[Pages S16943-S16948]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

THE 7-YEAR BALANCED BUDGET RECONCILIATION ACT OF 1995

Mr. HATFIELD. Mr. President, I ask that the Chair lay before the
Senate a message from the House of Representatives on a bill (H.R.
2491) to provide for reconciliation pursuant to section 105 of the
concurrent resolution on the budget for fiscal year 1996.
The PRESIDING OFFICER laid before the Senate the following message
from the House of Representatives.
Resolved, That the House disagree to the amendment of the
Senate to the bill (H.R. 2491) entitled ``An Act to provide
reconciliation pursuant to section 105 of the concurrent
resolution on the budget for fiscal year 1996'', and ask a
conference with the Senate on the disagreeing votes of the
two Houses thereon.
Ordered, That the following Members be the managers of the
conference on the part of the House:
For consideration of the House bill and the Senate
amendment, and modifications committed to conference: Mr.
Kasich, Mr. Walker, Mr. Armey, Mr. DeLay, Mr. Boehner, Mr.
Sabo, Mr. Bonior, and Mr. Stenholm.
As additional conferees from the Committee on the Budget,
for consideration of title XX of the House bill, and
modifications committed to conference: Mr. Kolbe, Mr. Shays,
Mr. Hobson, Ms. Slaughter, and Mr. Coyne.
As additional conferees from the Committee on Agriculture,
for consideration of title I of the House bill, and subtitles
A-C of title I of the Senate amendment, and modifications
committed to conference: Mr. Roberts, Mr. Emerson, Mr.
Gunderson, Mr. de la Garza, and [VACANCY].
As additional conferees from the Committee on Banking and
Financial Services, for consideration of title II of the
House bill, and title III of the Senate amendment, and
modifications committed to conference: Mr. Leach, Mr.
McCollum, Mrs. Roukema, Mr. Gonzalez, and Mr. LaFalce.
As additional conferees from the Committee on Commerce, for
consideration of title III of the House bill, and subtitle A
of title IV, subtitles A and G of title V, and section 6004
of the Senate amendment, and modifications committed to
conference: Mr. Bliley, Mr. Schaefer, and Mr. Dingell.
As additional conferees from the Committee on Commerce, for
consideration of title XV of the House bill, and subtitle A
of title VII of the Senate amendment, and modifications
committed to conference: Mr. Bliley, Mr. Bilirakis, Mr.
Hastert, Mr. Greenwood, Mr. Dingell, Mr. Waxman, and Mr.
Pallone.
As additional conferees from the Committee on Commerce, for
consideration of title XVI of the House bill, and subtitle B
of title VII of the Senate amendment, and modifications
committed to conference: Mr. Bliley, Mr. Bilirakis, Mr.
Tauzin, Mr. Barton of Texas, Mr. Paxon, Mr. Hall of Texas,
Mr. Dingell, Mr. Waxman, Mr. Wyden, and Mr. Pallone.

[[Page S 16944]]

