Hearings to examine Member Day.

The Senate Health, Education, Labor, and Pensions Committee will please come to order. Let me compliment the committee. This Congress, we have voted almost unanimously to advance 14 bipartisan, pro-patient, pro-worker, pro-family bills. We've also passed a historic bipartisan package of legislation that lowers drug prices, holds drug middlemen accountable, funds primary care, and increases access to pediatric cancer treatments. As chair, my focus is cutting through the noise to deliver for Louisiana and for the United States of America. In my practice of medicine for over 25 years, I cared for people who were economically vulnerable, uninsured, living on the edge economically. And a lot of families feel that way now. Health care, drug prices, college tuition is all too expensive, and for these families, it is not sustainable. The more that we can do in this committee, working together, taking power from giant insurance companies and giving it to patients so that they are in charge of their own health, taking power from federal bureaucrats and giving it to parents so they can be in charge of their child's education, giving workers more freedom to pursue the job arrangement that works best for them, and employers the ability to adapt retirement and health benefits to the choices the workers make, the more we are doing our job. This hearing is to discuss ideas to do all those things. A few bills I want to highlight. Literacy continues to be a challenge. In particular, individuals with learning needs are underserved by the status quo. My 21st Century Dyslexia Act would improve screening for individuals with dyslexia and enhance access to evidence-based interventions and resources, empowering these capable students with the tools they need to improve reading ability. My College Transparency Act empowers students and families with more information around student outcomes at an institution so they can make the best college decisions for the future. We also have a responsibility to bring stability to businesses and workers to make our nation competitive in a 21st century economy. Congress has not updated labor laws for almost 100 years. Yet the economy and the way we work has dramatically changed. We have the opportunity to pass legislation to make health and retirement benefits more portable to meet the needs of today's workers. This should be bipartisan. Part of the American dream is having the financial freedom to retire. I've worked with Senator Kaine on multiple bills as regards this, including the Helping Young Americans Save for Retirement Act and the Auto Re-enroll Act of 2025. I thank Senator Kaine for his leadership and collaboration. Earlier this year, the committee and the Senate unanimously passed a bill that I worked on with Senator Hassan, the Employee Ownership Act, and we also passed Senators Marshall and Kaine's Retire Through Ownership Act, bills expanding employee stock ownership programs so that more workers can benefit from the success of their employer. Let's keep delivering. Let's make health care, higher education, and life less expensive. I'm looking forward to hearing about areas we can work on together. Before we begin, as a reminder, members on committee will have three minutes to testify and off-committee members will have two minutes. With that, I recognize Senator Kaine for his testimony.

Thank you, Chair Cassidy, and to my colleagues, I appreciate this opportunity for both on and off-committee members to offer bipartisan priorities. And I have just a couple that I would like to discuss. The first is my bipartisan and bicameral Child Care Workforce Act with Senator Britt. The bill would establish a pilot program to increase the supply of quality child care services by providing competitive funding to eligible entities that are interested in adopting or expanding pay supplement programs for child care workers. This is an effort that's been successful in Maine, Nebraska, Virginia, D.C., and other locations to increase child care supply and reduce turnover. Virginia families pay some of the highest child care costs, yet according to 2021 Early Childhood Workforce Index, 43 percent of our child care workers rely on public assistance. Again, we pay a lot for child care, and yet 43 percent of workers rely on public assistance, so there's something not working. Research about the D.C. program suggested that after two years of implementation, there were nearly 1,500 additional child care slots available if you do these supplements. And it would be a major victory for child care workers and working families. So that's number one. Second is my bipartisan and bicameral Supporting Healthy Moms and Babies Act, which would eliminate out-of-pocket costs such as copays or deductibles associated with childbirth for moms with employer-sponsored health insurance. This is a bill that I started working on with Vice President Vance when he was in the Senate, and I'm proud to continue the work with Senators Hyde-Smith, Gillibrand, and Hawley. The average cost associated with pregnancy, childbirth, and postpartum care for women enrolled in employer-sponsored health insurance amounts to about $3,000 in out-of-pocket costs, with one in six moms paying over $5,000. No mom should go without care because of a fear that they can't afford it. Advocates across the ideological spectrum, sort of strong pro-life and strong pro-choice organizations, support this bill, and I would urge the committee to consider it. Lastly, the bipartisan, bicameral Help Copays Act that Senator Marshall has championed ensures patients can access life-saving medication they need by requiring PBMs to count the value of copay assistance towards a patient's cost-sharing requirement. The bill has technical assistance and is ready for markup in committee. Mr. Chair, I thank you for the opportunity to highlight these three bipartisan priorities.

Thank you, Senator Kaine. Senator Murkowski.

Thank you, Mr. Chairman, and thanks for the opportunity to pitch our priorities. I kind of like this format here. Thank you. Just to give a heads-up to the committee, I'm chair of the Indian Affairs Committee and we've been working really hard on the Native Children's Committee Implementation Act. This is a bill that I'm going to be introducing shortly, a bipartisan bill with Senator Schatz, but it crosses multiple jurisdictions and it works to improve access to health services, education, workforce development, and child care programs for Native families. So I'll be looking forward to working with the committee on this as well. Turning to the bills that I would like to highlight today, the first is the reauthorization for ALS, or ACT for ALS. The original authorization expires this year. This has long been a priority for me, and moving forward on this reauthorization is a big deal here. There is no cure for ALS, we know that. The initial authorization has worked to support ALS research, accelerate drug development, and help individuals who are not eligible for clinical trials to get access to the investigational treatments. This is an effort that Senator Coons and I are leading on. We've got great partnership over in the House and we'd really like to see this get marked up in committee. The second bill is one that this committee knows well, it's the Safe Step Act. This bill places limits on step therapy practices used by health plans to prevent harm when patients are required to retry certain medicines that have previously failed. So what we do in the Safe Step is we outlined five exceptions to fail-first protocols. We've seen this before as I mentioned, we had good success last Congress when it was included in the larger PBM Reform Act as an amendment. So hoping that we can get this one marked up again this Congress. And then just very briefly here, a few other things that I am tracking. One is the LGBTQ+ Youth Access Act. This directs the Secretary of HHS to ensure that we have sufficient resources dedicated to LGBTQ youth contacting the 988 suicide prevention hotline. Several of my colleagues have been very engaged in this, but when we're thinking about how we provide for supports, mental health, suicide prevention, a hotline is so key. And then the last matter is the State-Based Education Loan Awareness Act. I've introduced this with Senators Reed, Cassidy, and Shaheen to increase awareness of low-cost non-federal loans so that we can make some smart financial decisions, reduce the cost of borrowing in financial for in post-secondary ed. So again, another education priority that we're looking forward to working with you, Mr. Chairman, and the rest of the committee on. So thanks for the opportunity to pitch my priorities this morning.

