S10456 CONGRESSIONAL RECORD — SENATE October 2, 2008 

a degree of disability of 10 percent or more, 

generally, within one year of separation 

from service, and for active tuberculosis or 

Hansen’s disease if manifested to a degree of 

disability of 10 percent or more within three 

years of separation from service. 

In 1962, Public Law 87–645 extended the period of time after separation from service 

that a diagnosis of multiple sclerosis may be 

presumed to be service-connected from three 

to seven years for veterans with wartime 

service. 

Senate Bill 

Section 806 of S. 1315, as amended, would 

require VA to enter into a contract with the 

IOM to conduct a comprehensive epidemiological study to identify any increased risk 

of developing multiple sclerosis, and other 

diagnosed neurological diseases, as a result 

of service in the Southwest Asia theater of 

operations or in the Post 9/11 Global Operations theaters. The Southwest Asia theater 

of operations is defined in section 3.3317 of 

title 38, Code of Federal Regulations. The 

Post 9/11 Global Operations theater is defined 

as Afghanistan, Iraq, or any other theater 

for which the Global War on Terrorism Expeditionary Medal is awarded for service. 

The mandated study would examine the incidence and prevalence of diagnosed neurological diseases, including multiple sclerosis, 

Parkinson’s disease, and brain cancers, as 

well as central nervous abnormalities, in 

members of the Armed Forces who served 

during the Persian Gulf War period and 

Post–9/11 Global Operations period. The 

study would also collect information on possible risk factors, such as exposure to pesticides and other toxic substances. IOM 

would be required to submit a final report to 

VA and the appropriate committees of Congress by December 31, 2012. 

House Bill 

The House Bills contain no comparable 

provision. 

Compromise Agreement 

Section 804 of the Compromise Agreement 

generally follows the Senate language. 

TERMINATION OR SUSPENSION OF CONTRACTS

FOR CELLULAR TELEPHONE SERVICE FOR CERTAIN SERVICEMEMBERS

Current Law 

The Servicemembers Civil Relief Act 

(SCRA), currently found in the appendix to 

title 50, beginning at section 501, is intended 

to provide for the temporary suspension of 

judicial and administrative proceedings and 

transactions that may adversely affect the 

civil rights of servicemembers during their 

military service. Title III of the SCRA extends the right to terminate real property 

leases to active duty servicemembers on deployment orders of at least 90 days. It also 

allows for the termination of automobile 

leases for use by servicemembers and their 

dependents on military orders outside the 

continental United States for a period of 180 

days or more. 

Senate Bill 

Section 804 of S. 1315, as amended, would 

expand the SCRA to allow for the termination or suspension, upon request, of the 

cellular telephone contracts of 

servicemembers deployed outside the United 

States. 

House Bill 

Section 4 of H.R. 6225, as amended, would 

extend the SCRA protections to enable 

servicemembers with deployment orders to 

terminate or suspend service contracts without fee or penalty for such services as cellular phones, utilities, cable television, or 

internet access. 

Compromise Agreement 

Section 805 of the Compromise Agreement 

generally follows the Senate language, except that it also includes a provision allowing servicemembers to suspend or terminate 

cellular phone contracts if they receive orders for a permanent change of duty station. 

CONTRACTING GOALS AND PREFERENCES FOR

VETERAN-OWNED SMALL BUSINESS CONCERNS

Current Law 

Section 502 and 503 of Public Law 109–461, 

the Veterans Benefits, Health Care, and Information Technology Act of 2006, require 

VA to provide certain contracting preferences to small businesses owned by veterans and service-disabled veterans. 

House Bill 

Section 2 of H.R. 6221, as amended, would 

amend section 8127 of title 38 to require the 

Secretary to include in each contract the 

Secretary enters with an agent acting on 

VA’s behalf for the acquisition of goods and 

services a provision that requires the agent 

to comply with the contracting goals and 

preferences for small business concerns 

owned or controlled by veterans set forth in 

sections 502 and 503 of Public Law 109–461. 

