(Senate - May 18, 2005)

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[Pages S5437-S5448]
From the Congressional Record Online through the Government Publishing Office []


      By Mr. COLEMAN (for himself, Mr. Smith, Ms. Snowe, Mr. Dayton, 
        and Mr. Harkin):

[[Page S5438]]

  S. 1060. A bill to amend the Internal Revenue Code of 1986 to allow a 
credit against income tax for the purchase of hearing aids; to the 
Committee on Finance.
  Mr. COLEMAN. Mr. President, today I am introducing legislation to 
help millions of Americans enjoy the gift of sound. I am pleased to be 
joined by Senators Gordon Smith, Olympia J. Snowe, Mark Dayton, and Tom 
Harkin, who I know care as deeply about these issues as I do.
  Hearing loss is one of the most common and widespread health problems 
affecting Americans today. In fact, thirty-three babies are born each 
day with hearing loss, making deafuess the most common birth defect in 
America. According to the National Council on Aging, as many as 70 
percent of our elderly experience hearing loss. All told, 31.5 million 
Americans currently suffer from some form of hearing loss.
  The good news is that 95 percent of individuals with hearing loss can 
be successfully treated with hearing aids. Unfortunately, however, only 
22 percent of Americans suffering from hearing loss can afford to use 
this technology. In other words, over 24 million Americans will live 
without sound because they cannot afford treatment.
  That is why we are introducing the Hearing Aid Assistance Tax Credit 
  This legislation provides help to those who need it most, our 
children and seniors, by providing a tax credit of up to $500, once 
every 5 years, toward the purchase of any ``qualified hearing aid'' as 
defined by the Federal Food, Drug, and Cosmetic Act.
  Hearing aids are not just portals to sound, but portals to success in 
school, business, and life. That is why a number of diverse 
organizations, including the Hearing Industries Association, Self Help 
for Hard of Hearing People, the International Hearing Society, the Deaf 
and Hard of Hearing Alliance, American Speech-Language-Hearing 
Association, and the American Academy of Audiology support the Hearing 
Aid Assistance Tax Credit Act.
  I ask unanimous consent that their letters of support be printed in 
the Record.
  Hearing loss may be one of the most common health problems in the 
United States, but it doesn't have to be. We can tackle the problem 
head on with the Hearing Aid Assistance Tax Credit Act.
  I look forward to working with my colleagues this Congress to approve 
this commonsense solution to a serious problem.
  There being no objection, the materials were ordered to be printed in 
the Record, as follows:

         Deaf and Hard of Hearing Alliance: A Coalition of 
           Consumer and Professional Organizations,
                                                     May 18, 2005.
     Hon. Norm Coleman,
     U.S. Senate,
     Washington, DC.
       Dear Senator Coleman: We, the undersigned, representing 
     both consumer and health professional organizations of the 
     Deaf and Hard of Hearing Alliance (DHHA), write to express 
     our strong support for the ``Hearing Aid Assistance Tax 
     Credit Act'' you are introducing in the Senate today. While 
     we support and encourage more comprehensive solutions, we 
     believe your legislation can aid some who presently have no 
     options but to pay out of pocket for these essential devices.
       Enactment of your legislation will provide a tax credit of 
     up to $500 per hearing aid, available once every five years, 
     towards the purchase of a hearing aid(s) for individuals age 
     55 and over, or those purchasing a hearing aid for a 
       As you have pointed out with the introduction of this bill, 
     special tax treatment would improve access to hearing aids 
     since only 22 percent of Americans who could benefit from 
     hearing aids currently use them. Approximately 1 million 
     children under the age of 18 and nearly 10 million Americans 
     over the age of 54 have a diagnosed hearing loss but are not 
     currently using a hearing aid.
       The expense of the hearing aid is an important factor why 
     Americans with hearing loss go without these devices. Some 40 
     percent of individuals with hearing loss have incomes of less 
     than $30,000 per year. Nearly 30 percent of those with 
     hearing loss cite financial constraints as a core reason they 
     do not use hearing aids. In 2002, the average cost for a 
     hearing aid was over $1,400, and almost two-thirds of 
     individuals with hearing loss require two devices, thereby 
     increasing the average out of pocket expense to over $2,800. 
     The new tax credit you propose will assist many who might 
     otherwise do without and have limited options.
       Hearing aids are presently not covered under Medicare, or 
     under the vast majority of state mandated benefits. In fact, 
     71.4% of hearing aid purchases do not involve third party 
     payments, placing the entire burden of the hearing aid 
     purchase on the consumer.
       The need is real. Hearing loss affects 2-3 infants per 
     1,000 births. For adults, hearing loss usually occurs more 
     gradually, but increases dramatically with age. Ten million 
     older Americans experience age-related hearing loss. For 
     workers, noise induced hearing loss is the second most self-
     reported occupational injury. Ten million young adults and 
     working aged Americans have noise-induced hearing loss.
       Enactment of your bill will make a difference in the lives 
     of some people with hearing loss. Currently 1.28 million 
     Americans of all ages purchase hearing aids each year, with 
     many individuals requiring two devices, bringing the total 
     number of hearing aids purchased across all age groups to 
     approximately 2 million. This number has remained constant 
     over recent years. While the legislation is not intended to 
     cover the full cost of hearing aids, it will provide some 
     measure of financial assistance to the groups who are in need 
     of these devices but are unable to afford them.
       Thank you for your leadership on this important issue. We 
     look forward to working with you to seek enactment of your 
     legislation during the 109th Congress.
         Alexander Graham Bell Association for the Deaf & Hard of 
           Hearing (AGBell), American Academy of Audiology (AAA), 
           American Speech-Language-Hearing Association (ASHA), 
           Conference of Educational Administrators of Schools and 
           Programs for the Deaf (CEASD), Cued Language Network of 
           America (CLNA), Media Access Group at WGBH.
         National Association of the Deaf (NAD), National Court 
           Reporters Association (NCRA), National Cued Speech 
           Association (NCSA), Self Help for Hard of Hearing 
           People (SHHH), Telecommunications for the Deaf, Inc. 
           (TDI), TECHUnit.

                                                     May 17, 2005.
     Hon. Norm Coleman,
     U.S. Senate,
     Washington, DC.
       Dear Senator Coleman: The American Speech-Language-Hearing 
     Association (ASHA) commends you for your continued leadership 
     on behalf of the estimated 28 million American children and 
     adults with hearing loss by introducing legislation to 
     provide assistance to those purchasing hearing aids. The 
     Hearing Aid Assistance Tax Credit Act will provide financial 
     assistance to those who need hearing aids, but are unable to 
     afford them. This bill will provide much needed assistance to 
     those adults over 55 years of age and families with children 
     who experience hearing loss.
       Studies indicate that when children with hearing loss 
     receive early intervention and treatment with devices such as 
     hearing aids, their speech and language development improves 
     dramatically, making the need for special education services 
     less likely and costly. Research has also shown that the 
     quality of life greatly improves for elderly individuals who 
     use hearing aids.
       On behalf of the 118,000 audiologists, speech-language 
     pathologists, and hearing, speech, and language scientists 
     qualified to meet the needs of the estimated 49 million (or 1 
     in 6) children and adults in the United States with 
     communication disorders, we thank you for introducing this 
     important piece of legislation and look forward to working 
     with you and your staff.
     Dolores E. Battle,
       President, American Speech-Language-Hearing Association.

                                International Hearing Society,

                                        Livonia, MI, May 16, 2005.
     Hon. Norm Coleman,
     Hart Senate Office Building,
     Washington, DC.
       Dear Senator Coleman: On behalf of the International 
     Hearing Society (IHS), I write to enthusiastically endorse 
     the Hearing Aid Assistance Tax Credit Act. IHS represents the 
     vast majority of traditional hearing aid dispensers (hearing 
     aid specialists) in the United States. Hearing aid 
     specialists are licensed in 49 states (and registered in 
     Colorado) specifically to provide hearing health services. 
     Our members test hearing; select, fit and dispense hearing 
     aids; and provide hearing rehabilitation and counseling 
     services. Hearing aid specialists dispense approximately one-
     half of all hearing aids in this country.
       IHS is deeply appreciative of your interest in improving 
     access to hearing health care. Only approximately 20% of 
     those who could benefit from amplification actually utilize 
     hearing aids. Allowing a credit against tax for the purchase 
     of hearing aids would likely promote access to this effective 
     but dramatically underutilized device.
       We look forward to working together to promote the nation's 
     hearing health, a vital component of overall health and well-
     being. Please contact me or our Washington Counsel Karen S. 
     Sealander of McDermott Will & Emery with questions or for 
     further information.
                                                   Harlan S. Cato,

[[Page S5439]]

                                                     May 18, 2005.
     Hon. Norm Coleman,
     U.S. Senate,
     Washington, DC.,
       Dear Senator Coleman: On behalf of the Hearing Industries 
     Association (HTA) and the individuals with hearing loss 
     served by our members, I want to thank you for introducing 
     the Hearing Aid Assistance Tax Credit Act, and offer HIA's 
     strong endorsement and support for this worthwhile 
       The Hearing Industries Association (HIA) is dedicated to 
     providing information about, promoting the use of, and 
     enhancing access to amplification devices in the United 
     States. These devices include externally worn hearing aids, 
     implantable hearing aids (cochlear, middle ear and brain 
     stem) and an array of assistive listening devices (both 
     personal and public area communication systems used in 
     auditoriums, theaters, classrooms and public buildings). Our 
     members work with the medical community and hearing aid 
     professionals to treat hearing loss in children and adults, 
     and we have seen firsthand the dramatic benefit that hearing 
     aids can provide in terms of greater safety, increased 
     ability to communicate, and an overall significantly enhanced 
     quality of life.
       For the 31.5 million Americans who have some degree of 
     hearing loss, the vast majority (95%) can be treated with 
     hearing aids. Yet only 20% of those with hearing loss use 
     hearing aids, while a full 30% cite financial constraints as 
     the reason they do not use hearing aids. This modest bill 
     would help countless older adults and children who need 
     hearing aids, but simply cannot afford them. The benefits, in 
     terms of reduced special education costs for children, as 
     well as reduced injuries and psychological and mental 
     disorders associated with hearing loss in older adults, are 
       Again, on behalf of HIA and the individuals with hearing 
     loss whom we serve, we applaud your leadership in introducing 
     the Hearing Aid Assistance Tax Credit Act, and look forward 
     to working with you to pass the bill in the 109th Congress.
                                                     Carole Rogin,
     Hearing Industries Association.

