NATIONAL INSTITUTES OF HEALTH. WE DON'T DETERMINE IN THE BUDGET
           RESOLUTION WHICH OF THE NUMEROUS N.I.H. ACTIVITIES GET WHAT
           AMOUNT OF MONEY. I HAVE BEEN TO THE SUBCOMMITTEE WITH THE
           DISTINGUISHED CHAIRMAN PRESIDING, MAKING A VERY STRONG, STRONG
           PITCH THAT WE PUT MORE MONEY INTO RESEARCHING MENTAL ILLNESS.
           HE RECALLS THAT. WE WERE ABLE OVER THE YEARS TO RAISE THOSE
           KIND OF INSTITUTES TO A LEVEL OF FUNDING WHERE I CAN GIVE YOU
           TWO OR THREE WHICH ARE NOW ON THE CUTTING EDGE AGAIN AND WHICH

           HAVE EXCITED YOUNG SCIENTISTS AND THE VERY BEST TO GET INTO
           FIELDS THEY MIGHT NOT HAVE THAT ARE CRITICAL TO US SOLVING SOME
           OF THE ENORMOUS PROBLEMS OF THE SUFFERING HUMAN BEINGS, NOT
           ONLY AMERICANS BUT HUMANS. NOW, SO I'M AN ADVOCATE, BUT, MR.
           PRESIDENT, I GUESS I WOULD SAY IN A TIGHT BUDGET, ENOUGH IS
           ENOUGH. $1.5 BILLION IS ENOUGH. $15.5 BILLION, OVER FIVE YEARS,
           IS ENOUGH. AND I CAN'T DO ANY BETTER. I CAN'T MAKE THE FUNDING

           ANY MORE ASSURED IN A BUDGET RESOLUTION THAN I HAVE DONE IN
           THIS BUDGET RESOLUTION. I CANNOT, IF SENATOR SPECTER WERE TO
           PREVAIL, WE CANNOT ASSURE ANYONE THAT THE DESIRED LEVEL OF
           N.I.H. FUNDING WILL BE WHAT SENATOR SPECTER ASSUMES BY HIS
           AMENDMENT. BECAUSE HE IS, ONCE AGAIN, GOING TO BE BACK INTO THE
           COMPETITION OF TAKING ALL THE MONEY THAT HIS COMMITTEE GETS AND
           DECIDING AMONG HUNDREDS OF PROGRAMS HOW MUCH THE N.I.H. GETS.

           SO, THAT'S ONE SIDE OF THIS COIN. NOW, WITH EVERY COIN, THERE
           ARE TWO SIDES WHEN YOU TAKE AWAY -- WHEN YOU ADD, YOU GOT TO
           TAKE AWAY. BECAUSE THE DISTINGUISHED SENATOR DID NOT TRY TO
           BREAK THE BUDGET. HE DID NOT TRY TO BREAK THE CAST, BECAUSE HE
           PLEDGED LAST YEAR AND E# KEPT HIS PLEDGE, THAT WE WOULD STAY ON
           THIS PATH -- A BALANCED BUDGET AND THE CAPS. NOW, THERE ARE
           SOME WHO WOULD LIKE TO BREAK THE CAPS FOR ANY GOOD PROPOSAL.
           THE DISTINGUISHED SENATOR FROM PENNSYLVANIA IS NOT DOING THAT.
           HE IS SAYING, LET US CUT OTHER DOMESTIC PROGRAMS TO PAY FOR THE

           NEW INCREASE OVER AND ABOVE THE $1.5 BILLION THAT WE PROVIDED,
           AND THE SENATOR INCLUDED DEFENSE IN THE .4% CUT. SO DEFENSE
           GETS CUT ACROSS THE BOARD AND DOMESTIC PROGRAMS GET CUT ACROSS
           THE BOARD. SO THAT DEFENSE GETS CUT $1.1 BILLION OVER FIVE
           YEARS -- EXCUSE ME, OVER ONE YEAR, IN ORDER TO PAY FOR THIS $2
           BILLION INCREASE. AND I'LL JUST TICK OFF SOME SO EVERYBODY

           KNOWS. THE VETERANS GET $76 MILLION REDUCTION, THE ENVIRONMENT
           GETS AN $89 MILLION. AGRICULTURE, BECAUSE IT IS SMALLER, GETS
           $17 MILLION, TRANSPORTATION, $160 MILLION, AND ON AND ON. NOW,
           MR. PRESIDENT, IT MAY VERY WELL BE THAT THE UNITED STATES
           SENATE TODAY WANTS TO SAY IN ADDITION TO WHAT THE BUDGET
           RESOLUTION CONTAINS, WITH ALL THE OTHER PROGRAMS BEING
           RESTRAINED DRAMATICALLY, THAT IN ORDER TO GIVE IT TWO MORE --
           $2 BILLION MORE, THAT WE OUGHT TO DO THESE THINGS, INCLUDING

