Ron Wyden

Mr. WYDEN

Mr. WYDEN. I very much appreciate the Senator from California making me aware of this. I was not. It just seems to me, as the Senator has indicated, that it is time to act. Before I came to the Congress and served in the House where we served together, I was head of a senior citizens group, a great panel. I had not run for public office before. I had never been involved in public office. When we started that senior citizens group we said we are going to focus on the good ideas that help people. We do not care whether they are Democrat. We do not care whether they are Republican. We are just going to focus on the ideas that help people. I think that is what Dr. Ganske did when he took this up in the House, a Republican physician, who said that what we need to do is help people. We certainly are not helping people by having these gag rules that keep people from knowing about their rights much. So the House, as we have discussed, and in the committee on a unanimous basis, said we are going to stand up for the patients, we are going to stand up for the providers, the vast majority of doctors who are honest and ethical, and want to tell their patients about their rights. And it made great bipartisan progress. That is what I want to do here. I know the Senator from Nebraska has been trying to help me for the better part of 24 hours. I want to yield to him.

Mr. WYDEN

Mr. WYDEN. Reserving the right to object, and I do not intend to object, I just want it understood that I have spent the last couple of hours trying to work, in a bipartisan way, to address this, to address the budgetary concerns. I want the majority leader, Senator Lott, to understand that I have no interest in prolonging this. I do want to protect the rights of these vulnerable patients and get that done today. But I have no desire to prolong this. Mr. President, we are going to continue, as the majority leader requested, to work to try to fashion something that is acceptable. We thought we had something a minute ago, but, apparently, we have some more work to do. With that, I withdraw my reservation. I appreciate the majority leader trying to help us by setting that aside.

Mr. WYDEN

Mr. WYDEN. Mr. President, let me also, in closing, quote briefly from a few of these endorsements. The Association of American Physicians writes: Restrictions on communication with our patients not only undermine quality of care, but [constitutes] a blatant violation of the Hippocratic oath. Prohibition of ``gag rules'' is a crucial step toward protecting patients. The Center for Patient Advocacy writes: It has become common for insurers to incorporate clauses or policies into providers' contracts that restrict their ability to communicate with their patients. Such gag clauses seriously threaten the quality of care for American patients. Mr. President, let me conclude by saying that my part of the country was involved in the pioneering work in the managed care area. I have seen in my community--we have perhaps the highest concentration of managed Medicare in the country, with almost 50 percent of the older people in managed care--that it is possible to offer good quality managed care services. What has concerned me is that there has been a pattern documented of managed care plans cutting corners and, unfortunately, imposing these gag clauses which get in the way of the doctor-patient relationship and the patient having the kind of information that a patient needs in order to make their own decisions about their health care. I don't think that is what the health care future of our country is all about. As I talk to patients, and I have sought to work in this area since my days with the elderly before being elected to Congress, I find that patients today hunger for information. I suspect in the years ahead, you are going to have medical patients in our country at their computer looking at the Internet to get information about medical services, and it seems to contradict the future of American health care to have these gag rules which would cut off essential information in managed care plans between providers and plans and their patients. Mr. President, I hope that my colleagues will support this legislation. It has received bipartisan support on both sides of the Hill. I hope this will receive a unanimous vote here in the Senate today.

Mr. WYDEN. If the Senator from Nebraska will allow me to reclaim my time, let me just say I think that both of you have indicated your desire to work on this. I very much appreciate your comments. I say to Senator Kerrey, I know of your interest in this health care issue and the fact that it has been longstanding. Let us say that for purposes of working on this in a bipartisan way, I will not request that the vote be taken right now and look forward to voting a little bit later today on this when the staffs have had a chance to work with it further.

Mr. WYDEN. Yes.

Mr. WYDEN. This is simply a matter of patients and managed care organizations not being subjected to these gag rules which keep them from having information. But I think that the request that the Senator from Alabama and the Senator from Nebraska makes is a reasonable one. I saw the thrashing we were going through at the beginning in the effort to work out a number of these amendments on a bipartisan basis. So I am happy to hold off a bit in terms of a vote to work further with the Senator from Nebraska and the Senator from Alabama. Let me say, also, that I have noted that what the Senator from North Carolina has indicated he was interested in as well is quite similar to what I have sought to do. If anything, it just corroborates the proposition that we are discussing here today that there is bipartisan interest on both sides of Capitol Hill in this matter with the growth of managed care in our country. This is an issue that millions of consumers care about that I think, for those of us who believe in managed care, has great potential. It is absolutely critical at this time to lock in these consumer protections and restrict these gag rules. From my previous experience in working with the Senator from Alabama, I know that he will pursue this in good faith. I ask that we have the vote a bit later and have an opportunity to consult further with the Senators from Nebraska and Alabama. I will be happy to yield.

Mr. WYDEN. Let me first say to my friend, this is not an issue involving the Congressional Budget Office.

Mr. WYDEN. Mr. President, I have an amendment No. 5206, involving managed health care.

Mr. WYDEN. Mr. President, I have an amendment involving managed care; 5206 is the number of the amendment.