       Dear Senator Coleman: On behalf of Self Help for Hard of 
     Hearing People, the Nation's largest consumer group for 
     people with hearing loss, we would like to express our 
     support of the Hearing Aid Assistance Tax Credit Act.
       More than 28 million Americans at all stages of life have 
     some form of hearing loss. If left untreated, hearing loss 
     can severely reduce the quality of one's personal and 
     professional life. A landmark study conducted by the National 
     Council on Aging (NCOA) concluded that hearing loss was 
     associated with, among other things: depression, impaired 
     memory, social isolation and reduced general health. For 
     infants and children left untreated, the cost to schools for 
     special education and other programs can exceed $420,000, 
     with additional lifetime costs of $1 million in lost wages 
     and other health complications, according to a respected 1995 
     study published in the International Journal of Pediatric 
       While fully 95 percent of individuals with hearing loss 
     could be successfully treated with hearing aids, only 22 
     percent currently use them, according to the largest national 
     consumer survey on hearing loss in America. Almost \1/3\ of 
     the individuals surveyed cite financial constraints as a core 
     reason they do not use hearing aids, which is not surprising 
     since hearing aids are not covered under Medicare, or under 
     the vast majority of state mandated benefits. In fact, over 
     71 percent of all hearing aid purchases involve no third 
     party payments, thereby placing the entire burden of the 
     purchase on the consumer.
       The Hearing Aid Assistance Tax Credit Act offers a 
     practical, low cost, and common sense solution to help older 
     individuals who may not otherwise be able to afford to 
     purchase a hearing aid, or those purchasing a hearing aid for 
     their child. The bill is not intended to cover the full cost 
     of hearing aids, but would simply provide some measure of 
     financial assistance to the populations who are most in need 
     of these devices but may not be able to afford them: those 
     approaching or in retirement, and families with children.
       This bipartisan initiative is endorsed by virtually the 
     entire spectrum of organizations and consumer groups within 
     the hearing health community. We view this legislation as an 
     effective and responsible means to encourage individuals to 
     treat their hearing loss in order to maintain or improve 
     quality of life.
       We are pleased to offer you our support.

                                                 Terry Portis,

                                               Executive Director,
     Self Help for Hard of Hearing People.

                                American Academy of Audiology,

                                         Reston, VA, May 17, 2005.
     Hon. Norm Coleman,
     U.S. Senate, Hart Senate Office Building,
     Washington, DC.
       Dear Senator Coleman: The American Academy of Audiology, 
     the largest organization of audiologists representing over 
     9,700 audiologists, commends you on your leadership on 
     hearing health care issues and championing policies that 
     benefit individuals with hearing loss.
       The Academy supports the Hearing Aid Assistance Tax Credit 
     Act which would provide a tax credit of up to $500 per 
     hearing aid, available once every five years, towards the 
     purchase of a hearing aid(s) for individuals age 55 and over, 
     or those purchasing a hearing aid for a dependent. As you 
     have pointed out with the introduction of this bill, special 
     tax treatment would improve access to hearing aids since only 
     22 percent of Americans who could benefit from hearing aids 
     currently use them. Approximately, 1 million children under 
     the age of 18 and nearly 10 million Americans over the age of 
     54 have a diagnosed hearing loss but are not currently using 
     a hearing aid.
       Hearing aids are presently not covered under Medicare, or 
     under the vast majority of state mandated benefits. In fact, 
     71.4 percent of hearing aid purchases do not involve third 
     party payments, placing the entire burden of the hearing aid 
     purchase on the patient/consumer. This legislation is a 
     beginning step to helping some individuals with this expense 
     and raises the awareness of the impact that hearing loss has 
     on today's society.
       In addition, the Academy endorses the Hearing Health 
     Accessibility Act (S. 277) to provide Medicare beneficiaries 
     with the option of going to an audiologist or a physician for 
     hearing and balance diagnostic tests. Direct access would 
     improve Medicare beneficiaries' access to hearing care 
     without diminishing the important role of medical doctors, or 
     expanding the scope of practice for audiology. The Academy 
     urges you to support this legislation as well.
       The Academy appreciates the opportunity to work with you to 
     promote these important initiatives in the 109th Congress. 
     Again, we thank you for your leadership in introducing the 
     Hearing Aid Assistance Tax Credit Act and for your dedication 
     to the needs of individuals with hearing loss and the health 
     care professionals providing the services they need to fully 
     function in society.
                                                  Richard E. Gans,

                                S. 1060

       Be it enacted by the Senate and House of Representatives of 
     the United States of America in Congress assembled,


       This Act may be cited as the ``Hearing Aid Assistance Tax 
     Credit Act''.


       (a) In General.--Subpart A of part IV of subchapter A of 
     chapter 1 of the Internal Revenue Code of 1986 (relating to 
     nonrefundable personal credits) is amended by inserting after 
     section 25B the following new section:


       ``(a) Allowance of Credit.--In the case of an individual, 
     there shall be allowed as a credit against the tax imposed by 
     this chapter an amount equal to the amount paid during the 
     taxable year, not compensated by insurance or otherwise, by 
     the taxpayer for the purchase of any qualified hearing aid.
       ``(b) Maximum Amount.--The amount allowed as a credit under 
     subsection (a) shall not exceed $500 per qualified hearing 
       ``(c) Qualified Hearing Aid.--For purposes of this section, 
     the term `qualified hearing aid' means a hearing aid--
       ``(1) which is described in section 874.3300 of title 21, 
     Code of Federal Regulations, and is authorized under the 
     Federal Food, Drug, and Cosmetic Act for commercial 
     distribution, and
       ``(2) which is intended for use--
       ``(A) by the taxpayer, but only if the taxpayer (or the 
     spouse intending to use the hearing aid, in the case of a 
     joint return) is age 55 or older, or
       ``(B) by an individual with respect to whom the taxpayer, 
     for the taxable year, is allowed a deduction under section 
     151(c) (relating to deduction for personal exemptions for 
       ``(d) Election Once Every 5 Years.--This section shall 
     apply to any individual for any taxable year only if such 
     individual elects (at such time and in such manner as the 
     Secretary may by regulations prescribe) to have this section 
     apply for such taxable year. An election to have this section 
     apply may not be made for any taxable year if such election 
     is in effect with respect to such individual for any of the 4 
     taxable years preceding such taxable year.
       ``(e) Denial of Double Benefit.--No credit shall be allowed 
     under subsection (a) for any expense for which a deduction or 
     credit is allowed under any other provision of this 
       (b) Clerical Amendment.--The table of sections for subpart 
     A of part IV of subchapter A of chapter 1 of such Code is 
     amended by inserting after the item relating to section 25B 
     the following new item:

``Sec. 25C . Credit for hearing aids.''.

       (c) Effective Date.--The amendments made by this section 
     shall apply to taxable years beginning after December 31, 
      By Mr. NELSON of Florida (for himself, Mr. Burns, and Mrs. 
  S. 1063. A bill to promote and enhance public safety and to encourage 
the rapid deployment of IP-enabled voice services; to the Committee on 
Commerce, Science, and Transportation.
  Mr. NELSON of Florida. Mr. President, I rise today with my 

[[Page S5440]]

Senators Burns and Clinton, to introduce the ``IP-Enabled Voice 
Communications and Public Safety Act of 2005'' and ask unanimous 
consent that the text of the bill be printed in the Record.
  There being no objection, the bill was ordered to be printed in the 
Record, as follows:

                                S. 1063

       Be it enacted by the Senate and House of Representatives of 
     the United States of America in Congress assembled,


       This Act may be cited as the ``IP-Enabled Voice 
     Communications and Public Safety Act of 2005''.


       (a) 911 and E-911 Services.--Notwithstanding section 2(b) 
     or any other provision of the Communications Act of 1934, the 
     Commission shall prescribe regulations to establish a set of 
     requirements or obligations on providers of IP-enabled voice 
     service to ensure that 911 and E-911 services are available 
     to customers to IP-enabled voice service. Such regulations 
     shall include an appropriate transition period by which to 
     comply with such requirements or obligations and take into 
     consideration available industry technological and 
     operational standards, including network security.
       (b) Non-discriminatory Access to Capabilities.--Each entity 
     with ownership or control of the necessary emergency services 
     infrastructure shall provide any requesting IP-enabled voice 
     service provider with nondiscriminatory access to their 
     equipment, network, databases, interfaces and any other 
     related capabilities necessary for the delivery and 
     completion of 911 and E911 calls and information related to 
     such 911 or E911 calls. Such access shall be consistent with 
     industry standards established by the National Emergency 
     Number Association or other applicable industry standards 
     organizations. Such entity shall provide access to the 
     infrastructure at just and reasonable, nondiscriminatory 
     rates, terms and conditions. The telecommunications carrier 
     or other entity shall provide such access to the 
     infrastructure on a stand-alone basis.
       (c) State Authority.--Nothing in this Act, the 
     Communications Act of 1934, or any Commission regulation or 
     order shall prevent the imposition on or collection from a 
     provider of voice services, including IP-enabled voice 
     services, of any fee or charge specifically designated or 
     presented as dedicated by a State, political subdivision 
     thereof, or Indian tribe on an equitable, and non-
     discriminatory basis for the support of 911 and E-911 
     services if no portion of the revenue derived from such fee 
     or charge is obligated or expended for any purpose other than 
     support of 911 and E-911 services or enhancements of such 
       (d) Standard.--The Commission may establish regulations 
     imposing requirements or obligations on providers of voice 
     services, entities with ownership or control of emergency 
     services infrastructure under subsections (a) and (b) only to 
     the extent that the Commission determines such regulations 
     are technologically and operationally feasible.
       (e) Customer Notice.--Prior to the compliance with the 
     rules as required by subsection (a), a provider of an IP-
     enabled voice service that is not capable of providing 911 
     and E-911 services shall provide a clear and conspicuous 
     notice of the unavailability of such services to each 
     customer at the time of entering into a contract for such 
     service with that customer.
       (f) Voice Service Provider Responsibility.--An IP-enabled 
     voice service provider shall have the sole responsibility for 
     the proper design, operation, and function of the 911 and 
     E911 access capabilities offered to the provider's customers.
       (g) Parity of Protection for Provision or Use of IP-enabled 
     Voice Service.--
       (1) Provider parity.--If a provider of an IP-enabled voice 
     service offers 911 or E-911 services in compliance with the 
     rules required by subsection (a), that provider, its 
     officers, directors, employees, vendors, and agents, shall 
     have immunity or other protection from liability of a scope 
     and extent that is not less than the scope and extent of 
     immunity or other protection from liability that any local 
     exchange company, and its officers directors, employees, 
     vendors, or agents, have under the applicable Federal and 
     State law (whether through statute, judicial decision, 
     tariffs filed by such local exchange company, or otherwise), 
     including in connection with an act or omission involving the 
     release of subscriber information related to the emergency 
     calls or emergency services to a public safety answering 
     point, emergency medical service provider, or emergency 
     dispatch provider, public safety, fire service, or law 
     enforcement official, or hospital emergency or trauma care 
       (2) User parity.--A person using an IP-enabled voice 
     service that offers 911 or E-911 services pursuant to this 
     subsection shall have immunity or other protection from 
     liability of a scope and extent that is not less than the 
     scope and extent of immunity or other protection from 
     liability under applicable law in similar circumstances of a 
     person using 911 or E-911 service that is not provided 
     through an IP-enabled voice service.
       (3) PSAP parity.--In matters related to IP-enabled 911 and 
     E-911 communications, a PSAP, and its employees, vendors, 
     agents, and authorizing government entity (if any) shall have 
     immunity or other protection from liability of a scope and 
     extent that is not less than the scope and extent of immunity 
     or other protection from liability under applicable law 
     accorded to such PSAP, employees, vendors, agents, and 
     authorizing government entity, respective, in matters related 
     to 911 or E-911 communications that are not provided via an 
     IP-enabled voice service.
       (h) Delegation Permitted.--The Commission may, in the 
     regulations prescribed under this section, provide for the 
     delegation to State commissions of authority to implement and 
     enforce the requirements of this section and the regulations 