As additional conferees from the Committee on Economic and
Educational Opportunities, for consideration of title IV of
the House bill, and title X of the Senate amendment, and
modifications committed to conference: Mr. Goodling, Mr.
McKeon, and Mr. Clay.
As additional conferees from the Committee on Government
Reform and Oversight, for consideration of title V of the
House bill, and title VIII and sections 13001 an 13003 of the
Senate amendment, and modifications committed to conference:
Mr. Clinger, Mr. Schiff, and Mrs. Collins of Illinois.
As additional conferees from the Committee on International
Relations, for consideration of title VI of the House bill,
and section 13002 of the Senate amendment, and modifications
committed to conference: Mr. Gilman, Mr. Burton of Indiana,
and Mr. Hamilton.
As additional conferees from the Committee on the
Judiciary, for consideration of title VII of the House bill,
and title IX and section 12944 of the Senate amendment, and
modifications committed to conference: Mr. Hyde, Mr.
Moorhead, and Mr. Conyers.
As additional conferees from the Committee on National
Security, for consideration of title VIII of the House bill,
and title II of the Senate amendment, and modifications
committed to conference: Mr. Spence, Mr. Hunter, and Mr.
Dellums.
As additional conferees from the Committee on Resources,
for consideration of title IX of the House bill, and title V
(except subtitles A and G) of the Senate amendment, and
modifications committed to conference: Mr. Young of Alaska,
Mr. Tauzin, and Mr. Miller of California.
As additional conferees from the Committee on
Transportation and Infrastructure, for consideration of title
X of the House bill, and subtitles B and C of title IV and
title VI (except section 6004) of the Senate amendment, and
modifications committed to conference: Mr. Shuster, Mr.
Clinger, and Mr. Oberstar.
As additional conferees from the Committee on Veterans'
Affairs, for consideration of title XI of the House bill, and
title XI of the Senate amendment, and modifications committed
to conference: Mr. Stump, Mr. Hutchinson, and Mr. Montgomery.
As additional conferees from the Committee on Ways and
Means, for consideration of titles XII, XIII, XIV, and XIX of
the House bill, and subtitles H and I of title VII and title
XII (except section 12944) of the Senate amendment, and
modifications committed to conference: Mr. Archer, Mr. Crane,
Mr. Thomas, Mr. Shaw, Mr. Bunning of Kentucky, Mr. Gibbons,
Mr. Rangel, and Mr. Stark: Provided, That Mr. Matsui is
appointed in lieu of Mr. Stark for consideration of title XII
of the House bill.
As additional conferees from the Committee on Ways and
Means, for consideration of title XV of the House bill, and
subtitle A of title VII of the Senate amendment, and
modifications committed to conference: Mr. Archer, Mr.
Thomas, Mrs. Johnson of Connecticut, Mr. McCrery, Mr.
Gibbons, Mr. Stark, and Mr. Cardin.

Mr. HATFIELD. I move that the Senate insist on its amendment and
agree to the conference requested by the House.
The motion was agreed to.
The PRESIDING OFFICER. Under the previous order, the four motions to
instruct the conferees are now in order. The motions to instruct are
relative to Social Security, health care, Medicare and tax cuts, and
nursing home standards.

Motion to Instruct--Nursing Home Standards

Mr. PRYOR. Mr. President, I have the first motion to instruct the
conferees, and this motion does, in fact, relate to the nursing home
standards. Is it in order now?
The PRESIDING OFFICER. Yes, it is in order.
Mr. PRYOR. Mr. President, I send my motion to the desk to instruct
conferees.
The PRESIDING OFFICER. The clerk will report.
The legislative clerk read as follows:

motion to instruct conferees

Mr. Pryor moves that the managers on the part of the Senate
at the conference on the disagreeing votes of the two Houses
on the Senate amendments to the bill H.R. 2491 be instructed
to insist upon maintaining the Federal nursing home reform
provisions of law that were enacted as part of the Omnibus
Budget Reconciliation Act of 1987 and that provide for
Federal quality standards and mechanisms for enforcement of
such standards for nursing homes under the medicare and
medicaid programs without an option for a State to receive a
waiver of such standards.

The PRESIDING OFFICER. Under the previous order, the Senator from
Arkansas is recognized for 40 minutes.
The Senator from Michigan will be recognized for 20 minutes.
Mr. PRYOR. Mr. President, later today, the U.S. Senate is going to be
making a very, very interesting decision relating to the choice of the
standards that we are going to employ for the 2 million nursing home
residents who are today residing in America's nursing homes.
By the year 2030, Mr. President, we will no longer have 2 million
nursing home residents. We are going to have 4.3 million nursing home
residents residing in America's nursing homes. The question that we are
going to decide this afternoon, Mr. President, is going to be that
choice that we express as to which standards and how high the standards
will be of protection--or I should say the protection for these nursing
home residents who today reside in America's nursing homes.
In 1987, the U.S. Congress decided, after serious studies, after
absolute horror stories, that it was time to have uniform standards on
the Federal level. In 1987, for the first time, sweeping reform
measures, sweeping standards were enacted in what we call now OBRA '87.
Mr. President, necessitating this action was the fact that many of the
States were not complying with the law, nor were they enforcing present
State standards, nor was there a uniform code of standards nationwide
that governed the policing, you might say, the regulating and the
standard setting that protected nursing home patients.
OBRA '87 came about. Today we are proud to report that, last evening,
approximately 142,000 nursing home residents in America went to bed,
went to sleep unrestrained. We are proud to report, Mr. President, that
30,000 nursing home patients today in America do not have bedsores
because of the nursing home reforms and the strict guidelines of 1987.
In 1987, it was not a partisan effort. In fact, the late Senator John
Heinz, former Senator Durenberger, former Senator Mitchell, majority
leader George Mitchell of Maine, and many others in the Senate
coalesced to bring about a bipartisan effort to have uniform, very
carefully crafted procedures and standards on the national level,
whereby these nursing home residents would be protected.
Mr. President, the irony of all of this argument today is, I do not
know why this issue is before the U.S. Senate. These standards were
working. In fact, these standards were working very well.
I ask unanimous consent that each of these letters I will refer to be
printed in the Record.
There being no objection, the letters were ordered to be printed in
the Record, as follows:

Beverly Enterprises, Inc.,

Fort Smith, AR, October 25, 1995.
Hon. David Pryor,
Russell Senate Office Building,
Washington, DC.
Dear Senator Pryor: Beverly Enterprises, the nation's
largest provider of long term care services in the United
States, supports strong, uniform and consistent Federal
Standards for nursing homes and believes the focus of current
efforts should be on improving, not eliminating the current
standards.
Since Congress enacted the Nursing Home Reform Statute of
1987 (OBRA '87), Beverly has supported the Statute and
continues to support the retention of Federal Standards.
It is critical that the health, well-being and dignity of
our nation's elderly citizens be protected in every nursing
home in the country. We believe that Federal quality
standards are an effective way to ensure that this is
achieved.
Beverly's commitment to the OBRA '87 Standards is evidenced
by our institution's training programs throughout the company
and the adoption and application of standards that in many
instances exceed OBRA requirements. Prior to the
implementation of OBRA '87, in October of 1990, our quality
Management program required our facilities to meet standards
similar to those required by OBRA '87. As a result we have
exceeded the compliance rate of the industry as a whole for
the last five years. The recent Consumer Report study
recognized Beverly's compliance rates.
We recognize the need for industry-wide standards. We agree
fully that there must be uniformity and consistency in
quality standards across the States. OBRA '87 has been an
impartial landmark in setting the ground work and we urge
Congress not to eliminate the progress that has been made in
improving the care provided to our nation's frail elderly.
Sincerely,
David Banks.
____

Statement of Stewart Bainum, Jr., Submitted to the Senate Special
Committee on Aging, October 26, 1995

As the Chairman and Chief Executive Officer of Manor Care,
Inc., I want to express our strong support for retention of
the Nursing Home Reform Act of 1987 (OBRA `87). Manor Care
owns and operates 170 skilled nursing

[[Page S 16945]]
facilities in 28 states, and provides care to over 20,000 residents.
The OBRA `87 reforms represent the most comprehensive
revision of nursing home regulations since the inception the
Medicare and Medicaid programs in the sixties. As I recall,
the bill was over 1000 pages long, and addressed critical
areas of care, such as resident assessment and care planning,
nurse aid training and testing, resident rights, nurse
staffing ratios, and enforcement. The final product reflected
the agreement reached among 60 national organizations,
representing consumers, seniors, providers, and state
regulators. It was a painstaking process that worked. In
fact, OBRA might depict one of the finest collaborative
achievements ever in the history of health care legislation.
Manor Care proudly supported OBRA in 1987 because the
legislation offered a valuable means of protecting and
promoting the quality of life for one of the most vulnerable
segments of our population. We must afford nursing home
residents an environment which is safe and ensures their
physical and mental well-being. OBRA `87 has been widely
successful in accomplishing this goal.
Manor Care pledges to continue to meet these federal
quality standards because they are reasonable, and have led
to significant improvements in the care delivered to our
residents. As a national company, we are supportive of the
uniformity and consistency these standards provide across the
states.
OBRA created a system of care delivery to help guarantee
the dignity and respect of institutionalized seniors. Do not
undo the valuable work that has been done. We ask that
Congress support retention of the Nursing Home Reform Act and
its standards. Stated most simply, it is the right thing to
do.