Senate Bill 

The Senate Bills contain no comparable 

provision. 

Compromise Agreement 

Section 806 of the Compromise Agreement 

generally follows the House language except 

that it would apply, to the maximum extent 

feasible, only to contracts entered into after 

December 31, 2008. 

PENALTIES FOR VIOLATION OF INTEREST RATE

LIMITATION UNDER SERVICEMEMBERS CIVIL

RELIEF ACT

Current Law 

The SCRA provides that penalties under 

title 18 may be imposed against anyone who 

knowingly takes part in or attempts to violate certain applicable protections. 

House Bill 

Section 5 of H.R. 6225 would amend section 

207 of the SCRA by placing a fine of $5,000 

and $10,000 on any individual or organization, 

respectively, who knowingly violates certain 

SCRA rights of a servicemember. It would 

further provide for attorney fees and treble 

damages in certain cases. 

Senate Bill 

The Senate Bills contain no comparable 

provision. 

Compromise Agreement 

Section 807 of the Compromise Agreement 

follows the House language to add penalties 

in section 207 of the SCRA. 

FIVE-YEAR EXTENSION OF SUNSET PROVISION

FOR ADVISORY COMMITTEE ON MINORITY VETERANS

Current Law 

Section 544 of title 38 required the Secretary to establish an Advisory Committee 

on Minority Veterans. Under section 544(e) of 

title 38, the Committee will cease to exist on 

December 31, 2009. 

House Bill 

Section 1 of H.R. 674 would repeal the sunset date on the Advisory Committee on Minority Veterans. 

Senate Bill 

The Senate Bills contain no comparable 

provision. 

Compromise Agreement 

Section 808 of the Compromise Agreement 

would extend the sunset date on the Advisory Committee on Minority Veterans for 

five years from the current date of expiration, until December 31, 2014. 

AUTHORITY OF SECRETARY OF VETERANS AFFAIRS TO ADVERTISE TO PROMOTE AWARENESS

OF BENEFITS UNDER LAWS ADMINISTERED BY

THE SECRETARY

Current Law 

The Anti-Deficiency Act, section 1341 of 

title 5, prohibits the use of appropriated 

funds for publicity or propaganda purposes. 

Section 404 of Public Law 110–161, the Consolidated Appropriations Act of 2008, reinforced this prohibition stating: 

No part of any funds appropriated in this 

Act shall be used by an agency of the executive branch, other than for normal and recognized executive-legislative relationships, 

for publicity or propaganda purposes, and for 

the preparation, distribution or use of any 

kit, pamphlet, booklet, publication, radio, 

television, or film presentation designed to 

support or defeat legislation pending before 

Congress, except in presentation to Congress 

itself. 

Although executive branch departments 

and agencies are prohibited from using appropriated funds to engage in ‘‘publicity or 

propaganda,’’ there is no such prohibition 

against disseminating information about 

current benefits, policies, and activities. 

Military recruiting advertising campaigns 

are a primary example of an acceptable use 

of appropriated funds. 

House Bill 

Section 2 of H.R. 3681 would add a new section 532 to title 38 authorizing the Secretary 

to advertise in national media to promote 

awareness of benefits under laws administered by the Secretary. 

Senate Bill 

The Senate Bills contain no comparable 

provision. 

Compromise Agreement 

Section 809 of the Compromise Agreement 

follows the House language. 

MEMORIAL HEADSTONES AND MARKERS FOR DECEASED REMARRIED SURVIVING SPOUSES OF

VETERANS

Current Law 

Section 2306(b)(4)(B) of title 38 authorizes 

VA to furnish an appropriate memorial headstone or marker to commemorate eligible individuals whose remains are unavailable. Individuals currently eligible for memorial 

headstones or markers include a veteran’s 

surviving spouse, which is defined to include 

‘‘an unremarried surviving spouse whose subsequent remarriage was terminated by death 

or divorce.’’ Thus, a surviving spouse who remarried after the veteran’s death is not eligible for a memorial headstone or marker 

unless the remarriage was terminated by 

death or divorce before the surviving spouse 

died. However, a surviving spouse who remarried after the veteran’s death is eligible 

for burial in a VA national cemetery without 

regard to whether any subsequent remarriage ended. 