Mr. WYDEN. Mr. President, again, this amendment involves some very important rights with respect to consumer protection as it relates to health care practitioners, health care plans and the fact that it appears that some physicians are actually gagged in terms of what they can tell their patients about their illnesses and their treatment. These gag provisions often are included in contracts for purely financial reasons. They limit the kinds of therapies that physicians or other licensed health care practitioners may recommend. It can restrict a practitioner from recommending a patient consult a physician outside a plan or go to a facility outside the plan's network. In addition, these kinds of approaches may even prohibit a practitioner from discussing financial incentives or penalties physicians may be subject to based on treatments that are recommended or ignored, in the case of an individual physician. Mr. President, the preamble of the Hippocratic oath tells physicians, ``First, do no harm.'' The message of these gag restrictions, unfortunately, is, ``First, support the bottom line.'' That is not good health care, and it is certainly not good managed care. Several months ago, the Washington Post cited a startling example involving Mid-Atlantic Medical Services health plans, a large Washington metro area provider. This plan wrote a letter to network practitioners informing them that: Effective immediately, all referrals from (the plan) to specialists may be for only one visit. And in bold type the letter stated: We are terminating the contracts of physicians and affiliates who fail to meet the performance patterns for their specialty. Obviously, this is a bad deal for patients on two counts. First, the patients may not be getting the kind of health care that is needed. Second, the plan may restrict the physician from informing the patient about referral restrictions so the patient doesn't even know whether they are being medically shortchanged via the plan's policy. In my home State of Oregon, where we do have a great number of managed health care services and plans, our State law specifically prohibits these kinds of provisions. Many managed care plans in our State are offering good quality services. They are able to do it in a way that allows them to be both patient-oriented and consumer-friendly and still be sensitive to their financial needs. Unfortunately, even in our State, a State where there are good managed care plans, problems can develop. For example, an orthopedic surgeon in Portland recently was in a situation where their managed care plan demanded that this particular physician diagnose problems in patients apart from the ones for which they were referred. He was, in effect, in a situation where he was told to keep his mouth shut and instead re-refer those particular patients back to their primary care physician. This physician wrote to us: This is extremely disappointing to patients, as you might imagine. This requires more visits on their part to their primary care physician and then back to me, which is extremely inefficient. Another physician, a family practice physician in rural Enterprise, OR, wrote that this antigag legislation is needed because ``when a physician recommends medical treatment for a patient and a plan denies coverage for that treatment, patients and physicians need an effective mechanism to challenge the plan.'' I think it is understood that the free flow of information between doctors and patients is the very foundation of good health care. State legal protections on this matter vary. Some States have taken steps to limit these gag rules, but one of the reasons that I come to the floor today and why this legislation has received strong bipartisan support is that I think it is time for a national standard to deal with a national problem. This amendment is rifle-shot legislation prohibiting only oral gag provisions in contracts or in a pattern of oral communications between plans and practitioners that limit discussion of a patient's physical or mental condition or treatment options. Health plans would still be able to protect and enforce provisions involving all other aspects of their relationship with their practitioners, including the confidentiality of proprietary business information. In developing this amendment, Mr. President, I and others have talked with many who offer managed care health services, as well as practitioners and consumer advocates. Our enforcement provision specifies penalties for violations by plans of up to $25,000 per event. The amendment also specifies that State laws which meet or exceed the Federal standard set herein will not be preempted by Federal law. I would like to point out to my colleagues that this amendment has been endorsed by the Association of American Physicians and Surgeons, the American Association of Retired Persons, the Center for Patient Advocacy, Citizen Action, Consumers Union, the American College of Emergency Physicians and a number of other organizations. I ask unanimous consent to have printed in the Record letters from these groups.

Mr. WYDEN. Mr. President, I rise to offer an amendment which will add much-needed new protections for the sacred, confidential relationship between physicians and their patients. In doing so, I want to single out, on a bipartisan basis, the excellent work done by a number of Members of Congress on this issue. In particular, I would like to single out Dr. Greg Ganske, a Member of the House, a physician, a Republican. He has done excellent work with Congressman Markey in the House, and also to thank Senator Kennedy, who joins me in this effort. This matter of protecting the rights of patients in health maintenance organizations has been thoroughly bipartisan through this Congress, and I want to make sure that this body understands that there is a very strong track record of bipartisan support for this issue.

Mr. WYDEN. Yes.

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

Mr. WYDEN

Mr. WYDEN. Thank you, Madam President. Madam President, at the heart of this debate is a judgment each Senator must make about what the Federal Government ought to stick its nose into. This has been a Congress dedicated to the proposition of reducing the role of the Federal Government in the lives of our citizens. This Congress has sought to turn away the Federal desire to intrude and leave important decisions to private individuals and, if necessary, local and State government. Marriage has historically been a private matter between two people. It has long been a matter that has been reserved for the States. Now the Congress that has sought to contract Federal power hungers for Federal regulation of the institution of marriage. This Federal expansionism makes no sense to me. When I talk with gay and lesbian Oregonians, they invariably ask me about the concerns held by the majority of Americans. They ask about jobs and wages and health care and crime. Not once has a gay or lesbian Oregonian come to me and asked that the Federal Government endorse their lifestyle. They simply ask to be left alone. In this regard, they are very similar to what I hear from ranchers and small business owners and fishermen and scores of other of our citizens. One of the fundamental principles on which our Nation was built is the freedom to enjoy life, liberty, and the pursuit of happiness. The Constitution doesn't give Congress or the States the power to specifically exclude an individual or group of individuals from the enjoyment of life, liberty, or the pursuit of happiness. But this legislation would. Is the legislation constitutional? Where in the Constitution does it say equal rights for all--except those that the majority disagrees with? This bill is not only of dubious constitutionality, it seems to me to be a repudiation of traditional conservatism. It is conservative, Madam President, to keep private conduct private. It is certainly conservative to promote monogamy. It is conservative to promote personal responsibility and commitment. This bill isn't conservative; it is Big Brother to the core. My judgment is that this is a subject the Federal Government ought not stick its nose into. I yield the floor.

