Markup of 8 Bills and Budget Views and Estimates Letter

The committee will come to order. Without objection, the chair is authorized to declare a recess at any time. Today, the Ways and Means Committee is meeting to consider eight bills aimed at two important goals. Expanding access to health care, particularly, particularly, for those in rural and underserved areas, and reducing waste, fraud and abuse in programs in this committee's jurisdiction. Americans should be able to get quality care in the communities where they live and work yet for the sixty million Americans in this country who rely on Medicare, outdated and unfair rules make this difficult. The policies in our legislation cut through the Washington red tape, hurting seniors' access to care. Our first bill recognizes the important role community pharmacists play, delivering care for patients. Ninety percent of Americans live within five miles of a pharmacy. And in rural communities, a pharmacist is frequently the first point of care for patients. This legislation from Representatives Adrian Smith and Brad Schneider allows Medicare to reimburse pharmacists for test and treatments for common respiratory illnesses, like strep throat and the flu. Pharmacists across this country provide this critical primary care to patients every day. This bill ensures seniors on Medicare can can receive the same care from a trusted medical professional. The second bill helps independent physicians keep their doors open by modernizing the Medicare physician fee schedule. The current system is outdated, it's unpredictable, and over half of independent physicians cited Medicare reimbursement cuts as a major reason why they chose to consolidate. This bill from Doctor Murphy and Representative Swasey protects patient access to care by stabilizing Medicare reimbursements, and holds Washington bureaucrats accountable for unreliable calculations. We will consider legislation from Representatives Representative Carol Miller that improves the lives of kidney disease patients by expanding access to safe and effective home dialysis. This committee heard from Americans about how home dialysis allowed them to take control of their lives and improve their health. Home dialysis has fewer side effects and increased life expectancy, yet patients face barriers to starting treatment at home. This bill better enables seniors to engage in home dialysis by offering critical services, such as staff assistant home dialysis and renal mental health support services. Next, we will take up fraud prevention legislation. As too many Americans know from personal experience, fraud is not a victimless crime. Fraud steals benefits from the very Americans that programs like Medicare, TANF, and unemployment insurance were created to help. The size and scale of fraud in this country is staggering. Sixty billion dollars, sixty billion dollars is lost each year from Medicare alone. That's nearly a thousand dollars every year for each Medicare beneficiary. That doesn't even include the other government programs where we know that there is fraudulent activity. Wide-spread fraud not only disrespects hard-working Americans, But it destroys public trust and incentivizes future criminals to steal from taxpayers. That's why fraud cannot be swept under the rug. We cannot ignore the multi-billion dollar elephant in the room. The policies we will consider today complement President Trump's new anti-fraud task force, by helping recover stolen taxpayer dollars and implement tough new guardrails to stop future fraudsters. Legislation introduced by Representative Van Duyn cracks down on the hospice and home health f- health fraud epidemic in this country. Just last month, this committee heard firsthand testimony about a system that has so failed to protect taxpayer dollars, that a fraudulent hospice was able to claim a Los Angeles burrito stand as its headquarters. This is absolutely unacceptable. This bill provides the desperately needed oversight that should have done should have been done years ago. Hospices will be subject to frequent in-person inspections to ensure only legitimate operations are certified. Providers that fail to submit quality data, a a telltale sign of fraud, will pay a tripled fine. Most importantly, we protect seniors from fraudsters by alerting them when they are enrolled in hospice and providing clear instructions on how to disenroll and report the fraud. Our next bill tackles the massive fraud in durable medical equipment. Items like catheters and medical braces have become big business for fraudsters to the point that a quarter of all Medicare DME payments are improper. Medicare's outdated payment policies are a barrier to detecting fraud in real time. DME suppliers having an entire year to submit reimbursement claims and tens of thousands of claims are still submitted on paper each year. This bill from Representative Bean improves the ability of modern technology to better detect DME fraud in Medicare. These fraud prevention reforms will help protect Medicare benefits for the deserving Americans relying on this critical program. The next bill offered by Representatives Van Duyn and Suozzi helped recover nearly one billion dollars in fraudulent COVID error unemployment benefits abandoned in banks identified by the Labor Department and Specter General. That money could have already been returned to taxpayers had the federal government enforced state responsibility to reclaim the money. This bill charges a new federal task force with working with states to coordinate the recovery of those dollars from financial institution and doubles the statute of limitations to ten years for prosecuting fraud. Legislation from Representative Kerry tackles the fraud affecting the TANF program. Money meant for the vulnerable has become the target for fraud and state misuse due to a lack of federal guardrails. This bill strengthens federal oversight of state TANF spending, so taxpayer funds benefit the truly needy and aren't treated as slush funds or rainy day funds by states. This bill has come together thanks to the ideas of several colleagues on this committee. In addition to Congressman Kerry, a provision led by Congressman Smith sets a federal income thr- thr- threshold for TANF. Congresswoman Tenney championed a provision to prevent states from using TANF funds to fill state budget deficits. And policy crafted by Congressman Kerry introduced a three-year limit for states to spend TANF funds. Legislation from Congressman Arrington, included in this bill, ensures taxpayers will finally know the annual rate of improper payments in TANF in service of eliminating all improper payments from this critical program. We will also consider legislation from Representative Austin Scott that helps disability insurance beneficiaries return to work by reauthorizing the Social Security Administration's authority to test new approaches that remove barriers for beneficiaries looking to work. Lastly, we will also consider the committee's views and estimates for the budget committee. I want to thank my colleagues for leading these bills and I look forward to advancing them to the floor. I'm now pleased to recognize the ranking member from Massachusetts, Mister Nill, for his opening statement.