Senate Bill 

Section 602 of S. 3023, as amended, would 

extend eligibility for memorial headstones 

or markers to a deceased veteran’s remarried 

surviving spouse, without regard to whether 

any subsequent remarriage ended. 

House Bill 

The House Bills contain no comparable 

provision. 

Compromise Agreement 

Section 810 of the Compromise Agreement 

follows the Senate language. 

f 

OBJECTION TO DISCHARGE 

Mr. GRASSLEY. Mr. President, as 

the ranking Republican of the Finance 


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October 2, 2008 CONGRESSIONAL RECORD — SENATE S10457 

Committee acting on behalf of a number of Republicans on the Finance 

Committee, I am objecting to discharging S. 3656 from the committee. 

While there are several provisions in 

the bill I personally strongly support, 

there are many problems in this bill 

and questions that have been raised 

about this bill. In addition, this bill 

has not come before the committee and 

the issues it addresses have not had the 

benefit of hearings or any committee 

action. As a result, I cannot support 

this bill being discharged from the 

committee at this time. 

One of the provisions in S. 3656 that 

I personally support would delay implementing provisions of a CMS proposed 

rule that would change conditions of 

participation for rural health clinics 

and decertify clinics that are no longer 

in nonurbanized areas. The provision 

would also delay the proposed changes 

to the existing payment methodology 

for rural health clinics and Federally 

qualified health centers. 

The CMS proposed rule would impose 

new location requirements for RHCs 

and require that clinics be located in a 

nonurbanized area, as defined by the 

U.S. Census Bureau, as well as meet 

shortage area designation requirements. Only new RHCs applying for the 

program are currently required to meet 

these criteria, but the CMS proposal 

would extend these requirements to already certified RHCs. According to 

CMS, about 500 of the approximately 

3,700 RHCs operating today may not 

meet these requirements. Rural clinics 

in Iowa and elsewhere could also be severely impacted by the CMS proposed 

payment changes since RHC costs in 

Iowa and other States are already 

higher than the existing Medicare reimbursement cap. 

Iowa is currently in the throes of a 

growing shortage of physicians, especially in the more rural areas of the 

State, due to inequitable geographic 

adjustments in physician payment that 

result in Iowa physicians receiving 

some of the lowest Medicare payments 

in the country even though they provide some of the highest quality care. 

These geographic payment disparities, 

which discriminate against rural areas, 

have further exacerbated the problems 

of access to care for beneficiaries in 

rural areas. 

The CMS proposed rule could have a 

severe adverse impact on a number of 

rural health clinics in Iowa, including 

many located in counties that have 

been declared disaster areas from the 

severe flooding Iowa suffered earlier 

this year. If the CMS rule is finalized 

as proposed, rural health clinics in 

Iowa and elsewhere may be forced to 

close their doors, even though they 

have served rural populations very well 

for many years, leaving Iowa with 

fewer physicians and some patients 

with little access to primary care and 

other critical medical services. 

As you can see, these provisions for 

rural health centers are important, 

which makes it all the more disappointing that my friends on the 

other side of the aisle did not work together with us to develop a bipartisan 

bill and that the committee is not in a 

position at this time to consider these 

important issues properly. I am very 

pleased, however, that a key issue for 

rural health centers in the proposal has 

already been addressed through a provision that was included in the Health 

Care Safety Net Act. That provision 

changes the CMS certification period 

for shortage area designations from 3 

to 4 years in order to align the CMS 

certification period for shortage area 

designations with the Health Resources 

and Services Administration’s, 

HRSA’s, designation review period. I 

want to thank Senators ORRIN HATCH, 

PAT ROBERTS, GORDON SMITH, TOM

HARKIN, RON WYDEN, KENT CONRAD, and 

JOHN BARASSO for championing the resolution of this important issue and 

Senator MAX BAUCUS for working together with me to facilitate its inclusion in the Health Care Safety Net Act. 