Senator Hassan.

Well, thank you, Mr. Chair, and I like the way Senator Murkowski just characterized this, pitch my priorities. So you know, it's cool. So I have three to talk about. I'll start by discussing a bill that would help women in rural areas who live in maternal health care deserts. For women who are in labor or experiencing another obstetric or reproductive health emergency, every minute can obviously count. However, in some areas of New Hampshire, it may take more than an hour to drive to the nearest labor and delivery unit. That's why I introduced legislation with Senators Collins, Britt, and Smith to help ensure that rural hospitals have the equipment and the training that they need to treat pregnant or postpartum women who need urgent medical attention. This bill would help small rural hospitals purchase needed equipment, establish a training curriculum for staff who are not maternal health specialists, and establish a pilot program for a hotline to help clinicians consult with an OB-GYN in urgent situations. I thank the committee for working with us on this bill, and I look forward to the committee's consideration of it at the next possible markup. Bill number two. Families in New Hampshire and across the country need access to affordable life-saving medications. However, pharmaceutical companies exploit loopholes in the patent system in order to build what are known as patent walls around their products. Doing so sometimes blocks low-cost generic versions of their medications for literally decades. I think we had one pharmaceutical company in front of Finance, I pulled up a list, they had 100 different patent moves or maneuvers on one single drug to just keep blocking the generics. My bipartisan bill with Senator Hawley, the Medication Affordability and Patent Integrity Act, would improve access to generic drugs by closing a loophole in coordination between the FDA and the Patent Office. That means they'd have to share the same information with both so they couldn't claim a patent change in order to get new exclusivity moving forward. I want to thank you, Chair Cassidy, and Ranking Member Sanders, for your staff's work to reach an agreement on this bill last Congress. This bill would allow patients to access lower-cost medications sooner and will save taxpayers more than $100 million over a decade. So I ask the committee to mark this up at the earliest possible time. And lastly, my final bill is the Gateway to Careers Act, which I co-lead with Senators Young, Collins, and Kaine. This bill would establish a competitive grant program at the Department of Labor to build career pathway programs which combine work, education, and support services to help individuals earn industry-recognized credentials. These programs are rooted in strong local partnerships between employers, workforce partners, and education partners who develop a clear sequence of steps that workers can take in order to advance in their career. Obviously, we're at a time when the economy and workforce are rapidly changing. We have to invest in effective evidence-based models like this to ensure that America's businesses have the workforce to keep up and that workers are not left behind. Again, I'll thank you, Mr. Chair and Ranking Member, for including the Gateway to Careers Act in the bipartisan Workforce Innovation and Opportunity Act last Congress. I look forward to working with the committee to get this bill across the finish line. Thank you.

Senator Marshall.

Well, thank you, Mr. Chairman, and to Ranking Member, and especially to our committee staffs, both the majority, minority, for taking the time to hear what our priorities are. I'm going to present three bills. They are bipartisan. They can make a huge impact. We have the votes that could be signed into law. These are real bills that the President would sign. Our first one is our Patients Deserve Price Tags Act. I want to especially thank my cosponsor, Senator Hickenlooper, for his help and work on this. Americans know the price of milk before they buy it. In health care, patients are handed a blank price tag. That ends with Patients Deserve Price Tags Act. The bill could save families potentially $1,000 a month. This bill could do more to impact the cost of health care than any legislation that I'm aware of, and we could change it right now. It could generate over $75 billion in new tax revenue over 10 years, independently verified by former CBO and JCT experts. It requires hospital labs and insurers to post real prices upfront, give employers full claims data and audit rights, and mandates itemized bills after care. Stakeholders have been heard, the text is ready, and I ask the committee to make this a priority. Next, I'm going to talk about our American Franchises Act, and I want to thank my cosponsor, Senator Angus King, for his friendship and leadership on this. There's over 800,000 franchise small businesses that employ almost nine million Americans and generate $900 billion in economic output. These businesses have been one of America's greatest engines of opportunities, franchises. They give women, minorities, and veterans a path to their American dream. For a decade, they've been whipsawed by four different joint employer standards. The American Franchise Act establishes one clear permanent standard, ending the chaos and giving small business owners the certainty they need to hire and grow. Four standards in 10 years is chaos, and I urge the committee to give us a chance to mark up our American Franchises Act. Lastly, I'm going to talk about prior authorization, our Improving Seniors' Timely Access to Care Act. It's not on this committee, but so many people in this committee, we share the same priorities and it touches healthcare in so many ways, mostly those on Medicare Advantage. Prior authorization is the number one complaint I hear from seniors and physicians across Kansas. Nearly three out of four Medicare Advantage enrollees face unnecessary delays, delays in their healthcare, not because of their doctor's judgment, but because of an insurance company said no. For seniors, delays mean misdiagnosis, worsening conditions, and irreversible harm. This bill has 67 Senate cosponsors, 260 House cosponsors. Our bill fixes that. It requires electronic prior authorization, real-time decisions, and full transparency on denial rates. The votes are there, and I ask the Finance Committee to help us get this across the finish line and maybe even a chance for unanimous consent opportunities with the support of members of this committee. Thank you, Mr. Chairman, and I yield back.

Thank you, Senator Marshall. Senator Hickenlooper.