           CUTTING DEFENSE $1.1 BLT. I DON'T BELIEVE THE SENATE WILL DO
           THAT, BUT IF THEY CHOOSE TO DO THAT, THEN OBVIOUSLY THE
           APPROPRIATORS WILL STRO GIVE THAT EVERY CONSIDERATION. I DON'T
           SEE HOW WE CAN DO THE DEFENSE ONE BECAUSE WE'RE ALREADY HAVING
           A VERY DIFFICULT TIME MEETING THE DEFENSE NEEDS WITH THE

           NUMBERS THAT ARE IN THE BUDGET AND THE FIRE WALL THAT PROTECTS.
           BUT LET ME JUST SAY, WITH RESPECT TO SENATOR SPECTER, SENATOR
           SPECTER, YOU SAID YOU WANT TO DO THIS TO DEFENSE ALSO. I WOULD
           LIKE TO YOU THINK ABOUT THAT. BECAUSE IF YOU DO, THEN I BELIEVE
           THE FIRE WALL PREVAILS AND YOU MAY HAVE A SUPERMAJORITY
           REQUIREMENT. BUT I LEAVE THAT TO YOU. THAT'S NOT FOR ME. NOW,
           HAVING SAID WHAT I'VE SAID, I DO NOT WANT TO DETRACT FROM THE
           FACT THAT THE NATIONAL INSTITUTES OF HEALTH ARE A FABULOUS
           COMMUNITY OF THE BEST SCIENTISTS IN THE WORLD, AND WHEN YOU

           REALLY LOOK AT WHAT THEY'RE DOING, YOU KNOW, THEY'RE ON A
           COURSE TO CURE MANY, MANY ASPECTS OF HUMAN SUFFERING AND HUMAN
           DISEASE. YOU ADD TO WHAT THEY ARE DOING IN THE NORMAL RESEARCH,
           YOU ADD SOMETHING LIKE THE GENOME MAPPING, THE MAPPING OF ALL
           THE CHROMOSOMES OF A HUMAN BODY, AND THOSE ARE BEING LOOKED AT
           IN TERMS OF THEIR RELATIONSHIP TO DISEASE, AND YOU HAVE A
           FORMIDABLE GROUP OF SCIENTISTS AND RESEARCH EQUIPMENT MOVING IN
           A PATH OF PERHAPS -- PERHAPS -- WHAT MAY BE CALLED "THE

           GENERATION YET TO COME," WHICH WILL AB ABWELLNESS GENERATION IN
           THE WORLD THAT. COULD BE WHEN THE DREZ DISEASES ARE NO MORE. SO
           I DON'T WANT TO SOUND LIKE THIS IS JUST A TYPICAL ENTITY. IT IS
           A VERY PROMINENT AND IMPORTANT ONE. BUT I DO BELIEVE THAT
           CONSISTENT WITH LIMITED RESOURCES AND BECAUSE WE HAVE TO TAX
           OUR PEOPLE, WE HAVE LIMITED RESOURCES; AND SOME THINK THEY'RE
           TAXED TOO MUCH ALREADY. THEN I BELIEVE THE BUDGET RESOLUTION
           TREATS THIS FORMIDABLE RESEARCH COMMUNITY FAIRLY WELL. I

           RESERVE THE BALANCE OF MY TIME. MR. SPECTER: MR. PRESIDENT?
           STPHER STPHER THE SENATOR FROM PENS OPINIONS.
           

           MR. SPECTER: HOW MUCH TIME REMAINS?
           
           

           THE PRESIDING OFFICER: SIX AND A HALF MINUTES. SPECK TIME HOW
           MUCH TIME REMAINS --ICS
           

           MR. SPECTER: HOW MUCH TIME REMAINS ON BOTH SIDES?
           
           

           THE PRESIDING OFFICER: SIX AND A HALF MINUTES.
           

           MR. SPECTER: SENATOR HARKIN HAS MADE A REQUEST TO HAVE FIVE
           MINUTES RESERVED, BUT HE'S AT ANOTHER HEARING, AND I WONDER IF
           WE MIGHT ACCOMMODATE HIM AT A LATER TIME?
           