And, of course, I want to again thank 

Senators KENNEDY and ENZI for working with us on this issue. Thanks to 

this bipartisan collaborative effort, 

that bill with the RHC provision in it 

has now passed both Chambers and is 

on its way to being signed into law. 

Another provision in S. 3656 would 

prevent the application of a CMS policy to phase out a payment adjustment 

for indirect medical education, IME, 

under the Medicare capital Inpatient 

Prospective Payment System, IPPS. 

Currently, teaching hospitals receive 

this upward payment adjustment under 

the capital IPPS. CMS announced in 

the fiscal year 2008 Medicare Hospital 

IPPS final rule that they would begin 

to phase out the IME adjustment for 

capital IPPS in fiscal year 2009. 

As the former chair and currently 

the ranking member of the Senate Finance Committee, it has long been one 

of my priorities to ensure Medicare 

payments are both accurate and equitable. I question whether this proposed 

change to IME payments would further 

this goal, which many of us share. 

The appropriateness of the IME capital IPPS adjustment has been analyzed extensively not only by CMS, but 

also by the Medicare Payment Advisory Commission, MedPAC, which advises Congress on Medicare payment 

issues. CMS has documented relatively 

high and continued positive margins 

for teaching hospitals under the capital 

IPPS compared to nonteaching hospitals. In fact, from 1998 through 2006, 

teaching hospitals had an aggregate 

positive capital IPPS margin of 11.2 

percent while nonteaching hospitals 

had an aggregate capital IPPS margin 

of ¥0.8 percent. Based on those figures, 

it leaves open the question of whether 

the proposed change to IME payments 

is not justified. Certainly this is something the Finance Committee should 

explore further. 

S. 3656 also proposes to establish a 

moratorium on a CMS rule regarding 

Medicaid payments for hospital outpatient services. Earlier this year, Congress placed moratoriums on 6 other 

proposed Medicaid regulations. Just as 

I opposed those moratoriums, I strongly oppose this one as well. The Finance 

Committee has not held the first hearing as to why a delay in this regulation 

is justified. The Finance Committee 

has not considered whether payments 

currently being made by some states to 

hospitals for outpatient services are 

being made consistent with the statutory rules governing the upper payment limit. The CMS regulation in 

question was intended to clarify what 

payments from States to hospitals are 

allowable. We should not simply place 

a moratorium on this regulation without the committee properly investigating the issue first. Medicaid is a 

critical program for children, pregnant 

women, the disabled, and the elderly. 

We have a responsibility to the people 

who depend on the program to make 

sure that funds are being appropriately 

spent. Placing a moratorium on these 

regulations without fully exploring 

these issues in the committee first is 

not consistent with that responsibility. 

This bill also would intervene in a 

dispute between CMS and the State of 

California. The State of California has 

been seeking approval of an extension 

of their family planning waiver for 6 

years. For 6 years, CMS has been urging California to improve their collection of Social Security numbers and 

citizenship documentation for women 

enrolled in the program. Given the concerns that have been raised about noncitizens receiving benefits to which 

they are not entitled, this provision 

raises a number of serious concerns. 

This bill would essentially require CMS 

to approve of the extension of California’s waiver without requiring California to fulfill their obligation to improve their process of ensuring that 

people who receive benefits are actually eligible for those benefits. 

In addition, this bill does nothing to 

assist ‘‘tweener hospitals,’’ which are 

hospitals that are too large to be critical access hospitals but too small to 

be financially viable under Medicare’s 

prospective payment systems. I consider this to be a high priority because 

so many seniors in Iowa rely on these 

tweener hospitals for vitally needed 

health care services in rural areas of 

our State. If the Senate is going to 

consider Medicare legislation that is 

along the size and scope of the provisions proposed in S. 3656, including provisions to address the problems 

tweener hospitals face is a must. 

