservation and other Department of Energy facilities to the WIPP facility in New Mexico. For the past 5 years, the Department of Energy has worked cooperatively with States and Indian tribes to develop the WIPP Land Withdrawal Act transportation system. It has been applied with success to a variety of shipments of nuclear materials moving literally from coast to coast. The Department of Energy has been working well with Western States in preparing shipments of transuranic wastes to the WIPP facility. I believe the WIPP Act, which the Senator from Minnesota builds on with his amendment, takes the right approach to address issues such as advance notification to the States of shipments, agreement of avoiding adverse weather conditions, qualification of carriers and emergency training and response of emergency responders. I do believe that this issue is one of bipartisan concern. In the Senate Energy Committee, my colleague from Oregon, Senator Smith, joined me in offering the amendment that was adopted in committee, now strengthened by the Wellstone amendment. I thank the Senator from Minnesota for yielding me this time, and I am very hopeful that it will be possible on a bipartisan basis to accept the Wellstone amendment, which I believe builds on the progress that was made in committee with respect to tightening safety measures, to proving accountability for moving these dangerous wastes across the country. I thank the Senator from Minnesota for yielding me time. Mr. WELLSTONE addressed the Chair.

Mr. WYDEN. Mr. President, in light of the objection, I ask unanimous consent that I be permitted to proceed for 10 minutes as in morning business for the purpose of submitting a resolution.

Mr. WYDEN

Mr. WYDEN. Yes.

Mr. WYDEN. Mr. President, the resolution that I submit today would change the Senate rules that deny floor access to those individuals who are visually impaired and need to use guide dogs to carry out their official duties. By denying floor access to Ms. Shea and her guide dog, the Senate, in my view, is violating the Congressional Accountability Act, which requires that Congress abide by the requirements and intent of the Americans With Disabilities Act. A guide dog is a person's vision. A guide dog is a working dog, not a pet. This guide dog is with Ms. Shea all the time. He is with her in meetings in my office. He goes with her to energy committee hearings and has even gone with her to nuclear weapons facilities. Mr. President and colleagues, I had hoped that there would be no need to offer this resolution, but I am forced to because discrimination still persists here. Ms. Shea is being treated differently simply because she is visually impaired and needs to use a guide dog. Now, some may believe that the Senate fulfills its obligations under the Americans With Disabilities Act--

Mr. WYDEN. I thank my colleagues. Mr. President, some believe that the Senate is fulfilling its obligations under the Americans With Disabilities Act if they provide someone to accompany Ms. Shea to the Senate floor. But let me say that an unknown staff person is no substitute for a working guide dog. The relevant language from the Americans With Disabilities Act says that an employer must provide reasonable accommodation for an individual with a disability. The Equal Employment Opportunity Office has said, ``reasonable accommodation [is] when an employer permits a person who is blind to use a guide dog at work.'' Let us put ourselves in Ms. Shea's situation. Imagine that you need to go on the Senate floor to carry out your official duties, but, wait, you must first check your ability to see with the doorkeeper, or go to the Rules Committee to get a resolution. I fail to see the logic of this, and I fail to see the justice behind it. Miss Shea's situation doesn't require extra financial resources nor special treatment. She just wants to do her job as a professional. A large part of the problem seems to be a lack of understanding. So let me tell the Senate a little bit about what guide dogs do. They are working dogs, not pets. A guide dog is that person's vision, an integral part of that person's essential activities and professional responsibilities. A blind person or a visually impaired person, such as Ms. Shea, has learned to turn over her diminishing sight to her dog and trusts that dog with her safety. This guide dog has blocked Ms. Shea from oncoming traffic. He knows his left from his right. He is a marker to others that Ms. Shea is visually impaired. She has gone to the Senate Energy Committee hearings and nuclear weapons facilities. This dog has even met more just access with respect to the Soviet Union. Yet, here in the United States, on the Senate floor, where we passed the ADA and the Congressional Accountability Act, we are refusing access to someone who needs to use a guide dog. This guide dog has a serious job, and, I might add, the dog performs it very well. This is the tool that Ms. Shea uses to be a productive member of the work force, and today we are denying her the ability to do her job to the best of her ability. Ms. Shea is part of a growing work force of persons who want to be independent, who want to be productive, and who have been raised with a can-do attitude. Let me conclude by describing how the guide dog would work on the floor. Ms. Shea would most likely tell him to ``follow me,'' and as they walked down the aisle, the dog would alert Ms. Shea to each step by stopping. Then Ms. Shea would say to him ``find the chair,'' and then Ms. Shea would sit down and the dog would lay right beside her. We would all forget that the dog was even here. In leaving, Ms. Shea would tell the dog to ``find the door'' once again, and the dog would alert her to where all the steps are and take her right to the door. Mr. President, that is all there is to it. It seems to me that the Senate should change its rules to ensure that there is justice for people like Ms. Shea. To tell someone like Ms. Shea that she cannot come to the Senate floor with either a white cane or a guide dog and only with an escort is demeaning. You take away her right to decide what is the best method for her to carry out her job as a professional. You take away her sense of independence. You take away her dignity. You make her dependent on others. That is not what the Americans With Disabilities Act is all about. Ms. Shea has Usher's Syndrome. That is the leading cause of deaf- blindness in the United States. She has struggled and worked hard to get where she is today as a professional. She is independent and self- sufficient, and she told me that she can cope with losing her eyesight, but she should not be forced to face blatant discrimination. It is time for the Senate to change its rules. I look forward to working with my colleagues on the Rules Committee to do this. It is time to ensure that the visually impaired in our country have justice, and have justice in the way that Congress envisioned with the Americans With Disabilities Act and the Congress Accountability Act. I thank my friends from Minnesota, Nevada, and Alaska for joining me as cosponsors this morning on this resolution.