Mr. WYDEN

Mr. WYDEN. I thank the Chair. Mr. President, I, too, rise to speak in support of the Bradley-Frist amendment. I am going to be very brief this afternoon, but I did want to take a minute or two and discuss a General Accounting Office report that I will have coming out next week. The General Accounting Office has summarized a number of findings in a report for me, which report will be available next week, and I would like to discuss those findings very briefly. First, it seems to me that, if you pass this important legislation, our country increases the odds that the next generation gets off to a healthy start. That is what this legislation is all about: getting off to a healthy start. As I mentioned, I asked the General Accounting Office a number of months ago to help the Congress identify the risks attributable to foreshortened hospital stays for mothers and their newborns, as well as to analyze health care plans on how well they provide postpartum care. The General Accounting Office has given me a letter, Mr. President, that I will make a part of the Record this afternoon, but I would like to summarize very briefly just four of the findings in the General Accounting Office report that they will have next week. The first is the General Accounting Office has pinpointed studies analyzing readmission statistics that indicate that babies staying less than 48 hours do, in fact, have a higher rate of rehospitalization for health problems. The General Accounting Office concludes that not every early discharge is a danger to each and every child, but certainly there are studies that do indicate that readmission statistics demonstrate that babies staying less than 48 hours do, in fact, have a higher rate of rehospitalization. Second, the General Accounting Office has found that a number of the discharge plans are simply that they are just a drive-by delivery with no at-home follow up to ensure that the mother and the child are doing well. Third, the General Accounting Office has found that while a number of the States do have laws on the books that deal with this practice, not all of the insured individuals, and certainly some of the most vulnerable of America's families, are protected by these laws. So I think it is fair to conclude that there is a very significant variation with respect to consumer protection in terms of State laws, and I think that, too, makes a compelling argument for the Bradley-Frist legislation. Fourth--and I close with this point, because I think it is the most significant one and, in and of itself, makes the case for the Bradley- Frist bipartisan legislation--the General Accounting Office has found that a significant number of plans offer doctors alternative financial incentives for early discharge and significant penalties for keeping young mothers and babies in the hospital longer than the plans would like. So what we have--and I point out that this will be the first Government study looking at this problem--is already significant evidence that two sets of disincentives to good health for young families exists on the basis of the GAO report: first, the question of plans offering financial incentives for early discharge and, second, the matter of heavy penalties that the GAO has found in a number of instances for keeping young mothers and babies in the hospital longer than the plans would like. What it comes down to--and I sure hope we get a unanimous vote in a few minutes with respect to this legislation--is that this Congress has a chance to put some votes behind all of the family-friendly rhetoric. I am very hopeful that the Bradley-Frist legislation will pass on a bipartisan basis. I think that the Senator from New Jersey has contributed so much, but what an important bill on which to finish a stellar career. Mr. President, I ask unanimous consent to have printed in the Record the letter from the General Accounting Office to which I referred.

Mr. WYDEN. Mr. President, I yield the floor and will make for the Senators a copy of the General Accounting Office's findings a matter of the Record. I yield the floor. Mr. HELMS addressed the Chair.

Mr. WYDEN

Mr. WYDEN. Mr. President, I rise today to discuss for a few moments what will, hopefully, be before the Senate before too long. Also, I will make some comments with respect to the antiarthritic drug, Lodine. I am particularly pleased that the Senate will have a chance to vote shortly on the Kassebaum-Kennedy legislation, because breaking this political logjam on health care reform means that millions of Americans who are stuck in jobs because they have a preexisting health problem will have a new margin of health security and economic freedom. This legislation is good for American families. It is good for our workers and our business. What it means is that fear of losing critical health insurance coverage no longer would be a roadblock on the road to a better job and a better life. I want to applaud the bipartisan efforts of the Senate conferees, particularly Senator Kennedy, Senator Kassebaum, and Senator Breaux, who put long and hard service into this legislation, and it will be an important step forward when adopted. Besides guaranteeing portability of health insurance coverage, this legislation contains little-noticed provisions that I think are going to make a great difference with respect to expanding health insurance coverage. This legislation, to the bipartisan credit of those Senate leaders, protects State flexibility with respect to State health insurance reforms. States like mine are laboratories for health care reform, and it is essential that we not turn out the laboratories at the State level with unnecessary Federal restrictions. Senators Kassebaum and Kennedy worked very closely with me so that the exemption language in this legislation will allow Oregon's humane, rational, and far-reaching health insurance reform program to go into effect later this year. It would provide extensive group to individual policy reform in much the same way our Federal legislation envisages, but the approach that Oregon is taking is one that I think other States and possibly the Federal Government will want to emulate in the days ahead. Mr. President, there are features of this bill and provisions that were not included that I think are unfortunate. During this debate, I have expressed concern about the possibility of some vulnerable Americans being left behind if medical savings accounts become widespread. Every Senator should want to oppose the balkanization of medicine, where the young, the healthy, and the wealthy get good affordable health coverage at the expense of the sickest, the neediest, and the elderly. It is appropriate to test out the MSA concept, however, and I do believe this conference report offers a reasonable compromise in the form of a limited MSA demonstration project. I join Senator Domenici and Senator Wellstone and many of my colleagues in mourning the loss of mental health parity in this legislation. Parity, in my view, is not just fair, it is good health care policy that saves health care dollars in the long run by assuring quality mental health coverage and particularly early intervention. I do not intend to vote against a good, bipartisan bill because of the loss of one provision, but I intend to join with colleagues of both parties to make sure that mental health parity is an issue revisited early in the next Congress. Finally, as happens often in large conference reports, a few stray cats and dogs find some homes. This bill is no exception. I am going to talk for a moment about a mongrel in this bill that seems to have a pretty bad case of fleas. There is a provision in this legislation that would give the antiarthritic prescription drug Lodine a 2-year patent extension. Supporters of this idea first tried to maneuver it into the 1997 agriculture appropriations bill in the House. It is now in this legislation, page 76, subtitle H. This is a bad idea, in my view, and it certainly should not be a part of an important bipartisan health reform bill. Lodine has already received one extension under the terms of the 1984 Hatch-Waxman amendments allowing for additional patent life on drugs which become involved in long regulatory approval delays. With that extension, the drug's manufacturers have built sales of $274 million. Many of these purchasers are seniors. Many of those who buy this anti-inflammatory drug are older people, walking on an economic tightrope, balancing their food costs against their fuel costs, their fuel costs against their medical bills, and they are paying for this drug, many of them, out of their pocket. Mr. President, if Lodine's current extension is allowed to run out in 1997, this drug likely would get a generic competitor, and those consumers, those vulnerable older people would get a price break as a result of the competition. They are not going to get that break with this extension. I think it is unwise for the Senate to take more money out of the pockets of older people in this fashion. There have not been any congressional hearings, have not been any deliberations to look at any public purpose served by another 2-year extension of the Lodine patent. I think granting this extension creates a poor precedent. I am sorry to see this provision in this bill. It is a good bill, a bipartisan bill that needs to be enacted, but it is wrong to have this special-interest provision in this legislation. Mr. President, I yield the floor. Mr. BAUCUS addressed the Chair.