Thank you, Mister Chairman. I I think it's safe to say that American families have had enough of Republican failures in the President's chaotic administration. They're rightly angry that a President who once promised to lower costs on day one now dismisses their pain as something he, quote, " doesn't even think about." They're rightfully scared as they watch gas prices, airfare, grocery prices soar right at the start of the summer The numbers speak for themselves. New polling shows that seventy percent of the American people believe that the president's economic policies are harmful to our middle class, and for good reason. They're reminded of this failure every time they pay a bill or visit a doctor, go to the gas station, or to the grocery store. They're demanding answers as to why House Republicans continue to pretend that they're powerless. and that they only will look the other way unless the President puts them on the phone. Presidents in this instance have done interesting things over many years, but I must tell you in long service here, this is remarkable as to what we've witnessed this week. A President that is both the plaintiff and a defendant in a lawsuit against the IRS. Or as he pointed out, "I'm in a position where I'm actually suing myself." The president attempted to settle this lawsuit, as he noted, even though he was on both sides, and certainly one that the courts would have thrown out had it reached that jurisdiction. He created a one point eight billion slush fund that will take care of friends and, in fact, enemies of the American family as to what happened on January sixth when criminals attacked this capital. This is dirty dealing at the highest level. The president gave himself a free pass from federal taxes. Further, he absolved the federal government from any responsibility for oversight of this fund and liability for fraud. The fund is cloaked in darkness and secrecy, which makes it ripe for committing more chaos. For someone who says he doesn't think about the American family's finances, he certainly has figured out a lot about his own. Republicans refuse any effort to bring down costs because they're concerned that they might upset the President. Unwilling to rein in this abuse to other authorities throughout the federal government, and they are complicit in the administration as it operates oftentimes in the dark of night, handing out special favors and pardoning people who never should have been pardoned. I hope that when we talk about fraud we will also include the administration as to what we've witnessed for these past few months and indeed years. Put real solutions on the table. We're all in favor of rooting out fraud wherever we find it, but also end the graft that we're witnessing every day across our capital. Bring relief to families who are buckling in this economy and protect their tax dollars from abuse and corruption. Anything less is just theater. And I yield back my time, Mr. Chairman.

Thank you. Our first order of business is H R thirty-one sixty-four, which will be re- which will be the Main Street Pharmacy Access Act. H R thirty-one sixty-four is a transformative yet common sense solution to improve patient access to primary care and will particularly have a positive impact in rural America which suffers significant phys physician shortages. Representative Adrian Smith has been a long time champion for this bill on behalf of rural Nebraskans who like rural Missourians often have to travel great distances to access health care. Representative Smith's district is larger than half the states in this country. He has been relentless in putting this bill before the committee's attention and building bipartisan support for policy that helps Americans get simple tests and treatments for common illnesses at their pharmacy. This legislation will have an incredible effect on rural and underserved communities, and I am glad we are delivering on the promise today. I'm pleased to recognize