Mr. WYDEN

Mr. WYDEN. Mr. President, I ask unanimous consent to speak up to 15 minutes as part of morning business.

Mr. WYDEN. Thank you very much, Mr. President.

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

Mr. WYDEN

Mr. WYDEN. Mr. President, I hope our colleagues will oppose the Bingaman amendment. This is not a question of ``not in my backyard'' run rampant. In fact, Hanford is in the State of Washington. It is not in the State of Oregon. The reason that it is important to include Hanford in this legislation is that there is no place in the United States where nuclear materials are now stored under worse conditions than at Hanford. In fact, there is already more high-level nuclear waste stored at Hanford than at any other Federal facility in the country. I offered this in the committee with Senator Smith of Oregon. I hope our colleagues will reject the Bingaman amendment.

Mr. WYDEN. Thank you very much, Mr. Chairman. I suspect that there are some who now think this whole discussion is sort of a question of ``not in my backyard'' run wild. I submit to my colleagues, that is not what is at issue. In fact, Hanford is in Washington State. It is not in the State of Oregon. But I care greatly about this because there is already more high-level nuclear waste now stored at Hanford than at any other Federal facility in the Nation. There is no place in the United States where nuclear materials are stored under worse conditions than at Hanford. So, the fact is, if there are to be tens of thousands of tons of additional nuclear waste parked at Hanford, even though it is not safely storing the waste it now has on site, there will be great problems for the Pacific Northwest. So, I tell the Senate today, and Senator Smith also joins me in this effort, that I think this is a critical public health and safety question that when, in fact, you have high-level nuclear waste stored there already and you cannot deal with that safely, you certainly should not put additional waste there. I thank Chairman Murkowski for yielding to me. I want to say to the Senate, this is not, in my view, a question of not in my backyard run rampant, but that there are really public interest reasons for ensuring that additional problems are not foist upon the Pacific Northwest. I thank the chairman for yielding.