Mr. WYDEN

Mr. WYDEN. Mr. President, I want to say first, I very much share Senator Hatfield's view with respect to the yeoman work that has been done by many parties, in terms of bringing this legislation together. I am especially pleased he has mentioned Ms. Buell and Mr. Pahl. It reflects the bipartisan effort that has gone into moving this legislation forward. I very much want to associate myself with Senator Hatfield's words of praise for the many staff who have worked on this legislation. I also want to begin by telling Senator Hatfield, on behalf of the people of our State, how much we appreciate the extraordinary efforts he has made in the conservation field specifically. As Oregonians know, when you think about the history of our State, it will not just be conservation that Senator Hatfield has touched. It will be the Oregon Health Sciences Center, where we have built a remarkable medical infrastructure that is going to serve our State into the 21st century. People are going to talk about the exceptional work that was done in the transportation field, where, again, we have led the Nation in terms of looking forward, in terms of making gutsy decisions. We are going to talk about the agriculture, the maritime efforts, particularly in the field of research which, again, gives us a chance to get out in front of these huge waves of change that so mark these and so many of the issues that are before the Senate. I just want to tell Senator Hatfield, I think it is particularly appropriate now, as we move to the last days of this session, that this legislation, which is something of a crowning jewel, moves forward in the Senate. It is a tribute to all of the exceptional work that he has done, now, for 3 decades for the people of our State. I want you to know how much I appreciate all this effort. As you know, I am looking into the possibility of being able to phone you express, when you are at the coast in a much-deserved retirement, to have you help on other matters. I am just so pleased that this legislation is moving forward today, and to be associated with you. Mr. President, very briefly let me comment on some of the provisions, the excellent provisions in this legislation. It is going to protect Opal Creek, both the drinking water source for the city of Salem and one of the crown jewels of our old growth forests. It is a remnant of what used to be common in the Oregon Cascade Range, but it is now the largest intact low elevation old growth forest that is left, after years of management in the region. Opal Creek is simply beloved. People hike and swim, and many go simply to experience the grandeur and solace that tall trees and waterfalls have to offer. Visitation is now at about 15,000 people annually, and increases each year. The President's Forest plan recognized the special nature of Opal Creek and designated it as a late-successional reserve and tier 1 watershed. Although that designation puts some limits to management in the watershed, it does not ensure permanent protection. Only an act of Congress can do that and Senator Hatfield is responding to the great interest among the people of our State in making sure that there will be permanent protection for Opal Creek. We have been trying to protect this treasure for more than 25 years. Last year, Senator Hatfield convened a working group of Oregonians interested in Opal Creek that included environmentalists, the timber industry, State and local officials, and the Forest Service. This legislation is a product of those efforts. One prominent Oregon environmental group called the provision precedent setting, and the most protective they have seen in any Federal legislation. Mr. President, this legislation, Senator Hatfield has noted, contains other extremely important provisions for our State. I am especially pleased Senator Hatfield has included in his bill, additional protection for the Bull Run Watershed. This is so important to water users in our State. Hundreds of thousands of Oregonians depend on that watershed for pure, clean drinking water. And the history of Federal protection for the Bull Run Watershed goes back more than 100 years, to President Harrison's proclamation reserving the drainage basin of the Bull Run and Little Sandy Rivers as protected sources of water for the City of Portland. The Bull Run Watershed now serves more than 20 water districts and over 735,000 people in our metropolitan area. It is projected by the year 2050, it will be the prime source of drinking water for over 1 million Oregonians. When I served in the House of Representatives, I joined with Congresswoman Elizabeth Furse in introducing H.R. 4063 in the 103d Congress. This earlier piece of legislation increased substantially protections for the Bull Run and the Little Sandy watersheds. Although S. 1662 does scale down the scope of lands covered by new protections, I am pleased that this legislation increases protections for the portion of the Bull Run watershed that serves as the municipal drinking water source for the city of Portland, while maintaining the existing protections for the remainder of the watershed. The city of Portland strongly supports these added protections for the Bull Run watershed. This legislation includes several other important provisions. It would fund two citizen working groups that have been active in addressing a wide array of ecological restoration, economic development and stability and drought impact reduction projects in the Klamath and Deschutes River basins in our State. I am excited about both of these groups because I firmly believe that the key to solving many of our environmental problems--the key to solving environmental problems--has to come from strong local input. Oregonians have been successful using this model of strong local involvement in reforming health care, in reforming welfare, and I am pleased to see that as a result of Senator Hatfield's legislation, the same effort to encourage local involvement is being used in the environmental area. I believe that no bill is ever perfect, and we all have things that we might want in an ideal situation. The proposal to create the Coquille Tribal Forest has caused concern, has caused anxiety among a number of our citizens. I commend Senator Hatfield for his hard work in addressing many of these concerns, while at the same time remaining true to his commitment to the Coquille tribe. I believe that the provision in this legislation is improved by reducing greatly the size of the transfer. I also believe it has been improved by requiring the land to be managed under applicable State and Federal forestry and environmental protection laws. The bill also would require that these lands be subject to critical habitat designations under the Endangered Species Act and the standards and guidelines of the Federal forest plans adjacent or nearby forest lands apply now and in the future. Additionally, changes to the bill ensure that the land will remain open to public access for hunting, fishing and recreation, and that the prohibition on the export of unprocessed logs from Federal lands are a matter of great importance to our citizens and will continue. With that said, I still remain concerned about the size of the land to be transferred from the Bureau of Land Management to the Bureau of Indian Affairs to be held in trust for the Coquille tribe. Further, I am concerned about adding another layer of complexity to an already confusing array of forest and environmental management requirements and a potential lack of clarity with regard to Tribal, State and Federal roles in environmental requirements. I am also very concerned about a lack of clear direction with regard to citizen appeals. I am very pleased to have a chance to work with Senator Hatfield on these matters. Senator Hatfield has worked very, very hard to try to develop consensus with respect to this issue which is extremely controversial, and I intend to work closely with him on this matter in the days ahead. Mr. President, despite my reservation about the Coquille Tribal Forest, I believe that, on balance, this is a good bill for Oregon. I also want to say that recognition for our former colleague, Mike Kopetski, is especially appropriate. I recall several years ago when my good friend, Mike Kopetski, first made his pledge to protect Opal Creek. Because Mike showed exceptional vision and leadership, the bill made great progress. I join Senator Hatfield in saying that because of the work done by former Congressman Kopetski, it has been possible to move this bill towards a reality. Though this bill is not perfect, through Senator Hatfield's efforts and wise judgment, there is a bill now before the Senate that will benefit countless Oregonians for generations to come. It remains one of the most important conservation efforts for the State of Oregon put forward in many, many years. I look forward to working closely with our senior Senator to ensure that this bill is signed into law. Mr. President, I yield the floor.