Mr. PRYOR. Mr. President, one of the letters is from Beverly
Enterprises, dated October 25, 1995. This is the largest provider of
long-term care services in the United States, supporting keeping the
stronger--not the weaker--standards embodied in this concept and
instructing our conferees to maintain the strongest nursing home
standards.
I will quote from the letter:

Beverly Enterprises, the nation's largest provider of long-
term care services in the United States, supports strong
uniform and consistent Federal standards for nursing homes
and believes the focus of current efforts should be on
improving, not eliminating the current standards.

This is signed by David Banks, the chief operating officer and
chairman of the board of Beverly Enterprises.
Here is a statement of Stewart Bainum, Jr., to the Special Committee
on Aging, October 26, 1995.

As Chairman and Chief Executive Officer of Manor Care,
Inc., I want to express our strong support for retention of
the Nursing Home Reform Act of 1987.
Manor Care proudly supported OBRA in 1987 because the
legislation offered a valuable means of protecting and
promoting the quality of life of one of the most vulnerable
segments of our population.

Mr. President, what we have seen is, once again, that these standards
are working so well--they are working as the Congress intended them to
work--and we have seen a dramatic decrease in the dehydration of
nursing home residents, a 50-percent decrease in dehydration since
1987. Second, we have seen a remarkable decrease of physical
restraints, some 50 percent, as compared to pre-1987 periods. We have
seen a remarkable decrease in indwelling urinary catheters used on
nursing home residents. We also point with great pride to that
significant victory. Across the board, the nursing home regulations
have not only worked, but they have worked well and they are working
today.
So why are we trying to repeal the nursing home standards that
everyone agreed to in 1987, that even the major providers agree to
today, that all of the statistics show are working, that the nursing
home residents are being protected, as they have been never before
protected in our nursing homes? Why is it that we are suddenly trying
to eliminate these standards?
Mr. President, to me, that is a mystery.
On October 27, by a vote of 51 to 48 in this Chamber, the Senate went
on record as adopting the more stringent and retaining the Federal
standards for nursing home protection.
A short while later, only about 6 hours later, Mr. President, we were
discussing and had laid before the Senate the so-called Roth amendment
which was sponsored by our colleague and friend, Senator Roth, the
chairman of the Finance Committee.
By a vote of 57 to 42, Senator Roth's amendment prevailed. In my
opinion and in the opinion of others, Mr. President, we dramatically, I
should say, weakened the present nursing home standards.
This is just not my opinion that we are weakening these standards,
Mr. President. It is also the opinion written on November 1 by the
National Association of State Long-Term Care Ombudsman Program
Directors, Mr. President.

Today we are writing to voice our opposition--from the
ombudsmen who are out there in these nursing homes every
day--to Senator Roth's omnibus floor amendment [which] was
passed and included nursing home provisions that can gravely
weaken the quality of care standards you helped to reinstate.
. . . we believe this will be harmful to the quality of
care provided to nursing home residents across the country.

Mr. President, not only do the ombudsmen out there in these homes
every day feel that we are about to weaken these standards unless we
instruct our conferees to keep the present hard standards--I should say
stronger standards.
We have a letter from the Nursing Home Reform Coalition group.

The Coalition, however, does have serious concerns about
the amendment providing for state waivers from the federal
standards, passed by the Senate on Friday, October 27. The
language in the amendment would allow States with standards
``equivalent to or stricter than'' the federal requirements
to use its own standards.

* * * * *

We urge you, Senator Pryor, and your colleagues, to
consider the following recommendations:
Do not support maintaining this waiver provision

* * * * *

Provisions giving the Secretary the authority to take
action against a facility providing substandard care, and
where the state has not taken adequate enforcement action.

