▶ 0:18:37Chair Cassidy: The senate committee on health, education, labor, and pensions will come to order. I joke sometimes, mypillow talk with my wife is about health care. And so how do you love her costs, how do you improve the relation, how do you improve the care?
▶ 0:18:54Chair Cassidy: I say that because, actually, americans expect us to find answers into often they see members of congress shouting insults or wasting time on political games and they get frustrated and they should be frustrated because we could be focused on how we make their life better. We have eight bipartisan bills before us today. These will make their life better.
▶ 0:19:20Chair Cassidy: Bills that help americans get a life-saving organ transplant, increase access to affordable drugs, support mothers and babies through health and pregnancy. And many of these should be easy bills moving through the committee quickly. Now, I don't know if they will be authored, but my ranking member has introduced partisan amendments which are irrelevant to these bills. That would have the effect to sabotage our bipartisan work.
▶ 0:19:50Chair Cassidy: These bills, these amendments, if attached, will keep this legislation from passing the committee in the senate. I don't know if my ranking member is actually going to offer them, but they should not be filed. And it is frustrating. With all due respect to my ranking member, it is grinding the committee to a halt.
▶ 0:20:16Chair Cassidy: Rather than passing simple common sense bills that help the american people. The argument will be these help the american people. We will have them marked up in july. That is the appropriate time for these amendments. People on both sides say they want regular order because the it is the response ability of people on both sides to do the hard activity in leadership to produce regular order.
▶ 0:20:47Chair Cassidy: I am leaving the senate. I was asked earlier, what will be my legacy? I want part of my legacy is he tried to preserve the institution. But that is a responsibility of us all. And now, I understand why americans are frustrated at congress. Remember, our original founders said we should not have parties because they thought it would descend into partisanship. We should not accept this as a new reality.
▶ 0:21:16Chair Cassidy: I would note as chair are permitted members of this committee a forum to discuss topics of importance, to move legislation on multiple occasions. When democratic preorders are not being elevated for consideration through normal mechanisms, this committee held the first ever member day hearing in the senate. Now, the ranking member was not there, but colleagues in this room and other senators raved about how much they enjoyed this.
▶ 0:21:43Chair Cassidy: Now we are track to act on ideas that came out of that that our colleagues raved about their opportunity to present. And I don't know if they will be presented, but what we have file now are partisan poison pill amendments to consider. We have other bills republicans and democrat members have identified as priorities that I wish to mark up july as I said. But if we cannot get through this markup productively, we will not be able to have that markup. There is a consequence for not having regular order.
▶ 0:22:15Chair Cassidy: I will remind my colleagues briefly remarks from the late senator's farewell address. He was loved. All of us, if we are loved like he was loved, we will have a special place in heaven. He believed in the 80/20 rule and that is how he ran the committee. No senator got everything they wanted all the time but bills got past and laws were made.
▶ 0:22:45Chair Cassidy: I told senator sanders we will continue to work on his priorities. Talked about these extensively. Of course we have disagreements. We can work through disagreements. The public health is of great importance to him and members on my side and on his side. We just recently increased and extended these programs. They have not lapsed. This committee is not going to finish this year without addressing them. I am hopeful we can address them next month. That is my plan.
▶ 0:23:15Chair Cassidy: But my colleagues on the democratic side have to make a choice. If they choose to support some of these poison pill amendments, it will blow up the bills they want. The bipartisan bills that I have been called about will be denied the opportunity for future markups to help constituents on what is important.
▶ 0:23:45Chair Cassidy: I suggest we put aside partisanship and do what is best for the american people. To my republican colleagues, do not take the bait of the political poison pill amendments. Policy differences are fine, part of the process, but taking hostage is not. It is up to all of us to allow this committee to function as a normal committee.
▶ 0:24:08Chair Cassidy: And we should all not deny o -- we should all deny a member. With that, I recognize senator sanders.
▶ 0:24:21Sen. Sanders: Thank you, Mr. chairman. I agree with one point that you made. The american people certainly are frustrated with congress. I think we are somewhere ahead of iran right now in terms of favorability, but not by much. And why is that? The reason for that is that all over this country people are hurting.
▶ 0:24:49Sen. Sanders: And I don't know about my republican colleagues, but I think the answer will be the same, but our talk to a lot of democratic candidates. And they tell me we are out there on the campaign trail, in town meetings. The issue that comes up more often than anything else is the understanding that our health care system today is broken. It is dysfunctional, and it is wildly expensive. And the american people are saying, does anybody in congress know that?
▶ 0:25:19Sen. Sanders: Do they know that I can't afford to send my kid to a doctor? I can't afford prescription drugs for my parents. So today, the so-called -- let me say a word about the so-called poison pills that I will be offering to address some of the crises that we face. And I want the american people to decide whether or not these to decide whether or not th they think these are poison pills.
▶ 0:25:51Sen. Sanders: Outrageously bipartisan efforts trying to sabotage the work of the chairman. For a start, as bad as our overall health care system is, and by the way as everybody on this committee knows, we spent twice as much per capita on health care than the people of any other nation. Over $15,000. Yet 85 million americans are not insured, underinsured. Some 65,000 people a year die because they cannot afford to go to a doctor.
▶ 0:26:22Sen. Sanders: Maybe we ought to be addressing that issue. Now, as bad as the overall health care system is committee primary health care system is an even worse shape. In america today, tens of millions of people live in communities where they cannot find a doctor. , a dentist, or a psychologist, even when they have decent insurance. I know that is true in vermont. I suspect that is true in every state in this country.
▶ 0:26:51Sen. Sanders: And if we do not get our act together, given the enormous shortage of doctors, dentists, and psychologists we have right now, the situation will only get worse in the future. We are facing a shortage of 400,000 nurses over the next two years. So, Mr. chairman, you think this is a poison pill that we talked about the need to make sure that we have nurses and doctors all over this country?
▶ 0:27:21Sen. Sanders: Does not seem to me to be a poison pill. Seems to be something we should have addressed years ago and we should address now. Over the next 12 years, we faced a shortage of 180,000 doctors and 400,000 mental health practitioners while over 60 million americans live in districts where they cannot find a dentist. Every major medical organization agrees that our investment in primary health care is woefully inadequate. And I suspect every member of this committee understands that as well.
▶ 0:27:51Sen. Sanders: There is a reason why most other major countries spend over twice as much as we do on primary health care and end up with far lower capital costs then we do. They invest in keeping people healthy, keeping them out of emergency rooms out of the hospital, and that makes sense to me.
▶ 0:28:12Sen. Sanders: The backbone of our current primary health care system, as weak as it is, here is the federally qualified community health center program, an issue I have worked on for many years. Today, more than 30 million men, women, children seem high-quality primary health care at community health centers in more than 16,000 neighborhoods located in every state in america. Many of these centers also provide dental care, mental health counseling, and low-cost prescription drugs.
▶ 0:28:44Sen. Sanders: Unfortunately, george washington university projects the community health centers will lose nearly $42 billion in revenue over the next five years. So, Mr. chairman, if you think it is a poison pill that we begin to address that issue right now, I would respectfully disagree. The national association of community health centers estimated that health centers will see an increase of one million uninsured patients in the coming years. That is why, Mr.
▶ 0:29:11Sen. Sanders: Chairman, the first amendment I will be proposing would increase community health center funding for $4.6 billion this year to $5.8 billion next year. Given the fact the majority of senators on this committee voted in favor of this funding level, I hope it will pass. But that is not the only amendment I offer. This amendment will also provide loan forgiveness and scholarships so we get more doctors and nurses into underserved areas. Mr.
▶ 0:29:38Sen. Sanders: Chairman, this amendment would provide $120 million over a three-year period so every state in america has a teaching health center. Teaching health centers, inordinately important way to make sure we have doctors and nurses in rural areas. Mr. chairman, I do not agree with you that these are poison pills.
▶ 0:30:02Sen. Sanders: I would say every amendment I am offering is widely supported by the american people, democrats, republicans, independents. I hope you will support them.
▶ 0:30:11Chair Cassidy: A couple things for clarity. You said that you are sabotaging the work of the chairman. This is sabotaging the work of the colleagues. These were not germane and were filed tuesday. There is a process which there is full consideration of a bill, of an amendment that comes before us, and then we take that processed amendment so we all understand it, we all have an ability to understand it. You drop a non-germane amendment, which by the way is not paid for, two days before hand.
▶ 0:30:42Chair Cassidy: You can have histrionics about how millionaires and billionaires are ripping off the american people come up is a process here, and the congress works better as a process.
▶ 0:30:50Sen. Sanders: Did I get these amendment in on time according to the process?
▶ 0:30:53Chair Cassidy: Absolutely. Are they paid for?
▶ 0:30:57Sen. Sanders: They will be paid for.
▶ 0:30:57Chair Cassidy: Let's work on it. In the future, let's work on it. We actually have a hearing in july in which we can pay for it. I told you that, and that is when we will do this. That is the way the congress is supposed to work. That is fair to the american people. Not moving things to find a way to pay for things.
▶ 0:31:17Sen. Sanders: Congress does not work.