Mr. WYDEN

Mr. WYDEN. Mr. President, as you know, I have come to the floor each day this week to talk about what I think is the critical need for the Senate to move forward with bipartisan Medicare reform. I believe there is a unique window of opportunity now for action, a window built around the proposition that our economy is moving forward in a positive way. Certainly, we are a few years away from the demographic earthquake that is coming, and I believe it is possible to fashion a bipartisan package that will also achieve real savings to advance the cause of enacting a balanced budget. I come to the floor today to reflect for just a few moments on some of the discussion over the last few days as it relates to Medicare and the budget. It is my view that Senator Domenici, the chairman of the Senate Budget Committee, said it very well a number of weeks ago when the Budget Committee first began hearings on this year's budget, when Senator Domenici said, with respect to Medicare, policy must drive the budget numbers. Unfortunately, that has not been the case in the past, and I am concerned, based on the discussions that have gone on in the last couple of days as well, that we are moving away from the need for structural Medicare reform that is in the interests of both seniors and taxpayers. In the last Congress, I think we did see a numbers-driven approach to Medicare. Over in the other body, there was a judgment made that spending for Medicare had to be reduced $274 billion. Others in my party proposed reducing Medicare spending by a smaller sum. In both instances, I do not think enough attention was paid to the need to come up with sensible policies that would really show how you could get to those kinds of budget savings proposed by either party in a way that was good for both seniors and for taxpayers. If we look at the debate over the last couple of days, we see some of the discussion again moving just to the question of a budget number. I am convinced that it is possible over the next 5 years to save about $100 billion as it relates to the Medicare Program and do it in a way that protects the interests of older people and also will help to reduce the deficit. But I think it is even more important--even more important, Mr. President--that this body understand that the big challenge is to lay the foundation for 21st century Medicare and that that challenge goes far beyond the question that has driven discussions the last couple of days. What we have to do is start bringing choice and competition to the Medicare Program. That is what is driving progress as it relates to health care reform in the private sector, and, obviously, choice and competition is what Members of this body enjoy through the Federal employee plan. I think it is possible to do this in a way that protects the rights of patients and makes sure that as we look to the future with more choice and more competition, that it is a future that does not involve health plans with gag clauses, does not strip seniors of their rights to appeal a denial of benefits, makes sure that their grievance procedures include what are called ``report cards'' so that our country can find out if people who sign up for health maintenance organizations drop out a few months later because service is unacceptable. The Congress now, as we move to try to develop a budget resolution, I think can find an opportunity to generate real savings. I do not want to, in any way, minimize the importance of that task in getting a budget. But we can do it in a way that will also ensure that the kind of structural changes in Medicare are made and we put this program on a solid footing. If that is not done, Mr. President, we will see a continuation of the kinds of problems that Chairman Grassley demonstrated this morning at the Senate Committee on Aging. Senator Grassley held a very important hearing as it related to accountability in the Medicare Program and particularly as it related to managed care. What Senator Grassley's hearing pursued was making sure that older people could have access to good information so they could make choices in their Medicare. In this country, we have, unfortunately, because Medicare has not been modernized, a situation where older people either have no choices, which goes on in rural parts of the United States, such as the area that the Presiding Officer represents and I represent, or, as we saw this morning in Chairman Grassley's hearing, places like Los Angeles where there is kind of a blizzard of information offered and it is not possible for older people to compare the policies that are offered to them in an intelligible kind of way. I said at Mr. Grassley's hearing that as we go forward with Medicare discussions let us make sure that his work, which is designed to empower consumers and is certainly not going to be a budget buster because it is largely an effort to try to force disclosure and comparability of these various plans--I urged that Chairman Grassley's work be included in a final bipartisan package. Suffice it to say, you do not hear much discussion in terms of the budget discussions about the work that Chairman Grassley is doing or about the role of the Federal Employees Health Benefits Plan. And, unfortunately, there has not been enough focus on how the Medicare Program rewards waste and penalizes frugality. The private sector consigned that kind of approach to the attic years ago but that is how Medicare does business today. Mr. President, and colleagues, I think that as these discussions go forward--and certainly yesterday they dominated the debate about the budget--we have to remember that it is critical that Medicare be part of an effort to help address the financial challenges that our Government faces. I think that that can be done in a way that is good for seniors and good for taxpayers, but that it is even more important that the bipartisan changes in Medicare focus on the structural and underlying concerns that are plaguing this program. In much of the United States, the Medicare Program is a bureaucratic Tin Lizzie. It is clunky. It is inefficient. It is volume driven. And it is doing all the kinds of things that if another agency, such as the Pentagon, was doing, there would be a vast outcry. But we are not making the changes that the Medicare Program needs so as to make it secure for the 21st century, so as to make it secure for both seniors and for taxpayers. And that is why I come to the floor today, to say that this debate that we have seen in the last couple of days about budget numbers is important, but it is even more important to talk about the underlying and structural changes that the program needs for the 21st century. Mr. President, let me conclude by saying that I think that this debate about Medicare has been a bit like a high school sock hop where in effect everyone looks at the dance floor and no one really wants to go first. And I believe that now, if we put a focus on bipartisan structural changes in Medicare, a focus that says that the old debate about just trying to find a budget number for purposes of the budget resolution is not the way to proceed, but that we have a bigger challenge which is to get this program on track for the 21st century, that that kind of approach will allow us to make real progress. I have enormous admiration for Chairman Domenici who has made it very clear that he wants to proceed in a way that does help to reform Medicare policy for the 21st century. I think it is very clear that the Clinton administration has in some of their Medicare proposals reforms that would also help to advance a bipartisan compromise. I tried to take, in my legislation, the Medicare Modernization and Patient Protection Act, some of the key principles that both political parties had advanced in recent years. I believe that if the Congress does not get stuck in the old debate about just finding a budget number, regardless of the implications for the program long term, we can, in this session of Congress, get the Medicare Program ready for the 21st century. That is what I am committed to doing, Mr. President. It is a bipartisan challenge. And I intend to come to this floor on an ongoing basis, as I have done today, to talk about the key issues with respect to Medicare reform. And the events of the last couple of days, which take us back, in my view, to just a budget question rather than making sure the policy changes are made, are exactly what we have to tackle. There is the opportunity now to get Medicare on the right course for the 21st century. As I have said, Mr. President, I have visited the floor each day this week to talk about Medicare reform, and the brief window of opportunity I believe this Congress may have to effect strong, stabilizing, and sensible structural reforms in this program. This should be about more than saving a targeted number of dollars in spending over the next 5 years, or adjusting the Medicare part B up or down to accommodate short term fiscal goals. To quote my friend Senator Domenici, the chairman of the Budget Committee, this should not be about numbers driving policy, not for something as important as the long-term integrity of the Medicare Program. We have the opportunity in the 105th Congress to begin turning this 30-year-old, Tin-Lizzie style program into a 21st century, comprehensive seniors health system, employing the tools and the innovations that have already marked much of the rest of American health care for the better. The reformed Medicare Program I envision, and which I believe is within our grasp, is a health plan that is about choice, quality, and access, and also about the efficiencies that characterize much of our Nation's private health care marketplace. Over the last few days, the conversation about Medicare reform has for the most part revolved around the negotiations between the White House and the congressional budget committees, and whether we can get close enough on a 5-year savings figure in order to proceed with marking up what we all hope will be a bipartisan budget resolution for 