I understand that legislation is often 

the art of compromise. We can’t always 

get everything we want in every bill 

and keep everything we dislike out. It 

is a balance. This bill is currently 

pending before the Finance Committee, 

and it raises significant issues of Medicare and Medicaid payment policies. 

The Finance Committee has not held 

hearings on these issues nor has it 

given these important issues proper 

consideration. Without allowing the 


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S10458 CONGRESSIONAL RECORD — SENATE October 2, 2008 

committee process to work, this bill 

has not been subject to the rigorous 

analysis and debate that the legislative 

process should require to avoid unintended consequences and poor decisionmaking. This process should be permitted to take place before legislation 

of this magnitude is sent to the full 

Senate. That is the committee’s role 

and it is an important one. 

If the full Senate were to routinely 

bypass the Finance Committee and 

consider major Medicare bills like this 

one that have not been processed by 

the members of the committee, then 

nothing would prevent the Senate from 

legislating on other Medicare and Medicaid issues without the benefit of 

hearings or committee action. Occasionally, the committee does process 

extensions of current law and smaller, 

generally technical bills through a 

more informal committee process, but 

it is a committee process nonetheless. 

If the committee is routinely bypassed 

entirely and not allowed to perform its 

vital role in the legislative process, it 

would be almost impossible to cope 

with the number and assortment of 

Medicare, Medicaid, and other issues 

that would come directly to the Senate 

floor in bills like S. 3656. To avoid that 

result is why the Senate has committees in the first place. 

Just an initial review of this legislation today produces more questions 

than answers and many obvious and serious concerns. It is disappointing that 

some of the important provisions in 

this bill, like the rural health center 

provisions and IME policy, are packaged into a bill that has not been presented in a timely way or brought before the committee for appropriate 

consideration, debate, and amendment. 

Just a quick review of this bill today 

quickly reveals, in any case, that both 

in terms of process and policy, this bill 

does not sufficiently achieve a balance 

I think is necessary, and I must, on behalf of myself and other members of 

the committee, object to discharging 

S. 3656 from committee for consideration by the full Senate. 

f 

NUCLEAR POWER 

Ms. MURKOWSKI. Mr. President, I 

don’t want to repeat what has already 

been said by Senator VOINOVICH recently, but I do want to explain why I 

am cosponsoring legislation designed 

to tackle in a comprehensive way the 

biggest issue still outstanding in our 

efforts to revitalize nuclear power for 

this Nation, that being how we handle 

the waste. 

I also want to talk about the retirement of the ranking member of the 

Senate Energy Committee, Senator 

PETE DOMENICI, who I will so deeply 

miss in the future. 

Concerning the nuclear bill, I am cosponsoring the U.S. Nuclear Fuel Management Corporation Establishment 

Act that has been crafted by Senator 

VOINOVICH, with Senator SESSIONS and 

a number of other Senators, and I have 

already cosponsored the SMART Act, 

which was crafted by the ranking member of the Energy Committee, Senator 

DOMENICI, and cosponsored by Senator 

SESSIONS and others, since the two bills 

work together to set up the policy and 

the management structure to improve 

how we handle the waste that nuclear 

powerplants generate. 

While it is obviously too late in this 

session of Congress for either bill to advance, I want to say that I am certainly intending to help reintroduce 

both bills next year and in working 

next session to merge them into a comprehensive plan to recycle and then 

properly store the remaining waste 

that results from nuclear power production. 

I am interested in working on these 

bills because I care about reducing 

greenhouse gases. And nuclear power is 

the best proven technology to produce 

power for this country without producing any carbon emissions. For anyone serious about tackling carbon 

emissions, finding a way to grow the 

next generation of nuclear power is 

vital. 