Thank you, Mr. Chairman, and thank also Ranking Member Sanders and the staff. Thanks for hosting this forum for all of us to discuss these important subjects. I'm going to focus on one bill, the one that Senator Marshall just mentioned, Patients Deserve Price Tags Act. And this bill's going to do something that seems novel, but it really shouldn't. We require the publication of real prices for healthcare procedures. Now, for patients, that's good, but also for employers, who should be able to provide their employees with the best prices possible. Copays have gone up. This gives everybody a fair shot. Healthcare functions in near total darkness. The lack of transparency in the healthcare industry is outrageous and something that is almost unique among other services and goods that Americans pay for every day. The way we shop for healthcare services now would be as if you, well, you could go to the grocery store, Senator Marshall referred. I use the metaphor of buying a car on a used car lot, and imagine if you had no information on what the fair market value is for that car, what other buyers were willing to pay in similar markets and what they had paid, how much the technology advances of the car contribute to the price, any of that. I mean, I could go on and on, but it is not just for the healthcare consumers that this information is so valuable and allows them to make financially sound decisions. The employers who sponsor healthcare plans total 180 million employees. Think about that. So we're talking about 180 million Americans that don't have access to this critical information, and their employers who would compare prices and navigate this have no light on this. Their power is gone because of the darkness. The purchasing power is being severely diminished currently because the employers aren't able to access healthcare data for their own covered employees. The Purchaser Business Group on Health conducted a review of multiple employers, including the City and County of Denver, where I know something about that having been the mayor, and they detailed extensive delays and runaround that employers were given by third-party middlemen when they attempted to access their own data. This is the kind of gaming and confusion in our healthcare system that drives American people nuts. We need to put a stop to it. The Patients Deserve Price Tags Act is going to allow patients to become more educated as consumers and shop for the best care at the best price. It's going to allow employers to finally have access to the data they need to negotiate best coverage for their employees, and it will let in much-needed sunlight to this system, which we believe will have cascading effects on overall healthcare spending in this country. Preliminary estimates as Senator Marshall said, statistically derived, show that this is $75 billion in additional revenue. Imagine as these prices come down, the savings we get in Medicare and Medicaid. So Senator Marshall and I are full steam ahead. We are grateful for all the robust support, and we appreciate this hearing to put it out there. Thank you, Mr. Chair.

Let the record show there was a standing ovation. [Laughter.] I'm not commenting on these bills except to say that staff is very active in getting technical assistance on this. It's reverberating against three between three different agencies, which as you all know, becomes like an exponent in terms of the amount of TA you have to have because this guy changes so these have to re-review, which they change and have to re-review. But that said, a lot of support for this. Thank you all. Senator Blunt Rochester.

Thank you, Chairman Cassidy, for providing this opportunity to share some of my priorities for Delaware and for the American people. As a former State Secretary of Labor, I'm really excited to discuss ways that we can make our workforce development, education, and economic development in this country stronger, smarter, more adaptable, and future-focused. One of my top priorities, which actually happens to be a Shark Tank competition from my staff, was actually to create an Advanced Research Projects Agency for Labor. ARPA-L, modeled after DARPA, which gave us the internet and GPS, that would leverage high-impact R&D to solve our most pressing workforce challenges. As we face a new world of work from AI, automation, even quantum, ARPA-L could address workforce shortages, ensure Americans aren't left behind, and give us a global competitive edge. While we can't future-proof our jobs or economy, and we shouldn't, we can be future-flexible. As part of that future-flex, I also want to urge the committee to advance my bipartisan legislation called the Immersive Technology for the American Workforce Act, which I am leading with Senator Britt. This innovative bill would support community colleges and CTE programs using virtual reality and augmented reality for training and education, reskilling and upskilling. My next priority is my bipartisan and bicameral National Nursing Workforce Center Act, legislation I am leading with Senators Tillis, Merkley, and Cramer. I urge my colleagues to pass this bill out of committee so that we can strengthen our nursing workforce. From up-to-date actionable information to predict emerging nursing trends to best practices, this bipartisan bill would help us address one of our biggest workforce challenges. This bill is also supported by numerous organizations and has received technical assistance from HRSA under both the President Biden administration and President Trump's administration. Lastly, I'd like to discuss a topic that many of the members of this committee are vitally interested in discussing, and that is vaccines. Given the court decision three days ago, in which a federal judge temporarily blocked many recent vaccine policy changes, it is even more important that this committee join forces to rebuild public confidence in vaccines. My Vaccine Act would create a nonpartisan process for selecting ACIP members, ensure that these members are only removed for specific valid reasons, and return ACIP to the nonpartisan independent panel of experts serving before the recent changes. This is important to all of us. It is about the health of our children, it is about the health of our country, and I hope that members will join me in this effort as well. I thank you so much for this opportunity. I appreciate your making this opportunity and considering my priorities, and I made the time. I yield back.

Thank you. And now, it's been worked out with the staff, so Senator Alsobrooks.

Thank you. Thank you so much, Mr. Chair, for holding this hearing today and for your commitment to working together to find common ground and advance bipartisan legislation. We have many common interests here, including a goal to lower prices for Americans, invest in life-saving research and research infrastructure, and protect Americans from public health threats, in part by protecting access to safe and effective, safe and effective vaccines. We're lucky to have a strong research and life sciences footprint in Maryland, and we want to continue to be on the forefront of innovation, developing cures for patients. I appreciate the opportunity today to highlight two bipartisan bills that will support life-saving research and frontline public health interventions. I know that many of us agree with the need to invest in more in women's health research. We have an obligation to our daughters to combat the conditions that leave women in crippling pain or at higher risk of chronic disease. That's why I'm proud to have introduced the U-FIGHT Act with Senator Lummis and the Women's Heart Health Expansion Act with Senator Britt. Uterine fibroids affect up to 80 percent of women in this country. It is a subject that is still often not openly discussed or even one that the general public is widely aware of, forcing women to suffer in silence. That's because despite impacting four out of five women, uterine fibroids receive .03 percent of all NIH funding. While the cause of uterine fibroids is still unknown, fibroids are often painful and are the most frequent reason for hysterectomies. Women who have fibroids are also more likely to have problems during pregnancy and delivery, and both the condition and the treatment can lead to infertility. So many women have to be their own advocates to seek relief. Patients wait on average three to six years and see two or more healthcare providers before they receive a diagnosis, underscoring the need for improved awareness and education. S. 2531, the U-FIGHT Act, would bring a welcome change to the current landscape, expanding access to early screening, detection, and intervention methods for individuals diagnosed with uterine fibroids. I'm proud to partner with Senator Lummis on this legislation and request that our committee consider it as a part of a bipartisan markup very soon. We also know that heart health that heart disease remains the leading cause of death for women across the country, from Maryland to Alabama. That's why I was pleased to be able to work closely with Senator Britt to introduce the Women's Heart Health Expansion Act, which would reauthorize the WISEWOMAN program at the CDC. WISEWOMAN provides free cardiovascular risk screenings to reduce the risk for heart disease and stroke to lower-income, uninsured, and underinsured women. The program provides critical funding to state departments of health and health consortiums from Alaska to Louisiana, but at current funding levels is not able to serve every state. Outdated restrictions are also limiting the population it can reach. This bill removes those barriers, expands providers, and authorizes 250 million to take life-saving prevention nationwide. Thank you.