           

           MR. DOMENICI: DO YOU HAVE FIVE MINUTES REMAINING?
           
           

           MR. SPECTER: YES, I HAVE THE TIME.
           

           MR. DOMENICI: I WOULD TRY TO WORK IT IN.
           

           MR. SPECTER: THANK YOU. I THANK MY COLLEAGUE, SENATOR DOMENICI,
           FOR HIS COMMENTS. HE HAS ENUMERATED PROGRAMS WHICH WILL BE CUT.
           IT IS A MATTER OF PRIORITIES. WHEN HE HAS RECITE TAD THERE IS
           AN ASSUMPTION OF $1.5 BILLION FOR THE NATIONAL INSTITUTES OF
           HEALTH, I HAVE TO DISAGREE WITH HIM BECAUSE THE BUDGET
           COMMITTEE ASSUMES ONLY AN OUTLAY INCREASE OF $350 MILLION OVER
           THE LEVEL FROM FISCAL YEAR 1998 AND THERE ARE ALSO INCREASES IN
           EDUCATION AND CHILD-CARE PROGRAMS, SO IF THERE COULD NOT

           POSSIBLY BE AN INCREASE IN N.I.H., WITH AN INCREASE OF ONLY
           $350 MILLION IN OUTLAYS, AND AS SENATOR DOMENICI HAS RECITED A
           NUMBER OF CUTS, LET ME JUST RECITE A PARTIAL LIST OF THE PEOPLE
           WHO COME TO ME AS CHAIRMAN OF THIS SUBCOMMITTEE, THOSE WHO WANT
           INCREASES IN FUNDING FOR BREAST CANCER, CERVICAL CANCER, COLON
           CANCER, ALZHEIMER'S DISEASE, CYSTIC FIBROSKIS, DIABETES,

           KIDNEYS AILMENTS, PARKINSON'S, SCHIZOPHRENIA, EPILEPSY, HEART
           DISEASE, PROSTATE SKERX PULMONARY DISORDERS, AIDS, I THINK I
           MESSAGESEDALS HIRMSE, HUNTINGTON'S DISEASE, TO MENTION ONLY A
           FEW. AND THE FACT IS THAT MANY SENATORS RECEIVE AWARDS FROM
           ALZHEIMER'S OR FROM PARKINSON'S OR FROM AIDS, ETSZ, AND THIS IS
           A MATTER OF PRIORITY, PURE AND SIMPLE. SENATOR DOMENICI SDIM A
           VALUED MEMBER OF THE SUBCOMMITTEE. HE AND I SIT NECT NEXT TO

           EACH OTHER AND THE APPROPRIATIONS COMMITTEE THE -- HAVE FOR
           YEARS. HE TALKS ABOUT MENTAL ILLNESS PROGRAMS. WE HAVE
           ACCOMMODATED THAT AS A VERY HIGH PRIORITY. THAT'S WHAT THE
           SENATE HAS TO DO IS ESTABLISH THE PRIORITIES THAT I SAY THAT
           IT'S WORTH THE .4% CUT ACROSS THE BOARD FOR THIS HIGH PRIORITY
           FOR THE NATIONAL INSTITUTES OF HEALTH. I YIELD THE FLOOR.
           

           MR. DOMENICI: HOW MUCH TIME DO I HAVE REMAINING?
           
           

           THE PRESIDING OFFICER: THE SENATOR HAS THREE MINUTES REMAINING.
           

           MR. DOMENICI: I YIELD BACK -- FLO, I RESERVE MY THREE MINUTES
           AND ASK UNANIMOUS CONSENT THAT THE THREE MINUTES REMAINING IN
           OPPOSITION AND FIVE MINUTES REMAINING BY THE PROPONENT BE
           RETAINED UNTIL -- SUBSEQUENT TO THE DEBATE ON THE KENNEDY
           AMENDMENT, WHICH WILL START NOW.
           

           THE PRESIDING OFFICER: IS THERE OBJECTION?
           NO OBJECTION, SO ORDERED.
           

           MR. DOMENICI: THANK YOU VERY MUCH.
           

           THE PRESIDING OFFICER: THE PENDING QUESTION IS THE KENNEDY

           AMENDMENT, NUMBER 2183. MR. KENNEDY: MR. PRESIDENT?
           
           

           THE PRESIDING OFFICER: THE SENATOR HAS 15 MINUTES TO EXPLAIN
           HIS AMENDMENT. THE SENATOR FROM MASSACHUSETTS.
           