Mr. WYDEN

Mr. WYDEN. Mr. President, I rise today to introduce legislation with Senator D'Amato to reauthorize the Self-Employment Act. As waves of economic change turn our economy into a high-wire act, the Self- Employment Act has helped turn the unemployment safety net into a trampoline of opportunity for the unemployed. The Self-Employment Assistance Program takes an innovative and cost-effective approach to helping eligible dislocated workers become self-sufficient; it enables them to use their weekly unemployment checks to start their own businesses. Harvard Business School reported earlier this year that from 1978 to the present, 22 percent of the work force, or 3 million workers, at the country's top 100 companies had been laid off, and that 77 percent of all the layoffs involved white-collar workers. Many of these highly skilled workers will never be able to return to their former positions, but some are highly motivated to start their own firms. In 40 out of 50 States, however, those who start their own businesses are forced to give up their weekly unemployment compensation checks as soon as the company starts generating revenue--but before it provides enough income to support the worker. It is exactly this problem the Self-Employment Assistance Program is designed to correct. In a few short years, the Self-Employment Act (Public Law 103-182; title V) has already enabled thousands of unemployed Americans to use their unemployment compensation to establish new businesses. Two experimental programs, in Massachusetts and Washington, have already shown that self-employment programs can create jobs at no cost to the taxpayer. Using existing funds, the Massachusetts program created dozens of new businesses but actually paid $1,400 less unemployment per worker than the State average. The Washington program created more than 600 new jobs and the firms were paying an average of $10.50 an hour to workers they had hired. The legislation we introduce today reauthorize a program that allows--but does not require--State to establish self-employment assistance [SEA] programs as part of their unemployment insurance [UI] programs. It permits States to provide income support payments to the unemployed in the same weekly amount as the worker's regular unemployment insurance [UI] benefits would otherwise be, so that they may work full time on starting their own business instead of searching for traditional wage and salary jobs. In effect, this legislation removes a high hurdle facing those who have the ingenuity, motivation, and energy to start their own businesses. It eliminates a barrier in the law that has forced workers interested in self-employment to choose between receiving UI benefits and starting a new business. Self-employment assistance has not only proved to be a viable reemployment option for unemployed workers; its benefits have exceeded its costs as well. While the law is not a panacea for all of our Nation's unemployed, it's an opportunity for many skilled workers to get back to work faster and helps create new jobs as well. In a recent tour around Oregon, my State SEA officials found tremendous enthusiasm for this program. They reported to me: ``* * * the SEA Program in Oregon is meeting the goal of providing Oregon dislocated workers--as identified through worker profiling--with access to entrepreneurial training and financial assistance while pursuing self-employment and the establishment of a business.'' Among the examples of businesses developed under the Oregon SEA Program this year are a marine maintenance and repair company, drop-in day care centers at shopping malls and a handmade hats, quilts, and bags business working to develop a mail-order firm. The 1993 SEA law is based upon self-employment programs that have worked well in 17 other industrialized nations. As the author of two laws, in 1987 and 1993, that have promoted self-employment, I can attest to the dramatic success of the self-employment concept. According to a June 1995 Department of Labor [DOL] evaluation of the Washington State and Massachusetts pilot programs, the two projects ``clearly demonstrate that self-employment is a viable reemployment option for some unemployed workers . . . about one-half of those interested actually do start a business and an average of two-thirds were still in business 3 years later.'' In addition, the DOL report found that self-employment assistance programs increased business starts among project participants, reduced the length of their unemployment periods and increased their total time in employment. Both the Washington and Massachusetts models proved to be cost effective for the participants as well as for taxpayers. Over the past 2\1/2\ years, 10 States used the 1993 legislation to create self-employment programs: California, Connecticut, Delaware, Maine, Maryland, Minnesota, New Jersey, New York, Oregon, and Rhode Island. To date, DOL has approved six State plans--California, Delaware, Maine, New Jersey, New York, and Oregon--and four of these-- Delaware, Maine, New York and Oregon--have actually implemented their SEA programs. Let me briefly describe how the program works. The law directs the DOL to review and approve State SEA Program plans. In States that operate SEA programs, new UI claimants identified through worker profiling--automated systems that use a set of criteria to identify those claimants who are likely to exhaust their UI benefits and need reemployment assistance--will be eligible for self-employment assistance. State SEA programs provide participants with periodic-- weekly or biweekly--self-employment allowances while they are getting their businesses off the ground. These support payments are the same weekly amount as the worker's regular UI benefits. The SEA participants are required to participate in technical assistance programs-- entrepreneurial training--accounting, cash flow, finances, taxes, etc.--business counseling--business plans, marketing, legal requirements, insurance, etc.--and finance--to ensure they have the skills necessary to operate a business. Finally, SEA programs are required to operate at no additional cost to the unemployment trust fund: The law stipulates that the payment of SEA allowances may not result in any additional benefits charges to the unemployment trust fund. Individuals may choose at any time to opt out of the SEA Program; they may resume collection of regular unemployment compensation until the total amount of regular unemployment compensation paid and the SEA paid equals the maximum benefit amount. States are responsible for the costs of providing basic SEA Program services, like business counseling and technical assistance, but may allow participants to pay for more intensive counseling and technical assistance. Mr. President, as we move into the global economy of the 21st century, it is imperative that the Government adopt fresh strategies so that our many skilled buy unemployed workers can start anew in the private sector. Congress should extend the Self-Employment Assistance Program so that States will have the continued flexibility to help unemployed workers create their own businesses. Our bipartisan bill promotes the spirit of entrepreneurship. It carries forward a reasonable, and sensible reform of the unemployment insurance system that bears no cost to the taxpayer. I would like to thank Senator D'Amato for joining me as an original cosponsor of this bill. New York has a very active and successful Self Employment Assistance Program, and I look forward to working closely with him to see this important program reauthorized. Mr. President, I ask unanimous consent that the text of the bill be printed in the Record.