       Section 158 of the National Telecommunications and 
     Information Administration Organization Act (as added by 
     section 104 of the ENHANCE 911 Act of 2004) is amended--
       (1) by redesignating subsections (d) and (e) as subsections 
     (e) and (f), respectively; and
       (2) by inserting after subsection (c) the following:
       ``(d) Migration Plan Required.--
       ``(1) National plan required.--No more than 18 months after 
     the date of the enactment of the ENHANCE 911 Act of 2004, the 
     Office shall develop and report to Congress on a national 
     plan for migrating to a national IP-enabled emergency network 
     capable of receiving and responding to all citizen activated 
     emergency communications.
       ``(2) Contents of plan.--The plan required by paragraph (1) 
       ``(A) outline the potential benefits of such a migration;
       ``(B) identify barriers that must be overcome and funding 
     mechanisms to address those barriers;
       ``(C) include a proposed timetable, an outline of costs and 
     potential savings;
       ``(D) provide specific legislative language, if necessary, 
     for achieving the plan; and
       ``(E) provide recommendations on any legislative changes, 
     including updating definitions, to facilitate a national IP-
     enabled emergency network.
       ``(3) Consultation.--In developing the plan required by 
     paragraph (1), the Office shall consult with representatives 
     of the public safety community, technology and 
     telecommunications providers, and others it deems 


       (a) In General.--For purposes of this Act:
       (1) 911 and e-911 services.--
       (A) 911.--The term ``911'' means a service that allows a 
     user, by dialing the three-digit code 911, to call a public 
     safety answering point operated by a State, local government, 
     Indian tribe, or authorized entity.
       (B) E-911.--The term ``E-911 service'' means a 911 service 
     that automatically delivers the 911 call to the appropriate 
     public safety answering point, and provides automatic 
     identification data, including the originating number of an 
     emergency call, the physical location of the caller, and the 
     capability for the public safety answering point to call the 
     user back if the call is disconnected.
       (2) Ip-enabled voice service.--The term ``IP-enabled voice 
     service'' means an IP-enabled service used for real-time 2-
     way or multidirectional voice communications offered to a 
     customer that--
       (A) uses North American Numbering Plan administered 
     telephone numbers, or successor protocol; and
       (B) has two-way interconnection or otherwise exchange 
     traffic with the public switched telephone network.
       (3) Customer.--The term ``customer'' includes a consumer of 
     goods or services whether for a fee, in exchange for an 
     explicit benefit, or provided for free.
       (4) Ip-enabled service.--The term ``IP-enabled service'' 
     means the use of software, hardware, or network equipment 
     that enable an end user to send or receive a communication 
     over the public Internet or a private network utilizing 
     Internet protocol, or any successor protocol, in whole or 
     part, to connect users--
       (A) regardless of whether the communication is voice, data, 
     video, or other form; and
       (B) notwithstanding --
       (i) the underlying transmission technology used to transmit 
     the communications;
       (ii) whether the packetizing and depacketizing of the 
     communications occurs at the customer premise or network 
     level; or
       (iii) the software, hardware, or network equipment used to 
     connect users.
       (5) Public switched telephone network.--The term ``public 
     switched telephone network'' means any switched common 
     carrier service that is interconnected with the traditional 
     local exchange or interexchange switched network.
       (6) PSAP.--The term ``public safety answering point'' or 
     ``PSAP'' means a facility that has been designated to receive 
     911 calls.
       (b) Common Terminology.--Except as otherwise provided in 
     subsection (a), terms used in this Act have the meanings 
     provided under section 3 of the Communications Act of 1934.
      By Mr. COCHRAN (for himself, Mr. Kennedy, Mr. Warner, Ms. 
        Cantwell, Ms. Collins, and Mr. Dayton):
  S. 1064. A bill to amend the Public Health Service Act to improve 
stroke prevention, diagnosis, treatment, and rehabilitation; to the 
Committee on Health, Education, Labor, and Pensions.

[[Page S5441]]

  Mr. KENNEDY. Mr. President, the month of May is Stroke Awareness 
Month, and it is a privilege to join Senators Cochran, Warner, 
Cantwell, Collins, and Dayton in introducing the Stroke Treatment and 
Ongoing Prevention Act of 2005. The STOP Stroke Act is a vital step in 
building a national network of effective care to diagnose and quickly 
treat victims of stroke and improve the quality of care for stroke 
patients across America.
  For over 20 years, stroke has been the third leading cause of death 
in our country, affecting about 700,000 Americans a year and killing 
approximately 163,000 a year. Every 45 seconds, another American 
suffers a stroke. Every 3 minutes, another American dies. Few families 
today are untouched by this cruel, debilitating, and often fatal 
disease that strikes indiscriminately, and robs us of our loved ones. 
Even for those who survive, a stroke can have devastating consequences. 
Over half of all survivors are left with a disability.
  Prompt treatment with clot-dissolving drugs within three hours of a 
stroke can dramatically improve these outcomes. Yet, only 2-3 percent 
of all stroke patients are treated with such a drug within those 
crucial first three hours. Few Americans recognize the symptoms of 
stroke, and crucial hours are often lost before a patient receives 
treatment. Emergency room staffs are often not trained to recognize and 
manage the symptoms, which further adds to the delay in treatment. 
Patients at hospitals with primary stroke centers have nearly five 
times greater chance of receiving clot-dissolving drugs.
  Modern medicine is generating new scientific advances that increase 
the chance of survival and at least partial or even full recovery 
following a stroke. Physicians are learning to manage strokes more 
effectively, and they are also learning how to prevent them in the 
first place.
  But science doesn't save lives and protect health by itself. We need 
to do more to bring new discoveries to the patient and new awareness to 
the public. That means educating as many people as possible about the 
warning signs of stroke, so that they know enough to seek medical 
attention. It means training doctors and nurses in the best techniques 
of care. It means finding better ways to treat victims as quickly and 
as effectively as possible--so that they have the best chance of full 
  Our bill provides grants to States to implement statewide systems of 
stroke care that will give health professionals the equipment and 
training they need to treat this disorder. It also establishes a 
continuing education program to make sure that medical professionals 
are well trained and well aware of the newest treatments and prevention 
strategies. The initial point of contact between a stroke patient and 
medical care is usually an emergency medical technician. Grants under 
this bill may be used to train these personnel to provide more 
effective care to stroke patients in the crucial first few moments 
after an attack.

  The bill directs the Secretary of Health and Human Services to 
conduct a national media campaign to inform the public about the 
symptoms of stroke, so that more patients can recognize the symptoms 
and receive prompt medical care. The bill also authorizes the Secretary 
of HHS, acting through CDC, to operate the Paul Coverdell National 
Acute Stroke Registry, which will collect data about the care of stroke 
patients and assist in the development of more effective treatments.
  The bill also provides new resources for states to improve the 
standard of care for stroke patients in hospitals, and to increase the 
quality of care in rural hospitals through improvements in 
  On Monday, the Wall Street Journal published an excellent article on 
the inadequate treatment that stroke patients often encounter when 
ambulances bring them to hospitals with staffs not trained in the early 
treatment of stroke or lacking the needed equipment to intervene early. 
Over twenty years ago, the survival of trauma victims was very much 
dependent on whether the ambulance took them to a hospital with a 
trauma care center, or to a hospital not equipped to treat traumatic 
injury. Congress passed the Trauma Care Systems Planning and 
Development Act of 1990 that revolutionized the treatment for accident 
victims. Now in 2005, it is long past time to see that state of the art 
care is made available to stroke patients as quickly as possible.
  Stroke is a national tragedy that leaves no American community 
unscarred. Fortunately, if the right steps are taken during the brief 
window of time available, effective treatment can make all the 
difference between healthy survival and disability or death. We need to 
do all we can to see that those precious few hours are not wasted. The 
STOP Stroke Act is a significant step in reaching that goal. May is 
Stroke Awareness Month, and I urge Congress to act quickly on this 
legislation, and give stroke victims a far better chance for full 
  I ask unanimous consent that the full text of a Wall Street Journal 
article of May 9 on this issue be printed in the Record.
  There being no objection, the article was ordered to be printed in 
the Record, as follows:

              [From the Wall Street Journal, May 9, 2005]

            Stroke Victims Are Often Taken to Wrong Hospital

                         (By Thomas M. Burton)

       Christina Mei suffered a stroke just before noon on Sept. 
     2, 2001. Within eight minutes, an ambulance arrived. Her 
     medical fate may have been sealed by where the ambulance took 
       Ms. Mei's stroke, caused by a clot blocking blood flow to 
     her brain, occurred while she was driving with her family 
     south of San Francisco. Her car swerved, but she was able to 
     pull over before slumping at the wheel. Paramedics saw the 
     classic signs of a stroke: The 45-year-old driver couldn't 
     speak or move the right side of her body.
       Had Ms. Mei's stroke occurred a few miles to the south, she 
     probably would have been taken to Stanford University Medical 
     Center, one of the world's top stroke hospitals. There, a 
     neurologist almost certainly would have seen her quickly and 
     administered an intravenous drug to dissolve the clot. 
     Stanford was 17 miles away, across a county line.
       But paramedics, following county ambulance rules that 
     stress proximity, took her 13 miles north, to Kaiser 
     Permanente's South San Francisco Medical Center. There, 
     despite her sudden inability to talk or walk and her facial 
     droop, an emergency-room doctor concluded she was suffering 
     from depression and stress. It was six hours before a 
     neurologist saw her, and she never got the intravenous clot-
     dissolving drug.
       In a legal action brought against Kaiser on Ms. Mei's 
     behalf, an arbitrator found that her care had been negligent, 
     and in some aspects ``incomprehensible.'' Today, Ms. Mei 
     can't dress herself and walks unsteadily, says her lawyer, 
     Richard C. Bennett. The fingers on her right hand are curled 
     closed, and she has had to give up her main avocations: 
     calligraphy, ceramics and other types of art. Kaiser declined 
     to comment beyond saying that it settled the case under 
     confidential terms ``based on some concerns raised in the 
       Stroke is the nation's No. 1 cause of disability and No. 3 
     cause of death, killing 164,000 people a year. But far too 
     many stroke victims, like Ms. Mel, get inadequate care thanks 
     to deficient medical training and outdated ambulance rules 
     that don't send patients to the best stroke hospitals.
       Over the past decade, American medicine has learned how to 
     save stroke patients' lives and keep them out of nursing 
     homes. New techniques offer a better chance of complete 
     recovery by dissolving blood clots and treating even more 
     lethal strokes caused by burst blood vessels in the brain. 
     But few patients receive this kind of treatment because most 
     hospitals lack specialized staff and knowledge, stroke 
     experts say. State and county rules generally require 
     paramedics to take stroke patients to the nearest emergency 
     room, regardless of that hospital's level of expertise with 
       Stroke care is positioned roughly where trauma care was a 
     quarter-century ago. By 1975, surgeons expert at treating 
     victims of car crashes and other major accidents realized 
     that taking severely injured patients to the nearest 
     emergency room could mean death. So the surgeons led a push 
     to make selected regional hospitals into specialized trauma 
     centers and to overhaul ambulance protocols so that 
     paramedics would speed the most severely injured to those 
     centers. Now, in many areas of the U.S., accident victims go 
     quickly to a trauma center, and trauma specialists say this 
     change has saved lives and lessened disability.
       Eighty percent or more of the 700,000 stokes that Americans 
     suffer annually are ``ischemic,'' meaning they are caused by 
     blockage of an artery feeding the brain, usually a blood 
     clot. Most of the rest are ``hemorrhagic'' strokes, resulting 
     from burst blood vessels in or near the brain. Although they 
     have different causes, both result in brain tissue dying 
     by the minute.
       Several factors have combined to prevent improvement in 
     stroke care. In some areas, hospitals have resisted movement 
     toward a system of specialized stroke centers because 
     nondesignated institutions could lose business, according to 
     neurologists who favor the