For our off-committee senators, thank you for being here. Senator Baldwin will go and then we'll be through here. Everybody else has already spoken. Senator Baldwin.

Thank you, Mr. Chairman. I appreciate the opportunity to discuss our priorities before the committee today. I started working on the Ensuring Lasting Smiles Act after hearing the story of Aiden Abbott from Slinger, Wisconsin. When I met with Aiden, he told me his story of being born with ectodermal dysplasia, a rare congenital disease that affects the development of hair, teeth, and nails. This disorder requires intense dental care and oral care as well as reconstructive surgeries throughout his life. Despite having comprehensive health insurance, the Abbotts were denied coverage for Aiden's serious dental care needs and were often forced to pay thousands of dollars out of pocket for his treatments. Unfortunately, Aiden's story is all too common in individuals born with congenital anomalies or birth defects because they must have access to the coverage and health treatments that they need and deserve. I was proud to introduce my bipartisan Ensuring Lasting Smiles Act with Senator Ernst to close the coverage gap and ensure health plans cover all medically necessary services related to a patient's anomaly or birth defect. Insurance companies often claim that these procedures are cosmetic when they actually are needed to ensure that a child can eat, can speak, and can breathe. This is coverage that these families already paid for. Our bill would simply ensure that insurance companies don't deny the care that they should be covering. In 2022, this bill passed the House with overwhelming bipartisan support, and I believe that the Senate can do the same this Congress. We have 47 bipartisan cosponsors, including myself and Senator Ernst, and we're gathering more support all the time. Any of my colleagues here are welcome to join us in this fight anytime. I ask that the committee consider this bill in a markup as soon as possible, and to that end, any help from you, Mr. Chairman, and from Ranking Member Sanders in quickly obtaining an updated CBO score would be much appreciated. And before I close, I wanted to mention one other bipartisan bill that I introduced with Senator Capito, the Palliative Care and Hospice Education and Training Act, otherwise known as PCHETA. This bill would bolster the palliative care and hospice workforce to meet the growing need for care. I had the pleasure of visiting Agrace, a community-based and palliative care provider in Madison last week. I know that many of my colleagues also have priorities in the workforce space, and I hope that PCHETA will be considered for any future workforce efforts by this committee. Thank you again, Mr. Chairman, for this opportunity.

Thank you, Senator Baldwin. Now Senator Ernst.

Thank you, Chairman Cassidy and Ranking Member Sanders, and I truly appreciate you taking the time to hold this member's day hearing, and I also appreciate the chance to talk about the bipartisan work that Senator Baldwin and I have been engaged in helping our folks back home access the care that they need. As a mother and more recently a grandmother, I'm incredibly thankful that my grandson Miles was born a healthy baby. But not every family is so fortunate. About one in 33 babies born in the United States each year will have a congenital anomaly, also known as a birth defect. Children born with congenital conditions affecting the eyes, ears, teeth, mouth, or jaw are not just cosmetic but can affect a child's ability to breathe, to eat, and speak. Yet insurers still label many of these treatments as non-covered services for cosmetic reasons. On my river-to-river tour across Iowa, I met Allie Steel from Dallas County, who at just six years old was diagnosed with ectodermal dysplasia. Despite having insurance, Allie's family was still looking at tens of thousands of dollars in out-of-pocket costs just to provide her with functional teeth. That's why Senator Baldwin and I have championed the Ensuring Lasting Smiles Act, or ELSA. This bill is not an insurance mandate. It simply closes a loophole so families who already pay tens of thousands of dollars each year for health insurance can access the care they were promised. I'm grateful for the strong support this legislation has received from nearly half of the Senate. Passing ELSA would ensure children born with congenital anomalies can receive basic care so they can see, hear, chew, swallow, and speak. Those are functions we often take for granted, but every child deserves them. Mr. Chairman, I hope the committee will consider this bill for its next markup. Thank you for your time, and I look forward to working together to get this bill across the finish line. Thank you, Senator Cassidy.

Thank you, Senator Ernst. And now Senator Lankford.