Mr. WYDEN

Mr. WYDEN. Mr. President, I rise today to introduce legislation with Senator D'Amato to reauthorize the Self-Employment Act. As waves of economic change turn our economy into a high-wire act, the Self- Employment Act has helped turn the unemployment safety net into a trampoline of opportunity for the unemployed. The Self-Employment Assistance Program takes an innovative and cost-effective approach to helping eligible dislocated workers become self-sufficient; it enables them to use their weekly unemployment checks to start their own businesses. Harvard Business School reported earlier this year that from 1978 to the present, 22 percent of the work force, or 3 million workers, at the country's top 100 companies had been laid off, and that 77 percent of all the layoffs involved white-collar workers. Many of these highly skilled workers will never be able to return to their former positions, but some are highly motivated to start their own firms. In 40 out of 50 States, however, those who start their own businesses are forced to give up their weekly unemployment compensation checks as soon as the company starts generating revenue--but before it provides enough income to support the worker. It is exactly this problem the Self-Employment Assistance Program is designed to correct. In a few short years, the Self-Employment Act (Public Law 103-182; title V) has already enabled thousands of unemployed Americans to use their unemployment compensation to establish new businesses. Two experimental programs, in Massachusetts and Washington, have already shown that self-employment programs can create jobs at no cost to the taxpayer. Using existing funds, the Massachusetts program created dozens of new businesses but actually paid $1,400 less unemployment per worker than the State average. The Washington program created more than 600 new jobs and the firms were paying an average of $10.50 an hour to workers they had hired. The legislation we introduce today reauthorize a program that allows--but does not require--State to establish self-employment assistance [SEA] programs as part of their unemployment insurance [UI] programs. It permits States to provide income support payments to the unemployed in the same weekly amount as the worker's regular unemployment insurance [UI] benefits would otherwise be, so that they may work full time on starting their own business instead of searching for traditional wage and salary jobs. In effect, this legislation removes a high hurdle facing those who have the ingenuity, motivation, and energy to start their own businesses. It eliminates a barrier in the law that has forced workers interested in self-employment to choose between receiving UI benefits and starting a new business. Self-employment assistance has not only proved to be a viable reemployment option for unemployed workers; its benefits have exceeded its costs as well. While the law is not a panacea for all of our Nation's unemployed, it's an opportunity for many skilled workers to get back to work faster and helps create new jobs as well. In a recent tour around Oregon, my State SEA officials found tremendous enthusiasm for this program. They reported to me: ``* * * the SEA Program in Oregon is meeting the goal of providing Oregon dislocated workers--as identified through worker profiling--with access to entrepreneurial training and financial assistance while pursuing self-employment and the establishment of a business.'' Among the examples of businesses developed under the Oregon SEA Program this year are a marine maintenance and repair company, drop-in day care centers at shopping malls and a handmade hats, quilts, and bags business working to develop a mail-order firm. The 1993 SEA law is based upon self-employment programs that have worked well in 17 other industrialized nations. As the author of two laws, in 1987 and 1993, that have promoted self-employment, I can attest to the dramatic success of the self-employment concept. According to a June 1995 Department of Labor [DOL] evaluation of the Washington State and Massachusetts pilot programs, the two projects ``clearly demonstrate that self-employment is a viable reemployment option for some unemployed workers . . . about one-half of those interested actually do start a business and an average of two-thirds were still in business 3 years later.'' In addition, the DOL report found that self-employment assistance programs increased business starts among project participants, reduced the length of their unemployment periods and increased their total time in employment. Both the Washington and Massachusetts models proved to be cost effective for the participants as well as for taxpayers. Over the past 2\1/2\ years, 10 States used the 1993 legislation to create self-employment programs: California, Connecticut, Delaware, Maine, Maryland, Minnesota, New Jersey, New York, Oregon, and Rhode Island. To date, DOL has approved six State plans--California, Delaware, Maine, New Jersey, New York, and Oregon--and four of these-- Delaware, Maine, New York and Oregon--have actually implemented their SEA programs. Let me briefly describe how the program works. The law directs the DOL to review and approve State SEA Program plans. In States that operate SEA programs, new UI claimants identified through worker profiling--automated systems that use a set of criteria to identify those claimants who are likely to exhaust their UI benefits and need reemployment assistance--will be eligible for self-employment assistance. State SEA programs provide participants with periodic-- weekly or biweekly--self-employment allowances while they are getting their businesses off the ground. These support payments are the same weekly amount as the worker's regular UI benefits. The SEA participants are required to participate in technical assistance programs-- entrepreneurial training--accounting, cash flow, finances, taxes, etc.--business counseling--business plans, marketing, legal requirements, insurance, etc.--and finance--to ensure they have the skills necessary to operate a business. Finally, SEA programs are required to operate at no additional cost to the unemployment trust fund: The law stipulates that the payment of SEA allowances may not result in any additional benefits charges to the unemployment trust fund. Individuals may choose at any time to opt out of the SEA Program; they may resume collection of regular unemployment compensation until the total amount of regular unemployment compensation paid and the SEA paid equals the maximum benefit amount. States are responsible for the costs of providing basic SEA Program services, like business counseling and technical assistance, but may allow participants to pay for more intensive counseling and technical assistance. Mr. President, as we move into the global economy of the 21st century, it is imperative that the Government adopt fresh strategies so that our many skilled buy unemployed workers can start anew in the private sector. Congress should extend the Self-Employment Assistance Program so that States will have the continued flexibility to help unemployed workers create their own businesses. Our bipartisan bill promotes the spirit of entrepreneurship. It carries forward a reasonable, and sensible reform of the unemployment insurance system that bears no cost to the taxpayer. I would like to thank Senator D'Amato for joining me as an original cosponsor of this bill. New York has a very active and successful Self Employment Assistance Program, and I look forward to working closely with him to see this important program reauthorized. Mr. President, I ask unanimous consent that the text of the bill be printed in the Record.