[[Page S5442]]

     changes. In addition, stroke treatment has lacked an 
     organized lobby to galvanize popular and political interest 
     in the ailment.

                            doctor ignorance

       A big reason for the backwardness of much stroke treatment 
     is that many doctors know little about it. Even emergency 
     physicians and internists likely to see stroke victims tend 
     to receive scant neurology training in their internships and 
     residencies according to stroke specialists.
       ``Surprisingly, you could go through your entire internal 
     medicine rotation without training in neurology, and in 
     emergency medicine it hasn't been emphasized,'' says James C. 
     Grotta, director of the stroke program at the University of 
     Texas Health Science Center at Houston.
       Many hospitals don't have a neurologist ready to deal with 
     emergencies. As a result, strokes aren't treated urgently 
     there, even though short delays increase chance of severe 
     disability or death. Even if doctors do react quickly, recent 
     research has shown that many aren't sure what treatment to 
       For example, a survey published in 2000 in the journal 
     Stroke showed that 66 percent of hospitals in North Carolina 
     lacked any protocol for treating stroke. About 82 percent 
     couldn't rapidly identify patients with acute stroke.
       As with other life-threatening conditions, stroke patients 
     are better off going where doctors have had a lot of practice 
     addressing their ailment. A seven-year analysis of surgery in 
     New York state in the 1990s showed that patients with 
     ruptured blood vessels in the brain were more than twice as 
     likely to die--16% versus 7%--in hospitals doing few such 
     operations, compared with those doing them regularly. A 
     national study published last year in the Journal of 
     Neurosurgery showed a similar disparity.
       Another major shortcoming of most stroke treatment, 
     according to many neurologists, is the failure to use the 
     genetically engineered clot-dissolving drug known as tPA. 
     Short for tissue plasminogen activator, tPA, which is made by 
     Genentech Inc., has been shown to be a powerful treatment 
     that can lessen disability for many patients. A study 
     published in 2004 in The Lancet, a prominent medical journal, 
     showed that the chances of returning to normal are about 
     three times greater among patients getting tPA in the first 
     90 minutes after suffering a stroke, even after accounting 
     for tPA's potential side effect of cerebral bleeding that can 
     cause death. But several recent medical-journal articles have 
     found that nationally, only 2% to 3% of strokes caused by 
     clots are treated with tPA, which has no competitor on the 
       Some authors of studies supporting the use of tPA have had 
     consultant or other financial relationships with Genentech. 
     Skeptics of the drug point to these ties and stress tPA's 
     side-effect danger. But among stroke neurologists, there is a 
     strong consensus that the drug is effective.
       One reason why many patients don't receive tPA is that they 
     arrive at the hospital more than three hours after a stroke, 
     the time period during which intravenous tPA should be given. 
     But many hospitals and doctors don't use tPA at all, even 
     though it has been available in the U.S. since 1996. The 
     dissolving agent's relatively high cost--$2,000 or more per 
     patient--is a barrier. Medicare pays hospital a flat 
     reimbursement of about $6,700 for stroke treatment, 
     regardless of whether tPA is used.

                           airport emergency

       Glender Shelton of Houston had an ischemic stroke caused by 
     a clot at Los Angeles International Airport on Dec. 30, 2003. 
     In full view of other holiday travelers, Ms. Shelton, then 
     66, slumped over, and an ambulance was called. It was 4:45 
       By 5:55 p.m., she arrived at what now is called Centinela 
     Freeman Regional Medical Center, four miles away in Marina 
     del Rey. Hospital records show that doctors thought Ms. 
     Shelton had suffered an ``acute stroke.'' But she didn't get 
     a CT scan, a recommended initial step, until 9 p.m. By then, 
     she was already outside the three-hour window for safely 
     administering intravenous tPA. Records also say she didn't 
     receive the drug ``due to unavailability of neurologist until 
     after the patient had been outside the three-hour time 
       Ms. Shelton's daughter, Sandi Shaw, was until recently 
     nurse-manager of the prestigious stroke unit at the 
     University of Texas Health Science Center at Houston. Ms. 
     Shaw says that at her unit, her mother would have had a CT 
     scan within five minutes of arriving, and tPA probably would 
     have been administered 30 or 35 minutes after that.
       Today, according to her daughter, Ms. Shelton often can't 
     come up with words or relatives' names, can't take care of 
     her finances, and can't follow certain basic commands in 
     neurological tests.
       Kent Shoji, an emergency-room doctor at Centinela Freeman 
     who handled Ms. Shelton's case, says, ``She was a possible 
     candidate for tPA,'' but a CT scan was required first. ``The 
     order was put in for a CT scan,'' Dr. Shoji says, ``I can't 
     answer why it took so long.''
       A Centinela Freeman spokeswoman says, ``We did not have 24/
     7 coverage with our CT scan, and we had to call, a technician 
     to come in. That's pretty common with a community hospital.'' 
     The hospital has since been acquired by a larger health 
     system and now does have 24-hour CT capability.

                         `Parochial Interests'

       A hospital-accrediting group has begun designating 
     hospitals as stroke centers, but that is only part of what is 
     needed, stroke experts assert. They say hospitals typically 
     have to come together to create local political momentum to 
     change state or county rules to that ambulances actually take 
     stroke patients to stroke centers, not the nearest ER. New 
     York, Maryland and Massachusetts are moving toward creating 
     stroke-care systems, and Florida recently passed a law 
     creating stroke centers. But in many places, short-term 
     economic interests impede change, some doctors say.
       ``There are still very parochial interests by hospitals and 
     physicians to keep patients locally even if they're not 
     equipped to handle them,'' says neurosurgeon Robert A. 
     Solomon of New York Presbyterian Hospital/Columbia. 
     ``Hospitals don't want to give up patients.''
       The University of California at San Diego runs one of the 
     leading stroke hospitals in the country. It and others in the 
     area that are well prepared to treat stroke patients have 
     sought for a decade to set up a regional system, but there 
     has been little progress, says Patrick D. Lyden, UCSD's chief 
     of neurology, ``Some hospitals are resisting losing stroke 
     business,'' he says. ``We have the same political crap as in 
     most communities. Paramedics still take people to the local 
       Among the opponents of the stroke-center concept during the 
     1990s was Richard Stennes, the ER director at Paradise Valley 
     Hospital south of San Diego. In various public debates, Dr. 
     Stennes recalls, he argued that many apparent stroke patients 
     would be siphoned away from community hospitals even if they 
     didn't turn out to have strokes. Also, he argued that tPA 
     might cause more injury than it prevents. And then there was 
     the economic issue: ``Those hospitals without all the 
     equipment and stroke experts,'' he says, ``would be concerned 
     about all the patients going to a stroke center and taking 
     the patients away from us.'' Dr. Stennes has since retired.
       ``All hospitals and clinicians try to deliver the right 
     care to patients, especially those with urgent medical 
     needs,'' says Nancy E. Foster, vice president for quality of 
     the American Hospital Association, which represents both 
     large and small hospitals. ``Community hospitals may be 
     equally good at delivering stroke care, and it would be 
     important for patients to know how well prepared their local 
     hospital is.''
       Stroke experts aren't proposing that every hospital needs 
     to specialize in stroke care but instead that in every 
     population center there should be at least one that does. In 
     Atlanta, Emory University's neuro-intensive care unit 
     illustrates the special skills that make for top care. Owen 
     B. Samuels, director of the unit, estimates that 20% to 30% 
     of patients it treats received poor initial medical care 
     before arriving at Emory, jeopardizing their futures or even 
     lives. Brain hemorrhages, for example, are commonly 
     misdiagnosed, even in patients who repeatedly showed up at 
     emergency rooms with unusually severe headaches, Dr. Samuels 
       The Emory unit has 30 staff members, including two neuro-
     critical care doctors and five nurse practitioners. A team is 
     on duty 24 hours a day. The unit handles about two dozen 
     patients most days, keeping the staff busy. On the ward, 
     nearly all patients are unconscious or sedated, so it's 
     eerily silent. Patients generally need to rest their brains 
     as they recover from stroke or surgery.
       After a hemorrhagic stroke, blood pressure in the cranium 
     builds as blood continues to seep out of the ruptured vessel. 
     Pressure can be deadly, cutting off oxygen to the brain. Or 
     escaped blood can cause a ``vasospasm,'' days after the 
     original stroke, in which the brain reacts violently to 
     seeped-out blood. In the worst case, the brain herniates, or 
     squeezes out the base of the skull, causing death. To avoid 
     this, nurses at Emory constantly monitor brain pressure and 
     temperatures. They put in drain lines. They infuse medicines 
     to dehydrate, depressurize and stop bleeding.
       Since Emory launched the neuro-intensive unit seven years 
     ago, 42% of patients with hemorrhagic strokes have become 
     well enough to go home, compared with 27% before. Fewer need 
     rehabilitation--31% versus 40%--and the death rate is down.
       Damica Townsend-Head, 33, gave the Emory team a scare. 
     After surgery last fall for a hemorrhagic stroke, her brain 
     swelling was ``really out of control,'' Dr. Samuels says, 
     raising questions about whether she would survive. The staff 
     put a ``cooling catheter'' into a blood vessel, which allowed 
     the circulation of ice water to bring down the temperature in 
     her blood and brain. They intentionally dehydrated her brain 
     to lower pressure. A month later, she woke up and recovered 
     with minimal disability. She still walks with a cane and 
     tires easily, but her speech is normal and she hopes to 
     return soon to work. ``I consider her what we're in 
     business for,'' Dr. Samuels says.