           MR. KENNEDY: I'D YIELD MYSELF FIVE MINUTES, MR. PRESIDENT. MR.
           PRESIDENT, THIS SENSE OF THE SENATE IS VERY, VERY SIMPLE, AND I
           FIND EXTRAORDINARILY COMPELLING, AND I FIND IT DIFFICULT TO
           UNDERSTAND WHY IT WILL NOT BE ACCEPTED. AND I THINK THE BEST
           WAY TO REALLY EXPLAIN IT IS TO GO THROUGH THE AMENDMENT ITSELF,
           BECAUSE IT IS SO SIMPLE AND SO COMPELLING. ALL WE ARE SAYING IS
           THAT IT IS A SENSE OF THE SENATE THAT CONCERNS A PATIENT'S BILL

           OF RIGHTS, THAT CONGRESS DEFIANCE, PATIENTS LACK RELIABLE
           INFORMATION ABOUT HEALTH PLANS AND THE QUALITY OF CARE THAT
           HEALTH PLANS PROVIDE. WE HAVE HAD A WIDE RANGE OF DIFFERENT
           HEARINGS THAT HAVE DEMONSTRATED THAT, MR. PRESIDENT. SECOND
           SECONDLY, IT SAID, EXPERTS AGREED THAT THE QUALITY OF HEALTH
           CARE CAN BE SUBSTANTIALLY IMPROVED, RESULTING IN LESS ILLNESS
           AND LESS PREMATURE DEATH. THE BUSINESS COMMUNITY, THE HEARINGS
           BEFORE THE PRESIDENTIAL COMMISSION, MANY JOURNAL ARTICLES BY
           EXPERTS ALSO SUPPORT THAT FINDING. THIRD, THAT SOME

           MANAGED-CARE PLANS HAVE CREATED OBSTACLES FOR PATIENTS WHO NEED
           TO SEE SPECIALISTS ON AN ONGOING BASIS AND HAVE REQUIRED THAT
           WOMEN GET PERMISSION FROM THEIR PRIMARY-CARE PHYSICIAN BEFORE
           SEEING A GYNECOLOGIST. THIS WAS A CENTRAL FINDING AGAIN OF THE
           PRESIDENTIAL COMMISSION ON THE QUALITY OF HEALTH CARE, AND IT
           WAS OVERWHELMING. THE EVIDENCE THAT DEMONSTRATED THAT
           PARTICULAR CHALLENGE THAT WE'RE FACING IN THE COUNTRY TODAY.
           FOURTH, THAT A MAJORITY OF CONSUMERS BELIEVE THAT HEALTH PLANS
           COMPRISE -- COMPROMISE THEIR QUALITY OF CARE TO SAVE MONEY. THE

           FACT IS, IT'S 80% OF THOSE THAT ARE INVOLVED IN VARIOUS
           MANAGED-CARE PROGRAMS HAVE REACHED THAT CONCLUSION. WE'VE GOT
           THAT EVIDENCE. IT'S BEEN READILY REFERRED TO. THAT'S THE
           FINDING. ALL YOU HAVE TO DO IS LOOK AT THE MOVIE "AS GOOD AS IT
           GETS" AND SEE HELL ENHUNT'S EXTRAORDINARY PERFORMANCE, ATNDZ
           ANY MOVIE THEATER IN THIS COUNTRY AND YOU'LL -- AND IF YOU HAVE
           ANY QUESTIONS ON THAT ISSUE, THEY'LL BE RESOLVED. FIFTH, THE
           FEDERAL PREEMPTION UNDER THE EMPLOYEE RETIREMENT INCOME
           SECURITY ACT OF 1974 PREVENTS STATES FROM EORCING PROTECTIONS

           FOR 125 MILLION WORKERS AND THEIR FAMILIES RECEIVING HEALTH
           INSURANCE THROUGH THE EMPLOYER-BASED GROUP HEALTH PLANS. MR.
           PRESIDENT, ALL WE KNOW IS THAT THIS IS SOMETHING THAT IS
           UNDERSTANDABLE. IT EXISTS NOWENDER THE ERISA PREEMPTIONS. WE
           HAVE FOUND OUT THE UNJUSTICES THAT ARE CREEDED BY FEDERAL
           JUDGES, THE STATE INSURANCE COMMISSIONERS. THERE IS NO REASON
           AT ALL THAT WE OUGHT TO GIVE AN EXCLUSION TO A CERTAIN GROUP OF