1998. I hope we can. And I commend all the parties involved in trying to hammer this out. I know it is tough. It is obvious from my limited involvement in this process that the determination of the Medicare piece may be the single most important function of putting together a Federal budget, or failing in that effort, this year. But I would go beyond that. I believe that my colleagues and I will be spending years together talking about Medicare as the major piece of the Federal budget process. I say this because Medicare threatens to be the monster that devours the budget, and with it the prospect of a health and secure future for millions of future retirees. And quite obviously, the longer we wait to put the brakes to the run away spending aspects of this program, the greater the political crunch we face in terms of dealing with the economic impact of the 75 million baby boomers--this demographic tsunami--that is set to begin hitting the program in the year 2013. During the next 30 years, we will see a society shift from the current four taxpaying wage-earners supporting each retiree to just two workers for each retiree. You do the math. The prospect is far from pretty. And that picture doesn't get better by merely formulating a number for spending reductions over the next 5 years. We can and must do better. If we focus merely on the short-term problems--and I agree that they are substantial--we risk losing the chance to change Medicare's essential structure to deal with the long-term, and much tougher problems to come. And that is why I must say that I am disappointed in certain aspects of the President's budget--I think this Congress can do better. Specifically, we are given in the President's Medicare reform ideas a method of adjusting rates in our payments to Medicare managed care plans which will No. 1, not focus a significant and targeted reduction in the rates of payment that we make to vastly over-paid plans in many of our large metropolitan areas, and No. 2, continues the ``starve-'em, and kill-'em'' approach to paying for coordinated plans--and for encouraging choice, in rural areas around the country, and in areas of high health care efficiency like my home State of Oregon. I've said it before, earlier this week. I will say it again. This is not the way to bring 21st century medicine to our Nation's 38 million Medicare eligible citizens. It is not the way to begin the long-term restructuring of the Medicare necessary to establishing a humane, cost-efficient and choice- rich program that will maintain financial equilibrium well into the next century, and not for just the next half dozen years. Mr. President, we must look to what is happening in the private health insurance market in this Nation in order to chart the new course for Medicare. Over the last decade, run away cost-growth in that market has been reduced to rises in per capita spending that are now just about steady with the increase in the consumer price index--a massive, massive change. No employer, now, will tell you that health care is cheap. But certainly, far fewer employers are now saying that the cost of health care provided to employees is putting them out of business. Our business is the Federal budget. We have a fiduciary responsibility to keep the Government solvent. I ran my election campaign on the promise that I would work my hardest--and bear my share of the heavy lifting--to balance the budget and end deficit spending. And I know that all of us, every one of us, Democrat and Republican, realizes that balance can't be bought cheaply or painlessly. Addressing Medicare's long-term financial problems in ways that maintain the program's long-standing commitment to a defined package of benefits, no matter how sick or poor the senior, must be at the top of our Federal budget agenda. Mr. President, today I want to conclude my floor statements this week with a short list of basic principles which I believe must under-line Medicare's restructuring effort this year, and which I am convinced a broad, bipartisan consensus may be reached. I am not arguing that this is the entire reform menu. And many will note that there's a lot of spinach on the bill of fare before you get to the desert portions. But I do believe that this is a square-meal reform agenda: First, I believe that we have to agree in a bipartisan fashion that Medicare remains a defined benefits program, first, last, and always. We should never turn Medicare into an exercise where elderly and frail beneficiaries, most often single women living on their own on limited fixed incomes, are given a check once a month and told, ``here's your benefit, your voucher--go out and buy health care you need and if the benefit runs out I hope you can find help, elsewhere.'' This would be an egregious retreat from a basic social contract with our Nation's senior citizens, and one for which I think there is little justification given the kinds of savings we can extract from the program by requiring better management, better plans and more choice. Second, we must develop spending controls that guarantee access, but at the lowest possible cost to the program and the beneficiaries. Medicare must employ prospective payment systems, putting providers on a daily reimbursement diet, for skilled nursing facilities and for home care, and for other portions of fee-for-service Medicare as opportunities present themselves. I have introduced a bill that would in part save approximately $20 billion over 5 years from these kinds of management systems in home care and skilled nursing facilities. Similar gatekeeping ought to be considered for other portions of Medicare that are now driven totally by volume. Third, the current system of paying for Medicare managed care plans, based primarily on the local cost of fee-for-service Medicine, makes no sense, and we've got to fix it. We have the strange situation where the highest-cost, volume-driven portion of the program determining how we pay, or reimburse, the part of the program designed to operate as a managed, cost-efficient model. Our purpose is defeated by trying to marry two completely antagonistic systems. And there are very unwholesome results in the form of beneficiaries in vast numbers of counties where Medicare managed care payments are either dramatically too low, or horrendously too high. In California alone, the U.S. General Accounting Office has estimated that this leads to over-payments to plans as high as $1 billion per year. We have to de-couple the cost of fee-for-service medicine from the formula we use to determine payments to Medicare managed care plans. Fourth, in a world where we hope that Medicare beneficiaries will have many more choices for health care, Medicare must work much harder to empower those consumers to make appropriate choices. And this is about better information about the plans available to them, and tools by which consumers can make informed choices about which plan is best for them. Mr. President, today I spent some time at a Senate Select Committee on Aging hearing that focused on this very issue. We heard testimony on the horrendous difficulty beneficiaries had in places where choice currently exists, trying to figure out what each available plan might provide. The plan brochures are confusing and filled with technicaleeze. And most importantly, it's obvious that there's no way most consumers are going to be able to sit down at a kitchen table and compare one plan against another. That's got to change. We need a system for Medicare beneficiaries not unlike the system we have in the Federal Employees Health Benefits Program where plans are required to present themselves using conforming language so that comparisons can be drawn. And we need qualitative analysis by HCFA regarding how well individual plans perform--report card grades, if you will, on items ranging from disenrollment, to how long doctors stay with plans, to how many grievances are filed by beneficiaries. Fifth, beneficiaries must be reassured that improving consumer protection is still a front-burner issue. Appeals processes on denial of services must be streamlined. Medicare supplemental insurance laws must be reformed to guarantee issue of Medigap policies to seniors. HCFA should employ more ombudsmen to help seniors navigate through a Medicare system that will offer more choices, and necessarily will be somewhat more complicated than traditional Medicare. Five points--a modest agenda. But one that can begin creating huge dividends for our most important social program if we begin our work, now. There is, I know, a great deal of attraction in subcontracting the job of reforming Medicare to a bipartisan commission. I have a great deal of respect for my colleagues who have made this argument. Indeed, the conventional wisdom is that Congress simply does not have the political will to tackle this tough question. I have had a number of conversations with colleagues on both sides of the aisle, however, and surprising as it may seem there appears to be a hunger to attempt Medicare reform, now. I think there's a general recognition that we enjoy a window of opportunity that is characterized by rapidly falling budget deficits, strong employment and a growing economy, and that the general environment for fixing Medicare may not get much better for an awfully long time. And finally, let me remind colleagues that the ideas offered here today are not radical, and are really not out of left field. This model of a competitive, choice-rich Medicare that is efficient while maintaining quality has been road-tested--indeed it exists today--in Oregon, where low-cost, high-quality, coordinated care Medicare now embraces almost 60 percent of the Portland metropolitan area market, and where the highest reimbursement rates for such care are still almost 20 percent below the national average. We have seen the future. It works. It is time for this Congress to begin implementing changes in Medicare that transforms the national program along the lines of what has worked for thousands of seniors in Oregon.