This doesn't happen very often for us off-committee to have the opportunity to be able to come and share ideas to the folks that are on committee. So I have 45 bills I'm going to take five minutes for each on, just be able to walk through them as far as ideas. But I really appreciate you doing this because it allows us to be able to just speak into things that we're passionate about. Let me give you just a few of those. The MAPS Act is an act that Senator Peters and I have done together. The MAPS Act is focused simply on trying to be able to find out our pharmaceutical supply chain, where it's coming from, and where the sources are from. This is something that we've worked on for a long time. It just should not be controversial on this. Senator Peters and I have worked for a long time to be able to find language that works, but it's identifying the supply chain. As we all know, a lot of it is foreign supply chain, and we just want to know where that's coming from. Where are our weak spots? Where are we struggling? And quite frankly, where can we identify where we can do American manufacturing in some of these areas? We have all seen times during COVID where supply chain got choked off and we had real challenges there. We should learn the lesson from that and be able to identify where's our weakness. We should be able to get antibiotics, IV drugs, so many different things that were very, very focal, very, very dependent on a few entities internationally to be able to deal with. So that's the MAPS Act. A couple others, the Conscience Protection Act is one that we've worked on for a long time. We also feel like this shouldn't be controversial, just protecting the basic conscience rights of individuals, especially nurses and PAs and others that are there that may have conscience issues with certain medical procedures. Those medical procedures for them are strongly held religious belief or just basic conscience belief, and they want to be able to serve people, but they also want to say, hey, I still have a conscience belief I don't want to have certain practices. Most of them will say it during their hiring process and they'll say to a hospital or a physician group, whatever they're working with, hey, I want to serve in all areas but this one I have a conscience issue on. Occasionally, they'll be short-handed and they'll say, sorry, give up on your conscience, you got to come help us on this. That should not be so. It is already, by the way, against federal law to be able to violate the conscience rights of a medical provider, but it requires the federal government to be the one to actually step in and actually enforce that. This gives a private right of action that if their conscience rights are protected, they as an individual can step in and do that. Obviously, we know US attorneys and folks all over the country are incredibly busy and they're very seldom protected, and so individuals feel like their conscience rights are not protected. The same for the Conscience Protection for Medical Residents Act. This is for medical residents, especially in OB-GYNs that are coming in and saying, hey, I came in to be able to deliver babies, to be able to serve women, to be able to do these things, to be able to take care of healthcare, but I also don't ever plan to be able to perform abortions, for instance. That's not my intent. Right now they have to intentionally opt out of that training, and there's always a fear in medical school if you choose to opt out of something, that's going to be a mark to you. This doesn't eliminate the training, doesn't eliminate a single abortion in America, doesn't change anything. It just says in the medical practice, actually as they go through the process, you opt in rather than opt out of that training. For those that plan to go that direction, they can get those that skill training, that doesn't change. But for those that say, hey, conscience issues for me, I never plan to actually perform an abortion, I'm going to learn to take care of miscarriages, I'm going to learn to take care of everything else, but that's not an area I want to be trained in because that's not an area I want to go. It gives them that ability. Last one deals with campuses, and it actually deals with what I just consider basic religious freedom. That a campus should not discriminate against a student and a student organization because of religious beliefs. There have been times that different entities within the Department of Education have reached in and said, if you're going to be on campus, then your campus leadership has to be diverse. So to say to a Jewish group, for instance, on campus, you have to have non-Jewish leaders. Well, I don't think that's right. Again, freedom of association is a common right among Americans on this. People should be able to pick their own leaders on this, especially for Jewish organizations and other organizations to say, please don't impose on them who the leaders of the campus organization have to be on it. Allow a campus organization and a campus group of students that wants to self-associate to also have their own selection of leaders and that not be imposed on them. Again, this should be a basic American right. It should not be controversial. It's one of the things I think if we had free conversation about it, we would all say, yeah, that's, I may agree or disagree with this group or this faith or whatever this may be, but they should not, they should not lose their right to be able to select their own leaders on a campus or to have the campus control the structure of their leadership. So that's what that does, and be glad to be able to get that in the bloodstream to be able to talk about of what that might look like to be able to actually implement. Thank you again for holding this and allowing us to be able to speak into it and glad to follow up any way we can.

Thank you, Senator Lankford. Senator Scott.

First, Chairman Cassidy, thanks for doing this. And thanks for meeting with me last week. Today I'm here to discuss my Clear Labels Act, a common-sense bipartisan piece of legislation led by myself and Senate Special Committee on Aging Ranking Member Gillibrand. The bill will inject a level of much-needed transparency into our drug supply chain. Our clothes have country of origin labeling. So does our food and hundreds of other products. Why shouldn't the drugs we rely on to make us and our families better not have the same level of transparency? The fact is most Americans prefer to buy American when they can. By labeling these essential drugs, Americans will have more information to help them make well-informed decisions. Country of origin transparency is not just a consumer right, it's a matter of national security, public health, and American pride. This bill is very straightforward. It requires finished drugs to include the place of business of each API original manufacturer, so you know where the ingredients come from, packer or distributor. That information would then be found directly on the drug's label or through a searchable electronic portal. This is a simple bill that creates the transparency the American people deserve. I want to thank Senator Tuberville, Senator Moody for already supporting this bill, and invite all members of the HELP Committee to join us in support of this legislation. Thanks, Bill.

Thank you, Senator Scott. Senator Raphael Warnock.

Thank you very much, Mr. Chair. I sit here as living proof of what good public policy can achieve. Without federal programs that are directly under this committee's jurisdiction, I would not be serving in the United States Senate. I'm a proud alum of Head Start, a proud alum of TRIO, which placed me on a college campus, convinced a kid growing up in public housing I belonged there because I was already there during my summer breaks and on weekends. And without Pell Grants, I would not have been able to graduate, making me the first college graduate in my family. These investments in good public policy literally changed the trajectory of my life. And what keeps me up at night is the recognition that it would be harder for me to achieve today the things that I achieved all those years ago. I am still fighting for that kid who grew up on Kay Street. And so I remain deeply committed to ensuring that others have the same opportunities through policies that bolster the workforce, that are good investments, and that give every child a chance and the recognition that a kid's outcome should not be based on their parents' income. When we do that, not only do we help that kid, in a real sense, we lift this country towards its greatness. One such investment that I'm fighting for in light of my own story and my own recognition of the difference these programs make is my bipartisan workforce development bill with Senator Marshall, the Pathways to Prosperity Act, which would fund partnerships between technical and community colleges and industry partners to work together and develop workforce development programs aligned to the real needs of nearby industries. Our technical colleges and community colleges, I think, are a vastly underutilized resource. So we must ensure that students are graduating with technical degrees that are in high demand and that yield good-paying jobs on day one. Last Congress, this committee advanced this bill in a workforce development package, and I urge the committee to support this legislation and get it passed off the floor. I also encourage you to consider the HEADWAY Act, my bipartisan bill with Senator Capito, which will help address the Head Start shortage by allowing Head Start teachers to teach under supervision while they are working on their degrees. This bipartisan bill is supported by the National Head Start Association, and it would cut red tape to get more Head Start teachers in the classrooms right away. I hope this committee will advance this bill, which will help both teachers and small children get a great head start. Finally, I am excited to share that next week, Senator Britt and I will introduce bipartisan legislation to expand access to research grant opportunities for our nation's HBCUs, our historically black colleges and universities. These schools have historically punched way above their weight. They've been doing so much for so many with so very little for so long that I think too often we as a nation take for granted. I am a graduate of Morehouse College. I know firsthand what these schools produce, and I hope this committee will take up that bill once it's introduced to ensure that our HBCU students, as part of the larger ecosystem of all of our great colleges and universities, will have the same opportunities to participate in cutting-edge research, research that our nation needs in order to remain competitive. And to keep our competitive edge, we need everybody's talent. Together, these bipartisan efforts will expand opportunities and keep the American dream within reach. Thank you so much.