                            public awareness

       The public's low awareness of stroke symptoms--and the need 
     to respond immediately--can also hinder proper care. Ischemic 
     strokes, those caused by clots or other artery blockage, 
     cause symptoms such as muscle weakness or paralysis on one 
     side, slurred speech, facial droop, severe dizziness, 
     unstable gait and vision loss. People with this kind of 
     stroke are sometimes mistaken for being drunk. In addition to 
     intense head

[[Page S5443]]

     pain, a hemorrhagic stroke often leads to nausea, vomiting or 
     loss of balance or consciousness. Still, many people with 
     some of these symptoms merely go to bed in hopes of improving 
     overnight, doctors say. Instead, they should go immediately 
     to a hospital and demand a CT scan as a first diagnostic 
       The well-funded American Heart Association, established in 
     1924, has made many people aware of heart attack symptoms and 
     thereby saved many lives. In contrast, the American Stroke 
     Association was started only in 1998 as a subsidiary of the 
     heart association. The stroke association spent $162 million 
     last year out of the heart association's $561 million overall 
       Justin Zivin, another University of California at San Diego 
     stroke expert, says the stroke association ``is a terribly 
     ineffective bunch. When it comes to actual public education, 
     I haven't seen anything.''
       The stroke association counters that it is buying 
     television and radio ads promoting awareness, similar to ones 
     produced in 2003 and 2004. The group also sponsors research 
     and education, including an annual international stroke-
     medicine conference.
       It's not just the general public that fails to recognize 
     stroke symptoms. Often, emergency-room doctors and nurses 
     don't either. Gretchen Thiele of suburban Detroit began 
     having horrible headaches last May, for the first time in her 
     life. ``She wasn't one to complain, but she said, `I can't 
     even lift my head off the pillow.' '' recalls her daughter, 
     Erika Mazero. Ms. Thiele, 57, nearly passed out from the pain 
     one night and suffered blurred vision. When the pain recurred 
     in the morning, she went to the emergency room at nearby St. 
     Joseph's Mercy of Macomb Hospital. Ms. Mazero says that 
     during the six hours her mother spent there, she was given a 
     CT scan, but not a spinal tap, which could definitively have 
     shown she had a leaking brain aneurysm, meaning a ballooned 
     and weakened artery in her brain. After the CT, Ms. Thiele 
     was given a muscle relaxant and pain medicine and sent home, 
     her daughter says.
       Two months later, the blood vessel burst. Neurosurgeons at 
     William Beaumont Hospital in Royal Oak, Mich., did emergency 
     surgery, but Ms. Thiele suffered massive bleeding and died. 
     Ali Bydon, one of the neurosurgeons at Beaumont, says a CT 
     scan often is inadequate and that her condition could have 
     been detected earlier with a spinal tap, also called a lumbar 
     puncture. ``Had she had a lumbar puncture and perhaps an 
     operation earlier, it might have saved her life,'' says Dr. 
     Bydon. ``In general, a person who tells you, `I usually don't 
     get headaches, and this is the worst headache of my life,' is 
     something that should alarm you.''
       In addition, he says Ms. Thiele ``absolutely'' was 
     experiencing smaller-scale bleeding in May that foreshadowed 
     a more serious rupture. If doctors identify this kind of 
     bleeding early, he says, chances of death are ``minimal.'' 
     But when a rupture occurs, he says, ``25% of patients 
     never make it to the hospital, 25% die in the hospital and 
     25% are severely disabled.''
       A St. Joseph's hospital spokeswoman says the hospital has 
     ``very aggressive standards for treatment, and we met this 
     standard.'' declining to elaborate.

                            determined nurse

       Paramedics did the right thing after Chuck Toeniskoetter's 
     stroke, but only because of some extraordinary intervention. 
     Mr. Toeniskoetter, then 55, was on a ski trip, Dec. 23, 2000, 
     at Bear Valley, near Los Angeles. He had just finished a run 
     at 3:30 p.m. when, in the snowmobile shop, he began slurring 
     his words and nearly fell over. Kathy Snyder, the nurse in 
     the ski area's first-aid room quickly diagnosed stroke. She 
     called a helicopter and an ambulance.
       Ms. Snyder says she knew the closest hospital with a stroke 
     team was Sutter Roseville Medical Center in Roseville, CA. 
     The helicopter pilot was planning to take Mr. Toeniskoetter 
     to a closer ER, but Ms. Snyder says she stood on the 
     helicopter runners, demanding the patient go to Sutter. The 
     pilot eventually relented. Mr. Toeniskoetter went to Sutter, 
     where he promptly received tPA. Today, he has no disability 
     and is back running a real estate-development business in the 
     San Jose area. ``Trauma patients go to trauma centers, not 
     the nearest hospital,'' he says. ``Stroke victims, too, 
     require a real specialized sort of care.''
       One-third of all strokes are suffered by people under 60, 
     and hemorrhagic strokes in particular often strike young 
     adults and children. Vance Bowers of Orlando, Fla., was 9 
     when he woke up screaming that his eyes hurt, shortly after 1 
     a.m. on Jan. 8, 2001. Malformed blood vessels in his brain 
     were bleeding. He was in a coma by the time an ambulance 
     delivered him at 1:57 a.m. to the nearest emergency room, at 
     Florida Hospital East Orlando.
       Emergency-room doctors soon realized Vance had a 
     hemorrhagic stroke. But neurosurgery isn't performed at that 
     hospital. A sister hospital 14 minutes away by ambulance, 
     Florida Hospital Orlando, did have neurosurgical capability. 
     But in part because of administrative tangles, Vance didn't 
     get to the second hospital until 4:37 a.m., more than two 
     hours after his arrival. Surgery began at 6:18 a.m. ``This 
     delay may have cost this young man the possibility of a 
     functional survival,'' Paul D. Sawin, the neurosurgeon who 
     operated on Vance, said in a letter to the hospitals' joint 
       Florida Hospital, an emergency-medicine group and an ER 
     doctor recently agreed to settle a lawsuit filed against them 
     in Orange County, Fla., Circuit Court by the Bowers family. 
     The defendants agreed to pay a total of $800,000, court 
     records show. Monica Reed, senior medical officer of the 
     hospital, says the care Vance received was ``stellar'' and 
     that any delays weren't medically significant. Vance's 
     stroke, not the care he received, caused his injuries, she 
       Vance, now 13, survived but is mentally handicapped and 
     suffers daily seizures, his mother, Brenda Bowers, says. Once 
     a star baseball player, he goes by wheelchair to a class for 
     disabled children. He speaks very slowly but not in a way 
     that many people can understand. ``He remembers playing 
     baseball with all of his friends,'' his mother says but they 
     rarely come around any more. ``He really misses all that.''
      By Mr. THUNE (for himself and Mrs. Clinton):
  S. 1065. A bill to amend title 10, United States Code, to extend 
child care eligibility for children of members of the Armed Forces who 
die in the line of duty; to the Committee on Armed Services.
  Mr. THUNE. Mr. President, today I rise with my distinguished 
colleague from New York, Senator Clinton, to introduce legislation that 
will provide a surviving spouse with two years of child care 
eligibility on any military instillation or Federal facility with a 
child care center. The legislation was inspired by our work on the 
Senate Armed Services Committee. In February the committee held an 
important hearing on improving survivor benefits and the government's 
role in helping survivors cope with the loss of a loved one. All too 
often surviving spouses are forced to make difficult, life changing 
decisions alone. Both Senator Clinton and I are determined to provide 
as much help as possible to those who must bear the burden of loss, 
particularly those with young children. By providing two years of child 
care eligibility, our goal is to ensure that a surviving spouse has the 
time and tools necessary to make a healthy adjustment to life after the 
servicemember's death. Many decisions face survivors, most importantly, 
how to make a living. Often that means having to re-enter the work 
force after years of being a working mother. The question of how to 
adequately care for young children while trying to find employment or 
restart a career should not be an issue. Further, we have expanded this 
eligibility to include access to child care centers in other Federal 
facilities. This will aide surviving spouses with children if they are 
in the process of relocating to an area of the country without a 
military base nearby, but in the proximity of a local Federal building. 
I am honored that Senator Clinton is working with me on this 
legislation and I encourage my colleagues to support this important 
      By Mr. VOINOVICH (for himself, Ms. Stabenow, Mr. Bunning, Mr. 
        Levin, Mr. Alexander, Mr. DeWine, Mr. McConnell, and Mr. 
  S. 1066. A bill to authorize the States (and subdivisions thereof), 
the District of Columbia, territories, and possessions of the United 
States to provide certain tax incentives to any person for economic 
development purposes; to the Committee on Finance.
  Mr. VOINOVICH. Mr. President, I rise today to introduce the Economic 
Development Act of 2005 to authorize States to provide tax incentives 
for economic development purposes.
  This legislation is crucial to preserve tax incentives as an 
important tool for State and local governments to promote economic 
development in the wake of last year's decision by the Sixth Circuit 
Court of Appeals in Cuno v. DaimlerChrysler.
  In its decision in Cuno, the Sixth Circuit struck down Ohio's 
manufacturing machinery and equipment tax credit, which I helped enact 
while I was Governor of Ohio, on grounds that it violated the 
``dormant'' Commerce Clause of the U.S. Constitution. The court ruled 
that the tax incentive violated the Commerce Clause of the U.S. 
Constitution because it granted preferential tax treatment to companies 
that invest within the State rather than in other States.
  The Cuno decision has had severe repercussions across the country. 
The decision immediately cast doubt on the constitutionality of tax 
incentives presently offered by all fifty States. As

[[Page S5444]]

a result, States and businesses have been reluctant to go forward with 
new projects that depend on the availability of tax incentives out of 
concern that the Cuno decision may be used to invalidate those 
incentives. This legal uncertainty has worsened an already challenging 
economic environment. Furthermore, the decision threatens to undermine 
federalism by dramatically restricting the ability of States to craft 
their tax codes to promote economic development in the manner they 
determine is best. If left standing, this decision will handcuff the 
States in the Sixth Circuit, as well as States in other circuits where 
the court chooses to follow Cuno, in their efforts to promote economic 
growth and create jobs. Additionally, it will cripple their ability to 
compete internationally. In today's competitive economic environment, 
we can not afford to unilaterally discard the use of tax incentive to 
attract business to this country. As a former Governor who had to 
compete against Japan, Canada, China and Europe for new business 
projects, I know just how important a role tax incentives can play in 
attracting new businesses. I can assure you that our competitors are 
certainly not going to stop using tax incentives. Neither should we.
  Fortunately, the U.S. Constitution gives Congress the power to 
determine which State actions violate the Commerce Clause. The purpose 
of the Economic Development Act of 2005 is therefore to have Congress 
override the decision in Cuno by authorizing States to provide tax 
incentives for economic development purposes. The legislation would 
remove the legal uncertainty surrounding tax incentives created by the 
Cuno decision and preserve the States' power to design their tax codes 
to promote economic development.
  The history of the tax incentive struck down in Cuno demonstrates the 
important role tax incentives can play in promoting economic 
development. When I was Governor of Ohio, at my request and as part of 
my jobs incentive package, the Ohio Legislature enacted the 
manufacturing machinery and equipment tax incentive to encourage 
businesses to expand their operations in Ohio and to help draw new 
businesses to Ohio. It worked. Between 1993 and 1997, Ohio was ranked 
number one in the Nation by Site Selection and Industrial Development 
magazine three times for highest number of new facilities, expanded 
facilities, and new manufacturing plants. Since the program's 
inception, businesses have been eligible to claim a total of $2 billion 
in credits toward $34 billion in new equipment investments.
  Currently, this incentive is part of an incentive package being 
offered to automobile manufacturer DaimlerChrysler in support of its 
plans for a $200 million expansion of their Jeep plant. The ruling by 
the Sixth Circuit in Cuno, however, puts that expansion in jeopardy and 
threatens to undermine Ohio's competitiveness in attracting new 
  In the Cuno decision, the Sixth Circuit ruled that the manufacturing 
machinery and equipment tax incentive, given by Ohio to DaimlerChrysler 
as part of its incentive package, violated the Commerce Clause of the 
U.S. Constitution because it discriminated against interstate 
commerce by granting preferential tax treatment to companies that 
expanded within the State rather than in other States.