Mr. WYDEN

Mr. WYDEN. Mr. President, I have come to the floor each day this week to talk about what I think is the critical need for the Senate to develop a bipartisan plan to reform Medicare. Medicare is a lifeline for millions and millions of American families, and I think it is understood by every Member of this body that this is a program that faces financial crisis as we look to the next century. Today, as part of the effort to build support for a bipartisan Medicare reform effort I will look specifically at the Medicare reimbursement formula. I think it is important to take this subject up because I believe today's Medicare reimbursement system in many instances overcharges taxpayers on costs and shortchanges older people who need and deserve good quality care. Now, Mr. President, as we all know, there are essentially two major types of health care in America. There is traditional health care, what is known as fee-for-service. It means just what it sounds like. Providers get paid on the basis of the number of services that they render. This, unfortunately, can encourage waste. If, for example, an older person in traditional health care receives 10 medical tests and 4 would have been sufficient, under traditional health care the provider gets paid for 10. The other type of health care is what is known as managed care or health maintenance organizations. This is essentially a prepaid kind of arrangement. It creates incentives to hold down costs. But as we know, in some instances, tragically, it has also been used as a tool to hold back on needed health care that older people depend on. The Federal Government, looking to the great demographic changes, the demographic earthquake that our country will face in the next century, has sought to try to change this system of reimbursement and, in particular, try to encourage the availability of good quality--I want to emphasize that, good quality--managed care or health maintenance organizations. They set up a plan for reimbursing these organizations known as the average adjusted per capita cost, or AAPCC. Now, I am the first to admit that discussion of this topic is pretty much a sleep-inducing, eye-glazing issue, but certainly for folks in rural Wyoming, rural Oregon and across this country, the low-cost areas, it has great implications, but also it has great implications for the system as a whole. I believe that the Federal Government has botched the job of handling this reimbursement system, and it is time to make some fundamental changes. Under this reimbursement system, Medicare pays health maintenance organizations 95 percent of the estimated cost of treating a patient under fee-for-service plans in a particular county. What this very often means is that in an area where there has not been an effort to inject competition, where there has not been an effort to drive out waste, you have wasteful, inefficient fee-for-service health care being offered, and it is being used, essentially, as a path to guide reimbursement for the HMO's, the health maintenance organizations. I brought a couple of charts to the floor today. The first is one that shows that many, many of our counties across this country that have tried to hold down costs are reimbursed for health maintenance organizations, or the competitive part of the Medicare system, in a way that is below the national average. Certainly, Mr. President, you and others like myself who represent rural areas see how critical this issue is because our providers have difficulty providing the defined benefits under Medicare, let alone some of the extras such as reduced drugs, eyeglasses and hearing aids that are available in many of the high-cost areas. For example, as my next chart illustrates, in 1997, one of the very high-cost reimbursement areas was in Florida, in Dade City, FL, with $748 a month received there, whereas in Arthur, NE, they receive $221 per month. So the question, essentially, is to our colleagues, again, on a bipartisan basis, our colleagues from Nebraska, Senator Kerrey and Senator Hagel: Is it true that a typical 72-year-old Nebraskan is that much healthier than a typical New Yorker of the same age? Well, Medicare thinks so. That is how the Federal Government does business. The Federal Government conducts its affairs that way. I think it is wrong. It is that way not just for folks in Nebraska but many other parts of the country like ours that, again, we share on a bipartisan basis, and as a result our seniors get a much thinner Medicare benefit package than they would if they were in an area that was much more costly. For example, in my home community of Portland, OR, we have the highest concentration of HMO's in the country, the highest level of penetration of HMO's in the United States, just about 60 percent, and we are reimbursed at a level significantly below the national average of $467. We get reimbursed at a $387-per-month level. What happens is a senior who lives in Dade City, FL, or in southern California or parts of New York State calls seniors I represent in Oregon and asks them how Medicare is going, and seniors in the high-cost areas say, ``It's going great because we can get prescription drugs, eye glasses and hearing aids all at essentially little or no cost,'' and seniors in Oregon get none of those things, and, in fact, many of their providers in rural parts of our State have difficulty providing basic services. So the question then becomes, what are some of the fundamental ways in which to change this system which so often rewards waste, penalizes the frugal and, in effect, creates an incentive for various parts of the country to do business as usual, even though the General Accounting Office and other bodies are saying that business as usual will be bad news for both seniors and for taxpayers. Several practical suggestions are at hand, Mr. President, and suggestions that I believe ought to be adopted on a bipartisan basis. I think for the long term, it is time to separate out, to literally cut off the link between HMO's, the managed care, and fee-for-service, because I think what we are having today is a situation that literally creates incentives for wasteful health care. Second, it seems to me there ought to be a new minimum payment floor that brings up all the counties that have been low cost, and especially those in rural areas, and certainly the President of the Senate, just as I see in rural Oregon, understands the importance of that. Third, it seems to me that the Senate, on a bipartisan basis, ought to begin a gradual effort to move to a national reimbursement level, a blended kind of level, and do it gradually so that areas that have been more inefficient are not going to face all of the changes overnight, but are going to understand very clearly that with an effort to move to a blended or national reimbursement rate, Congress is not going to tolerate what we have today, which is a system that rewards waste. Finally, Mr. President, it seems to me that the Federal Government should be trying to promote competition, serious competition, as the private sector does, in areas of high-cost managed care or significant penetration of health maintenance organizations. There is no question in my mind that some HMO's are overpaid. We do need to produce competition in those areas. I believe that that can be carefully targeted. That, in my view, is the guts of reimbursement reform, Mr. President. I would like to conclude my remarks today by saying that going to the next level of Medicare reform after we take care of the reimbursement issue is a logical step because it flows from what needs to be