Thank you, Senator Warnock. Senator Boozman.

Well, thank you, Mr. Chairman, and thanks to the entire committee for hosting this Member Day hearing. I think it's an excellent idea. This is a wonderful opportunity to raise awareness about policy solutions that the Senate is actively pursuing to address issues that impact Americans' everyday health. Today, I would like to speak about an issue that unfortunately affects many Americans, including my own family. In fact, I think everybody in this room has probably has somebody, a friend or a loved one, that is affected that Congress can act on to save lives and curb growing healthcare costs, increasing access to prostate cancer screenings. Prostate cancer is the second leading cause of cancer deaths for men in the U.S., with African American men as well as men with a family history being disproportionately affected. The Prostate-Specific Antigen Screening for High-risk Insured Men Act is legislation that we're proud to lead along with Senator Booker to expand insurance coverage for life-saving screenings for men who are at high risk. Importantly, our bill does so without imposing cost-sharing requirements. The PSA test is a proven and effective tool for detection. When caught in the early stage, prostate cancer is almost 100 percent survivable. Unfortunately, the survival rate plummets to about 37 percent when discovered at a later stage. Too many men still delay getting their PSA levels checked, so it's important that we lower barriers to care for high-risk men, including financial barriers such as copays, deductibles, and coinsurance. Not only can this save lives, but we'll also save the American healthcare system dollars down the road. Preventive medicine such as early screenings for individuals who need it most is one of the tools in our toolbox that will help tackle chronic diseases and improve the quality of life for patients. It's vital for policy to keep pace with advances in medical screening technology, and this bipartisan bill, this isn't about Democrats and Republicans, this is just about all of us helping our neighbors, it's just that. Thank you very much, and again, thank you for the committee holding this very important hearing.

Senator Booker. Got it. Thank you. Senator Merkley.

Yeah, Warnock just totally sucked it up, you know what I'm saying? He's a pastor. Well, Mr. Chairman, great idea holding this gathering. Thank you. And I have four bills to attempt to present to you, bipartisan bills, in two minutes. The first is reauthorization of a Title VIII, the Nursing Workforce Act. We know that nurses, like my wife Mary, make the world better one bedside at a time. But we're in the middle of a nursing workforce crisis. 130,000 nurses have left the workforce since 2022, and 40 percent of the remaining nurses say they will retire within the next four years. That's why Senator Collins, Senator Baldwin, Senator Blackburn, and myself have introduced a bill to reauthorize Title VIII nursing workforce development program. We have to do more to retain our existing nurses and to train our future nurses. Second bill, School Access to Naloxone Act, and a third bill, Work to Save Lives Act. According to the CDC, adolescent opioid fatalities quadrupled from 2018 to 2023 from opioid overdoses. And in 2023, a bit of a medical miracle, FDA introduced naloxone, which reverses opioid overdoses. They save lives, but to save lives, you have to have them in the schools and in the workplaces. So Rick Scott and I introduced the School Access to Naloxone Act that provides grants to schools to stock it and train staff on how to administer it. And Senator Murkowski and I introduced the Work to Save Lives Act, which requires OSHA to issue guidance to employers on how to stock the drug and train employees on its use. Two straightforward ways to take advantage of an incredible medical development that saves lives in our schools and in our workplaces. Fourth, the Fair College Admissions for Students Act. This bill, which I've introduced with Senator John Kennedy, recognizes that courts have struck down programs to help people who are the least advantaged gain admission to schools, to universities. But there's still in place programs to help the most advantaged students gain admission. It's called legacy programs. And however well-qualified children of donors and alumni may be, they already have all kinds of advantages. In fact, it's estimated that they're four times more likely to get in with the legacy advantage. So to counter the unfair advantage of money and connections in accessing higher education, Senator Kennedy and I introduced the Fair College Admissions for Students Act to level the playing field so that folks who are not legacy students aren't discriminated against in the college admissions process. Four good bills, all bipartisan. Thank you. I'd love to see all four of them marked up.

Thank you, sir. And Senator King.

Thank you, Mr. Chairman, and thank you for this innovative idea of allowing us to discuss the bills that we are presenting before your committee. I have two that I'd like to discuss. One is called the falls, it's the Falls Prevention Act, Stand Strong Falls Prevention Act. Falls, as you know, are one of the leading causes of injury and even death, particularly among seniors. One out of every four seniors has a serious fall, and often those lead to more serious complications. This is something that we can at least make some serious efforts to prevent. The bill would do a simple thing, it would create a falls prevention office within HHS and develop a national falls prevention plan and put together an advisory committee. One of the problems we have is that we under Medicare, for example, we pay for the treatment but not for prevention. Medicare will pay for a $30,000 hip replacement or hip repair after a fall, they won't pay $10 for a non-slip bath mat in the in the tub or a grab bar throughout the house. So, I believe this is a bill that we're not talking about a lot of money. In fact, we're talking about saving money. Falls cost Medicare and Medicaid on the order of $55 billion a year. So, I believe this is a place where we can find significant savings, not only in money, but in the pain and suffering of families and people throughout the country. The second bill is an education bill. The Department of Education has a program called...