Today nuclear energy provides about 

20 percent of the Nation’s electricity. 

As Senator VOINOVICH may have mentioned those 104 operating powerplants 

save America from producing about 681 

million metric tons a year of carbon dioxide. If we are going to deal with global warming, we must find a way not 

just to keep nuclear power going, but 

also growing to help meet this Nation’s 

growing thirst for electricity. 

I was in France in late June and 

toured the French nuclear waste recycling facilities at LaHague. Recycling 

allows you to gain twice as much nuclear power from a given amount of 

uranium ore. More importantly, it cuts 

substantially the amount and the halflife, and in some cases, the toxicity of 

the waste that you later have to store. 

That is important for the environment. 

In these two bills, the Nuclear Fuel 

Management Corp. will set up a Government corporation to take authority 

to manage spent nuclear fuel and provide both interim storage, the development of geologic repositories, such as 

the Yucca Mountain facility currently 

under consideration, and also to handle 

the construction and operation of any 

reprocessing and fuel fabrication facilities. 

The SMART bill is designed to further the process of siting and advancing the construction of up to two reprocessing plants, since it would help 

to encourage cities in this country to 

welcome such plants. These bills, perhaps pared with one introduced last 

year to remove some potential regulatory hurdles to construction and 

opening of a Yucca Mountain repository, would effectively amount to a 

comprehensive solution to the waste 

issue. They would be the final pieces to 

the puzzle. That is the case because of 

the efforts of Senator PETE DOMENICI. 

PETE DOMENICI 

Ms. MURKOWSKI. Mr. President, at 

the risk of embarrassing him, I want to 

take a moment to say how vital Senator DOMENICI has been in solving most 

of the nuclear puzzle. He really led the 

rebirth of the nuclear industry and I 

want to say how much I will miss him 

since he has been a prime mover in the 

effort to bring about a new nuclear age 

in this country. 

As most of you know Senator DOMENICI has served 36 years in the Senate. 

But some of you may not know that he 

gave up a promising career in baseball 

to become a public servant. He started 

playing when he was 10, eventually 

pitching for a minor league team called 

the Albuquerque Dukes. But he left 

baseball to become a math and science 

teacher at Garfield Junior High in his 

native State of New Mexico, later went 

onto law school and ran for the U.S. 

Senate in 1972. And he’s been here ever 

since. 

About a dozen years ago the Senator 

realized that this Nation desperately 

needed a new source of electricity. He 

realized that there are higher uses for 

high-priced natural gas than to burn it 

for power generation, and that until 

carbon capture and storage can be perfected and widely practiced that the 

expansion of coal-fired power might 

have environmental drawbacks. So he 

crafted the forerunner of policies that 

today make up the Nuclear Power 2010 

program, which is designed to have the 

Government partner with industry to 

approve the design and speed the licensing of the next generation of power 

plants that absolutely preclude the 

type of radiation accident that happened three decades ago at Three Mile 

Island. 

He has been the sponsor of the loan 

guarantees, the architect of reauthorizing a responsible liability program 

and the person most responsible for 

harnessing the research capacities of 

America to breathe life into the research and nuclear construction sectors. One news outlet called him ‘‘the 

nuclear renaissance man.’’ And he is 

recognized by all as the driving force 

behind the industry’s resurgence. 

But he has done so much more. His 

work on the Energy Policy Act of 2005 

and on last year’s Energy Independence 

and Security Act were landmarks in bipartisan legislating. He helped renewable and alternative energy, from wind 

and solar to biomass, and especially 

biofuels to develop, helping create 

Clean Renewable Energy Bonds to pay 

for the construction of renewable energy plants. During the bills he refereed more policy disputes and generated more compromises than I have 

time to mention. 

But he also was the sponsor of so 

much other landmark legislation during his storied career. One bill finally 

passed the Senate earlier this week to 

require parity for mental health treatment benefits. As Senate budget chairman, he helped set up the Nation’s 

budgeting system, which was still 


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