done with the reimbursement formula. By getting good data and more logical data about the various counties, the Health Care Financing Administration will be in a position to make information available to older people and their families across this country about how to make better choices with respect to their health care. Today, what we have is a situation where many older people get no choices at all. We see that in many rural parts of our country because of the reimbursement formula. The reimbursement formula is so low that many plans won't come in, so seniors in those areas get few choices. In the high-cost areas, the Federal Government has put out a mishmash of information which makes it impossible to choose between the various services that are available to them, and that is absolutely key because in those high- cost areas we have exactly the places where it is most important to get competition. Yesterday, I brought to the floor--I am going to blow it up in the days ahead so that it's possible for the Senate to see it in more detail--an example of what it is like for an older person in Los Angeles to try to navigate through the various health choices available to her. In fact, it takes one full wall, in a picture that the General Accounting Office took, just to put the various pieces of information that that senior would have to wade through. So I want to see us now have the Federal Government look to what the private sector is doing to empower seniors and their families to get understandable, clear information about Medicare so that they can make appropriate choices. This involves details on the way different Medicare choices and plans work, data on the experience of seniors with similar health and income backgrounds, the methods and the decision steps used by plans to pay participating practitioners and health care facilities and providers. And, Mr. President, certainly, Members of this body should understand that this is doable because this is largely the kind of information that is available to Members of the Senate and other Federal employees who participate in the Federal employee health plan. So in ensuring that seniors can receive a full list of plans available to them, enrollment fairs are an approach that has been looked at in the past, and there may be other ways to do that, such as publishing appropriate performance data on plans. These kinds of steps are approaches that the Federal Government has pursued and have related to Senators and members of the Federal service. It seems to me that there is no reason to further delay making this kind of information available to those who depend on Medicare. Older people ought to be in a position to enroll and disenroll from a plan at any time. Certainly, this kind of approach will encourage competition. Perhaps at some point there ought to be incentives to try to keep people in plans that are cost effective, and I think that the Federal Government can look to this kind of approach. But, certainly, significant rights of older people to enroll and disenroll in plans is critical. So these kinds of rights, like appeal rights when you have been denied benefits, a good grievance procedure--in effect, a patients' bill of rights--is what is fundamental to making sure that older people are in a position to get the kind of information they need in order to make choices about their health care and, at the same time, inject competition into this system. We have made many of these decisions already as it relates to Federal employees and Senators. We have made them as it relates to the private sector and, in fact, we have even made them in areas that have parallels to this program--for example, in the Medigap Program. I and others were involved in this to try to make sure that seniors who purchased supplemental coverage would be in a position to make sure they could get full value and have a place to turn to for their questions. We can take a lesson from the Medigap Program, and the Federal Government ought to make available troubleshooters to answer questions from older people as we move to competition. So, Mr. President, let me conclude by saying that I think every Member of this body understands that business as usual with respect to Medicare is unacceptable. I will tell you, if you don't like the program, if you really dislike Medicare, keep it the way it is, because the way it is is going to be a path that will cause, in my view, great calamity for families and seniors. If you believe Medicare is a program that has made an enormous difference in the lives of older people, I think that is the best argument for a bipartisan Medicare reform effort, a bipartisan Medicare reform effort that would ensure that seniors got guaranteed, secure benefits, not some check or some sort of voucher that just said, well, maybe this will be enough for your care and maybe it won't. Seniors deserve guaranteed, secure benefits. Many of my colleagues on the other side of the aisle have been absolutely right in saying that much of Medicare across this country is an outdated tin lizzy kind of program, a program that the private sector consigned to the attic years ago. So let us try to bring the parties together around the proposition that there ought to be defined, secure, guaranteed benefits, around the proposition that it is time to bring the revolution in the private sector to Medicare, and do it in a way that protects patients' rights-- no gag clauses or limitations on what older people can know about plans, grievance procedures, appeal rights. Those are the kinds of issues I think that both parties can agree on. I intend to come to the floor day after day to bring the issues of Medicare reform to the attention of the Senate and to the attention of the public, because I believe this is going to be the issue that is going to dominate the debate about our priorities, particularly our domestic priorities, for the next 15 to 20 years. I believe that every Member of this body in the next century is going to be asked: What did you do in 1997 to get Medicare on track? I believe there are opportunities now, as we move to the budget, as we move to efforts to have a bipartisan balanced budget, to start the changes that will put Medicare on track for older people and taxpayers. Senator WYDEN. Mr. President, to reiterate, the heart of the Medicare Program is the 38 million beneficiaries now dependent on this health care system as an essential social lifeline. Any changes we make to Medicare must, first and foremost, consider the likely effects those reforms will have on these beneficiaries, many of whom are frail, infirm, and low-income. As I've said every day on the floor of the Senate this week, I'm going to be talking today about the choices and access those beneficiaries ought to have, but who in too many parts of the country have no choices and poor access to health care. I'm also going to be talking about the window of opportunity we have in this Congress to enact significant changes in the program to cure the half-trillion-dollar shortfall we can expect in this program by the end of the coming decade, and to bring new choices, new access and new efficiencies necessary to save Medicare for not just the next 5 years, but into 2010, 2020, and 2030. As I said yesterday, Medicare is a 1965-model tin-Lizzy health care program showing little resemblance to the rest of American health care. Various out-dated, out-moded and bureaucratic features of Medicare practically encourage practitioners in the greater part of the Medicare system to drive up unnecessary care and resulting over-billing--actions which