Angus, who's that last bill with?

I'm sorry?

The last bill, the first one you did, who's that your bipartisan...

Stand Strong Falls Prevention Act, and it's it's before your committee.

No, but do you have a Republican cosponsor?

Oh, let's see.

If not, that's okay, I just wanted to note it.

Let's see. Senator Rounds.

Got it.

Sorry. The Civics Act is sponsored by James Lankford, he's my lead cosponsor, Tim Kaine, Roger Wicker, Chris Van Hollen, and Eric Schmitt. There's a program in the Department of Education providing grants to school districts for what we call constitutional education and that kind of thing. What we're doing is basically saying if you accept one of these grants, you have to teach civics. Pretty straightforward. We're not mandating it for every school in the country, but if you accept one of the grants from from the Department of Education in this area, you've got to teach about the U.S. Constitution, the branches of government, what are the what is the First Amendment, how many senators and representatives. I think it's it's obvious to all of us that there's a over the last 30 or 40 years, for some reason, the education in civics has fallen by the wayside and it's not really taught in many high schools in America. This is an effort to bring that back to American education, I think will make a significant contribution. We're not talking about a lot of money or any money here, we're just talking about promoting civics education, which is I think something that's lacking in our schools today.

Okay. Thank you.

Thank you.

It looks like you're getting a full dose of Maine here, Senator.

I'm mainlining.

Senator Collins.

Mr. Chairman, thank you so much for giving members the opportunity today to discuss priority bills. Senator Shaheen is on her way to join me in discussing the third bill, but I thought in the interest of your time, I would begin and talk about two of the three bills while we're waiting for her. The first is the Rural Obstetrics Readiness Act. I introduced this bill with Senator Hassan, as well as Senators Britt and Smith, so it's a fully bipartisan bill. The Rural Obstetrics Readiness Act would help prepare rural healthcare facilities that do not have a designated labor and delivery unit to respond to obstetric emergencies. In Maine, almost one-third of hospitals have closed their obstetrics units in recent years. That creates real problems. The grants and training opportunities created in this bill are greatly needed. Second, I would like to raise the Geriatrics Workforce Improvement Act, which I've introduced with our committee colleague, Senator Kaine. There is, as the Chairman's well aware, a significant shortfall of healthcare providers who specialize in geriatrics. This is particularly important in a state like mine, which has the oldest population by median age in the entire country. Our bill would reauthorize funding for the Geriatrics Workforce Enhancement Program and Geriatric Academic Career Awards, which operate in 37 states, including one program in the state of Maine. Reauthorizing these programs would help ensure that older Americans will be cared for by a healthcare workforce specifically trained to meet their unique and complex health needs. The third bill that I wanted to comment on is the INSULIN Act. And I know Senator Shaheen is on her way. We are the long-time co-chairs of the Senate Diabetes Caucus, and one of our top priorities is to make insulin more affordable. Our INSULIN Act would impose out-of-pocket limits for patients with commercial insurance, tackle commercial pharmacy benefit managers, and ensure that patients are the ones who are benefiting from the savings that they negotiate, and encourage biosimilar competition in order to lower list prices. Our bill also includes provisions to help uninsured Americans access affordable insulin. Just this week, I met with a young woman who a few years ago ended up in the hospital because she was stretching out her insulin, not taking as much as she was prescribed because she simply couldn't afford the cost. When the bill is introduced, I would encourage my colleagues to support it. We will be introducing it very shortly, and I hope, Mr. Chairman, that you'll move quickly to mark it up. Again, Mr. Chairman, I really salute you for inviting members in today to share their priorities. I have many other bills that I'm involved in, but I tried to narrow it to just three to stay close to your time limit. And again, I know that my partner, Senator Shaheen, is here to talk about the INSULIN Act. As I said, we've worked together on so many diabetes bills over the years, and all of them are important, but in the interest of time, we thought we would talk about this one today. So, with your permission, I'll turn it over to my partner, the co-chair of the Diabetes Caucus, Senator Jeanne Shaheen.

Yes, ma'am. Thank you.

Well, Mr. Chairman, thank you for this opportunity. Thank you to the committee and thank you to Senator Collins. Hopefully, I won't repeat what she's had to say about the INSULIN Act. As she said, she and I have co-chaired the Diabetes Caucus since I got to the Senate almost 18 years ago, and she was doing it before then. So, we've had a chance to work on diabetes and so many pieces of legislation. This INSULIN Act, which is the one I'm hoping we can have the committee take up, is one that we have worked on for the last two Congresses. We were joined in this effort by Senators Warnock and Kennedy, and it really addresses the real burden that so many families face with diabetes. And I've seen it personally because my granddaughter has type one. It's a a huge personal issue and it's also a policy issue. There are over 40 million people in the United States with diabetes, over 300,000 of these are children. U.S. families annually face over $300 billion in direct medical costs due to the disease. It is the most expensive chronic condition in the United States, as I'm sure you're aware, Mr. Chairman, as a physician. And one of the greatest ongoing costs is the daily insulin that people with diabetes need to keep themselves alive. Over the course of a lifetime, the cost of insulin can add up to hundreds of thousands of dollars. Now, we've already capped insulin for Medicare enrollees at $35 a month. This new INSULIN Act, which we plan to introduce next week, will address insulin affordability for children, adults, and those who are uninsured. It will do as the Medicare provision does, cap the cost of employer and private insurance coverage of insulin at $35 a month, create a pilot program to provide a $35 a month insulin for uninsured diabetes patients, and it's a direct way to help American families facing economic pressures and will make people healthier in the long run. So, I urge the committee to take up this bill, and as I said, it also has the support from Senators Kennedy and Warnock, so it's very bipartisan. Thank you, Mr. Chairman.

Thank you, Senator Shaheen. Senator Rosen.