▶ 0:31:18Chair Cassidy: Clearly it is not working with that but that is my mission. We will begin consideration of today's bills. For the awareness of all senators and staff, we intend to vote on them and mince as they are raised but will hold the vote on final passage on both bills until the end of session. We will keep members and staff updated on the timing of the vote for final passage. As a reminder, we discussed in our abutment identifying the amendment -- when discussing an amendment, identify the amendment with a name and number.
▶ 0:31:49Chair Cassidy: We will begin with 1782, the charlotte woodward organ transplant discrimination protection act. I would like to thank senator moody for her leadership. She has taken up the mantle of marco rubio who championed this legislation in the last two congress is. I think senator hassan, who has made a steadfast partner on this bill and has consistently in her time on the committee spoken passionately for those who are disabled.
▶ 0:32:15Chair Cassidy: This legislation is another example of the important work achievable working in a bipartisan manner and a critical step in improving and restoring trust in the U.S. transplant system. We have a managers amendment to s. 1782. I moved to adopt it in the nature of a substitute and have it considered original text for the purpose of future amendment. All of those in favor, please say aye. Opposed, say nay. The motion is agreed to.
▶ 0:32:43Chair Cassidy: Before we offer and him and mince, do any members wish to speak on the bill?
▶ 0:32:47Sen. Moody: Thank you, chairman cassidy. I know you have worked really hard to get us where we are today. Senator hassan, thank you. I know you were calling a lot of folks last night asking them to withhold eminence that might derail this bill. I even think senator kaine. I know he was considering offering at abutment. I hope he is understanding this is important and has been coming for a long time. Even had your constituent charlotte woodward in the room with us today.
▶ 0:33:17Sen. Moody: And all of the senators who have cosponsored this. I would also like to thank the representative in the house. She really has rolled up her sleeves and helped us get this to where we are today. Baby zion, who I consider my forever constituent, would have had his fifth birthday monday had he received the heart had he received the he lifesaving heart transplant he needed in the nicu.
▶ 0:33:44Sen. Moody: So many love and miss zion, who was born with down syndrome and died in 2021. Transplant barriers exist in our health care system and people within electoral disabilities should not be discriminated against for something as vital as an organ transplant. Today, we are happy to have charlotte woodward with us in the room. This bill is bipartisan. It passed the house unanimously just last year.
▶ 0:34:09Sen. Moody: We as we vote today will think about charlotte and baby zion and all of those who would benefit from this legislation. I urge my colleagues to vote in favor of this bill to protect people like them from discrimination moving forward. Thank you again, chairman.
▶ 0:34:23Chair Cassidy: Senator sanders.
▶ 0:34:25Sen. Sanders: This is an important bill. I hope we can pass it.
▶ 0:34:28Sen. Hassan: Thank you. I am also grateful we have charlotte with us today as we consider this bill and am grateful to senator moody for her taking up leadership on this bill as she came to the senate. No one should be discriminated against because they experienc d e disabilities. Few issues have stakes as high as whether some but he lifesaving transplant or not. So I urge my colleagues to support the bill.
▶ 0:34:58Sen. Hassan: And I would love to see it move forward separately. Thank you.
▶ 0:35:02Sen. Kaine: I would like to call up and discuss kaine amendment one to this bill. And let me describe it, and the chairman and I will chat a little bit about it. I am very glad miss woodward is here. This is a good bill. I am a cosponsor of it. I really like it. The timing of the bill, this is the one bill on the list that deals with the rights of folks with disabilities.
▶ 0:35:31Sen. Kaine: And the timing is sort of exquisite. In a way maybe exquisitely bad because of the announcement by the administration this week that they are forcing the special ed functions of the fed to be pushed over to hhs. So what this amendment would do would be to block shifting the functions of the office of special ed and rehab services to other federal agencies.
▶ 0:35:58Sen. Kaine: Let me explain why I think this is so important and not a poison pill and something I hope we can work on together. President trump was elected president, and he promised he wanted to get rid of the department of education. So that is what he said. If you want to do it, I would disagree, but he has a majority in both houses, so the way to do that would be to get congress to approve getting rid of the department of education and change the law. That is not what the president has done.
▶ 0:36:29Sen. Kaine: Instead, he has treated the department of education as if it is a going out of business sale of a discount furniture outlet and handed off willy-nilly the responsibilities of that agency. Just to remind folks, the student loan portfolio, let's give that to the small business administration. They did not want it. They were not staffed up to do it and were not confident in doing it, so now it is in the department of treasury. Career in technical education, let's give that to the department of labor.
▶ 0:36:59Sen. Kaine: The department of labor melted down because of the scandal nature that I sadly voted for, and that agency has put itself. But on this one, this was the core of the doe that we care the most about, that we asked secretary mcmahon about when she was here for her confirmation hearing. Who will have the backs of kids that have disabilities and special needs?
▶ 0:37:26Sen. Kaine: Given that this is the only bill in this that deals with disabilities, I filed this amendment and you and I chatted about it. So I would like to call it up or find an acceptable way to deal with this issue so the committee can try to block these services from being put in the hands of an hhs headed by a cabinet secretary that many of us have lost hope in.
▶ 0:37:49Chair Cassidy: So you are offering? Ok. The amendment is unrelated to the underlying bill which is a part partisan measure intended to ensure health care providers and organ transfer centers may not deny or restrict access to organ transplant solely on the basis of an individual's physical or mental disability.
▶ 0:38:15Chair Cassidy: The office of special education rehab services in the abutment would not be moved to hrsa or oc r, which are the only two agencies implicated by the underlying bill. This bill would prevent the passage of a thoughtful bill. For the record, I will share with everyone I agree that that should not be moved to hhs.
▶ 0:38:44Chair Cassidy: Let me just put that on the record. And if an iaa is signed, I think it should be with dol. Better served to provide rehabilitative services to introduce people with disabilities into the mainstream. But I will say to my colleagues this is not the time and place to address the issue.
▶ 0:39:10Chair Cassidy: But I ask my colleague to withdraw the amendment, and I will publicly commit to working with him for the next markup in july at finding something which is an accommodation for everyone's concern.
▶ 0:39:20Sen. Kaine: Mr. chair, let me say I appreciate that, and I think that is a good-faith offer. So here is what I would like to do. I will withdraw the amendment to the charlotte woodward bill if I get a commitment that at the july markup I will get a vote either on a bipartisan solution that we reach or on this amendment, which I will introduce as standalone
▶ 0:39:51Sen. Kaine: Legislation. And I would ask, I hope we can find a bipartisan way, and I think we can because there are members on both sides of the I/o that don't want is put in hhs. So I think we can find a bipartisan agreement.
▶ 0:40:07Chair Cassidy: You are a united states senator and you have the right to offer that and I will protect that and you have my commitment.
▶ 0:40:09Sen. Kaine: We will have a vote either on the bipartisan accord or this amendment that I will file a separate legislation at the next markup which will be before the august recess.
▶ 0:40:18Chair Cassidy: Yes.
▶ 0:40:19Sen. Kaine: In that case, I withdraw the amendment.
▶ 0:40:21Chair Cassidy: Ok. Anyone else? I will now begin with -- I think the senators for working on the legislation. Lowering cost of medications. I am committed to making health care more affordable. The high cost of health care is multifaceted, which means it takes more than one approach, so I urge my colleagues to support this bill.
▶ 0:40:52Chair Cassidy: I am going to take the chair's prerogative and call up first sanders number six as we begin consideration of s. 3014. >> Mr. chairman.
▶ 0:41:04Chair Cassidy: Sanders number six will add portions of the insulin act to s. 3014, legislation to address the abuse of fda processes that delay the entry of cheaper drugs. There are a few things that should be noted for the record. First, s. 3014 is identical to a version of the ensuring timely access to generics act that the health committee passed last congress on a bipartisan basis when ranking number sanders was the chair.
▶ 0:41:37Chair Cassidy: This 2023 markup occurred after senators shaheen and collins first introduced the insulin act at the time the ranking number did not file an amendment to incorporate the policy or otherwise attach it to this bill. I would also note that during the time senator sanders served as chairman, there was no vote scheduled on the insulin act. Instead, he publicly disparaged ceos and manufacturers at a benefit hearing but there was no vote on the insulin act.
▶ 0:42:05Chair Cassidy: Senator sanders even toggled the hearing, the need to make insulin affordable for all americans. I will think intuitively that if the ranking member believed it is a solution to the problem, he would have brought it forward as chair. But that brings me to today. I am fully committed to affordable insulin. I am on the record in support of $35 insulin.
▶ 0:42:30Chair Cassidy: The rebate passed through part of the insulin act was signed into law in january as part of our larger reform efforts. S. 3014 is also part of the insulin act as introduced in this congress. I commend senators collins and shaheen for tireless work advocating on behalf of patients who need insulin to survive. Partly because of their efforts, most commercial insurance companies voluntarily cover insulin for only $35 out-of-pocket.
▶ 0:42:56Chair Cassidy: Trump rx and other direct to consumer platforms make it available for $35 today. The insulin act has 25 bipartisan cosponsors, including nine from the committee. I venture to say the mass suggests the amendment will pass. But I will let senators know that, transparently, when senator sanders was chair this was never addressed.
▶ 0:43:19Chair Cassidy: It suggests to me the amendment today was not sincere or done properly, particularly since it contains texts of matters that were already signed into law. It has not been scored by the cbo. Nor does it have technical assistance from hhs. It is easy to speak about how we need to have something for the american people. But to get that something done, there is a process you go through. That includes getting a score from cbo and technical assistance from hhs.