  The Cuno decision is troubling for several reasons. First, I believe 
the Sixth Circuit failed to appreciate the need for States to condition 
the availability of certain tax incentives on the undertaking of the 
specified economic activity within a State. In the case of the 
manufacturing machinery and equipment tax incentive, Ohio needed to 
limit the availability of the tax incentive to the investments 
undertaken in the State. Otherwise, Ohio would have been giving 
companies a tax incentive for activity that did not benefit the State. 
In other words, Ohio would have been effectively subsidizing investment 
in other States. We all know that in economics there is no free lunch 
and States should not be forced to provide a free lunch when they 
choose to give tax incentives. If Ohio or any other State is willing to 
forego tax revenue, it should be allowed to receive something in 
return, namely investment or other economic activity in the State. 
Accordingly, Ohio's tax incentive did not discriminate against 
interstate commerce. It merely required companies, if they chose to 
take advantage of the incentive, to undertake the investment in Ohio, 
the same State that would be foregoing tax revenue to provide the 
  There is also a little legal fiction present in the Cuno decision. 
The court states that Ohio could have provided a direct subsidy to 
companies that undertook investment in the State. Because Ohio decided 
to structure the program as a tax credit, however, the court said that 
it ran afoul of the Commerce Clause. I do not see how a direct subsidy 
does not violate the dormant Commerce Clause, but a tax credit does. 
They are economically the same.
  If left standing, the Cuno decision will have a particularly 
detrimental effect on the U.S. manufacturing sector. From rising energy 
and health care costs to frivolous lawsuits and unfair international 
trade practices, the U.S. manufacturing sector and the hard working men 
and women who drive it are getting squeezed from all sides. Despite all 
they are up against, it's a testament to their ability and 
determination that they are still the most productive manufacturers in 
the world. This Sixth Circuit decision, however, is a new roadblock 
that threatens to take away one of the most effective and efficient 
means for assisting manufacturers who want to create new jobs here in 
America. The Economic Development Act of 2005 will make sure that 
manufacturers don't lose key tax incentives just when such incentives 
are needed the most.
  The Cuno decision also sets a bad precedent that, if not checked, 
could upset our carefully balanced federal system. One of the most 
ingenious aspects of the U.S. Constitution is that it leaves a great 
deal of power with the States. It gives the States flexibility to 
devise their own solutions and, in the process, fosters innovation in 
government. Thus, the States are the laboratories of our democracy and 
an innovation they have developed to help create jobs and prosperity 
are programs that encourage new growth through tax incentives for 
training, job creation, and investment in new plants and equipment. The 
availability of tax incentives was critical to our success in Ohio and 
in being number one in new plant construction and expansion. Because 
Ohio had the ability to devise tax incentives that fit its economic 
development needs, we were able to create thousands of new jobs. My 
legislation will guarantee that the States remain our engines of 
  This legislation is something that Congress should have done a long 
time ago. The courts are not well-suited to making the often complex 
policy decisions regarding whether a tax incentive truly discriminates 
against interstate commerce and hinders the creation of a national 
market, or whether a tax incentive actually fosters innovation and job 
growth. Such decisions necessarily involve a careful weighing of 
competing and often mutually exclusive interests, and therefore should 
be made by Congress. Moreover, judicial decisions often fail to provide 
bright lines on which incentives run afoul of the dormant Commerce 
Clause, injecting uncertainty about the validity of certain tax 
incentives that makes businesses weary of relying on them and reduce 
their effectiveness. Indeed, the Supreme Court itself has called its 
dormant Commerce Clause jurisprudence a ``quagmire.'' Hence, it is time 
that Congress provide some clear rules on the treatment of tax 
incentives under the Commerce Clause.
  As Supreme Court Justice Felix Frankfurter stated nearly a half-
century ago:

       At best, this Court can only act negatively; it can 
     determine whether a specific state tax is imposed in 
     violation of the Commerce Clause. Such decisions must 
     necessarily depend on the application of rough and ready 
     legal concepts. We cannot make a detailed inquiry into the 
     incidence of diverse economic burdens in order to 
     determine the extent to which such burdens conflict with 
     the necessities of national economic life. Neither can we 
     devise appropriate standards for dividing up national 
     revenue on the basis of more or less abstract principles 
     of constitutional law, which cannot be responsive to the 
     subtleties of the interrelated economies of Nation and 
       The problem calls for solution by devising a congressional 
     policy. Congress alone can provide for a full and thorough 
     canvassing of the multitudinous and intricate factors which 
     compose the problem of the taxing

[[Page S5445]]

     freedom of the States and the needed limits on such state 
     taxing power. Congressional committees can make studies and 
     give the claims of the individual States adequate hearing 
     before the ultimate legislative formulation of policy is made 
     by the representatives of all the States. . . . Congress 
     alone can formulate policies founded upon economic realities. 
     . . .

  The Economic Development Act of 2005 is a good first step toward 
providing the prudent and carefully considered legislation that Justice 
Frankfurter urged the Congress to pass nearly a half century ago.
  At its core, the Economic Development Act of 2005 recognizes that 
decisions should be made, if possible, at the State and local level. 
States make and should make decisions about the programs and services 
they want to provide with their tax dollars, not the least of which are 
economic development programs. Highway funding, education funding, 
welfare funding, and funding for seniors programs all vary from state 
to state because State legislatures, acting on behalf of their 
citizens, make choices and set priorities. This has allowed government 
policy to reflect the diversity of interests in our great republic and 
results in better and more responsive government. Accordingly, states 
should be allowed to prioritize economic development in an effort to 
create jobs and prosperity for their citizens, and, yes, attract 
business from outside their State. If States choose to use tax 
incentives to promote economic development, then that is not a 
violation of the interstate commerce clause, that's simply their 
choice. It is called federalism, and it should not be thwarted by the 
  There are a couple of points about this legislation that I would like 
to discuss. First, this legislation is carefully crafted to protect the 
most common and benign forms of tax incentives, but not to authorize 
those tax incentives that truly discriminate against interstate 
commerce. I believe this bill strikes the right balance between 
protecting States' tax rights and preserving long-established 
protections against truly discriminatory State tax practices. Second, 
this legislation does not invalidate any tax incentives. It only 
authorizes tax incentives. Any tax incentive not covered by the 
legislation's authorization is simply subject to the traditional 
dormant Commerce Clause review by the courts. Third, this legislation 
does not require any state to provide tax incentives. Although I had 
success using tax incentives to foster economic growth in Ohio while I 
was Governor, I recognize that some states have concerns about whether 
and how to offer tax incentives and therefore believe it should be left 
to the states to resolve these concerns.
  I am pleased that this legislation is being co-sponsored by all of 
the Senators representing States in the Sixth Circuit. We all realize 
that the right of states to make their own decisions about the programs 
and services they offer within their boundaries is their own and should 
not be taken away. Moreover, if the Supreme Court fails to review the 
Cuno decision, then our States, the States in the Sixth Circuit, will 
be at a competitive disadvantage in attracting businesses against other 
states which are not affected by the Cuno decision and can offer tax 
  The bill has also been endorsed by Governor Bob Taft of Ohio, the 
National Governors Association, the National League of Cities, the 
National Association of Counties, the National Conference of Mayors and 
the Federation of Tax Administrators, as well as by broad-based 
business coalitions and the Teamsters.
  I am hopeful that the seriousness of this issue, and the severity of 
the ruling's possible ramifications, will allow us to see quick and 
positive consideration of my bill. The States are in a crisis mode 
because of this ruling. In Ohio, as I'm sure is the case across the 
country, many important projects have been put on hold as we await the 
court's further action.
  The challenges that manufacturers and workers face today are daunting 
but surmountable. The last thing we need, however, is an artificial 
legal hurdle that threatens to trip us up. I urge my colleagues to 
support the Economic Development Act of 2005 so that we can preserve 
the ability of the States to foster economic development and help put 
our economy, and especially our manufacturing industries, back on the 
road to recovery and prosperity.
  I ask unanimous consent that the text of the bill be printed in the 
  There being no objection, the bill was ordered to be printed in the 
Record, as follows:

                                S. 1066

       Be it enacted by the Senate and House of Representatives of 
     the United States of America in Congress assembled,


       This Act may be cited as the ``Economic Development Act of 


       Congress hereby exercises its power under Article I, 
     Section 8, Clause 3 of the United States Constitution to 
     regulate commerce among the several States by authorizing any 
     State to provide to any person for economic development 
     purposes tax incentives that otherwise would be the cause or 
     source of discrimination against interstate commerce under 
     the Commerce Clause of the United States Constitution, except 
     as otherwise provided by law.


       (a) Tax Incentives Not Subject to Protection Under This 
     Act.--Section 2 shall not apply to any State tax incentive 
       (1) is dependent upon State or country of incorporation, 
     commercial domicile, or residence of an individual;
       (2) requires the recipient of the tax incentive to acquire, 
     lease, license, use, or provide services to property 
     produced, manufactured, generated, assembled, developed, 
     fabricated, or created in the State;
       (3) is reduced or eliminated as a direct result of an 
     increase in out-of-State activity by the recipient of the tax 
       (4) is reduced or eliminated as a result of an increase in 
     out-of-State activity by a person other than the recipient of 
     the tax incentive or as a result of such other person not 
     having a taxable presence in the State;
       (5) results in loss of a compensating tax system, because 
     the tax on interstate commerce exceeds the tax on intrastate 
       (6) requires that other taxing jurisdictions offer 
     reciprocal tax benefits; or
       (7) requires that a tax incentive earned with respect to 
     one tax can only be used to reduce a tax burden for or 
     provide a tax benefit against any other tax that is not 
     imposed on apportioned interstate activities.
       (b) No Inference.--Nothing in this section shall be 
     construed to create any inference with respect to the 
     validity or invalidity under the Commerce Clause of the 
     United States Constitution of any tax incentive described in 
     this section.