Thank you, Mister Chairman, and certainly thank you to the members of the committee for considering the Main Street Pharmacy Access Act, formerly known as " E-caps". I'd like to give a special uh thanks to my colleague, Brad Schneider from Illinois, who has been uh great to work with on this bill. Across Nebraska and throughout rural America, access to health care can be a challenge. By nature of living in a rural area, oftentimes patients must drive significant distances to receive the care they need. The long drive can be a significant obstacle to receiving care in a timely manner, especially for seniors. It can be the reason someone delays, for example, getting a flu test. If they do have the flu, that delay can lead to the illness progressing and a late start on treatment. I mention seniors because despite private insurance and Medicaid providing coverage, Medicare does not provide reimbursement to pharmacists for testing and treating common respiratory illnesses. A person could go their whole life getting tested for the flu by their community pharmacist. But the day this person turns sixty-five and enrolls in Medicare, the community pharmacist no longer offers them the same service, because Medicare doesn't pay for it. In turn, the senior now may have to drive several towns over to get a flu test. Pharmacists are among the most accessible health care professionals in the country. Roughly nine in ten Americans live within five miles of a pharmacy. Pharmacists play an important role in filling health care gaps, particularly in rural areas, And this role shouldn't end when a person turns sixty-five. The Main Street Pharmacy Access Act takes a practical, targeted approach to addressing this gap for seniors. Our legislation allows Medicare to reimburse pharmacists for testing and treating common respiratory illnesses. Importantly, this bill doesn't touch scope of practice. It totally defers to states, and states will continue to determine what pharmacists are permit- are permitted to do. But in states where pharmacists are allowed to test and treat common respiratory illnesses, This bill allows Medicare to cover it, just like private insurance and Medicaid already do. This bill is about access. This is about making life easier for Medicare beneficiaries, both rural and urban. Improving access to basic testing and treatment can help patients receive care earlier and reduce unnecessary emergency room visits. I appreciate the broad bipartisan and stakeholder support this legislation has received from pharmacists along with patient advocates and rural health organizations. Thank my colleagues who have worked collaboratively on this issue with me, and I urge members to support the bill. Thank you. I yield that.

I now recognize the ranking member from Massachusetts, Mister Nill, for his opening statement.

Thank you, Chairman. Let me yield my time to Mister Schneider.

Uh, thank you, and I want to thank uh the Chairman and Congressman Adrian Smith so for working uh with me on on this bill. Access to health care is one of the most critical challenges facing the American people today. Far too many Americans For far too many Americans, getting a doctor near their home, let alone getting an appointment, can be a challenge. As Mister Smith noted, eighty-nine percent of Americans live within five miles of a pharmacy. In contrast, only fifty-eight percent of Americans live within five mi- miles of a health care facility employing physicians, and roughly one in seven Americans live in what is designated a physician shortage area. Over the last decade, wait times to see a primary care doctor have increased by sixteen percent. More hospitals have closed and have opened, and the cost to receive care has increased by roughly thirty percent. Access to care is becoming a crisis, particularly for many patients in underserved rural and urban communities. When a child has strep throat, when a parent gets the flu, when someone needs a COVID test, they don't always have easy access to a doctor or a hospital. But there's a very good chance that they have a pharmacy nearby. The pharmacist isn't just an option. It is often the only accessible provider available. When COVID-19 hit, our hospitals were overwhelmed. The heroic staffs pushed to the limits. Many doctors' offices were closed. I remember and absolutely recall the uncertainty I felt when I did not know where my family and I could turn to receive health care services. During this time of crisis, Congress acted and allowed pharmacists to provide certain necessary services during the public health emergency. Pharmacies in every community, urban, suburban, and rural, single si- sites and large chains alike stepped up in a way that this country will not forget. Walgreens, which I'm proud to have headquartered in my district, stood up testing sites at thousands of locations across America. They alone administered more than ninety million COVID-19 vaccinations. They launched a vaccine equity initiative specifically to reach underserved communities who were hit hardest by the pandemic. When the federal government needed a trusted nationwide partner to get shots in their arms into arms fast, pharmacies like Walgreens answered the call. The Main Street Pharmacy Act, formerly known as the Insuring Community Access to Pharmacies Act to Pharmacies Act or ECAPS, which I'm grateful to co-lead with my friend Adrian Smith, recognizes that pharmacists are not merely secondary players in the healthcare system. They are essential front-line providers. This legislation would create a permanent payment pathway for pharmacists test, treat, and vaccinate against flu, RSV, strep throat, and COVID-nineteen in the states where they are already licensed to deliver these services. During such a dark time, pharmacists proved to be an invaluable public health partner in the COVID pandemic. This common sense legislation would codify what we already know works, what much of the country has been operating with under the l- over the last six years. Passing this legislation gives pharmacists the certainty they need continue investing in local communities, benefiting families in every corner of the country. I urge my colleagues to vote yes on this bill, and I yield back.

