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Specifically, these provisions include a section based upon legislation, H.R. 1224, which I have sponsored, along with Representative CARDIN, to ensure fair and equitable Medicare f unding for residents being trained to be physicians. Section 541 of Title V of this bill would, for the first time, ensure that teaching hospitals, such as those at the Texas Medical Center, will receive higher Medicare r eimbursements for their physician residents. Under current law, these graduate medical education resident payments are based upon hospital-specific costs. As a result, teaching hospitals in Texas currently receive as much as six times less than those paid to hospitals in New York. This

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provision would fix this equity by establishing three new tiers of payments for residencies. For those teaching hospitals whose payments are more than 40 percent above the national average, their GME payments would be frozen for Fiscal Year 2001 and 2002. From Fiscal Year 2003 to 2005, their payments would be reduced by a factor of market basket minus 2 percent. For those hospitals whose payments are less than 40 percent of the national average, their payments would be increased to at least 70 percent of the national average.

   This bill also includes a modified version of legislation, H.R. 1483, which I have sponsored, along with Representative CRANE, to provide graduate medical education funding for nursing and paramedical education programs. Under existing law, Medicare p ayments for nursing and paramedical graduate medical educational programs are based upon the number of traditional Medicare p atients seen at these teaching hospitals. As more Medicare p atients enroll in Medicare m anaged care plans, many of these patients are no longer seen at these facilities. As a result, teaching hospitals receive less funding for these nursing and paramedical programs. H.R. 1483 would carve out a portion of the payment paid to Medicare m anaged care plans and transfer these funds to those hospitals with these teaching programs similar to the manner in which physicians training programs are paid. Under this conference report, teaching hospitals with nursing and paramedical teaching programs will receive $60 million in new funding. Regrettably, this funding will not come from Medicare m anaged care plans. Rather, this funding would be transferred from physicians training programs. As a result, teaching hospitals with both physician and nursing training programs will receive no new net funding. I will continue working to restore to original funding stream so that Medicare m anaged care plans contribute toward the cost of these training programs.

   Other important Medicare p rovisions include adjustments to ensure the higher costs of training our nation's physicians. This provision would increase Medicare r eimbursements for Indirect Medical Education (IME) costs. The conference report provides an IME reimbursement of 6.5 percent in Fiscal Year 2000, 6.25 percent in Fiscal Year 2001, and 5.5 percent thereafter. Under existing law, these IME payments would be reduced to 5.5 percent. These provisions are estimated to save hospitals $700 million over five years.

   I am also pleased that this conference report includes language to provide higher reimbursements for pap s mears. Under existing law, Medicare r eimbursements for pap s mears are $7.15 each. This bill would increase this reimbursement level to $14.60 per pap s mear. This reimbursement level has not been increased for many years and will help to ensure that senior citizens receive this important preventive health test. This provision also covers the new pap s mear technology so women would be eligible to receive these state-of-the-art tests which have a better record of finding and diagnosing ovarian cancers. The Congressional Budget Office estimates that this provision will cost $100 million over five years and $300 million over ten years. I am pleased that Congress has decided to provide the investment for many women whose lives will be saved by this test.

   This conference report also includes a provision to ensure that the State of Texas can keep $27 million to help states conduct outreach identifying Medicaid eligible children. The State of Texas has the highest uninsured rate of 24.5 percent of its population. The Texas Department of Health has determined that 800,000 of the 1.4 million uninsured children are eligible for, but not enrolled in, Medicaid. Under existing law, the State of Texas and other states would lose up to $500 million on December 31, 1999 because of a sunset provision in the Welfare Reform Act of 1995. This measure eliminates this deadline while ensuring that the State of Texas get the resources it needs to identify and enroll Medicaid-eligible children.

   The conference report further includes $150 million in Medicare r eimbursements for immunosuppressive drugs. Under existing law, Medicare b eneficiaries can only receive three years of immunosuppressive drugs following a lifesaving transplant operation. However, all of these patients must take these drugs indefinitely. I have cosponsored legislation, H.R. 1115, to eliminate this 3-year restriction. The conference report would provide eight months of additional coverage for these life-sustaining drugs in Fiscal Year 2001 and 2002. In addition, this funding permits the Secretary of Health and Human Services to extend this coverage up to $150 million over five years. Although the 3-year restriction was not eliminated, I believe that this extension is important because it means that Medicare b eneficiaries can receive the prescription drugs they need. For many Medicare b eneficiaries, these immunosuppressive drugs are extremely expensive and a financial burden. Many of these transplant operations are conducted at the teaching hospitals in my district at the Texas Medical Center. I will continue to work to extend this coverage indefinitely for those who need it.

   As a Co-Chair of the Congressional Biomedical Caucus, I am pleased that this bill will provide a total of $17.9 billion, or $2.3 billion more for biomedical research at the National Institutes of Health (NIH). This fifteen percent increase is the second down payment on our efforts to double the NIH's budget over five years. This increase is necessary to ensure adequate funding for cutting-edge research such as the Human Genome Project being conducted at Baylor College for Medicine in my district. Currently, NIH funds only one in three of peer-reviewed medical research grants and many potential cures and treatments go undiscovered.