▶ 0:43:47Chair Cassidy: I plan to move to table this amendment and understand senators may choose to vote differently. Regardless of the outcome, I am committed to working with senators collins and shaheen to refine their legislation and thank them for the longtime work in this space. But before I make a motion to table, senator collins has requested to speak and I am sure senator sanders and others may as well.
▶ 0:44:10Sen. Collins: Thank you, Mr. chairman. Thank you for including the act on today's markup agenda. This is a bill that I first introduced in 2019 with senator shaheen and senator baldwin, both of whom have been very committed to it. I just want to explain a little bit about how this bill works.
▶ 0:44:39Sen. Collins: It increases competition from generic drugs through better oversight of the fda citizen petition process. Brand-name manufacturers were behind roughly 86% of all citizen petitions filed between 2016 and 2019.
▶ 0:45:05Sen. Collins: Overwhelmingly these petitions did not raise legitimate safety concerns, which is why the fda rejected more than nine out of 10 of these petitions. Despite the low success rate, petitions are still able to delay generic drug entry and can unfairly consume fda resources.
▶ 0:45:28Sen. Collins: Our bill, our bipartisan bill would strengthen the fda's ability to reject citizen petitions if it believes that the primary purpose of the petition is to delay approval of the lower-priced generic competitor.
▶ 0:45:48Sen. Collins: If enacted, this bipartisan bill would improve competition, save patients money, and also, according to the latest estimate from the cbo, save taxpayers $49 million. I find it extremely interesting that the ranking member has proposed nine amendments to this common sense bill. He has not proposed amendments to any other bill.
▶ 0:46:18Sen. Collins: I think it is pretty easy to figure out what the motivation is here. I am pleased that the ranking member finally supports the insulin bill and has proposed it as an amendment to this bill. I have worked alongside with senator shaheen, my cochair of the senate diabetes carcass, on legislation to lower the cost of insulin since 2019.
▶ 0:46:49Sen. Collins: And before that, I held a hearing in the aging committee on the cause. That is what led us to the insulin act, which has many components, including the ensuring timely access to generics act. This bill, the one before us now, passed out of the health committee.
▶ 0:47:11Sen. Collins: I would note that when senator sanders was chair in 2023, he had absolutely no interest in adding the ensuring timely access to generics act to the insulin act. Thank you.
▶ 0:47:26Chair Cassidy: Senator sanders.
▶ 0:47:28Sen. Sanders: Mr. chairman, it is true that when I was chair we brought the ceos of the major pharmaceutical companies before us. That is absolutely true. As you recall, we did that because they are charging the american people by far the highest prices in the world for prescription drugs. In some cases 10 times more. I and the american people wanted a simple answer.
▶ 0:47:59Sen. Sanders: Why do you charge us 10 times more than our canadian friends or people in europe? And out of that hearing, among other things, what we did get was a commitment that has been carried through to lower the outrageous, then outrageous cost of asthma inhalers. Millions and millions of people have asthma. They buy inhalers that cost them hundreds of dollars. The price now is $35. That is what we did in this committee.
▶ 0:48:23Sen. Sanders: And furthermore, in the inflation reduction act, I work hard on that as chairman of the budget committee at that time, we now pay -- seniors will not pay more than $35 for insulin in medicare. So I think we had some significant success. Once again, Mr. chairman, I think the issues that you consider to be poison pills are amendments that the vast majority of the american people support.
▶ 0:48:53Chair Cassidy: They are amendments without technical assistance and without a cbo score. >> Mr. chair? Mr. chair, quickly I want to recognize senator shaheen. Her name has been mentioned. She is not a member of the committee, but this is a very important priority for her so I wanted to underline that she has worked really hard on this issue.
▶ 0:49:13Chair Cassidy: Anyone else? I make a motion to table amendment six. I shall be voting yes to table. Will the clerk called the role. Senator sanders.
▶ 0:49:28Sen. Sanders: I urge my colleagues to vote no. This note is a vote on my abutment. I urge no vote on the motion to table.
▶ 0:49:36Chair Cassidy: It is on sanders amendment six. It is not on the underlying bill. So clerk should call the role. >> senator paul.
▶ 0:49:47Chair Cassidy: By proxy, yes. >> senator collins. >> no. >> senator murkowski. >> note. >> senator marshall. Senator scott. Senator hawley. Senator tuberville. Senator banks. Senator husted. Senator moody. Senator armstrong.
▶ 0:50:13Chair Cassidy: By proxy, yes. >> senator sanders.
▶ 0:50:17Sen. Sanders: No. >> senator murray.
▶ 0:50:19Sen. Sanders: No, by proxy. >> senator baldwin. Senator murphy.
▶ 0:50:25Sen. Sanders: No, by proxy. >> senator kaine. Senator hassan. Senator hickenlooper.
▶ 0:50:32Sen. Sanders: No, by proxy. >> senator markey.
▶ 0:50:35Sen. Sanders: No, by proxy. >> senator kim. Senator blunt rochester. Senator alsobrooks.
▶ 0:50:42Sen. Sanders: No, by proxy. >> chairman cassidy.
▶ 0:50:46Chair Cassidy: Cassidy is yes. >> I have 8-15.
▶ 0:50:52Chair Cassidy: So we are not tabling, so now we will vote on adoption of the amendment. I shall be voting no. The clerk shall call role. L. Sanders six. The one we just discussed, we shall now vote on passing. Did not table so we are voting to pass. Click should call the roll.
▶ 0:51:28Chair Cassidy: >> senator paul.
▶ 0:51:35Chair Cassidy: Yes, by proxy. >> senator collins. >> no. >> senator murkowski. >> note. >> senator marshall. Senator scott. Senator hawley. Senator tuberville. Senator banks. Senator husted. Senator moody. Senator armstrong. Senator sanders. Senator murray. Senator baldwin. Senator murphy. Senator kaine. Senator hassan. Senator hickenlooper. Senator markey. Senator kim. Senator blunt rochester. Senator alsobrooks.
▶ 0:52:05Sen. Sanders: Sorry, yes, by proxy. >> chairman cassidy.
▶ 0:52:14Chair Cassidy: No. >> 15-8.
▶ 0:52:17Chair Cassidy: The amendment passes. I ask unanimous consent to consider centers amendments one through five and amendment 7, 8, 9 en bloc.
▶ 0:52:30Sen. Sanders: No, I object. Mr. chairman, I call up sanders amendment one. Mr. chairman, let me begin please. Wait. I'm sorry.
▶ 0:52:56Chair Cassidy: Please, senator sanders.
▶ 0:52:58Sen. Sanders: Mr. chairman, it is no secret to anybody on this committee that we have a crisis in primary health care. I don't need to go through a long explanation. But he knows that is the case. Everybody here has committee health centers in their districts, and I think most of the people on this committee if not all are proud of the work that those federally qualified community health centers are doing.
▶ 0:53:24Sen. Sanders: Remember this committee understands community health centers and I expect in every state are under pressure now for a lot of reasons. They need help. As I mentioned earlier, and I don't think anybody disagrees, if we want to cut health care costs, if we want to ease human suffering, we have to make health care available to people when they need it. They need access to doctors, access to psychologists, access to low-cost prescription drugs, and that's what community health centers do.
▶ 0:53:52Sen. Sanders: So what this bill does are three basic things. It increases funding for community health centers from four point $6 billion to $5.8 billion. Second of all, it does something which again I think everybody in this committee understands is important, the concept of teaching health centers where medical school residents can now practice in primary health care facilities, other types of facilities rather than just teaching health centers.
▶ 0:54:22Sen. Sanders: That would bring more young doctors into rural areas, underserved areas, and into primary health care. There are now a number of states. We have expanded funding for this program recently, but there still remain a number of states. Alaska, kansas, kentucky, maine, south ravenna, indiana, vermont, new hampshire that do not have one teaching health center. That is addressed in this bill.
▶ 0:54:49Sen. Sanders: Lastly, what this amendment does is at a time where we have a massive shortage of doctors and nurses in this country, it substantially increases funding for the national health service. It helps our young doctors and nurses pay off their student debt if they agree to practice in underserved areas. So the problems are real. I think there is nobody in this room who disagrees with me. Let's do it. Thank you, Mr. chairman. >> Mr. chairman.
▶ 0:55:16Chair Cassidy: Let me comment first, please. This amendment is unrelated to the underlying bill on generic drugs, and adopting it will prevent this bill from advancing at today's market. Think about what I said at the outset. If we want congress to work, we have to work to make it work.
▶ 0:55:39Chair Cassidy: Having a bill which creates unrealistic increases in funding for some programs but for some reason strangely ignores the special diabetes program which is a bipartisan priority health members and includes the insulin act which we just passed, indicates it is not well thought through. I repeat that. We are supposed to be deliberative here. We are not supposed to be doing political punches.
▶ 0:56:07Chair Cassidy: Earlier this year, we increased funding for all of the public health extenders in a bipartisan fashion. So to say that we are not doing this is to ignore the work we have already done. There is some $6.6 billion in this new spending, which is not offset. It takes other members's priorities and inserts them into an unrelated bill in bad faith. The ranking member had months to engage with me on these priorities.