Mr. WYDEN

Mr. WYDEN. Mr. President, I yield myself 15 minutes. Mr. President, there is a concrete reason for voting for this less-than-perfect bill. For millions of Americans, this legislation can be a tool for turning the welfare check into a trampoline for opportunity and independence. I know this because my home State of Oregon has achieved it. Once more, the State of Oregon has marked a path for the Nation. By putting in place our welfare reform program, known as Jobs Plus, we have shown the Nation that it is possible to be both tough and compassionate. With our Jobs Plus Program, we have been able to have strong work requirements and critically needed child care and medical care for folks coming off of welfare. The plan is working for both taxpayers and those coming off of welfare. And as the President said yesterday, today's legislation can spark more States into going with the kind of approach we have at home. Mr. President, a few years ago, an Oregonian approached me on the street and said, ``You know, for me, welfare is kind of like `economic methadone.' You guys send me a check. The checks always come, but you people never let me do anything to break out, to get off welfare.'' This legislation provides the way to break out--a real key for unlocking the riddle of welfare dependency. I think it is an opportunity to remake this system that doesn't work for those who are in it and doesn't work for the taxpayers who pay for it. Take child care, for example. Child care is an absolute prerequisite to changing welfare. I chaired hearings looking at the child care issue, and we heard heartbreaking accounts of how, again and again, women would get off of welfare, they would be doing well in the private sector, but their child care would fall apart just as they were getting back on their feet. This bill provides $3.5 billion more than current law for that critically needed child care. That increase of $3.5 billion in child care is going to be absolutely critical to helping folks get off welfare. In addition, as several of my colleagues have noted, child support is strengthened. I am also pleased that Medicaid is protected as a guarantee for all of our Nation's children. Now, at the beginning of this Congress, there was a lot of talk about orphanages. A lot of us did not particularly think that all of these orphanages were exactly Boys Town, and nobody seemed to zero in on the question that if an orphanage was Boys Town, it would come with a big price tag for taxpayers. So a lot of us thought that we ought to do something better. I worked very hard to develop a new approach known as ``Kinship Care.'' What the Kinship Care amendment says is that the Nation's grandparents--the millions of loving grandparents--would get first preference when a youngster from a broken home needs help. Instead of sending the children away, the grandparents, if they met the child custody standards, would get first preference. Along with Congresswoman Eleanor Holmes Norton, Congressman Clay Shaw, and Senator Dan Coats, on a bipartisan basis, we all worked together on this kinship care amendment. Now, as we look to the 21st century when, as a result of the population trends and demographics, there are going to be many more grandparents, we have an opportunity to keep families together, to use a new model known as kinship care to provide loving care for youngsters in a cost-effective way. Mr. President, this legislation doesn't meet my definition of perfection. I will say that I, frankly, detest a couple of these provisions--particularly, what was done with the food stamp shelter deduction and the legal immigrant provisions. So this legislation doesn't meet my textbook standard of what would constitute perfection. I, like a number of our other Senators, am going to fight very hard to make changes in this area. As I think it is critical to do, we ought to be constructive and we ought to look at useful ways that Senators can work on a bipartisan basis for changes. For example, there has been a lot of talk in this Congress about the idea of a lock box, the idea of special accounts so that when the spending is reduced, those funds are protected for deficit reduction. I have supported that concept. I think the lock box makes sense. Frankly, I think we ought to look at a new idea, and we can call it the lunch box. We could make sure that when you eliminate some of those tax loopholes, when you go after wasteful spending, some of those funds could be put in what I call the lunch box, and we could use these savings to try fresh approaches to ensure that all Americans have access to good nutrition. I think there are a number of new, innovative approaches that we ought to try and that are going to be needed, even after this bill is enacted and signed into law. At the end of the day, Mr. President, the question, to me, is straightforward: Is this legislation better than the status quo? Is it better than the system that an Oregonian told me was like economic methadone? I think that when you look at the child care provisions, at the Medicaid guarantee, when you look at the opportunity for States to follow the path that Oregon has followed with our Jobs Plus Program, I believe you see the case for supporting this legislation. I intend to vote for it. Mr. President, I yield the floor.

Mr. WYDEN

Mr. WYDEN. Mr. President, the purpose of this amendment is to give local communities time to work with the Department of Transportation and the Federal Railroad Administration to find grade crossing safety mechanisms that meet their needs. Without this amendment, the Federal Government, beginning in November of this year, will impose a one-size-fits-all standard on every community in America with a railroad grade crossing. Many communities have banned the blowing of train whistles. But the Federal Government would preempt these local laws and impose a requirement that trains begin blowing their whistles within one quarter mile of any crossing that does not have the most expensive grade crossing safety equipment. Without this amendment, every community in America that doesn't have the fancy, top-of-the-line grade crossing safety gates will be forced to go out and immediately spend upwards of $300,000+ to install this equipment, or face Federal preemption. This means small communities of several hundred will have to find $300,000 for this equipment, or see their local train whistle bans preempted by the Federal Government. Under current law, on November 2 of this year, all towns without complex and expensive grade safety requirements will be required to lift their train whistle bans. What this means for some towns in Oregon and across the country, is that day and night the communities are going to be barraged with train whistles. These communities are essentially being blackmailed by cacophony into raising taxes and putting up exorbitant amounts of money to install highly sophisticated safety measures--when in many cases, much simpler measures would have the same desired results. My friends, there is a better way to do this. Safety is paramount, but under these train whistle requirements, what we are seeing is cookie-cutter solutions to safety that may not be appropriate for all communities. Many communities can make substantial improvements in safety through public education, highway markings, and signage, but right now it looks like their only choice is a costly four quadrant gates--otherwise, they are going to be doomed to whistling trains. The original legislation, while placing an important emphasis on train safety, left out one key issue and that is community involvement in the decision making on train whistle bans. My very simple amendment would encourage the Department of Transportation to work with communities to develop effective local solutions. First, the Department would be required to take into account the interests of affected communities and the past safety record at the grade crossing involved when determining how to implement safety requirements. Second, where the Department determines that a grade crossing is not sufficiently safe, my amendment requires them to work in partnership with communities to develop reasonable safety requirements. In Oregon, there are two communities in particular that are concerned about the train whistle ban requirements, Pendleton and the Dalles. In these communities, trains may pass through certain neighborhoods every few minutes. Trains are required to blow their whistles one-quarter mile before reaching a grade crossing. Clearly this is a recipe for chaos. I think that it is important that the Department of Transportation work with these communities to develop effective and timely safety measures, instead of mandating costly and perhaps unnecessary grade crossing equipment or threaten them with nonstop whistles. My amendment will do just this and I urge the Senate to support its inclusion in this legislation.