       (a) Definitions.--For purposes of this Act--
       (1) Compensating tax system.--The term ``compensating tax 
     system'' means complementary taxes imposed on both interstate 
     and intrastate commerce where the tax on interstate commerce 
     does not exceed the tax on intrastate commerce and the taxes 
     are imposed on substantially equivalent events.
       (2) Economic development purposes.--The term ``economic 
     development purposes'' means all legally permitted activities 
     for attracting, retaining, or expanding business activity, 
     jobs, or investment in a State.
       (3) Imposed on apportioned interstate activities.--The term 
     ``imposed on apportioned interstate activities'' means, with 
     respect to a tax, a tax levied on values that can arise out 
     of interstate or foreign transactions or operations, 
     including taxes on income, sales, use, gross receipts, net 
     worth, and value added taxable bases. Such term shall not 
     include taxes levied on property, transactions, or operations 
     that are taxable only if they exist or occur exclusively 
     inside the State, including any real property and severance 
       (4) Person.--The term ``person'' means any individual, 
     corporation, partnership, limited liability company, 
     association, or other organization that engages in any for 
     profit or not-for-profit activities within a State .
       (5) Property.--The term ``property'' means all forms of 
     real, tangible, and intangible property.
       (6) State.--The term ``State'' means each of the several 
     States (or subdivision thereof), the District of Columbia, 
     and any territory or possession of the United States.
       (7) State tax.--The term ``State tax'' means all taxes or 
     fees imposed by a State.
       (8) Tax benefit.--The term ``tax benefit'' means all 
     permanent and temporary tax savings, including applicable 
     carrybacks and carryforwards, regardless of the taxable 
     period in which the benefit is claimed, received, recognized, 
     realized, or earned.
       (9) Tax incentive.--The term ``tax incentive'' means any 
     provision that reduces a State tax burden or provides a tax 
     benefit as a result of any activity by a person that is 
     enumerated or recognized by a State tax jurisdiction as a 
     qualified activity for economic development purposes.
       (b) Rule of Construction.--It is the sense of Congress that 
     the authorization provided in section 2 should be construed 
     broadly and the limitations in section 3 should be construed 


       If any provision of this Act or the application of any 
     provision of this Act to any person or circumstance is held 
     to be unconstitutional, the remainder of this Act and the 
     application of the provisions of this Act to any

[[Page S5446]]

     person or circumstance shall not be affected by the holding.


       This Act shall apply to any State tax incentive enacted 
     before, on, or after the date of the enactment of this Act.
      By Mr. HARKIN:
  S. 1074. A bill to improve the health of Americans and reduce health 
care costs by reorienting the Nation's health care system toward 
prevention, wellness, and self care; to the Committee on Finance.
  Mr. HARKIN. Mr. President, for more than a decade, I have spoken out 
about the need to fundamentally reorient our approach to health care in 
America--to reorient it towards prevention, wellness and self care.
  I don't think you'll find too many people who would argue with the 
statement that if you get sick, the best place in the world to get the 
care you need is here in America. We have the best trained, highest-
skilled health professionals in the world. We have cutting-edge, state-
of-the-art equipment and technology. We have world-class health care 
facilities and research institutions.
  But, when it comes to helping people stay healthy and stay out of the 
hospital, we fall woefully short. In the U.S., we spend in excess of 
$1.8 trillion a year on health care. Fully 75 percent of that total is 
accounted for by chronic diseases--things like heart disease, cancer, 
and diabetes. And what these diseases have in common is that--in so 
many cases--they are preventable.
  In the United States, we fail to make an up-front investment in 
prevention. So we end up spending hundreds of billions on 
hospitalization, treatment, and disability. This is foolish--and, 
clearly, it is unsustainable. In fact, I've long said that we don't 
have a health care system here in America, we have a ``sick care'' 
system. And it is costing us dearly both in terms of health care costs 
and premature deaths.
  Consider the cost of major chronic diseases--diseases that, as I 
said, are so often preventable.
  For starters the annual cost of obesity is $117 billion. For 
cardiovascular disease is about $352 billion. For diabetes it's $132 
billion. For smoking it's more than $75 billion. And for mental illness 
it's $150 billion; indeed, major depression is the leading cause of 
disability in the United States.
  Now, if I bought a new car, drove that car off the lot, and never 
maintained it--never checked the oil, never checked the transmission 
fluid, never got it tuned up--you'd think I was crazy, not to mention 
grossly irresponsible. The common-sense principle with an automobile 
is: ``I pay a little now to keep the car maintained, or I pay a whole 
lot later.''
  Well, it's the same with our national health priorities. Right now, 
our health care system is in a downward spiral. We are not paying a 
little now; so we are paying a whole lot later.
  For example, we are failing to address the nation's growing obesity 
epidemic. Today 65 percent of our population is overweight or obese. 
Obesity is associated with numerous health problems and increased risks 
of diabetes, heart disease, stroke, and several types of cancer, to 
name just a few.
  Another contributing factor to our health crisis is tobacco. We don't 
hear as much about the dangers of tobacco use, today, as we used to. 
That's because there is a perception that we've turned the corner--that 
we've done all that we need to do. But that perception is not accurate. 
In 2002, 46 million American adults regularly smoked cigarettes--that 
26 percent of our population. Nearly 40 percent of college-aged 
students smoke. What this means is that after decades of education and 
efforts to stop tobacco use, more than one in every four Americans is 
still addicted to nicotine and smoking.
  Mental health is another enormous challenge that we are grossly 
neglecting. Mental health and chronic disease are intertwined. They can 
trigger one another. It is about time we stop separating the mind and 
body when discussing health. Prevention and mental health promotion 
programs should be integrated into our schools, workplaces, and 
communities along with physical health screenings and education. 
Surely, at the outset of the 21st century, it's time to move beyond the 
lingering shame and stigma that often attend mental health.
  Seventy percent of all deaths in the U.S. are now linked to chronic 
conditions such as heart disease, cancer, and diabetes. In so many 
cases, these chronic diseases are caused by poor nutrition, physical 
inactivity, tobacco use, and untreated mental illness. This is 
  After many months of meetings and discussions with Iowans and experts 
across the nation, today I am re-introducing comprehensive legislation 
designed to transform America's ``sick care'' system into a true health 
care system--one that emphasizes prevention and health promotion.
  I am calling this bill the HeLP America Act, with HeLP as an acronym 
for Healthy Lifestyles and Prevention. The aim is to give individuals 
and communities the information and tools they need to take charge of 
their own health.
  Because if we are serious about getting control of health-care costs 
and health-insurance premiums, then we must give people access to 
preventive care . . . and we must give people the tools they need to 
stay healthy and stay out of the hospital.
  This will take a sustained commitment from government, schools, 
communities, employers, health officials, and the tobacco and food 
industries. But a sustained effort can have a huge payoff--for 
individuals and families, for employers, for society, for government 
budgets, and for the economy at large.
  As I said, the HeLP America Act is comprehensive legislation. It a 
very complex, multifaceted bill. But, this afternoon, I'd just like to 
outline the bill's major elements:
  The first component addresses healthy kids and schools. Prevention 
and the development of a healthy habits and lifestyles must begin in 
the early years, with our children. Unfortunately, today, we are 
heading in exactly the wrong direction. More and more children all 
across America are suffering from poor nutrition, physical inactivity, 
mental health issues, and tobacco use.
  For example, just since the 1980s, the rates of obesity have doubled 
in children and tripled in teens. Even more alarming is the fact that a 
growing number of children are experiencing what used to be thought of 
primarily as adult health problems. Almost two-thirds--60 percent--of 
overweight children have at least one cardiovascular disease risk 
factor. Recent studies of children have shown that increasing weight, 
greater salt consumption from fast food, and poor eating habits have 
contributed to the rise in blood pressure, higher cholesterol levels, 
and a shockingly rapid increase in adult-onset diabetes.
  The HeLP America Act will more than double funding for the successful 
PEP program, which promotes health and physical education programs in 
our public schools. I find it disturbing that more than one third of 
youngsters in grades 9 through 12 do not regularly engage in adequate 
physical activity. This is a shame, because studies show that regular 
physical activity boosts self-esteem and improves health.
  The HeLP America Act will also expand the Harkin Fruit and Vegetable 
Program to provide more free fresh fruits and vegetables in more public 
schools. The bill will also encourage give schools incentives to create 
healthier environments, including goals for nutrition education and 
physical activity.
  The HeLP America Act would also establish a grant program to provide 
mental health screenings and prevention programs in schools, along with 
training for school staff to help them recognize children exhibiting 
early warning signs. It will improve access to mental health services 
for students and their families.
  New to the HeLP Act this year is a strong focus on breastfeeding 
promotion. Sound nutrition begins the moment a baby is born and there 
is a vast body of scientific evidence that shows beyond a shadow of a 
doubt that mom's milk is the ideal form of nutrition to promote child 
health. But in the U.S. we don't do enough to encourage breastfeeding. 
The HeLP America Act seeks to remove some of those barriers and to 
encourage new mothers to breastfeed.
  The second broad component of the HeLP American Act addresses Healthy 
Communities and Workplaces. For example, the bill aims to create a 
healthier workforce by providing tax