▶ 0:56:35Chair Cassidy: I approached him first for a list of bills from markup two months ago. Instead, we get something on tuesday. Without technical assistance, without a score. Which by the way hurts the ability of us to pass the underlying legislation, which is bipartisan. Bipartisan, democrat and republican priorities. We should all be frustrated with this. I am committed to working towards a positive outcome in the public health extender funding.
▶ 0:57:04Chair Cassidy: We can address these issues that we will address when we have technical assistance when we just do the blocking and tackling we have to do. I urge my colleagues to oppose this poison pill effort. I make a motion to table the amendment. >> Mr. chairman. Vote first.
▶ 0:57:23Chair Cassidy: Go ahead.
▶ 0:57:25Sen. Marshall: Mr. chairman, I think many of us on this side of the aisle have supported committee health centers and certainly want to continue to support them. But I think we need to go back and measure twice and cut once here. We have thrown a lot of money at them. If you have seen one committee health center, you have seen one committee health center. They are not majoring success in any uniform fashion and I begged them to come back to me and say here is what we will measure.
▶ 0:57:55Sen. Marshall: We have these eight chronic diseases that we are spending 90% of our money treating those diseases. The committee health center is the perfect place to treat those chronic diseases, but they need to find out how to measure it. I feel like sometimes we are throwing money at it and not solving the problem. Certainly want to continue to work with the ranking member on how to best fund these community health centers, how to fund more nurses out there, all those things.
▶ 0:58:22Sen. Marshall: A lot of the same goals we share together, but I will have to vote yes on tabling for today.
▶ 0:58:29Sen. Collins: Thank you, Mr. chairman. Mr. chairman, the sanders amendment excludes as you point out the special diabetes program. Perhaps the ranking member is unimpressed with that program.
▶ 0:58:45Sen. Collins: I can tell you it is absolutely essential to children, teens, and others with type one diabetes and also for native americans and native alaskans who have a disproportionately high rate of type 2 diabetes.
▶ 0:59:06Sen. Collins: Along with senator shaheen, I have lumped in a champion for the special diabetes program, but I cofounded the senate diabetes caucus and now serve as cochair with senator shaheen. In february, as chair of the appropriations committee, I secured a $200 million reauthorization of the special diabetes program, which expires in december 31 of this year.
▶ 0:59:36Sen. Collins: We increased funding by $40 million. That is the highest funding level in the program's history. It has driven remarkable progress at preventing, treating, and managing diabetes while supporting critical research.
▶ 0:59:52Sen. Collins: It is inexplicable that other programs are being extended, but the ranking member either deliberately or by mistake did not include the special diabetes program. For that reason, I will vote to table this amendment.
▶ 1:00:14Sen. Sanders: Mr. chairman?
▶ 1:00:16Chair Cassidy: Senator sanders.
▶ 1:00:17Sen. Sanders: This amendment does not solve every aspect of the health care crisis in america. I can see that. I concede the family health centers in america are not. Mr. chairman, the american people understand that our american health care system where we are today is broken, dysfunctional. Let me repeat.
▶ 1:00:44Sen. Sanders: According to some very good studies some 60,000 americans die every year unnecessarily because they cannot afford to go into a doctor's office. Community health centers are the best tool we have. I am delighted to work with the senator from kansas. Let's improve community health centers, but right now they are in desperate financial shape. They need help. So, again, all this bill does, it does not solve every health care crisis in america.
▶ 1:01:13Sen. Sanders: It addresses the major tool that we have for primary health care, that is community health centers. It allows them to serve more people. It helps us get doctors and nurses into rural and underserved areas by increasing the national health service corps and also allows us to get more doctors and nurses through the teaching health center program, a very important tradition. Does not solve all the problems.
▶ 1:01:39Sen. Sanders: It is a major step forward in giving access to millions of americans who desperately need health care.
▶ 1:01:43Chair Cassidy: Anyone else wish to comment on this? I will just point out we will consider the same bills in july at a markup when they have been fully vetted, had technical assistance, and scored. This means a bipartisan priority for us all, but there is a process you have to go through in order to make congress work. Don't just drop it on tuesday. We shall now vote to table. The chair shall be voting yes to table. Clerk should call roll. I vote yes. Did I say yes? The chair shall be voting yes.
▶ 1:02:15Chair Cassidy: >> senator paul.
▶ 1:02:16Chair Cassidy: Yes, by proxy. >> senator collins. >> yes. >> senator murkowski. Senator marshall. Senator scott. Senator hawley.
▶ 1:02:27Chair Cassidy: I don't have a proxy on him. Yes, by proxy. >> senator tuberville. Senator banks. Senator husted. Senator moody. Senator armstrong.
▶ 1:02:43Chair Cassidy: Aye, by proxy. >> senator sanders.
▶ 1:02:47Sen. Sanders: No. >> senator murray.
▶ 1:02:49Sen. Sanders: No, by proxy. >> senator baldwin. Senator murphy.
▶ 1:02:52Sen. Sanders: No, by proxy. >> senator kaine.
▶ 1:02:55Sen. Sanders: No, by proxy. >> senator hassan. Senator hickenlooper. Senator markey.
▶ 1:03:02Sen. Sanders: No, by proxy. >> senator kim. Senator blunt rochester. Senator alsobrooks.
▶ 1:03:07Sen. Sanders: No, by proxy. >> chairman cassidy.
▶ 1:03:11Chair Cassidy: Chairman cassidy is yes to table. Senator murphy is in person. >> we have 12-11.
▶ 1:03:25Chair Cassidy: The amendment is tabled. Does anyone else have an amendment they would like to call up?
▶ 1:03:31Sen. Sanders: Number two. Like my first amendment, this amendment simply calls for an increase in funding for community health centers from $4.6 billion to $5.8 billion. I think I previously discussed why community health centers right now are in desperate need of increased funding.
▶ 1:03:59Sen. Sanders: And I would hope that members would support the amendment.
▶ 1:04:05Chair Cassidy: Does anyone else wish to comment on this? I will say the same thing I did before. We are considering this in july after the amendment or this appropriate legislation has been vetted, technical assistance, and scored. Right now, there is no "pay for" for this. If we wait a month, we will have a "pay for" and that is the way congress is supposed to work.
▶ 1:04:34Chair Cassidy: It is not scoring cheap political points for passing bipartisan legislation which is a bipartisan priority. >> Mr. chairman, may I?
▶ 1:04:43Chair Cassidy: Sure.
▶ 1:04:45Sen. Sanders: Very briefly. You say you will be bringing this in july. Correct?
▶ 1:04:52Chair Cassidy: We are having a markup in july and I presume you will be offering this then.
▶ 1:04:57Sen. Sanders: What I would like to know is if we can get rid of these of the summons very quickly. Will you support in july an increase in funding for committee health centers from $4.6 billion to $5.8 billion?
▶ 1:05:11Chair Cassidy: I am so happy to have that conversation but there are limited resources so within the limited resources we have to live. That is an uncomfortable reality of the congress and of the government. So when I see what the funding is, when senator marshall's point is that when we see this money laid out, how it is being used, and we have a full assessment of full need, I will make my decision.
▶ 1:05:35Chair Cassidy: My bio's I worked for 25 years or something like that in hospitals for the uninsured and medicaid. I got street credit when it comes to taking care of poor people without insurance. I will hold up to anybody in the united states of america. So to simply imply the only way you are righteous is to vote for something which is not scored, without technical assistance, and not thought through is absurd.
▶ 1:05:58Sen. Sanders: Well, I would just say that for a party that gave $1 trillion in tax breaks to the 1%, let's talk about limited resources sounds far-fetched.
▶ 1:06:08Chair Cassidy: So we have to do mouth around -- math around here. Does anyone else wish to speak on this? I moved to table the amendment. I shall be voting yes. The clerk should call the roll. >> senator paul. Senator collins. Senator murkowski. Senator marshall. Senator scott. Senator hawley. Senator tuberville. Senator banks. Senator husted. Senator moody. Senator armstrong.
▶ 1:06:42Chair Cassidy: Aye, by proxy. >> senator sanders.
▶ 1:06:51Sen. Sanders: No. >> senator murray. Senator baldwin. Senator murphy.
▶ 1:06:56Sen. Sanders: No, by proxy. >> senator kaine. Senator hassan. Senator hickenlooper.
▶ 1:06:58Sen. Sanders: No, by proxy. >> senator markey.
▶ 1:07:00Sen. Sanders: No, by proxy. >> senator kim. Senator blunt rochester. Senator alsobrooks.
▶ 1:07:04Sen. Sanders: No, by proxy. >> chairman cassidy.
▶ 1:07:09Chair Cassidy: I am an aye. >> I have 12-11.
▶ 1:07:15Chair Cassidy: Motion to table passes. Any other amendments?
▶ 1:07:22Sen. Sanders: Sanders amendment number three. Mr. chairman, the help committee has jurisdiction over the teaching health center program. Last year, we worked together to substantially increase funding for this program over a five-year period, and that is the good news. The bad news is despite this increased funding, there are 20 states in america that do not have one single teaching health center.