Mr. WYDEN

Mr. WYDEN. Mr. President, I rise today to introduce two new bills which I believe will help more fully inform patients and consumers about the health care choices they face, and safeguard the most critical relationship between care giver and patient. The first bill, which I introduce with my colleagues Senator Snowe and Senator Boxer, is the Health Care Quality Improvements Act of 1996. It amends and improves the 1986 public law which created the national practitioner databank, an informational resource maintained by the Department of Health and Human Services which is a compendium of State disciplinary actions and civil malpractice case judgments against caregivers. As of this year, some 86,000 caregivers are listed in this taxpayer-supported databank. Currently, this informational resource is accessible only by hospitals, insurance plans, and State boards of medicine and health care licensing. The legislation introduced by Senator Snowe and me, today, would for the first time allow public access to critically important databank records. Caregivers who have had at least three reportable incidents in their files would have their entire databank records opened to the public. This legislation also would create an Internet site on the World Wide Web allowing easier access for publicly accessible information. The second bill, the Patient Communications Protection Act of 1996, would make illegal provisions in some contracts between caregivers and health plans which restrict communications between caregivers and their patients. Too often, I believe, these contract provisions limit the free and necessary communications of information to patients regarding their medical condition and all possible modalities of treatment. This legislation, while upholding the right of plans to work with physicians to improve the overall quality of care within a health plan, clearly restricts plans from impeding the free flow of medical information between State-licensed caregivers and patient. The Health Care Quality Improvements Act is endorsed by a number of groups including Families USA, Consumer Action, the National Association of Health Data Organizations, and the United Seniors Health Cooperative. The Patient Communications Protection Act is supported by the Oregon Medical Association, the American Association of Retired Persons, the Center for Patient Advocacy, Citizen Action, the Consumers Union, and the American College of Emergency Physicians. Mr. President, I ask unanimous consent that the text of the bills be printed in the Record.

Mr. WYDEN

Mr. WYDEN. Mr. President, I rise today to introduce two new bills which I believe will help more fully inform patients and consumers about the health care choices they face, and safeguard the most critical relationship between care giver and patient. The first bill, which I introduce with my colleagues Senator Snowe and Senator Boxer, is the Health Care Quality Improvements Act of 1996. It amends and improves the 1986 public law which created the national practitioner databank, an informational resource maintained by the Department of Health and Human Services which is a compendium of State disciplinary actions and civil malpractice case judgments against caregivers. As of this year, some 86,000 caregivers are listed in this taxpayer-supported databank. Currently, this informational resource is accessible only by hospitals, insurance plans, and State boards of medicine and health care licensing. The legislation introduced by Senator Snowe and me, today, would for the first time allow public access to critically important databank records. Caregivers who have had at least three reportable incidents in their files would have their entire databank records opened to the public. This legislation also would create an Internet site on the World Wide Web allowing easier access for publicly accessible information. The second bill, the Patient Communications Protection Act of 1996, would make illegal provisions in some contracts between caregivers and health plans which restrict communications between caregivers and their patients. Too often, I believe, these contract provisions limit the free and necessary communications of information to patients regarding their medical condition and all possible modalities of treatment. This legislation, while upholding the right of plans to work with physicians to improve the overall quality of care within a health plan, clearly restricts plans from impeding the free flow of medical information between State-licensed caregivers and patient. The Health Care Quality Improvements Act is endorsed by a number of groups including Families USA, Consumer Action, the National Association of Health Data Organizations, and the United Seniors Health Cooperative. The Patient Communications Protection Act is supported by the Oregon Medical Association, the American Association of Retired Persons, the Center for Patient Advocacy, Citizen Action, the Consumers Union, and the American College of Emergency Physicians. Mr. President, I ask unanimous consent that the text of the bills be printed in the Record.

Mr. WYDEN

Mr. WYDEN. Mr. President, I rise in support of S. 1959, the fiscal year 1997 energy and water development appropriations bill. I am particularly pleased that the Senate is restoring funding for renewable energy programs. A portion of the restored funds will go to support a Federal interagency board, The Committee on Renewable Energy Commerce and Trade [CORECT]. This program came out of legislation authored by Senator Hatfield and myself in the 97th Congress which President Reagan signed. The premise of the legislation was simple: build effectiveness of Government export assistance programs by having Federal agencies work together, team together. CORECT has worked well. Not only has United States industry identified nearly $2 billion of potential in Latin America alone, but global sales for United States renewable energy equipment and services have more than doubled over the last few years. Mr. President, I also want to thank the chairman and ranking member for including funding for a particular project--the restoration of wetlands on the Williamson River in Oregon. This project is one of the results of an environmental initiative by my colleague, Senator Hatfield, over the past several years. When endangered fish concerns and other environmental problems started coming to light on the Upper Klamath River in the southern part of our state, it was Senator Hatfield who provided funding and direction to all the Federal agencies involved to work together on solutions, instead of standing around blaming each other for the problems. And, it was Senator Hatfield who got them to bring the local stakeholders together to work in league with the agencies in considering those problems and trying to agree on solutions--not in the courts, but sitting down face to face with each other. The people at that table--including the farmers who use water from the Bureau of Reclamation's Klamath project, the Klamath Tribe, hydro generators, other commercial interests, Oregon Trout, and the Nature Conservancy--probably won't ever achieve perfect harmony. They each have their own priorities. But working together, they have been able to agree on positive steps to take to solve some of the environmental problems in the Upper Klamath Basin--and the Tulana Farms wetlands restoration project at the mouth of the Williamson River is one of those. The Fish and Wildlife Service identified this restoration as a key element in restoring two endangered fish species on the river, and the Nature Conservancy worked with CH2MHill to design the project in such a way that it adds flexibility to the use of the hydro and irrigation projects on the river, rather than constraining it. They also designed the project to keep a parcel of the Tulana Farms property in agricultural production, because of its role as an important source of seed potatoes for neighboring farmers. The Federal Government has a responsibility to address the sorts of problems people are facing on the Upper Klamath. But I am proud to say that the Klamath Basin Working Group working with the Klamath Ecosystem Restoration Office did not simply pass the responsibility for solving these problems--or the bill--to the Federal Government. They have taken on a substantial part of that responsibility. The restoration work and management of the project will be done by the Nature Conservancy. PacifiCorp and the New Earth Co., both of which have operations on the Upper Klamath system, are contributing $4 million of private funding to the project. Complaining about a problem is a whole lot easier than solving it, especially when a solution affects lots of different interests, and lots of different people. I want to congratulate the people who have worked together to make this project possible, and urge my colleagues to support the work they have taken on. tva competing with private sector on engineering work