[[Page S5447]]

credits to businesses that offer wellness programs and health club 
memberships. Studies show that, on average, every $1.00 that is 
invested in workplace wellness returns $3.00 in savings on health 
costs, absences from work, and so on.
  At a field hearing in Iowa last year, I heard from Mr. Lynn Olson, 
CEO of Ottumwa Regional Health Center. The Center offers a 
comprehensive wellness program for its employees, including reduced 
health insurance premiums for those employees who meet individual 
health goals. The Center has seen tremendous savings from their 
investment in health promotion.
  My bill also creates a grant program for communities, encouraging 
them to develop localized plans to promote healthier lifestyles. For 
example, we want to support efforts like those going on in Webster 
County and Mason City, IA, where mall walking programs have been 
expanded into community-wide initiatives to promote wellness.
  At the same time, the bill provides new incentives for the 
construction of bike paths and sidewalks to encourage more physical 
activity, especially walking. It is shocking that, today, roughly one-
quarter of walking trips take place on roads without sidewalks or 
shoulders. And bike lanes are available for only about 5 percent of 
bike trips.
  As my colleagues know, I have been a longstanding advocate for the 
rights of people with disabilities. So I have given special attention 
to health-promotion programs and activities that include this 
population. I just mentioned the bill's incentives to create bike lanes 
and sidewalks on newly constructed roads. This will make a big 
difference to people with disabilities, who often are forced to travel 
in the street alongside cars because there are no sidewalks or bike 
lanes available for wheelchairs.
  The Centers for Disease Control has funded a program called Living 
Well with a Disability, which has actually decreased secondary 
conditions and led to improved health for participants. The program is 
an eight-session workshop that teaches individuals with disabilities 
how to change their nutrition and level of physical activity. The 
program not only increases healthy activities for people with 
disabilities, but has also led to a 10 percent decline in the cost for 
medical services, particularly emergency-room care and hospital stays.
  In addition, my bill includes a Working Well with a Disability 
program, which will build partnerships between employers and vocational 
rehabilitation offices with the aim of developing wellness programs in 
the workplace.
  Mr. President, the third component of the HeLP America Act addresses 
Responsible Marketing and Consumer Awareness. Having accurate, readily 
available information about the nutritional value of the foods we eat 
is the first step toward improving overall nutrition. Unfortunately, 
because of all the gimmicks and hype that marketers use to entice us to 
buy their products, determining the nutritional value of the foods we 
buy can be problematic--especially in restaurants. This is why the HeLP 
America bill proposes to extend the nutritional labeling requirements 
of the National Labeling and Education Act, which currently covers the 
vast majority of retail foods, to restaurants foods as well, which were 
exempted from the NLEA when it first passed.
  The marketing of junk food--especially to kids--is out of control. It 
was estimated that junk food marketers, alone, spent $15 billion in 
2002 promoting their fare. And, I don't have to tell you, they are not 
advertising broccoli and apples. No, the majority of these ads are for 
candy and fast food--foods that are high in sugar, salt, fat, and 
  Children--especially those under 8 years of age--do not always have 
the ability to distinguish fact from fiction. The number of TV ads that 
kids see over the course of their childhood has doubled from 20,000 to 
40,000. The sad thing is that, way back in the 1970s, the Federal Trade 
Commission recommended banning TV advertising to kids. And what was 
Congress's response? We made it even harder for the FTC to regulate 
advertising for children than it is to regulate advertising for adults. 
My bill will restore the authority of the FTC to regulate marketing to 
kids, and it encourages the FTC to do so.
  The fourth component of the HeLP American Act addresses 
Reimbursements for Prevention Services. Right now, our medical system 
is setup to pay doctors to perform a $20,000 gastric bypass instead of 
offering advice on how to avoid such risky procedures. The bill will 
reimburse and reward physicians for practicing prevention and 
screenings. It will also expand Medicare coverage to pay for counseling 
for nutrition and physical activity, mental health screenings, and 
smoking-cessation programs. It also would establish a demonstration 
project in the Medicare program, long overdue in my opinion, under 
which we can learn how best to use our health care dollars to prevent 
chronic diseases rather than just manage them once they've occurred. 
Frankly, it's a little embarrassing that we haven't done this before.
  Finally, let me point out that the HeLP America Act will be paid for 
by creating a new National Health Promotion Trust Fund paid for through 
penalties on tobacco companies that fail to cut smoking rates among 
children, by ending the taxpayer subsidy of tobacco advertising, and 
also by reinstating the top income tax rates for wealthy Americans.
  It's time for the Senate to lead America in a new direction. We need 
a new health care paradigm--a prevention paradigm.
  Some will argue that avoiding obesity and preventable disease is 
strictly a matter of personal responsibility. Well, we all agree that 
individuals should act responsibly. I'm all for personal 
responsibility. But I also believe in government responsibility. 
Government has a responsibility to ensure that people have the 
information and tools and incentives they need to take charge of their 
health. And that is what the HeLP America Act is all about.
  Of course, this description of my bill just scratches the surface. 
The HeLP America Act is comprehensive. It is ambitious. And I fully 
expect an uphill fight in some quarters of Congress.
  But just as with the Americans with Disabilities Act 14 years ago, I 
am committed to doing whatever it takes--and for as long as it takes--
to pass this critically needed legislation.
  It's time to heed the Golden Rule of Holes, which says: When you are 
in a hole, stop digging. Well, we have dug one whopper of a hole by 
failing to emphasize prevention and wellness. And it's time to stop 
      By Mr. THUNE (for himself, Ms. Snowe, Mr. Bingaman, Ms. Collins, 
        Mr. Domenici, Mr. Gregg, Mr. Johnson, Mr. Lott, Ms. Murkowski, 
        Mr. Stevens, and Mr. Sununu):
  S. 1075. A bill to postpone the 2005 round of defense base closure 
and realignment; to the Committee on Armed Services.
  Mr. THUNE. Mr. President, I rise today to introduce a bill that would 
delay the implementation of the 2005 round of the Defense Base Closure 
and Realignment report issued by the Department of Defense on May 13, 
2005. The bill would postpone the execution of any decisions 
recommended in the report until certain anticipated events, having 
potentially large or unforeseen implications for our military force 
structure, have occurred, and both the department and Congress have had 
a chance to fully study the effects such events will have on our base 
  The bill identifies three principal actions that must occur before 
implementation of BRAC 2005. First, there must be a complete analysis 
and consideration of the recommendations of the Commission on Review of 
Overseas Military Structures. The overseas base commission has itself 
called upon the Department of Defense to ``slow down and take a 
breath'' before moving forward on basing decisions without knowing 
exactly where units will be returned and if those installations are 
prepared or equipped to support units that will return from garrisons 
in Europe, consisting of approximately 70,000 personnel.
  Second, BRAC should not occur while this country is engaged in a 
major war and rotational deployments are still ongoing. We have seen 
enough disruption of both military and civilian institutions due to the 
logistical strain brought about by these constant rotations of units 
and personnel to Iraq and Afghanistan without, at the same time, 
initiating numerous base closures and the multiple transfer of units 
and missions from base to base. This is simply too much to ask of our 
military, our communities and the families of our

[[Page S5448]]

servicemen and women, already stretched and over-taxed. And frankly, 
our efforts right now must be devoted to winning the global war on 
terrorism, not packing up and moving units around the country.

  Our bill would delay implementation of BRAC until the Secretary of 
Defense determines that substantially all major combat units and assets 
have been returned from deployment in the Iraq theater of operations, 
whenever that might occur.
  Third, to review or implement the BRAC recommendations without having 
the benefit of either the Commission or Congress studying the 
Quadrennial Defense Review, due in 2006, and its long-term planning 
recommendations seems counter-intuitive and completely out of logical 
sequence. Therefore, the bill requires that Congress receive the QDR 
and have an opportunity to study its planning recommendations as one of 
the conditions before implementing BRAC 2005.
  Fourth and Fifth: BRAC should not go forward until the implementation 
and development by the Secretaries of Defense and Homeland Security of 
the National Maritime Security Strategy; and the completion and 
implementation of Secretary of Defense's Homeland Defense and Civil 
Support Directive--only now being drafted. These two planning 
strategies should be key considerations before beginning any BRAC 
  Finally, once all these conditions have been met, the Secretary of 
Defense must submit to Congress, not later than one year after the 
occurrence of the last of these conditions, a report that assesses the 
relevant factors and recommendations identified by the Commission on 
Review of Overseas Base Structure; the return of our thousands of 
troops deployed in overseas garrisons that will return to domestic 
bases because of either overseas base reduction or the end of our 
deployments in the war; and, any relevant factors identified by the QDR 
that would impact, modify, negate or open to reconsideration any of the 
recommendations submitted by the Secretary of Defense for BRAC 2005.
  This proposed delay only seems logical and fair. There is no need to 
rush into decisions, that in a few years from now, could turn out to be 
colossal mistakes. We can't afford to go back and rebuild installations 
or relocate high-cost support infrastructure at various points in this 
country once those installations have been closed or stripped of their 
valuable capacity to support critical missions. I, therefore, introduce 
this legislation today and call upon my colleagues to join us in 
supporting its passage.
  I ask unanimous consent that the text of the bill be printed in the 
  There being no objection, the bill was ordered to be printed in the 
Record, as follows:

                                S. 1075

       Be it enacted by the Senate and House of Representatives of 
     the United States of America in Congress assembled,

                   AND REALIGNMENT.

       (a) Postponement.--Effective May 13, 2005, the Defense Base 
     Closure and Realignment Act of 1990 (part A of title XXIX of 
     Public Law 101-510; 10 U.S.C. 2687 note) is amended by adding 
     at the end the following:

                   CLOSURE AND REALIGNMENT.

       ``(a) In General.--Notwithstanding any other provision of 
     this part, the round of defense base closure and realignment 
     otherwise scheduled to occur under this part in 2005 by 
     reasons of sections 2912, 2913, and 2914 shall occur instead 
     in the year following the year in which the last of the 
     actions described in subsection (b) occurs (in this section 
     referred to as the `postponed closure round year').
       ``(b) Actions Required Before Base Closure Round.--(1) The 
     actions referred to in subsection (a) are the following 
       ``(A) The complete analysis, consideration, and, where 
     appropriate, implementation by the Secretary of Defense of 
     the recommendations of the Commission on Review of Overseas 
     Military Facility Structure of the United States.
       ``(B) The return from deployment in the Iraq theater of 
     operations of substantially all (as determined by the 
     Secretary of Defense) major combat units and assets of the 
     Armed Forces.
       ``(C) The receipt by the Committees on Armed Services of 
     the Senate and the House of Representatives of the report on 
     the quadrennial defense review required to be submitted in 
     2006 by the Secretary of Defense under section 118(d) of 
     title 10, United States Code.
       ``(D) The complete development and implementation by the 
     Secretary of Defense and the Secretary of Homeland Security 
     of the National Maritime Security Strategy.
       ``(E) The complete development and implementation by the 
     Secretary of Defense of the Homeland Defense and Civil 
     Support directive.
       ``(F) The receipt by the Committees on Armed Services of 
     the Senate and the House of Representatives of a report 
     submitted by the Secretary of Defense that assesses military 
     installation needs taking into account--
       ``(i) relevant factors identified through the 
     recommendations of the Commission on Review of Overseas 
     Military Facility Structure of the United States;
       ``(ii) the return of the major combat units and assets 
     described in subparagraph (B);
       ``(iii) relevant factors identified in the report on the 
     2005 quadrennial defense review;
       ``(iv) the National Maritime Security Strategy; and
       ``(v) the Homeland Defense and Civil Support directive.
       ``(2) The report required under subparagraph (F) of 
     paragraph (1) shall be submitted not later than one year 
     after the occurrence of the last action described in 
     subparagraphs (A) through (E) of such paragraph.
       ``(c) Administration.--For purposes of sections 2912, 2913, 
     and 2914, each date in a year that is specified in such 
     sections shall be deemed to be the same date in the postponed 
     closure round year, and each reference to a fiscal year in 
     such sections shall be deemed to be a reference to the fiscal 
     year that is the number of years after the original fiscal 
     year that is equal to the number of years that the postponed 
     closure round year is after 2005.''.
       (b) Ineffectiveness of Recommendations for 2005 Round of 
     Defense Base Closure and Realignment.--Effective May 13, 
     2005, the list of military installations recommended for 
     closure that the Secretary of Defense submitted pursuant to 
     section 2914(a) of the Defense Base Closure and Realignment 
     Act of 1990 shall have no further force and effect.