Mr. President, I ask unanimous consent that the letter from the
Nursing Home Reform group, from the Ombudsmen who have written in about
the nursing home standards be printed in the Record.
There being no objection, the material was ordered to be printed in
the Record, as follows:

National Association of State Long-Term Care Ombudsman
Programs,
Austin, TX, November 1, 1995.
Hon. David Pryor,
U.S. Senate,
Washington, DC.
Dear Senator Pryor: Thank you for your successful effort in
offering an amendment that reinstated the nursing home
quality standards into the Senate Budget Reconciliation Bill.
It was rewarding that it received some bipartisan support.
This was particularly meaningful considering the House Bill
eliminated these critical federal standards entirely.
Today we are writing to voice our opposition to Senator
Roth's omnibus floor amendment was passed and included
nursing home provisions that can gravely weaken the quality
of care standards you helped reinstate.
As you know, the Roth amendment allows States to apply for
and be granted waivers from the federal nursing home
regulations. As stated in the amendment, a State can seek a
waiver if it has equivalent to or stricter requirements as
determined by the Secretary of Health and Human Services. For
the following reasons, we believe this will be harmful to the
quality of care provided to nursing home residents across the
country.
It could lead to 52 different sets of standards. This would
make federal oversight and enforcement impossible.
The provision lets the door open for States to seek private
accreditation of nursing homes as their form of quality
standards. The Ombudsman Program's experience has shown that
accreditation alone is no indication of quality care.
This would crate another level of federal bureaucracy
charged with the task of approving and then monitoring the
waiver.
There would be increased cost upon the states to write and
apply for a waiver as well as the federal government's cost
with the administration of the waivers.
____

National Citizens' Coalition

for Nursing Home Reform,

Washington, DC, November 1, 1995.
Hon. David Pryor,
U.S. Senate,
Washington, DC.
Dear Senator Pryor: The National Citizens' Coalition for
Nursing Home Reform commends you for your leadership in
having the federal nursing home standards maintained in
federal law. As you are aware, federal standards are critical
to achieving and maintaining uniform basic good standards of
quality of care and life for our nation's nursing home
residents, many of whom are frail and vulnerable.
The Coalition, however, does have serious concerns about
the amendment providing for state waivers from the federal
standards, passed by the Senate on Friday, October 27. The
language in the amendment would allow