   While I am grateful for the increase, I am concerned that the Republican majority continues to insist on a budget gimmick to delay up to $3 billion in NIH's budget until the final day of the next fiscal year. As a result, some medical research grants will be delayed. This is better than an earlier proposal to delay $7.5 billion, but it is still counterproductive to speed up research for cures to diseases like juvenile diabetes and AIDS.

   I am also pleased that this conference report includes funding for a project which I have been working on to provide $500,000 for the Center of Excellence for Research on Mental Health (CMRH) to the University of Texas MD Anderson Cancer Center in my district. This Center would build upon the Institute of Medicine report issued earlier this year indicating that there is a disproportionate share of minority and medically under-served patients who suffer from cancer and other health related diseases. The CRMH would establish a multi-disciplinary center for excellence in basic, applied, and clinical research to help meet the unique health-related challenges of minority and under-served populations. The goal of this Center would be to improve the low mortality rate among minority and medically under-served populations, and to translate these methods to other minority and under-served areas nationwide.

   This omnibus measure also contains language which I requested to help ensure that the National Institutes of Health (NIH) is conducting sufficient research on breast and ovarian cancer among women of Askenazi descent who carry the BRCA1 gene. There is an abnormally high incidence of breast and cervical cancer among Azkenazi Jewish women. This research will help to identify and isolate some of the reasons for this high incidence of cancer. This conference report urges the NIH to provide funding for a binational program between the United States and Israel establishing a computerized data and specimen sharing system, subject recruitment and retention programs, and a collaborative pilot research program.

   I am also pleased that this budget agreement makes education a top priority by providing $1.3 billion to hire and train 100,000 new teachers to help lower class size in the early grades. This is truly good news for our children and for their future. We know that school enrollments are exploding and that record numbers of teachers are retiring. Every parent and teacher in America knows that a child in a second-grade class with 25 students will not get as much attention as he or she needs and deserves. Overall, this plan means more teachers with higher educational credentials--and for students, more individual attention and a better foundation in the basics. I am also pleased that this budget doubles funds for after school and summer school programs while supporting greater accountability for results by helping communities turn around or close failing schools.

   This omnibus measure also strengthens America's role of leadership in the world by paying our dues and arrears to the United Nations, by meeting our commitments to the Middle East peace process, and by making critical investments in debt relief for the poorest countries of the world. Of critical importance is the $1.8 billion to fund the United States' commitment to the Wye River Agreement. For decades, the U.S. has worked with Israel--our most consistent Middle East ally--to provide the aid and military equipment necessary to defend itself against hostile neighbors. The funds appropriated in this year's budget send the message that the United

   States is a full partner in securing a lasting peace in the Middle East.

   This budget continues the Administration's COPS program by including funding to help local communities hire up to 50,000 police nationwide. This program has been tremendously successful in Harris County helping the County, and some of its cities including virtually all those in my district, more than 1,000 police positions to fight crime.

   This bill also includes important funding for the Immigration and Naturalization Service (INS) to combat illegal immigration and administer legal immigration both functions of government terribly important to the people of the 25th District. The bill also funds the upcoming

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census, which is important to government and commerce.

   Mr. Speaker, this is by no means a perfect bill and the process has been deplorable. However, this bill does meet important priorities in health care, education, crime control, immigration, general government and foreign affairs. Furthermore, this bill ensures that we maintain a balanced budget, dedicating the surplus to debt retirement and preserving its use for strengthening Social Security and Medicare i n the future. On that basis, I urge my colleagues to support its passage.

   Mr. BLILEY. Mr. Speaker, I also want to take this opportunity to explain to my colleagues an important change made to the Satellite Home Viewer Improvement Act of 1999 since the Conference Report was considered on the floor last week. As my colleagues know, I had been concerned that sections 1005(e) and 1011(c) of the Conference Report could unfairly discriminate against Internet and broadband service providers and, in doing so, would stifle the development of electronic commerce. I was particularly concerned that these provisions could be interpreted to expressly and permanently exclude any ``online digital communication service'' from retransmitting a transmission of a television program or other audiovisual work pursuant to a compulsory or statutory license.

   Under the agreement embodied in the bill before us, these provisions were deleted, and rightly so. They were essentially added after agreement had been reached on the fundamental parameters of the Satellite Home Viewer Improvement Act, without any consultation with the Committee on Commerce and, equally important, without any record evidence submitted about their necessity. The committees of jurisdiction will now have an opportunity to give deliberate and careful consideration to the application of the Copyright Act to the Internet and broadband service providers. The importance of the Internet and other online communications technologies for enhancing consumer access to information and programming cannot be overstated. Online technology has transformed the way consumers receive information, including audiovisual works. Because rapid technological changes are having an ever more positive impact on our economy, it is thus essential that we give full attention to this issue early next year.