           PRACTITIONERS THAT THE RESULT OF WHICH IS REFLECTED IN EITHER
           -- IN SOME INSTANCES -- DEATH OR MORE FREQUENTLY IN NEGLIGENCE.
           SIX, MR. PRESIDENT, THE ADVISORY COMMISSION ON CONSUMER
           PROTECTION AND QUALITY IN THE HEALTH CARE INDUSTRY HAS
           UNANIMOUSLY RECOMMENDED A PATIENT BILL OF RIGHTS, TO PROTECT
           PATIENTS AGAINST ABUSES BY HEALTH PLAN AND HEALTH INSURANCE
           INSURERS. UNANIMOUSLY. REPUBLICANS AND DEMOCRATS ALIKE
           PROVIDERS AND CONSUMERS, UNANIMOUSLY RECOMMEND THAT THERE BE A

           PATIENT'S BILL OF RIGHTS. SO IT VASE, THE SENSE OF THE SENATE
           THAT THE S. SUM SHONS UNDERLYING THIS RESOLUTION PROVIDE THE
           ENACT OF OF LEGISLATION TO ESTABLISH A PATIENTS' BILL OF RIGHTS
           FOR PARTICIPANTS IN HEALTH PLANS. AND THEN, MR. PRESIDENT, WE
           POINT OUT VERY BRIEFLY EXACTLY WHAT THOSE PROTECTIONS OUGHT TO
           BE AND IF THERE ARE MEMBERS OF THE SENATE THAT WANT TO DIFFER
           WITH THESE, I'D WELCOME THE OPPORTUNITY TO DEBATE THOSE OR
           DISCUSS THEM. FIRST, A GUARANTEE OF ACCESS TO COVERAGE SERVICES
           INCLUDING EMERGENCY CARE, SPECIALTY CARE, AND GYNECOLOGIST --

           ON ANDZ GYNECOLOGICAL CARE FOR WOMEN AND PRESCRIPTION DRUGS.
           DOES ANYONE DISPUTE THAT WE OUGHT TO BE ABLE TO GUARANTEE IN A
           PATIENTS' BILL OF RIGHTS THOSE KINDS OF PROTECTIONS?
           SECONDLY, PROVISION TO ENSURE THE SPECIAL NEEDS OF WOMEN ARE
           MET INCLUDING PROTECTING WOMEN AGAINST DRIVE-BY MASS STEK
           TOMES. THERE ARE A HALF A DOZEN MEMBERS OF THE SENATE THAT HAVE
           VARIOUS PIECES OF LEGISLATION TO ADDRESS THAT PARTICULAR NEED.
           THE CONGRESS HAS ENACTED THE PROHIBITION AND THE BANNING OF
           DRIVE-BY DELIVERIES OF CHILDREN. WE OUGHT TO BE ADDRESSING THE

           ISSUE OF DRIVE-BY MASTECTOMIE MASTECTOMIES. THIS SENSE OF THE
           SENATE REFERS TO THAT. THIRD, PROVISIONS TO ENSURE THE SPECIAL
           NEEDS OF CHILDREN ARE MET, INCLUDING ACCESS TO PEDIATRIC
           SPECIALISTS AND CENTERS OF PEDIATRIC EXCELLENCE. MR. PRESIDENT,
           THIS IS AN EXTREMELY IMPORTANT AND SIGNIFICANT NEED. ALL YOU
           HAVE TO DO IS LISTEN TO PEDIATRICIANS. SENATOR REID IS A LEADER
           IN THIS PARTICULAR ISSUE. WE KNOW THAT -- THE KIND OF
           CHALLENGES THAT EXIST, PARTICULARLY FOR NEWBORN BABIES BABIES,

           AND IT USED TO BE THAT 90% OF THE KINDS OF HEALTH DIFFICULTIES
           THAT NEWBORNS FACED WERE EXCLUDED FROM ANY COVERAGE. OF HEALTH
           INSURANCE. AND THERE STILL IS A PROBLEM. BECAUSE IN MANY OF THE
           INSURANCE FORMS THAT SAY THAT ANY PARTICULAR NEEDS OF A CHILD
           THAT OCCUR WITHIN THE FIRST TEN DAYS WILL BE OUTSIDE THE
           COVERAGE OF THE -- OF THIS INSURANCE POLICY. THE FACT OF THE
           MATTER IS, 90% OF THE DIFFICULTIES OCCUR DURING THAT PERIOD OF
           TIME. BUT SO MANY MOTHERS DID NOT
{END: 1998/04/02 TIME: 13-30 , Thu.  105TH SENATE, SECOND SESSION}