▶ 1:07:49Sen. Sanders: 12 of those states are represented by senate is on this committee, alaska, kansas, kentucky, maine, south carolina indiana, vermont, new hampshire, virginia, colorado, new jersey, and delaware. This commitment would provide $120 million over a three-year period, $40 million a year, to ensure every state in america can have a teaching health center. These centers are extremely important because they allow medical school graduates to complete their residencies in community health centers.
▶ 1:08:19Sen. Sanders: If we want more doctors and medical professionals to practice in rural and underserved areas, this is a very important way to do it. I asked my colleagues to vote for this amendment.
▶ 1:08:30Chair Cassidy: This amendment is unrelated to the underlying bill on generic drugs. Adopting it would prevent the bill from advancing it in today's markup. The committee has worked to ensure funding for teaching health centers does not lapse, and it does not lapse this year. Earlier this year, we provided $1 billion to this program over the next four years and paid for by a bipartisan agreement.
▶ 1:09:00Chair Cassidy: The new spending is not offset by the savings of the bill. The bill has not received technical feedback to ensure it meets its intended goals of creating residency programs in states that do not currently have them. This is not a good faith amendment. I am committed to working towards a positive outcome and public health extender funding as part of our july markup and ensuring that they do not expire at the end of the year.
▶ 1:09:26Chair Cassidy: I urge colleagues who care about process in the united states senate and going back to regular order to oppose this poison pill effort. And I make a motion to table the amendment. I shall be voting to table. Clerk should call the roll. >> senator paul.
▶ 1:09:46Chair Cassidy: He is to table by proxy. >> senator collins. Senator murkowski. Senator marshall. Senator scott. Senator hawley. Senator tuberville.
▶ 1:09:56Chair Cassidy: Aye, by proxy. >> senator banks.
▶ 1:10:01Chair Cassidy: Aye, by proxy. >> senator husted. Senator moody. Senator armstrong. >> senator sanders.
▶ 1:10:10Sen. Sanders: No. >> senator murray.
▶ 1:10:11Sen. Sanders: No, by proxy. >> senator baldwin. Senator murphy. Senator kaine.
▶ 1:10:15Sen. Sanders: No, by proxy. >> senator hassan. Senator hickenlooper.
▶ 1:10:21Sen. Sanders: No, by proxy. >> senator markey.
▶ 1:10:23Sen. Sanders: No, by proxy. >> senator kim. Senator blunt rochester. Senator alsobrooks. Chairman cassidy.
▶ 1:10:32Chair Cassidy: Cassidy vote yes to table. >> I have 12-11.
▶ 1:10:36Chair Cassidy: The amendment is table. Does anyone else have an amendment?
▶ 1:10:42Sen. Sanders: I do. Sanders amendment number four. Mr. chairman, we are facing a shortage of more than 187,000 doctors over the next 12 years, including a shortage of tens of thousands of primary care physicians. The national health service corps provides scholarships and payment to primary care providers who commit to practicing in an underserved area, but the program is woefully underfunded.
▶ 1:11:10Sen. Sanders: Today, national health service corps scholarship funds are sufficient to fund just 10% of the applications received for new awards. According to the latest available data, 43% of eligible medical providers who apply for this program did not receive funding. While congress provided a 13% increase in funding for this program, that increase is nowhere near what is required to fully fund the program.
▶ 1:11:38Sen. Sanders: The association of conditions for the underserved estimates the national health service corps needs at least $950 million annually to provide scholarships and programs to all eligible clinicians. Bottom line is everybody here knows we have a major crisis in terms of a shortage of doctors. It is getting worse. It is worse in primary care. It is worse in rural and underserved areas. Let's support the seven.
▶ 1:12:04Chair Cassidy: This amendment is unrelated to the underlying bill. Adopting it prevents this bill this bipartisan bill from advancing in today's markup. This can he has worked to ensure the funding for the national health service corps does not lapse, and it will not lapse this year. Earlier this year, we increased funding for this program in a paid for bipartisan agreement.
▶ 1:12:27Chair Cassidy: The 450 million dollars in new spending is not offset by the savings of the bill, nor does the bill have technical acids to explain how the dust technical assistance to explain how the funding would be added. This is a political judging amendment which is not a good faith. I am committed to working towards a positive outcome and the public health extender funding as part of our july markup and making sure they do not expire at the end of the year. I urge alex to oppose this poison pill effort.
▶ 1:12:58Chair Cassidy: I urge them to stand up for regular order in the congress, and I make a motion to table the amendment. The clerk shall call the roll. I shall be voting yes to table. >> senator paul.
▶ 1:13:08Chair Cassidy: Senator paul is yes, by proxy. >> senator collins. Senator murkowski. Senator marshall. Senator scott. Senator hawley.
▶ 1:13:16Chair Cassidy: Aye, by proxy. >> senator tuberville. Senator banks. Senator husted. Senator moody.
▶ 1:13:28Chair Cassidy: Aye by proxy for armstrong. >> ok. Senator armstrong. Senator sanders.
▶ 1:13:36Sen. Sanders: No. >> senator murray. Senator baldwin. Senator murphy. Senator kaine.
▶ 1:13:42Sen. Sanders: No, by proxy. >> senator hassan. Senator hickenlooper.
▶ 1:13:46Sen. Sanders: No, by proxy. >> senator markey.
▶ 1:13:47Sen. Sanders: No, by proxy. >> senator kim. Senator blunt rochester. Senator alsobrooks. >> chairman cassidy.
▶ 1:13:54Chair Cassidy: Aye to table. >> 12-11.
▶ 1:13:59Chair Cassidy: The motion is tabled. Does anyone have another commitment? >> yes, Mr. chairman, no secret we face a massive shortage of nearly 400,000 nurses over the next two years.
▶ 1:14:18Chair Cassidy: Last year, over 90,000 applications of nursing schools were rejected not because these applicants were unqualified but because there is a shortage of nurse faculty in america and insufficient capacity. During covid, the largest hospital in vermont, the hospitals spent $25 million on traveling nurses because we did not have enough local nurses.
▶ 1:14:48Chair Cassidy: I think the story is true in every state in this country. We need to get young people into nursing school. We need nurse educators to do that. The problem right now is nurse educators receive substantially lower salaries than they would as supervisors and hospitals. We need more nurse educators so we can have more nurses graduating nursing school so we can address the nursing crisis. This is an important amendment.
▶ 1:15:20Chair Cassidy: I hope members will support it.
▶ 1:15:21Chair Cassidy: Does anyone have comments?
▶ 1:15:25Sen. Murkowski: Thank you. What senator sanders has set in terms of the need is absolutely true. I think we recognize we have a nursing shortage in this country and the nurse faculty is important. This is something senator durbin and I have been working on for a period of time in fact this amendment is our bill. But it comes as a surprise this senator that it would be included and incorporated as part of this markup.
▶ 1:15:56Sen. Murkowski: We have been working with you and your teams to try to get this to a place we can get it through this committee. It is my understanding that we are looking to this july markup to do just that.
▶ 1:16:12Sen. Murkowski: I would hope that the progress were able to make between now and then will be representative, that senator sanders would be cooperative in working with us to get this to a place where, again, we can put into law a measure -- a bipartisan measure that will address the shortage. But to include it at this point in time on this measure, I think risks that progress that we have made. You have not moved to table, Mr.
▶ 1:16:43Sen. Murkowski: Chairman, that if you do so, I would be supporting that tabling motion at this time.
▶ 1:16:47Chair Cassidy: Anyone else wish to speak? I will say the amendment is not germane to the bill at hand related to generic drugs. The faculty recruitment is a complex challenge that schools have to navigate in a sustainable way to ensure the long-term health of their institution.
▶ 1:17:12Chair Cassidy: We have been discussing the nuances of this policy through good faith bipartisan negotiation to evaluate the idea on its merits and get questions answered. But when the sponsor of the legislation does not know it was coming up today and acknowledges this ongoing negotiation is ongoing and senator sanders has chosen to take that legislation to amend it and bring another sitters legislation, I only have the ability to access it on our
▶ 1:17:42Chair Cassidy: Incomplete information as of right now. I am committed to addressing workforce programs, particularly nursing workforce programs, as part of our markup in july. There is a regular order process that we go to and that anyone on either side of the dais that cares about returning to regular order should be committed to.
▶ 1:18:05Chair Cassidy: So I think senator collins and murkowski who both have showed leadership in the space and senator durbin is not only committed but we still have more work to do. I urge colleagues to oppose this poison pill effort and make a motion to table the amendment. I shall be voting to table. The clerk shall call the roll. >> senator paul.
▶ 1:18:26Chair Cassidy: Yes to table by proxy. >> senator collins. Senator murkowski, senator marshall, senator scott.
▶ 1:18:35Chair Cassidy: Aye by proxy. >> senator tuberville.
▶ 1:18:43Chair Cassidy: Aye by proxy. >> senator sanders.
▶ 1:18:49Sen. Sanders: Nope. >> senator baldwin. Sara murphy. Senator kaine. Senator hassan.
▶ 1:19:00Sen. Sanders: Know by proxy. >> senator kim. Senator blunt rochester. Senator alsobrooks. Chairman cassidy.
▶ 1:19:13Chair Cassidy: To table. [inaudible] >> 12 ayes, 11 nays.
▶ 1:19:26Chair Cassidy: Does anyone have another amendment?