Thank you. The committee will now proceed to consideration of H R thirty-one, sixty-four, the ensuring community access to pharmacy services act. Without objection, the measure will be considered as read and open for amendment at any point. At this time, I offer an amendment in the nature of a substitute, which was distributed in advance along with a green sheet explaining it. Without objection, the amendment in the nature of a substitute shall be considered

Thank you, Chairman Smith, Ranking Member Neal. Thank you, Chairman Smith, Ranking Member Neal. H. R. thirty-one, sixty-four contains two sections. Section one provides for the short title of the bill, which is renamed in the amendment in the nature of a substitute. to the Main Street Pharmacy Access Act. Section two amends section eighteen sixty-one of the Social Security Act to provide Medicare reimbursement for certain pharmacist's services, specifically testing and treatment relating to four respiratory illnesses, or to address a health need in the event of a public health emergency. Medicare will only reimburse for such services if they are provided in accordance with state scope of practice laws including under the supervision or working in collabor

Thank you. Are there any technical questions about the amendment and the nature of a subst substitute? Mister Doggett.

You just heard the uh chairman refer to the multi-million dollar elephant in the room. Does this bill do anything about it?

Does this bill

Yes. Does this bill do anything about the multi-million dollar elephant in the room,

do anything about

fraud?

About fraud?

Yes.

This bill provides Medicare reimbursement for pharmacist administered services.

It d- it does not address fraud, does it?

It contains

It may be meritorious, but it doesn't address the subject of fraud.

It contains guardrails for uh pharmacists administering these services to make sure they're provided within scope of practice.

N- none of which has anything to do with reducing the amount of fraud that may or may not be occurring.

Sure.

Sure. Thank you.

I'd remind the members, um, please ask questions, uh, and technical questions for technical questions. Um, mister, miss Moore.

That could be more technical than that.

Uh, thank you, Mr. Chairman, for recognizing me. I Um, when we when we look at this, this this provides Medicare reimbursement of pharmacists for certain evaluation and management related to COVID, influenza, rep resp uh respiratory uh syncy- uh syncytial virus or strep, as well as services related to a public health emergency such as the opioid emergency currently in effect. Would the pharmacist be able to provide opioids in this bill?

This bill does not change what pharm what services pharmacists are able to provide.

Um, um, they will not be able to treat people or provide opioids to people under this bill, will they?

Uh, that is completely dependent on state scope of practice law. This bill just changes what Medicare will reimburse for.

Okay. Um, so, um, what I I will these pharmacists be able to give a strep test or COVID test right there on the spot I think. We all know that we can give ourselves COVID tests, but how will they be able to determine whether it's a virus or bacteria infection? Do they provide the test right there on the spot?

Yeah, there are different levels of uh approved COVID or or strep tests, some of which um require more uh experience and and are to be administered by a practitioner. So those are the types of tests that uh the pharmacist would be able to provide and be reimbursed for.

And you may not know the answer to this question. Maybe it will be revealed during some of the discussion here. Um, uh, you know, I don't remember having a strep test, but I don't know how long it takes to get those results. You know, and you know, where would the pharmacist? It is important to determine whether it's strep or a virus. Because we don't want to give people too many antibiotics. That's dangerous. And if it is a a bacterial infection, they do need to be provided with those medications. If it's a virus, you know, how you know, is there clinical evidence? Well, you wouldn't know the answer to this. So thank you very much. So I'll just I'll just leave it at that. And hope and rely on my colleagues to explain these things to me.

Are there

I yield back.