[[Page S 16946]]
States with standards ``equivalent to or stricter than'' the federal
requirements to use its own standards.
If states had standards that were stronger than the federal
standards, there would be no need for a waiver, as the
stronger standards could be implemented through state
licensing requirements. States and facilities are always held
to the higher of state or federal standards. Thus, nothing is
gained by providing for such a waiver.
Further, it is unclear whether all of the state's standards
would have to be equal to or stronger than the federal
requirements, or whether a state waiver request would be
approved if some of the state standards were equal or
stronger. Only enforcement provisions are specified in the
amendment language, thus casting doubt that all standards in
state law will be evaluated.
When evaluating standards, it is not enough to approve a
waiver request based on the fact that a state plan contains
the same broad categories of requirements contained in the
federal standards. The Secretary has the responsibility of
also evaluating the substance of each category under the
state plan, and only approve a waiver if the substance of
each category is equal to or stronger than the federal
standards.
To highlight the importance of the substantive requirements
of the federal standards, the bill recently passed by the
House of Representatives contains what have been described as
``Quality Standards for Nursing Homes,'' provisions which
will replace the standards contained in the Nursing Home
Reform Act. In reality, the provisions in the House bill are
a mere shell--lacking any substance--of the requirements
under the Nursing Home Reform Act. Evaluating any State plan
under the type of general provisions contained in the House
bill, is no guarantee of the strength of those state
provisions. We have prepared side-by-side comparisons of
the requirements contained in the House MediGrant bill
with the requirements in the Nursing Home Reform Act, and
would be happy to share that with you. The same omission
occurs in the lack of substantive language in the waiver
provision.
Many states will argue that they currently have provisions
that are as good or better than the federal law. Most states
currently make that argument. California, for example,
announced in October 1990, the effective date of the nursing
home reform act, that since it's law was as good as the
federal law, it would not implement the federal law. A class
action lawsuit was filed against the state to compel
implementation of the law. The federal district court ruled
that California's law was not equivalent to federal law, and
ordered the state to implement the entire law immediately.
Currently, no state has all the provisions of the Federal
law, and there is no provision for a waiver from the federal
standards. This amendment will result only in costly and
unnecessary reviews of state plans and time spent defending
denials of waiver requests. Considering the budgetary cuts
facing the state and the federal governments, this is surely
not the most effective use of limited funds and resources.
The language in this amendment leaves several other
loopholes which would undermine the strength of the federal
standards. First, there is a provision for a 120-day approval
period, a time frame that includes public comment. This time
frame is not adequate for public comment to be solicited,
received, and the state plan evaluated. So the question
arises, what happens if there has been no approval or denial
by the 120th day? The amendment language is silent. It would
be a travesty if the waiver were deemed approved. We could
guarantee that states would then be free to implement
standards that were not at least equal to the federal
requirements. Residents would, once again, be put at risk of
being subjected to lower quality standards, poor care, and
violations of their rights.
Additionally, the amendment language does not include any
authority for the federal government to take enforcement
action against facilities. The enforcement authorized by the
amendment is against the State for failing to comply with
Medicaid law, or with the state law they have been granted a
waiver to use a place of federal law. Thus the Secretary
could never take action against a facility, an important tool
for achieving facility compliance in meeting contract
obligations.
Further, subparagraph (b) Penalty for Noncompliance limits
the federal government's ability to enforce the Medicaid
requirements to a withholding of ``up to but not more than''
2% of the State's ``MediGrant.'' Studies have shown that poor
care in nursing homes results in high costs to Medicare due
to unnecessary hospitalizations. The state, however, incurs
no cost after the resident leaves the nursing facility for
the hospital. Thus, it may prove to be less costly for some
states to incur a 2% penalty than to ensure that quality
standards are being maintained.
Uniform standards for nursing homes, in addition to
providing protections for residents and families, also serve
another purpose. Standardized resident-level data is
necessary in order to generate quality indicators. This
enables Federal oversight of quality issues across states and
facilitates quality improvement activities which result in
cost effective techniques for the care of nursing home
residents. This data also provides meaningful consumer
information. Allowing states to obtain a waiver from the
federal standards would seriously inhibit the ability to
collect this important data.
We urge you, Senator Pryor, and your colleagues, to
consider the following recommendations:
Do not support maintaining this waiver provision.
If it is inevitable that this provision will remain in the
bill, we urge you support including the following provisions
in the bill:
The requirement for a written determination that all
provisions and substance of state law are equal to or
stricter than the federal requirements in assuring that
residents attain and/or maintain their highest practicable
physical, mental, and psychosocial well-being before a waiver
will be granted;
Stating that any waiver request not approved in writing
within the specified time period would be deemed denied;
Provisions giving the Secretary the authority to take
action against a facility providing substandard care, and
where the state has not taken adequate enforcement action;
Requirement that the penalty for failure of a State to
comply with a provision of Medicaid law, or State law
requirements under a waiver, is the current 100% withholding
of Medicaid payments to the state;
Including a private right of action for residents and their
representatives to challenge the Secretary's granting of a
waiver before it goes into effect.
Thank you for your dedication to the quality of care and
services provided to nursing home residents. We look forward
to working with you on these issues.
Sincerely,
Elma Holder,
Executive Director.

Mr. PRYOR. I offer also some other concerns I have about the
standards as set forth in the Roth language versus the language that we
are trying to get the conferees to adopt at this time.
First, in States that get waivers, the Secretary of HHS will have no
enforcement authority against individual facilities and weaker
enforcement authority against the States as a whole.
Now, why do we want weaker authority? Why do we want weaker
standards? This is something that we are asking today as a question.
The second weakness is, Mr. President, that the language only says
what the Secretary can do to the States, not to individual nursing
homes.
For example, if a State has been given a waiver, if HHS determines
that the State, for example, of New Hampshire has laws and regulations
that are equal to or better than the Federal provisions, so the HHS
Secretary stamps a document saying, ``You are under no Federal
regulations,'' then the State of New Hampshire at that time,
notwithstanding that a nursing home or several nursing homes absolutely
are giving unconscionable treatment to their nursing home residents,
the Federal Government has no authority, no empowerment to do anything
about those particular homes.
They can move against a State. They cannot move against the
particular homes. Those residents, those nursing home residents, Mr.
President, are sitting there, lying there, housed there absolutely
helpless and without an advocate to come to their side to protect them.
The third concern, Mr. President, current law today allows the
Secretary to withhold all Medicaid funds from the States that have
problems in nursing homes.
Senator Roth's amendment that was approved by the Senate which
preempted the so-called Pryor-Cohen amendment, the Roth amendment only
allows the Secretary to withhold 2 percent of Medicaid funds from
waiver States.
What kind of a lever is that? What kind of a bargaining chip is that,
just to be able to hold 2 percent of the Medicaid funds from those
States with a waiver?
Also, Mr. President, look at the litigation. Just imagine the
litigation that is going to result if we do not keep the present
standards. If we wade off into this unknown field that our colleagues
on the other side of the aisle have presented to us and say, ``If you
get a waiver, you can do this,'' but there are no guidelines. We are
not sure what is going to be the law or the regulations that each State
will adopt. We will just do our best.
Mr. President, how much litigation is going to result from this
indecision, from this attempt at obfuscation of the nursing home
standards that have served us so well since 1987? To me it is
unconscionable for us to think about watering down the present
standards that we see today that have served us so well in nursing home
standards.
Mr. President, I am very hopeful that the Senate later on this
afternoon