over-charge the Government on costs, but short-change beneficiaries on good health care. Beginning in the last decade, the Government's partial solution to this was to institute coordinated care in Medicare. We encouraged health insurers to begin offering plans that managed service Medicare beneficiaries received, and we offered encouragement to beneficiaries to participate in the form of lower out-of-pocket costs and, we anticipated, a broader package of goods and services. And we would determine how each plan, in each city, would be paid for each beneficiary in the plan according to an arcane formula called the average adjusted per capita cost--or the AAPCC. Now, before your eyes glaze over, let me give you a very simplistic idea of how the local AAPCC payment rate is determined, and how this formulation really penalizes beneficiaries living in places where medical costs are relatively low. The AAPCC is any given county is formulated on the cost of providing medicine, per beneficiary, in the most costly portion of Medicare--the traditional sector known as fee-for-service. This is the portion of the program where beneficiary can elect to see just about any doctor they want, whenever they want, and the individual care providers in those situations can be reimbursed for just about any services they deem necessary for that beneficiary. No questions asked. No oversight. This may sound like a pretty good deal for the beneficiaries. But it doesn't always mean they get the care they need or require. For example, there's nothing to stop an individual provider in fee-for- service for ordering up 10 or 12 tests for a beneficiary, when only 3 or 4 really are required. This is one of the reasons why fee-for-service Medicare is growing at a much more rapid rate than the rest of the program--and it's one of the reasons we find ourselves in such a deep financial hole. It is also clear that the rapid growth of fee-for-service Medicare seems endemic to certain large metropolitan regions of the county. As my colleagues may be able to see, the areas in blue and white represent portions of the country where the AAPCC rate is below the national average. The areas in red and orange represents areas where the payments are above the average. And just for the record, the variation is huge. The 1997 high- reimbursement county is Richmond County, up in New York, at $767 per month, per beneficiary, while the lowest paid county was over here in Arthur County, Nebraska, at $221 per month. Now, I'd ask my colleagues Bob Kerrey and Chuck Hagel whether they think a typical 72-year-old Nebraskan is that much healthier than a typical New Yorker of the same age? Medicare seems to think so, and I think they're wrong. And unfortunately for folks in Nebraska and other low pay States--my home State of Oregon is certainly one of them--the difference is that they get a much thinner Medicare benefit package in coordinated care plans, if they have access to such plans at all because their monthly reimbursement rate is so abysmally low. Let's talk about some examples of how this hurts beneficiaries in cost-efficient counties where the reimbursement rate is particularly screwy. In Mankato, MN, where the average payment is $300 per month, beneficiaries in coordinated plans get their basic managed care coverage under Medicare rules--but nothing else. No discounts on prescription drug purchases, no additional preventative care, no hearing aid discounts, no coverage for eyeglasses. In Portland, OR, my home town, the rate is a little better at $387 per month, but that's still well below the $467 national average. That means the best additional benefit received by these folks, who have the highest managed care penetration rate in the country at about 60 percent, is a 30 percent discount on prescriptions up to a $50 maximum. Now, let's go up to the high end of this wacky AAPCC payment system. In Miami, FL, where the payment rate is all the way up to $748 per month, seniors in these programs get unlimited prescription drug reimbursements, a $700 credit for hearing aids, and dental coverage-- all add-ons that are virtually unheard of in most of the rest of the country. Mr. President, I wish I could say that this is the kind of cost- accounting that's going to add stability and integrity to the Medicare Program into the next century. Unfortunately, all this payment formula accomplishes is: First, huge overpayments in some counties, with resulting extravagant profits to insurance companies, and second, payments to other counties which are obviously too low, and which result in either no coordinated care offerings to beneficiaries in those communities or bare-bones plans that for millions of beneficiaries to incur higher out-of-pocket costs purely as a matter of geographic accident. I believe we can transform Medicare from an aging dinosaur insurance program into a comprehensive seniors health care system while maintaining our historic commitment to a basic package of benefits for every beneficiary, no matter their health or income status. But that transformation necessarily will involve providing seniors with many more choices with regard to their health plan selection. The current formula used for paying Medicare in rural counties and in other places where communities have worked hard to reduce general health care costs is precisely antagonistic to that purpose. This system denies folks choice because it necessarily results in poor quality health plans, high out-of-pockets expenses, or no managed care choices--or a combination of all three--for vast numbers of beneficiaries. And again, an accident of geography seems to be the deciding factor in the current state of affairs. I believe Medicare reform has to include remedies for these problems. This is not just a matter of increasing the benefit package for folks in low pay counties. More fundamentally, this is an issue of providing more choices, to encouraging the entry of more plans, into large areas of this country where the current AAPCC formula creates reimbursement rates which are so low--which are so nonsensical--as to completely discourage anything but fee-for-service Medicare in those communities. I believe reimbursement reform include several important features: A new minimum payment floor that brings all counties up to 80 percent of the national average, immediately. A new annualized reimbursement increase formula that shifts adjustments away from localized fee-for-service medicine costs, and toward actual cost increases in coordinated care. A systematic imposition of financial controls reimbursement growth in high-reimbursement counties in order to squeeze out what have to be monumental over-payments to plans in those communities, and huge losses to the Medicare Program. Mr. President, reforming Medicare isn't just about reforming payment systems, however. It's also about helping beneficiaries to become smarter shoppers in a new Medicare environment that we hope will offer many of them many more choices and options for care. Therefore, it is critical that we change the program in way that will empower seniors to make the appropriate choices. At the bottom, this means developing and executing a much better system of informing beneficiaries about their rights in managed care, and about the most important provisions of the health plans available to them. This information must be given to seniors as ``news they can use''--data that is in clear and accurate layman's language, and which conforms to standardized reporting practices so that consumers can compare one plan against another in a traditional kitchen-table- assessment. Indeed, these