Thank you. Are there additional technical questions about the amendment and the nature of a substitute? Seeing none, we will move to strike the last word. Does any member wish to strike the last word?

Missed Moore.

Missed Moore.

Um, thank you, I just want to get into a colloquy with the author of this bill. Um, I would like to be reassured that um that the pharmacists have the clinical experience um to be able to determine the difference between a virus and a bacterial infection and so would someone yield mister schneider

i'm a uh let me first say i'm not a doctor i am an engineer so i think i know everything But uh the the the test, whether it's for COVID, for flu, for um strep, these are are tests developed by companies most many US, um many around the world. They are administered by a professional, but the results, it it's it's the the reading of that. So a strep test and I'm gonna look to Doctor, is Doctor Murphy here?

Ooh, I can't.

Um yeah, a rapid strep test is a couple of minutes and it comes back positive or negative. And Hence the term rapid. What's that? Hence the term rapid.

Okay.

So um it would be the the the testing whether it's strips or whatever the um a medium may be, uh it is the pharmacist who is administering that test, but they're not determining whether it's a virus or a b a bacteria or anything else, it's the testing um products that would do that. Does that make sense?

Yeah, okay, so All right, the doctor has something to say. I mean, how will we it will they have uh access to a patient's profile to know that they're allergic to certain antibiotics? I discovered kind of the hard way that I was allergic to augmentum, um, is that would uh would this bill require that a patient's profile be available to them so that they can They can know whether or not they're providing penicillin to someone who's

They're they're not they're not providing medicine in this bill.

They're not they don't provide medicine?

That this would this would allow them to be reimbursed for the test. Think about during COVID as uh millions of people across the country went to their local pharmacist uh for the COVID test,

Right.

um to the pharmacist, and some people just may not be comfortable taking it themselves, or for the strep test. Um Pharmacists do provide uh vaccines um as they do today and and millions of people benefited from since COVID going I get my flu and and um uh COVID vaccine at my local Walgreens.

Good that you have one, I don't have one, it it moved. Um so you say that they won't be giving a medicine, so what do they do?

They would not be this isn't a prescription. Uh, they're not providing prescribed.

So they're just testing to see that you have strep but then they don't give you medicine?

They they're

Would the gentlelady yield?

Yes.

Yes.

Yes, uh the the bill would provide for mild treatment uh similar to if a patient would go to a walk-in urgent care. Uh instead they could go to the local pharmacist to be to be tested for the common respiratory illness and the mild treatment. So, I, pursuant to your concerns about allergies and so forth, uh of course that's always a concern regardless of where you go. Uh, a, a local pharmacist could, could have record of that as well. And similar to a, uh, if you're traveling and you walked into a, a, um, walk-in urgent care that wouldn't have the record, there, there's still, uh, consistent concerns there, but ultimately working through that to make sure the patient gets what they need on a, on a timely basis.

OK. Well, thank you, uh, Mr. Chairman. Thank you, gentlemen, for this colloquy. Um, and, you know, I have s- some slight discomfort, but I will listen to the debate. Thank you.

Thank you.

I yield back.

Thank you. Doctor Murphy?

Thank you, Mr. Chairman. Uh, I'll I'll first and foremost say in my thirty-five years of clinical medicine, I've had a, uh, had the great honor and wonderful enjoyment of having great relationships with my all of my pharmacists throughout, you know, literally a third of the state of North Carolina. I I would like to just bring up um some concerns I have just from from a medical standpoint and while I appreciate what is the limited scope in terms of testing and treating of specific ailments I do think that we do need to recognize a few things. I wou I would be remiss if I did not I think it is clinical uh I think it is important to see the patient's full clinical history um Underlying health health conditions, medications, allergies, allergies a patient hopefully would know their selves, but frankly, having dealt with that a lot of folks don't even know their own medicines. Pharmacists should have access to those things, uh but they don't know their own uh sometimes their own health history and sometimes their their um their allergies, especially in in the Medicare population and and in in Medicaid population. Um I uh one example is in the and I'll bring this out because it wou I think it's a very germane example. We saw of course on the television, as you many of you know, the bane of my existence is direct consumer advertising, and you heard the phrase " got COVID, it's Paxlovid." Well, I believe it was absolutely reckless in the pharmaceutical uh world to to say that, because just you had just because you had COVID did not mean you need Paxlovid. And if we get to the point and we start extrapolating, uh there is a real problem with antibiotic resistance in this country. Um strep is an antib- is a a bacteria generally very you're very easily treated with ampicillin some type of penicillin derivative. But if we get into treating urinary tract infections um not everybody who has a quote urinary tract infection needs an antibiotic, in fact a large number don't, they're colonized. And if we're gonna get further and further antibiotic resistance um with more and more antibiotics being prescribed it is a major, major problem. And the only reason I bring this up is so many pharmacies now are under the push pin of companies like United Healthcare for example. that owns pharmacy benefit managers and pharmacies, and I fear our pharmacists will get a lot of pressure from above to prescribe things. No medicine, aspirin, is not without side effects. Uh, no vaccine is without side effects. I don't care what Fauci told the world. Um, I know uh, I'd known several vaccine injuries that do occur. And what I what I urge is then that our pharmacists, and I know this, I mean, I love our pharmacists, I I just urge that there be a collaborative agreement or collaborative relationship with physicians who know these patients. Um, it is always a team approach,