▶ 1:19:29Sen. Sanders: I do. Everybody here knows sanders amendment number seven. Everybody knows we pay by far the highest prices in the world for prescription drugs. One of the reasons is that drug companies spend millions of dollars on tv commercials pushing their outrageously expensive drugs.
▶ 1:19:59Sen. Sanders: Turns out, and I don't know everybody knows this, with the exception of new zealand, the united states is the only country in the world where it is legal for pharmaceutical companies to advertise their drugs on television. Every other country thinks it is a good idea for doctors to make that decision not ads on television.
▶ 1:20:26Sen. Sanders: In my view, it is time for us to hang that international -- handle that international embarrassment. This is not just my view. I think members of the committee recall hhs secretary kennedy has said he believes we should ban pharmaceutical ads on television. The ama endorsed the better prescription drugs more than a decade ago.
▶ 1:20:48Sen. Sanders: And I think this is an intelligent way to give doctors control over their patient's needs and absurdity of us being one of two nations in the world to allow this travesty.
▶ 1:21:04Chair Cassidy: Does anyone else have a comment? I will note the supreme court has ruled that drug companies have a first amendment constitutional right to advertise. We may not like it but if you consider supporting the constitution in important issue, which I do, this is manifestly going to lose in court. I absolutely agree more transparency is needed as to how drug manufacturers market products to consumers but this is a bad faith effort to do so.
▶ 1:21:33Chair Cassidy: Prohibition on advertising politicize this fda's role in reviewing new products. Other senators have policies to address this issue more awful ways rather than a de facto ban -- thoughtful ways rather than a defacto ban. I make a motion to table the amendment. I shall vote aye to table. Clerk shall call the roll.
▶ 1:22:01Chair Cassidy: [roll call] I
▶ 1:23:00Chair Cassidy: Have 11 ayes, 12 nays.
▶ 1:23:07Chair Cassidy: Clerk shall call the roll. [roll call]
▶ 1:24:00Chair Cassidy: I vote against the amendment. Senator scott? [inaudible] >> 11 ayes and 11 nays.
▶ 1:24:16Chair Cassidy: Does anyone else have another amendment?
▶ 1:24:20Sen. Sanders: As a matter fact, I do. I always enjoyed this discussion about process, doing it by the book. Meanwhile, what, american people understand we have been doing process during about the book, the health care system is collapsing. People are dying because they can't afford the health care they desperately need despite the fact you're spinning twice as much per capita on health care as people of other nations.
▶ 1:24:47Sen. Sanders: Maybe just stand up, do the right thing, have the guts to take on the big money interests who make large campaign contributions. Everybody knows that we pay by far the highest prices in the world for prescription drugs, even president trump understands that. As a result of that reality, insanely --
▶ 1:25:11Chair Cassidy: What amendment are you bringing up?
▶ 1:25:14Sen. Sanders: Number eight as a result of high cost of prescription drugs, and this is insane, one out of four americans goes through the pharmacist cannot afford the medicine the doctors prescribed. So what happens when you don't get the medicine your doctor prescribes? You get sicker, maybe end up in the emergency room, maybe end up in the hospital and health care system spends a fortune which could have been saved if you had the blood he money to get the prescription drug in the first place.
▶ 1:25:45Sen. Sanders: President trump to his credit actually talks about this issue. During his state of the union address, president trump asked us to codify the most favored nation drug policy to ensure the american people pay no more for prescription drugs that people in other countries. Not a radical idea, guys.
▶ 1:26:12Sen. Sanders: Maybe we should not be paying 10 times more than europeans, canadians, japanese people, etc., etc. All it says is lettuce in this country not pay more than people in other countries. Trump believes that to be correct approach I believe that to be the correct approach amendment. That is what this amendment does.
▶ 1:26:36Sen. Sanders: If this amendment is signed into law, the price of a drug used to treat crohn's disease would be reduced from 152,000 a year to just 21,000. The price of a cancer drug would drop from $210,000 a year to just $88,000 a year. People in countries all over the world for a variety of reasons are paying a lot less than we do. Let's make sure we don't continue that. I would ask for a guest vote for this common sense amendment.
▶ 1:27:05Chair Cassidy: Senator collins?
▶ 1:27:09Sen. Collins: Thank you. I want to make an important distinction here. I voted for senator sanders' amendment to add most favored nation instructions to the reconciliation bill, but that is not what this is. Those instructions on the floor were general. This amendment is very specific and raises important questions that demonstrate why it needs much more thought.
▶ 1:27:40Sen. Collins: For example, I note royalty mechanism in the amendment uses foreign reference pricing to set the price per drugs here but does not correct the dangerous of discriminatory metrics known as quality adjusted life years. The problem with that is they discount the value of life because a patient is older or ill or has a disability.
▶ 1:28:12Sen. Collins: I cannot support that and I am surprised that the senator from vermont thinks that that is appropriate. The affordable care act rightfully prohibited the use of them in the medicare program. That certainly should be done here, too. This is just a perfect example of why something this complicated should go through the committee process.
▶ 1:28:41Sen. Collins: This is an extremely flawed approach. I will be voting to table the amendment.
▶ 1:28:47Chair Cassidy: Senator sanders?
▶ 1:28:49Sen. Sanders: The senator from maine knows this is not the end of the process. And if she has or anybody else has objections and was to improve the bill, which is often the case, not an unusual circumstance, that can be done. But the american people, frankly, are sick and tired hearing year after year from all of the reasons why we can't take on the pharmaceutical industry.
▶ 1:29:11Chair Cassidy: The senator has already spoken.
▶ 1:29:14Sen. Sanders: Thank you. >> this is a complicated bill, by the way, different from president trump's bill, that has no technical assistance. We just can't be incontinent saying we've got to do something, whom. You've got to think about it. Give us then, do not just do something, think.
▶ 1:29:38Sen. Sanders: There is something that is required to be done on drug cause, we should actually think about it not go afoul of what senator collins just pointed out. I am so committed to working with -- I've a track record of working on a bipartisan basis and with the white house to lower the cost of prescription drugs. This is not the correct path. It does not have technical assistance. We don't know how it works.
▶ 1:30:02Sen. Sanders: The amendment represents a significant expansion of federal authority over domestic supply chains, undermining existing forms designed to reduce competition. I urge colleagues to -- let's be serious about lowering costless just not be demonstrative. I moved to table the amendment. The clerk shall call the roll. [roll call]
▶ 1:31:38Chair Cassidy: Yes to table. >> 11 ayes and 11 nays.
▶ 1:31:50Chair Cassidy: Voting on adopting the. Amendment. [roll call]
▶ 1:32:37Chair Cassidy: 11 ayes and nays.
▶ 1:32:40Chair Cassidy: The motion fails. Does anyone else have an amendment?
▶ 1:32:46Sen. Sanders: I do. You would be happy to note this is the last one. [applause]
▶ 1:32:54Sen. Sanders: Maybe we could do some more. What you think? Sanders amendment number nine. Mr. chairman, president trump's so-called big beautiful bill made the largest cut to education in our nation's history in order to pay for the largest tax breaks for billionaires in market history.
▶ 1:33:16Sen. Sanders: If congress allows these changes to take effect, 7 million americans will be thrown off of their low cost student loan repayment plan known as the save plan and into a much more expensive plan. This means the average college graduate will be forced to pay $4000 more each year on the student loan payment. $4000 a year. That is an astronomical amount of money.
▶ 1:33:46Sen. Sanders: It is been estimated if these cuts go into effect, one out of every four student loan borrowers will be in default by the end of the summer. This is a crisis situation. Further, in just two weeks, working class students will be priced out of graduate training in programs like nursing, medicine, dentistry, and social work because of new restrictive arbitrary loan limits.
▶ 1:34:10Sen. Sanders: At a time when we have a shortage of nurses, doctors, dentists in this country, 21% of nursing students, more than half of the medical students, and three quarters of dental students will be priced out of a degree. We cannot and must not allow that to happen. This amendment will repeal these harmful cuts to federal student loans and fully restore access to financial aid. I urge my colleagues to vote yes on this amendment.
▶ 1:34:34Chair Cassidy: Does anyone else have comments? The amendment is unrelated to the bill being considered and put back into place biden student loan schemes which cost taxpayers $284 billion and allows students to once more current excessive amounts of debt.
▶ 1:34:53Chair Cassidy: In the working families tax cuts act congress placed common sense limits on federal student loans proposed to help drive down the cost of college and added accountability metrics to prevent steering of students into low value, high tuition programs. By the way, college tuition has increased much faster than any other household expense in the last 40 years. Something was wrong. What was wrong?
▶ 1:35:19Chair Cassidy: In 2023, the national bureau of economic research found uncapped federal borrowing for graduate programs did not improve access or degree attainment. Colleges merely raised tuition, capturing more student loans, trapping kids into debt. Thanks to loan limits, senate republicans enacted, college costs are now going down. Uc irvine recently announced they will be cutting tuition for the mb program by 38% in the upcoming fall semester.
▶ 1:35:47Chair Cassidy: Other colleges are starting to add -- offers deep discounts. This amendment would allow students once more to load up with excessive amounts of student loan debt. I ask colleagues to oppose the poison effort to make a motion to table the amendment. The clerk shall call the roll. [roll call]
▶ 1:36:49Chair Cassidy: Custody is yes to table. >> 12 ayes and 11 nays.