   Mr. STENHOLM. Mr. Speaker, as with any compromise legislation, the final budget agreement has both very positive aspects and very troubling features. The agreement provides funding for several high priority spending items, particularly rural health care and education. In addition, the agreement preserves increases in programs affecting agriculture, veterans, defense and other priority areas. However, it falls far short of the standards of fiscal responsibility that were set forth in the Blue Dog budget and will create serious problems for the budget process that will begin next year.

   This package provides much-needed relief for rural hospitals, nursing homes, community health centers, rural health clinics, home health agencies, and other health care providers who have struggled to cope with the impact of the Medicare p ayment reductions included in the Balanced Budget Act of 1997. Along with my colleagues in the House Rural Health Care Coalition, I introduced the Triple A Rural Health Improvement Act, legislation intended to help rural health care providers continue to provide vital services to rural seniors. I am pleased that this package includes a number of the important rural health provisions that we included in our legislation.

   Specifically, this bill includes protection for low-volume, rural hospitals from the disproportionate impact of the hospital outpatient prospective payment system, an alternative payment system for community health centers and rural health clinics, reforms of the Medicare R ural Hospital Flexibility/Critical Access Hospital program, expansion of Graduate Medical Education opportunities in rural settings, Rebasing for Sole Community Hospitals, Extension of the Medicare D ependent Hospital program, and permitting certain rural hospitals in urban-defined counties to be recognized as rural for purposes of Medicare r eimbursement.

   The most significant accomplishment of the budget process this year is the success of fiscally responsible Members to block efforts to spend the projected surpluses over the next ten years on tax cuts or new entitlement spending. The bulk of the projected surpluses over the next ten years are preserved for debt reduction. I intend to join with my fellow Blue Dogs next year to renew our efforts to lock up half of these projected surpluses for debt reduction. In spite of all of the budget gimmicks and other fiscal shortcomings of this budget agreement, our successful vigilance in other efforts will result in a reduction of at least $130 billion in debt held by the public, following on the $123 billion in debt reduction achieved in fiscal year 1999.

   Sadly, this particular budget agreement is a product of a terribly flawed process. Instead of spending the first eight months of the year debating a fiscally irresponsible tax cut that was destined to be vetoed, Congress should have been working with the administration to develop a responsible budget plan for the next five years. We should have set realistic spending caps and establish a framework for protecting the Social Security surplus and paying down the debt over the next five years.

   The negotiating process did establish a very valuable precedent as a result of the administration's commitment to offset all increased spending they requested. Since the administration proposed offsets for all of their increased spending

   requests, any spending above the discretionary spending caps and any spending out of the Social Security surplus was a result of the legislation passed by the Majority in Congress prior to the budget negotiations.

   The failure to put together a long-term budget framework has produced a bill that will cause real problems for the budget process next year and beyond. The cumulative effect of the budget legislation passed by Congress this year in the absence of a long-term plan will make it virtually impossible to comply with the discretionary caps in the next two fiscal years or balance the budget without counting Social Security. The discretionary spending caps in statute have lost much of their credibility as a tool to restrain spending.

   As a result of all of the budget gimmicks placed in the spending bills passed by the Majority before the budget negotiations began, the final agreement will result in spending at least $17 billion of the Social Security surplus in 2000 and will put us on a course to spend a similar or greater amount of the Social Security surplus in 2001 and consume more than 75% of the projected on budget surplus in 2002.

   When the timing shifts, emergency designations, and delays in the starting point for spending are taken into consideration, these bills put us on a path for an on-budget deficit of at least $20 billion in fiscal year 2001 and will reduce the fiscal year 2002 projected surplus from approximately $82 billion to approximately $13 billion in fiscal year 2002.

   My fellow Blue Dogs and I have advocated locking up a portion of the projected on-budget surpluses to reduce debt held by the public to effectively pay back the money borrowed from the Social Security trust fund. The impact the final budget agreement will have on the on-budget surplus in the next two years would have been mitigated if it was accompanied by a solid commitment to repay any monies borrowed from the trust fund to meet operating expenses through additional debt reduction. Unfortunately, the Majority leadership never seriously considered this approach.

   The outcome of the budget process this year underscores the critical importance of developing a responsible budget plan that addresses the long-term problems of Social Security and Medicare an d provides for a reduction in the national debt in addition to providing room for tax cuts and priority programs. I am committed beginning work early next year with the administration and Congressional leadership on a bipartisan budget framework.

   Mr. UDALL of Colorado. Mr. Speaker, I want to explain why I voted the way I did on this bill.

   First, I had very serious concerns about the way in which this bill came before the House. It was a far-reaching measure, rolling into one oversize pile not just five appropriations bills but also several important authorization bills. It was filed in the early hours of this morning. I am confident that very few if any Members were able to read it all. Yet that is how it was, and we had to vote it up or down, with only limited time for debate and no chance to change it.

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