Funny.

and I do absolutely understand the challenges that happen in rural America with not being able to access a physician. Um, that's an entirely different argument. But I would be remiss if I did not state there were some concerns, especially given the world of vertical integration and the pressure that so many pharmacists have, and that we have patients, sadly enough, that show up and because they have something, they want a prescription for this. Uh, this will continue to push a lot of the scope of practice laws even further, across the country, um, which is a challenge,

Yeah.

um, for medicine, is as it is. And so I - I will say those are my concerns. That said, I am going to support the underlying bill.

I like that.

I do want us to be very, very conscious as we move forward, um, of the - of the concerns that are raised, um, the concerns I have and - and the medical community as far as physician community have, with some of the possible

Sure.

dangerous not dangerous some of the uh concerns that would be overprescribing either of vaccines or of medications and if there's always a a a little slippery slope that once you allow one thing and then people are gonna say the next year well we can do this, and then we can do this, and then we can do this. Uh that said uh Representative Smith and I have had uh wonderful good discussions very fruitful discussions about my concerns with this, and so I appreciate him listening to that and staff listening to this. Uh, s- but I will under- support the underlying bill. Thank you. I'll yield back.

Thank you. Um, Mister Smith?

Thank you. I appreciate, uh, the doctor's, uh, insights here. I think of, uh, I want to emphasize that, uh, the the language in the bill simply provides for Medicare reimbursement for those services that are already reimbursed through Medicaid and commercial pay. There's no expansion of scope. Uh, I think it's important that any medical provider, of course, uh, interface with, uh, the primary care provider, uh, along the way, uh, when - when possible, and, uh, that - that - that's in the interest of - of the patient. All of this is in the interest of the patient, of course. And, uh, that, uh, this is a - a very narrow, uh, text here in the bill to make sure it doesn't do things that, uh, are certainly not intended. And then, like I said, makes it consistent with Medicaid and commercial pay. Thank you. I yield back.

Mister Nill.

Thank you, Chairman. Uh, appreciate the comments of uh Miss Moore as well as Doctor Murphy on this, and they've raised a series of appropriate questions as we've proceeded. So I think expanding to access to care is part of the goal that we've all had, particularly on our side here. But I think that there are some issues that need closer attention with this bill. The issue again that Miss Moore raised was how this interacts with public health emergencies as well as to how this interacts with the s- scope and practice that underlies many of the credentials that will be tested and I hope that the committee, as this moves through, will have an opportunity to further refine some of the thinking on this. I think that might be an appropriate measure as well.

Would the gentleman yield?

Please.

Uh certainly I I um Wanna emphasize though that this, this doesn't change any scope of practice. It does not widen it, it does not narrow it. That's been a priority uh along the path since original introduction.

Yep. Yeah, so it, I think that the questions that Doctor Murphy raised here, and Miss Moore raised here, are entirely appropriate for us to air in a public setting like this as we proceed to, I think, uh, will be in accommodation down the road.

You're back.

Mister Kustolf.