▶ 1:36:56Chair Cassidy: The amendment is tabled. I think that is the last of the amendments. We shall go to the consideration of the healthy start reauthorization act act. I think senators marshall, jolivette, baldwin for working this legislation to reauthorize healthy start program, improving maternal and infant health outcomes before, during, and after pregnancy. This bipartisan legislation, an example of the important work we can achieve, would work across the aisle.
▶ 1:37:27Chair Cassidy: I encourage my colleagues to support it. Before we off their cash offer any amendments, you any members wish to speak on the bill? Do any members wish to offer amendments? Senator marshall.
▶ 1:37:47Sen. Marshall: 3799. Mr. chairman, I want to emphasize how great success story this healthy start program is that targets communities with high infant mortality rates, improves health incomes before, during, and after pregnancy.
▶ 1:38:10Sen. Marshall: This amendment aligns the funding amount with what was appropriated in the fiscal 2026 appropriations bills and also shifts the start date to next year since the program has been funded for this year already. Thank you.
▶ 1:38:25Chair Cassidy: This is what it is nice to have an ob/gyn on the committee. Thank you. Anyone else? We shall vote on the amendment. The chair shall be voting yes. The clerk shall call the roll. [roll call]
▶ 1:38:46Chair Cassidy: Would you a voice vote? The ayes have it. The amendment is adopted. Next is s 4109 stem cell therapeutic and research reauthorization act.
▶ 1:39:06Chair Cassidy: I am thankful for reid, scott, langford, and smith on this legislation to extend the bill young cell transplantation program and improve access to stem cell therapy and bone marrow transplantation. This legislation facilitates further research and lifesaving advancement in the field while technology and innovation continue to improve. I urge colleagues to support this bill.
▶ 1:39:29Chair Cassidy: We have a manager's amendment to s 4109 and I moved to adopt the managers amendment and have a considered original text for the purpose of further amendments. All those in favor say aye. Opposed? The motion is agreed to. Do any members wish to speak on the bill? Senator scott?
▶ 1:39:52Sen. Scott: I want to thank you for your leadership on this in the colleagues as well as senator reed. I think this is incredibly important. I think about the impact that bone marrow and cord blood transplants are having around the country positive and powerful. Looking at the 150,000 transplant which means more patients have more time with their families than ever before because of the legislation work we are doing on this committee around congress.
▶ 1:40:20Sen. Scott: But it is in your leadership and I want to say thank you for the way you have lead in a bipartisan fashion keeping health as a primary issue, not republican or democrat, red or blue, rich or poor. Frankly, serving people in this country providing greater access to lifesaving opportunities and life extending opportunities. This will help folks with lymphoma. Other blood cancers and specifically sickle cell anemia as well. Thank you.
▶ 1:40:44Chair Cassidy: I want to acknowledge your leadership on the issue and your sensitivity to the issue that makes everyone else even more sensitive. Thank you very much. Anyone else? We will begin with consideration, moving on to the s2339, early act reauthorization of 2025. I think senators klobuchar and crapo for their work on this legislation. This helps ensure young women have access to information about breast cancer risk factors and early detection. I urge all colleagues to support the bill.
▶ 1:41:16Chair Cassidy: Managers amendment to s2339 and I moved to adopt that and have it be considered original text the purpose of further amendment s. All in favor say aye. Oppose? The motion is agreed to. Do any members wish to speak on the bill? Let's move on to s 4472, accelerating access to critical therapies for als act.
▶ 1:41:48Chair Cassidy: I think senators borkowski and kunz for the work on this legislation supporting cure for rare and degenerative diseases. This continues program supporting access to investigational therapies for als and rare neurodegenerative diseases. I urge all colleagues to support. We have a managers amendment to s4472. I moved to adopt it in the nature of a substitute and have a considered original text for the purpose of further amendment s. All in favor say aye.
▶ 1:42:21Chair Cassidy: Motion is agreed to. Two him new members wish to speak on the bill? Chair murkowski?
▶ 1:42:29Sen. Murkowski: Thank you for getting this bill to this place. As you have noted, this is significant in terms of research into the therapies for als read in 2020 one, we passed accelerating access to the for als act. This provides a pathway for people who are not ineligible for clinical trials to receive investigational treatments and provides funding to nih and fda to accelerate the research and data sharing development.
▶ 1:43:00Sen. Murkowski: Basically what we're talking about here is a process that allows individuals the right to try read as we know, an als diagnosis is effectively terminal. There is just the tragic course. So in opportunity, any ray of hope that can be found is what those who are living with als are hoping for. So the bill we have is a reauthorization of this program.
▶ 1:43:31Sen. Murkowski: You noted to the work that senator coons and I have been doing on this reauthorization that I tell you we have been working with some extraordinary advocates over the years. People like dan tate, brian wallick, jenny dwyer -- advocates who have just recently passed away like eric dane. Many of us have personal connections in this space. In that vein, Mr.
▶ 1:43:57Sen. Murkowski: Chairman, I would like to introduce into the record a statement from senator coons highlighting this success of the program, acknowledging the work of so many advocates and those who have helped us get to this point. This is a program that works and needs to keep working as we move toward possible treatments and, hopefully, one day a qr. We made a few improvements but we really want to get this passed and signed into law. I thank you and all those on the committee for the support.
▶ 1:44:27Chair Cassidy: Anyone else? We will move on to s 1854, biosimilar red tape elimination act. I think the sponsors -- I think the sponsors for their work on this legislation to improve access to affordable biosimilar medications.
▶ 1:44:49Chair Cassidy: We first began considering this in 2024 and I highlighted this bill at a hearing and april and glad to see the progress enabling biosimilars to be interchanged with brand name is, says that both evite and trump administrations took steps to advance. Under this bill, will ensure there are no clinically need differences between biosimilar and brand name products so patients are protected. I received two letters of support but I ask unanimous consent to enter into the record that is granted. We have a managers amendment to s 1954.
▶ 1:45:21Chair Cassidy: I moved to adopt that in the nature of the substitute and have a considered original text for the purpose of future amendments. All in favor say aye. The motion is agreed to. Do any members wish to speak on the bill? Seeing none, we shall move on to the medication affordability and patent integrity act which is s 2658. I thank the senators for the work on this legislation. Patents are critical.
▶ 1:45:52Chair Cassidy: But they are and should be time-limited and abuses can unfairly extend brand monopolies and keep drug prices higher than they should be. This legislation aims to make sure drug manufacturers get both fda and the patent office the same information. That said, their provisions in this bill dealing with patent litigation that fall on judiciary committee's jurisdiction. We do not make changes to those parts of the bill. I defer to the judiciary committee on patent changes that fall within their jurisdiction and expertise.
▶ 1:46:29Chair Cassidy: I will vote yes on this build with the expectation that we will need to work with the judiciary committee to move this bill forward. We have a managers amendment to 2658 and I moved to adopt that in the nature of a substitute and have a considered the text for future amendments. Ayes have it. Before offering amendments, to any wish to speak? Sir hassan? -- senator hassan?
▶ 1:46:58Sen. Hassan: For too long, big pharma has abused the patent process and blocked generic competition from entering the market, which has meant higher prices at the pharmacy counter for families.
▶ 1:47:14Sen. Hassan: One of the ways in which big pharma blocks -- boxes out generic medication is by filing endless patents to block any competition including by filing brand-new patents for original features of their drug that they disclosed to the fda years beforehand but with help from the patent office. Prescription drug costs are pushing families and seniors in particular to the brink, and it is time to end this big pharma loophole which is exactly what my bipartisan bill senator hawley will accomplish.
▶ 1:47:44Sen. Hassan: I acknowledge we need to continue to work with senator cornyn and the judiciary committee moving forward, but this would be a very good start and I appreciate that your and ranking members of support.
▶ 1:47:57Sen. Hawley: I want to add my voice in support of this legislation and I want to thank senator hassan for her leadership on this. Prescription drugs are just too expensive. They are way too expensive for every family and every individual in this country.
▶ 1:48:11Sen. Hawley: One of the reasons are too expensive is the big pharma companies tell the fda one thing and then they tell the patent office something else read they keep that disparity to themselves until it comes time for a piece of another competition, competitor, 70 who wants to get into enter and lo and behold, big pharma discovers, oh, actually, we have got some more information. We had that patent. No, you cannot file that we cannot allow it generic into the market.
▶ 1:48:38Sen. Hawley: There is less competition, prices remain high, it is a blatant attempt to gain the system. Our current system is great. They are gaming it. Because they are gaining it, they are keeping prices high for americans all across this country. This is a simple bill that would put a stop to that chicanery. I look forward to doing it today.
▶ 1:48:57Chair Cassidy: Anyone else? Do any members wish to offer an amendment? >> I call amendment number one.
▶ 1:49:12Chair Cassidy: Senator banks.
▶ 1:49:15Sen. Banks: I appreciate the intent of the legislation by the bills authors. What I don't favor is doing anything that would help the chinese communist party sheet and steal our ip and that is what my amendment would go at least to stop. It would ensure the same protections for trade secrets at the fbi would also apply the patent and trademark office. We know chinese biotech companies have been sifting through U.S. patent applications for a long time.