[[Page S 16947]]
when we begin our voting process is going to support this motion to
instruct the conferees to keep the present nursing home standards that
we have and, once again, that have served us so very well.
Mr. President, we are also looking today at the typical nursing home
resident. We look at those nursing home residents and realize that
before 1987 and before we had these particular nursing home standards
that we are trying to maintain today--look at the characteristics of a
nursing home patient, of a nursing home resident. All of us in this
Chamber, perhaps, have someone in a nursing home--an aunt, uncle, a
mother, dad, grandmother, grandparent, grandfather, relative, good
friend. We will look at the characteristic of the nursing home patient
and residents that we have today.
Mr. President, 77 percent of all of the nursing home residents need
help in dressing; 63 percent need help in toileting; 91 percent need
help in bathing; 66 percent have a mental disorder. Mr. President,
also, over 50 percent of the nursing home residents today in America
have no relative, no friend, no one that becomes their friend and their
advocate to make periodic visits, to make certain that basic rights are
adhered to.
We have certain things that OBRA '87 brought about. The right for the
nursing home patients and residents to choose their own physician. We
are about to repeal that, perhaps. We have basically the protection
that the nursing home residents can open their own mail and have the
confidentiality of their medical records being protected. We are about
to repeal that.
Mr. President, the average nursing home resident out there today, we
feel, needs every protection, the highest standards that we can bring
about. And for us to turn our back and say we are going to, basically,
obliterate these standards and have them no longer, in my opinion would
be a tragedy and a disgrace.