Thank you, Mister Chairman, thank you for holding the mark up today and appreciate you uh considering this legislation and I do move to strike the last word. Mister Chairman, I represent Tennessee's eighth congressional district that has a number of rural counties uh and it is uh within the primary care health professional shortage areas as designated by the Health Resources Services You know this from the district that you represent, Mister Chairman, but for many Americans living in rural areas, that hometown pharmacist could be the go-to person, he or she, for health advice, for testing and for treatment when they have the flu, the strep strep throat, or what have you. I believe that pharmacists can and do fill a gap in rural health care. And we've also seen a troubling wave of rural pharmacy closures across the nation. This legislation could address both of these issues. This bill, the Main Street Pharmacy Access Act, provides Medicare reimbursement to pharmacists for the testing and treatment of c- of common illnesses. These are services that pharmacists are already authorized to provide in states like my state of Tennessee. So whether it's a retail pharmacist in Memphis, Tennessee or Jackson, Tennessee or an independent pharmacist in rural West Tennessee, it's important to ensure that the government pays fairly for the services that they're trained to deliver. I think by supporting these trusted providers and strengthening their role in the health care system, we can improve access, we can lower cost, and deliver better outcomes for all of our constituents. Thank you, Mr. Chairman, and I'll yield back.

Mr. Iacom.

Mr. Chairman, I move to strike the last word. I'm a proud cosponsor of the Main Street Pharmacy Access Act, led by my friends Adrian Smith and Brad Schneider. When talking to Hoosiers back home, I constantly hear about concerns regarding the cost, quality, and access to health care. Access to health care is a huge issue, particularly for Hoosiers, I serve living in rural communities. They often face a limited number of providers and are forced to drive long distances to receive their care. Pharmacists are on the front lines of providing health care options in our communities and they are a critical part of our patients' team. Ninety percent of Americans within five mi- live within five miles of a pharmacist and all fifty states allow collaborative agreements between pharmacists and other medical providers. These agreements result in better health care outcomes better access, and lower health care costs. During the COVID-19 pandemic, licensed and trained pharmacists could receive Medicare reimbursement for testing and treating seniors with COVID. But this authority lapsed when the public health emergency ended. The Main Street Pharmacy Access Act would restore and expand seniors' access to to this important service by allowing pharmacists to receive Medicare reimbursement for testing and treatment services for respiratory illnesses such as strep throat, influenza, and RSV. This bill will help alleviate access issues and provide better health care outcomes for our seniors. I look forward to voting for this bill. I urge my colleagues to do the same. And, Mr. Chairman, I yield back.

Are there additional members who wish to strike the last word? Seeing no members, additional members wish to strike the last word, um are there any amendments to the amendment in the nature of a substitute? Miss Chu.

I have an amendment at the desk.

Order.

Uh, point of order has been reserved with the lady to suspend while the amendment is distributed. The General Lady may proceed.

Mister Chair, I have a simple amendment that I believe strengthens the underlying bill and strengthens the underlying bill and strengthens the underlying strengthens patient access to care. If Congress is going to expand the role of pharmacists in our health care system, then patients must be able to trust that when they walk into a pharmacy with a valid prescription for birth control, they will actually receive the medication they need. My amendment is very simple. It says that if a pharmacist refuses to dispense FDA approved birth control to a patient with a valid prescription, that pharmacist should not be eligible to participate in this new Medicare reimbursement program created by the bill. This is a very narrow, straightforward amendment tied directly to the purpose of the underlying legislation. If this bill is about expanding access to care, then pharmacists participating in this new reimbursement program should provide access to care. Nearly nine in ten women of reproductive age have used contraception. And an overwhelming majority of Americans, including Republicans, Democrats and Independents, support access to the full range of birth control. And birth control is not a one size fits all. Different people need different methods depending on their health needs and circumstances. That is why access to the full range of FDA approved contraceptive methods matter. Plus, millions of people rely on birth control to treat serious medical conditions and improve their quality of life, including endometriosis, PCOS, anemia, irregular bleeding, and other chronic conditions. Hormonal contraception can also reduce the risk of certain cancers. And we cannot ignore the broader reality, which is that reproductive health care access is under attack like never before across the country. Last year alone, fifty-one Planned Parenthood health centers were forced to close their doors, leaving patients with fewer options for essential care, including contraception. Nearly three quarters of those closures occurred in underserved areas, rural communities, or health professional shortage areas. For many patients, being denied medication at the pharmacy counter means taking another day off work, having the time and transportation to get to another pharmacy an unknown distance away delaying care or going without the medication entirely. So if this bill is truly about expanding access to care, then that must include access to FDA-approved birth control. We should not be expanding reimbursement while allowing patients to be turned away from medically approved legally prescribed contraception. That undermines the very purpose of the underlying bill. My amendment simply says that if you want to participate in this new Medicare reimbursement framework designed to expand patient access, then patients should be able to receive the medications their healthcare provider prescribed. That's reasonable, that's responsible, and that is what patients across this country deserve. That being said, I support the underlying bill and its goal of expanding access to care. In many communities, especially rural and underserved communities, pharmacists are some of the most accessible health care providers people see. For many Americans, the local pharmacist is on the front lines of our health care system. So I appreciate that this bill is intended to help patients get care more easily and more quickly. I urge my colleagues to vote yes on this amendment and I yield back.