▶ 1:49:44Sen. Banks: Looking to steal intellectual properties so they can copy or drugs. Now they're using ai to analyze our patent applications on a massive scale to develop their own drugs. I understand the bill sponsors intent to eliminate patent tickets, but we need to make sure the bill does not inadvertently expose U.S. drug companies trade secrets and intellectual properties to competitors.
▶ 1:50:06Sen. Banks: My amendment would first maintain all confidentiality and trade secret laws that already apply to the fda and then it would also create procedures for the patent and trademark office to notify patent applicants before the information is publicly disclosed. Third, it would allow patent applicants 30 days to object to disclosures and reject trade secrets or confidential information. I urge my colleagues to support my amendment to preserve the intent of the bill and avoid giving china are biotech industry's most precious trade secrets. I yield back.
▶ 1:50:37Sen. Banks: >> I appreciate senator banks, are concerned about the chinese communist party. It is a concern I share pretty but the patent office already has procedures for the handling of trade secret propriety and other proprietary and other protected materials.
▶ 1:50:54Sen. Banks: Even so, as part of our bipartisan agreement, the underlying bill expands upon existing trade secret protections and directs the patent office to update its regulations to ensure that sensitive information is protected when appropriate. Instead of simply protecting trade secrets, this amendment from senator banks would go much further and undermine the core obligation of the patent office to publish basic information about each patent vetted issues. I urge my colleagues to oppose this amendment.
▶ 1:51:24Chair Cassidy: Senator hawley.
▶ 1:51:29Sen. Hawley: This bill expands their protection for trade secrets at the patent office, and I just want to note that is what the pharma companies asked for the lesson we traduced this bill -- the last time we introduce this bill. The last time they said, we think differently about it. If you just put more protections when the patent office disclosures. So that is what we did. And they said, actually, we don't like those. We want something else. Next year it will be something else and then something else.
▶ 1:51:57Sen. Hawley: So long as they keep reaping billions of dollars in profits and nobody can afford prescription drugs. We have to put an end to this. I urge a no vote.
▶ 1:52:06Chair Cassidy: I think senator banks for offering this amendment. It is essentially sacred proprietary and confidential information from unnecessary disclosures while ensuring that actors don't miss use these protections for their own advantage. I support this amendment. The clerk shall call the roll.
▶ 1:52:26Chair Cassidy: [roll call] 8
▶ 1:53:23Chair Cassidy: Ayes and 12 nays. Senator collins is a no? 8 ayes, 13 nays.
▶ 1:53:36Chair Cassidy: The amendment is not adopted. Are there any others? >> I would like to call up who did amendment number one s 2658. This is an issue that was brought to my attention by constituents in ohio.
▶ 1:53:58Chair Cassidy: Ohio has some of the best children's hospitals and academic research institutions in the world in the vouching and cell therapies. The concern expressed to me this amendment would fix is the bill let's patent infringers escape liability just because a company's fda pto filings don't perfectly match.
▶ 1:54:26Chair Cassidy: But those agencies do different jobs. They review different information. So of course, those differences are normal. A mismatch is not proof of wrongdoing. It is merely just how the process works. Husted amendment one thing makes one fix, the inconsistency has to have an actual material affect before it can avoid the patent.
▶ 1:54:52Chair Cassidy: This will help achieve the goals goal of driving down costs rather than driving them up and I urge a yes vote.
▶ 1:54:59Chair Cassidy: Does anyone wish to speak?
▶ 1:55:03Sen. Hassan: Yet again, this is another example of big pharma picking away at a bill no matter how hard we try to end deceptive practice that they have been engaged in. This amendment would make it possible for big pharma to endlessly block generic medications from reaching patients.
▶ 1:55:23Sen. Hassan: The effect of the amendment would be to effectively remove the defense for generic companies that is provided in the bill, allowing big pharma to continue playing unfair patent games in order to block low-cost medications from the market.
▶ 1:55:39Sen. Hassan: I think all of us have hospitals and scientists in our states who want to make sure that they are being accurate with their submissions to the fda and the patent office, but it is critical we passed the underlying bill without this amendment in order to help lower drug prices for patients.
▶ 1:56:01Sen. Hassan: Because of course, patients can afford things are brilliant scientists are developing, it makes the work -- can't afford things are brilliant scientists are developing, it makes the work -- I urge my colleagues to vote against it.
▶ 1:56:15Chair Cassidy: I apologize for cutting and create senator
▶ 1:56:21Hawley Echo Sen. Hawley: To piggyback, I want to be clear because sometimes we are dealing with an area that is complicated as this one, this is the enforcement mechanism. The way this bill works is if a generic company enters the market and they see the pharma companies withheld information, then they say, no, you can't offer a generic witness would got the defense. There would be no way to enforce the bill brackett would become a resolution. This is what we are trying to do is get more competition.
▶ 1:56:51Hawley Echo Sen. Hawley: I'm a free-market guy. I love competition. We need more of it in the pharma space. We need to get these prescription drug prices down. I appreciate the concerns and happy to think about ways we can work with you going forward, but I want to point out if we were to adopt this, the entire enforcement mechanism of this bill would fall away. I urge a no vote.
▶ 1:57:09Chair Cassidy: Does anyone else wish to speak? I thank senator husted for this amendment. This makes changes to policy in the bill that are within the judiciary committee's jurisdiction. I commit to working with senators who stood in judiciary committee to address these commitments but I will support this amendment if not adopted I will still support the final passage of the bill. The clerk should call the roll.
▶ 1:57:40Chair Cassidy: [roll call]
▶ 1:58:26Chair Cassidy: Senator cassidy is aye on the amendment. 8 ayes, 13 nays. Does anyone else have an amendment?
▶ 1:58:44Sen. Husted: Thank you. I ask to call up husted amendment number 22 s2658. As we proceed with this knowing it has a strong tools of enforcement in this bill, nothing in the current bill prohibits entities tied to a foreign adversary from using the defense to undermine american innovators.
▶ 1:59:13Sen. Husted: Husted amendment number two make sure no person with ties to an adversary of the united states can utilize this defense against them to infringement without this limitation, the bill opens up a door to subsidize china and other hostile foreign nations on the backs of the american innovator. I am very concerned about this, using this legislation by our foreign adversaries as a jewel against our innovators.
▶ 1:59:44Sen. Husted: And the new therapies in vouching and cell therapy that could come from the research going on here in america. I urge a yes vote.
▶ 1:59:51Chair Cassidy: Anyone else wish to speak?
▶ 1:59:56Sen. Hassan: I want to thank senator husted for this amendment. I appreciate the intention. We're still examining whether there are any unintended consequences to this bill and how it would actually operate, but I look -- I do not oppose the amendment. I look forward to continue to work with you to make sure we get this right. I think senator hawley is in the same place.
▶ 2:00:17Sen. Sanders: Mr. chairman, like many other products, most of the generic drugs in american spy are produced overseas. Big pharma would like us to think this america -- this is about chinese dealing until actual property. Is it better of swiss drug companies whose attorneys generic and effexor keep cheaper generic drugs? No. My colleagues would have a conversation about revitalizing american manufacturing.
▶ 2:00:47Sen. Sanders: Let's do it. But that is not what this amendment is about. This is about big drug companies protecting the profit margins at the expense of american patients. I urge a no vote. >> I would like to note the amendment deals with foreign adversaries, not the swiss. As was suggested. This is about china.
▶ 2:01:12Chair Cassidy: Senator sanders says he is a no. Would you be open to a voice vote? All in favor say aye. The ayes have it. We shall proceed. This concludes consideration of 2658. We will vote on final passage of today's bills. I will note I will not vote on final passage of s3014.
▶ 2:01:41Chair Cassidy: I'm committed to working with senator sanders on refining -- senator collins on refining the insulin act moving forward. Will move to final passage of s 1782 as amended. . I moved to favorably report 1782, our people open to a voice vote? >> you can't on final passage.
▶ 2:02:14Chair Cassidy: Can we do it on block? Our people open to doing on final -- by one vote? Roll call vote?
▶ 2:02:30Chair Cassidy: Will do on block of s1782 as amended, s3799 as amended, s4109, s2339, s 4472, s 1954 as amended, s 2658 as amended. The clerk should call the roll.
▶ 2:03:01Chair Cassidy: I shall be voting aye. Weight. -- wait. I'm excluding s2658 is or might be some people voting against that. We will do on block for everything but that. I shall be voting aye.
▶ 2:03:26Chair Cassidy: [roll call] 22
▶ 2:04:19Chair Cassidy: Ayes, 0 nays.
▶ 2:04:23Chair Cassidy: We shall now move to final passage of s2658 as amended. I move to report favorably as amended. The clerk shall call the roll. I shall be voting no.
▶ 2:04:39Chair Cassidy: [roll call] 16
▶ 2:05:36Chair Cassidy: Ayes, 6 nays.
▶ 2:05:39Chair Cassidy: The bill passes. It will be favorably reported. I now move to authorize staff to make a new report, technical changes when preparing s 1782, 3799, 2339, 4472, 1954 and 2658. All this in favor say aye. Ayes have it. The motion is agreed to. The committee stands adjourned.
▶ 2:06:14Chair Cassidy: [captioning performed by the national captioning institute, which is responsible for its caption content and accuracy. Visit ncicap.org]