tools if we had them would be useful, today, with 80,000 beneficiaries per month choosing to leave fee-for-service Medicare for Medicare managed care organizations. According to Stanley Jones, chairman of the National Institute of Medicine's committee on choice and managed care: Many elderly are making these new choices without enough information to judge which option is best for them, what the plan they choose will actually cover, or how the plan will operate. Jones said that many seniors misunderstand the basic structure of HMO payment and care practices. He criticized Medicare managers for providing information to beneficiaries about differences in available health plans that ``appears primitive'' compared with what's available from private purchasers. Mr. President, last year I asked the General Accounting Office to look into this problem, and the GAO auditors came to similar conclusions: Though Medicare is the nation's largest purchaser of managed care services, it lags other large purchasers in helping beneficiaries choose among plans. The Health Care Financing Administration (HCFA) has responsibility for protecting beneficiaries' rights and obtaining and disseminating information from Medicare HMOs to beneficiaries. HCFA has not yet, however, provided information to beneficiaries on individual HMOs. It has announced several efforts to develop HMO health care quality indicators. HCFA has, however, the capability to provide Medicare beneficiaries useful, comparative information now, using the administrative data it already collects. The kind of data HCFA collects, now, of use to beneficiaries includes performance indicators such as: First, annual disenrollment rates, second, cancellation rates, third, so-called rapid disenrollment rates--the percentage of enrollees who disenroll within 12 months of signing up, fourth, rate of return to fee-for-service Medicare from the plan, and fifth, disenrollments tied specifically to sales agent abuses involving, among other things, marketers who mislead enrollees about what a plan may cover. I think we can go beyond these quality indicators. The Federal Employees Health Benefits Program [FEHBP], for example, includes a graded system of reports on the quality of key services in federal employee health plans. There is no reason why Medicare beneficiaries, who must make these decisions on their own without benefit of employers or corporate benefit managers, shouldn't have at least the kind of qualitative analysis available to members of Congress who are covered by FEHBP plans. Mr. President, I am heartened by the announcement earlier this year by HCFA Administrator Bruce Vladeck that the program would begin offering beneficiaries some qualitative information on managed care plans through the Internet. I think that's great for seniors that use the Internet in their homes or have access to that technology somewhere else. I think it's clear, however, that we need to step up efforts going beyond the limited information that eventually would be made available at a HCFA website. Here's the bare minimum of information that seniors need in a revamped Medicare program which empowers them to make appropriate choices: Details on the way different Medicare choices and plans work. Data on the experience of seniors of similar health and income background in those plans. The methods and the decision steps used by plans to pay participating practitioners and health care facilities and service providers. And here are the steps we need to take to insure seniors receive that information and the other tools they need to prevail in an increasingly more complex and choice-intensive Medicare marketplace: First, Medicare managers must ensure that every senior, in every county, receive a full list of plans available to him, with a detailed description of what each plan offers. These submissions must be written in a way that allows a consumer to make easy comparisons between plans. HCFA should require annual ``enrollment fairs,'' giving seniors a chance to review all plan materials at least once a year in order to determine if alternative Medicare offerings might be more suitable to the individual enrollee. Second, Medicare must collect, evaluate and publish appropriate performance data on every plan. Using independent quality review organizations like the National Council of Quality Assessment, Medicare must devise and publish qualitative analysis--consumer report cards--on each Medicare plan, further enabling seniors to make appropriate choices among offerings. Third, consumers must be allowed to enroll and disenroll from plans at any time during their first 12 months in a plan. After the first year of enrollment, disenrollment with guaranteed enrollment in a new plan would be limited to a first opportunity after six months in the second year. We would make it somewhat tougher to disenroll after the first year because we would expect plans to make investments of preventative health services for new enrollees in the initial few months of their enrollment. Fourth, health plan enrollees need a patient bill of rights that by Federal statute protects certain baseline issues fundamental to their good health. At the top of this list would be a Federal statute absolutely protecting the free and unfettered communication between patient and doctor on that enrollee's health condition and any appropriate services and procedures necessary to treat the patient. Fifth, give Medicare beneficiaries a certain and sure grievance and appeals process, and the information they need to use it. Medicare must streamline the current process, allowing beneficiaries to by-pass certain bureaucratic roadblocks in the present system--most especially those that force time-delaying procedural exercises when the outcomes already are known. On an initial enrollment, and at any time a beneficiary changes plans, an explanation of new or amended appeals procedures must be part of the enrollment exercise. And as with Medigap insurance, HCFA should hire and train ombudsmen and trouble-shooters tell help beneficiaries both understand provisions in plans, generally, and appeals and grievance procedures specifically. Sixth, every Medicare risk provider should offer at least one plan in his portfolio that includes a point-of-service provision, so that those seniors who would try plans if they could keep going to a particular practitioner would be allowed to do so. Mr. President, I have spent quite a number of years talking with seniors about their health care. Before I was elected to the House of Representatives in 1980, I was cochairman of the Oregon Gray Panthers. I know that seniors are deeply suspicious of any changes to Medicare, in particular, and many of them view the current debate over the shape and direction of the program with a good deal of alarm. But many more who I've talked to recognize the need for changes and, indeed, want to see this debate begin. And on the basis of those conversations I am convinced that seniors will feel a lot better about anything we do if we give them more decision-making power to fashion the health care they receive through the program. Fundamental to that is making sure they have the information and tools to make the right decision, at the front end, and to protect themselves in the case of disputed decisions while they are enrolled in plans. These changes would go a long way toward providing seniors with that kind of empowerment, and in the long run strengthening and improving Medicare as a critical government program. Mr. President, I yield the floor. Mr. FAIRCLOTH addressed the Chair.