Further discussion on the amendment? Uh, Mr. Smith.

Thank you, Mr. Chairman. I do rise in opposition to the amendment, having uh seen it for the first time just about three minutes ago. I I believe that this should be a separate uh piece of legislation um for discussion uh separately but certainly the the narrow scope of the bill I think is important to uh and that's a result of the bipartisan effort that has taken place for some time now, uh working through this and working through concerns and in shaping the bill, like I said, over some time. So um I would urge uh Miss Chu to introduce this as a separate piece of legislation. I respect her opinions um on uh these issues, but certainly would urge uh a no vote on the amendment. Thank you, I yield back.

Thank you, are there further discussion on the amendment? Seeing none, the question is on the adoption of the amendment from the gentle lady from California. All those in favor signify by saying aye.

Aye.

Aye.

All opposed say no.

No.

The no's have it, the amendment's not to adopt adopting. Are there additional amendments?

Mr. Chairman, can I ask for a roll call vote on that last amendment?

Will the clerk call the roll?

Mister Buchanan.

No.

Mister Buchanan, no. Mister Smith of Nebraska. Mister Smith of Nebraska, no. Mister Kelly. Mister Kelly, no. Mister Schweikert. Mister Schweikert, no. Mister Lihut. Mister Arrington. Mister Estes. Mister Estes, no. Mister Smucker. Mister Smucker, no. Mister Hearn. Mrs. Miller. Doctor Murphy.

Yes.

Doctor Murphy.

Yep.

No.

No, I said yes.

Doctor Murphy, yes. Mister Custoff.

No.

Mister Custoff,

No.

no. Mister Fitzpatrick.

No.

Mister Fitzpatrick, no. Mister Stubbe.

No. No.

Mister Stubbe, no. Miss Tenney. Mrs. Fischbach. Mrs. Fischbach, no. Mister Moore. Miss Van Duyn. Miss Van Duyn, no. Mister Feenstra. Mister Feenstra, no. Miss Maliatakis. Miss Maliatakis, no. Mister Carey. Mister Carey, no. Mister Joachim. Mister Joachim, no. Mister Miller.

No.

Mister Miller, no. Mister Bean.

No.

Mister Bean, no. Mister Moran. Mister Moran, no. Mister Neal. Mister Neal, yes. Mister Doggett. Doggett. Mister Doggett, yes. Mister Thompson. Mister Thompson, yes. Mister Larson.

Yes.

Mister Larson, yes. Mister Davis. Mister Davis, yes. Miss Sanchez. Miss Sanchez, yes. Miss Sewell. Miss Sewell, yes. Miss Delbene. Miss Delbene, yes. Miss Chiu. Miss Chu, yes. Miss Moore. Miss Moore, yes. Mister Boyle.

Yes.

Mister Boyle, yes. Mister Beyer. Mister Evans.

Yes.

Mister Evans, yes. Mister Schneider. Mister Schneider, yes. Mister Panetta. Mister Panetta, yes. Mister Gomez.

Aye.

Mister Gomez, yes. Mister Horsford. Miss Plaskett.

Yes.

Miss Plaskett. Yes. Mister Swasey. Mister Swasey. Yes. Mister Llood.

No.

Mister Llood. No. Mister Arrington.

Okay. How is Doctor Murphy recorded?

Doctor Murphy, yes. Doctor Murphy, no.