Mr. President, I see my colleague from Michigan, who has now come to
the floor. I understand he is going to manage this issue for the other
side. So, since he wants to speak, I assume, I will at this point yield
the floor and reserve the remainder of my time.
Mr. President, I suggest the absence of a quorum and ask unanimous
consent that the time for the quorum not be charged against either
side.
The PRESIDING OFFICER. Without objection, it is so ordered.
The clerk will call the roll.
The legislative clerk proceeded to call the roll.
Mr. ABRAHAM. Mr. President, I ask unanimous consent that the order
for the quorum call be rescinded.
The PRESIDING OFFICER. Without objection, it is so ordered.
Mr. ABRAHAM. Mr. President, I yield myself such time as I may need to
speak more generally on the reconciliation bill that is going to be
dealt with later this week.
Earlier, when this issue regarding motions to instruct was being
talked about, there were several I was considering bringing. Because of
the unanimous-consent agreement that was entered into, these are
precluded from being brought here today, but I would like to speak
responsive to those because I think it is important, as our conferees
begin to meet, that they focus on some of the issues of difference that
existed between the Senate package and the package that passed the
House.
In particular, as you will note, Mr. President, back during the final
hours of debate on the reconciliation bill, the so-called Byrd rule was
invoked to remove from the Senate reconciliation bill a number of
provisions which related to the welfare reform proposals that are in
the reconciliation bill. I had considered bringing back some of those
in the form of instructions to our Senate conferees to accede to what
the House has attempted to do in these areas, because I think it was a
huge mistake for the Senate to remove some of these things from our
package.
Specifically, during the final hours of that debate we removed part
of the welfare reform bill that would have provided States with an
incentive, in the form of additional dollars, to those States that were
able to reduce the rate of illegitimate births, of out-of-wedlock
births, through various programs they might enact so long as they did
not simultaneously increase the abortion rate as a way they might
accomplish the reduction in the out-of-wedlock births. This was a topic
we debated at great length here in the Senate when the topic of welfare
reform was before us. It is one that really had quite a bit of
consensus support on both sides of the aisle. In fact, an amendment
relating to it was defeated, an effort to take it out of our welfare
bill, with more than 60 Senators voting to retain this so-called
illegitimacy bonus language in the bill.
I think we have heard, from both sides of the aisle and across
America, great concern expressed in an ongoing basis over the problem
of rising numbers of illegitimate births in our country. Indeed, we
have even heard percentages that are projected to be as high as 40
percent of all children born in this country by the year 2000 will be
born out of wedlock. The social indicators are that children born under
these circumstances typically have higher rates of dropout from school,
higher drug abuse rates, higher likelihood of becoming, themselves,
involved in some type of criminal activity. It is a problem that spans
the entire country and it is one which we in the Congress, I think,
have responsibility to address.
The one and only way in which we attempted to address this very
specifically in the welfare reform bill was through this provision,
which would have provided States with the incentive to reduce the
number of illegitimate births. For that reason, I was stunned when the
Byrd rule was invoked, to try to remove--and in fact it did remove--
this provision from the bill. In my judgment it was a terrible
statement to make at the time when people from all political
perspectives are arguing this is a problem of national concern and a
problem we must address.
I can understand there were politics involved in the invocation of
the Byrd rule with regard to the reconciliation bill on a number of
fronts. But this statement was a mistake. I think making this statement
sent the wrong signal. I think in many ways it was a repudiation of the
concerns of average men and women, citizens across this country, who
have been focusing on what we are doing here and asking, hoping the
Congress will be responsive to a serious problem.
So, Mr. President, I say again, even though it is not in the form of
an instruction, it is this Senator's hope the conferees will work to
make sure the provisions in the reconciliation bill which addressed
out-of-wedlock births in the form of providing States with financial
incentives to address these problems locally will keep such language in
whatever package returns to us.
Another provision which was likewise removed was the provision which
would have capped the amount of time that people could be recipients of
welfare benefits to 5 years. As I have traveled throughout my State,
one of the concerns I hear expressed constantly by people is the notion
that they do not want to see welfare become a way of life. The best and
surest way to address that, I think, was the approach which we took
here in the Senate in the welfare bill we did consider. It was
overwhelmingly adopted. Approximately 87 Senators joined together to
support the bill. In that bill we had a 5-year limit on the benefits
that people would be allowed to receive from the welfare system. That,
too, was a provision that was struck during the debate on the
reconciliation package, again, I think sending absolutely the worst
possible signal the Congress of the United States could send to people
in this country who look to us to set rules that are fair and
responsive to their concerns.
As I talk to the hard-working men and women of my State, who pay
their bills and pay the taxes and are genuinely compassionate toward
those in need, what I hear them say is, ``Fine, we want to provide a
safety net. We want to be helpful. But we think there are certain
points at which enough is enough. Five years seems like a reasonable
period of time for them.''
For that reason, I sincerely hope, again, the conferees on the
reconciliation package, whether or not it is in the form of an
instruction from us, will be responsive to these concerns and retain
the sort of language which we had

[[Page S 16948]]
in the Senate bill prior to the invocation of the Byrd rule during the
last hours of debate.
Mr. President, I yield the floor.
The PRESIDING OFFICER. Who yields time?
Mr. PRYOR. Mr. President, I suggest the absence of a quorum, and I
ask unanimous consent that the time for the quorum not be charged
against either side.
The PRESIDING OFFICER. Is there objection?
Without objection, it is so ordered.
The clerk will call the roll.
The bill clerk proceeded to call the roll.
Mr. GREGG. Mr. President, I ask unanimous consent that the order for
the quorum call be rescinded.
The PRESIDING OFFICER (Mr. Abraham). Without objection, it is so
ordered.
Mr. GREGG. Mr. President, I yield myself 5 minutes off the motion.
The PRESIDING OFFICER. The Senator from New Hampshire is recognized.

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