Well, thank you, Chair Cassidy. This is a really a terrific forum for each and every one of us to talk about something that matters to everyone, their health. If you don't have your health, you don't have anything. You know that as a physician, so I really appreciate you providing us this opportunity. And so, I have a few bipartisan bills I'd like to speak about. My bipartisan Train More Nurses Act with Senator Collins directs HHS and the Department of Labor to do a full review of grant programs related to the nursing workforce and provide recommendations to Congress on how to improve them to increase nurse faculty. You can't increase nurses if you don't have nurses to train them, particularly in our underserved areas. It would also provide more pathways for experienced nurses to become faculty and to increase the pipeline of LPNs to become RNs. My many states, including Nevada, have severe shortages of nurses who provide that critical hands-on care. And this bill passed out of committee and the full Senate last Congress, and I ask the committee's support moving it forward again. Next, my bipartisan Supporting Our Seniors Act with Senator Boozman would create a long-term care commission to provide recommendations to Congress each year on how to address the crisis of adequate care for our aging population. I was the caregiver for both my parents and my in-laws, and I know firsthand how gaps in the system, well, it just hurts families and it makes it so hard to care for our loved ones, the ones who raised us in so many cases. So, I'll close with two bills to address the doctor shortage that's facing rural and underserved communities in Nevada and across the country. My bipartisan READY Act with Senator Boozman would defer student loan interest for dental students and medical residents while they're still in training. We need to get them into our pipeline. And my bipartisan SPARK Act with Senator Wicker would create a loan forgiveness program for specialists who serve in rural areas with shortages. And so I look forward to the committee to move all these bills forward. Again, thank you for the opportunity to be heard in this forum. It's really terrific. I look forward to doing it again.

Thank you, Senator Rosen. Did I see Senator Young come in?

He did, but he must have left. Well, thank you, Chairman Cassidy, for holding this Member Day hearing. I think this is a great idea, and I'm grateful for my two minutes. My first priority I'd like to bring to awareness to you is my National Biotechnology Initiative Act, or NBIA. This bill came out of the work of the National Security Commission for Emerging Biotechnology, which you know I chair, to strengthen America's biotech edge and outcompete China. The commission's capstone report offers 50 different recommendations, some to slow China down, others to encourage U.S. biotech innovation complementing the good work of this committee. A key recommendation of the report is the NBIA, which would establish an office within the executive branch to coordinate among the dozen or so federal agencies to streamline strategy and signal that biotech is a national priority to American innovators. My second priority I'd like to highlight is the MERIT Act, my legislation to end legacy preferences in higher education through the accreditation process. For too long, elite institutions have put pedigree and privilege ahead of merit. To be blunt, every American deserves a fair shot at an elite institution, whether born into wealth and connections or into a family working to get ahead. This policy would restore fairness and renew public trust in the admissions process. While the MERIT Act has not yet been reintroduced, I'm working to build substantial bipartisan support for a balanced, durable path to reintroduction, including through outside engagement in collaboration with Edward Blum, a longtime advocate for admissions reform. Thank you again, Mr. Chairman, for the opportunity to speak this morning, and I yield back 35 seconds.

Thank you, Mr. Marine. Senator Fischer. Ron Johnson? I'm sorry. Fischer? Ron Johnson. Ron Johnson was scheduled next. Okay.

I'll be quick. Take your time. Mr. Chairman, again, I appreciate the opportunity. Never done this before. So I think this is a good idea. I don't have anything written out. I just have two basic bills that I would hope as a doctor you'd agree with me on. I believe doctors and patients should be at the top of the treatment pyramid. Doctors obviously have the primary responsibility to their patients, and I think what's been happening is they've been being at the crushed at the bottom of the pyramid right now. So I've got two pieces of legislation that I think would address that. The first one would be, and I would hope that you were a big supporter of the Right to Try. That was not an easy bill to pass, by the way. I had to hold up the FDA user fee bill to get the HELP Committee to work with me, get Big Pharma to work with me. But we got it passed. We had to water it down quite a bit. Big Pharma told us they wouldn't support it, but they wouldn't sabotage it, then they went to sabotage it in the House, and then President Trump forced the House to take up the Senate bill, which was the only one that passed. The most important part of the bill right now is just its name, Right to Try. But it's not working as well as it should. Congress has repeatedly given the FDA, the agencies, the flexibility to allow particularly patients with rare diseases, and we're going through this right now, whether it's Duchenne muscular dystrophy, ataxia, Sanfilippo syndrome, we've held some good hearings in Aging Committee on these things, and they're just getting turned down. I mean, drugs that have been available that the patients are using, they're not going to be having access to. So I think it's time to improve the Right to Try bill with Right to Try 2.0, and we're working with the agencies right now to hone the language. But it shouldn't be necessary, but something's happened at the FDA. We're going to do some investigations in my subcommittee on that to find out what's at the heart of all these disapprovals. There's got to be a different regulatory process for drugs that are going to be administered to millions or billions of people versus tens or hundreds or thousands. There's got to be a different mindset, different approach. The second piece of legislation that I would be proposing is Right to Treat. It's not necessary. You already have as a doctor full off-label prescription rights, but those rights are not being allowed. Licensing boards are threatening pulling of licenses if doctors use drugs that just aren't approved by Big Pharma through the normal narrative. So I think I'm already over time. So those are the two pieces of legislation that are near and dear to my heart. As a doctor, I would hope you'd defend the rights of doctors to be the, as I say, top of the treatment pyramid. So thank you.

Thank you, RJ. Senator Fischer.

Good morning. Chairman Cassidy, I certainly appreciate the opportunity to come before you and this committee and bring an opportunity to speak about an important piece of legislation that I've introduced with Senator Gillibrand. It is the Child Care Modernization Act. This bill reauthorizes the Child Care and Development Block Grant program, which has supported working families since 1990 by providing child care assistance to low-income families with children under the age of 13. Today, it delivers $8.8 billion in funding to states and tribes, serving primarily young children, while also supporting before and after school care and summer programs. Despite strong bipartisan support over more than three decades, this program has not been reauthorized since 2014. Our bill not only reauthorizes this grant program, it modernizes it to reflect today's child care realities. It strengthens affordability for families while addressing the operational and workforce challenges that providers face. Specifically, the bill ensures parental choice by supporting a full range of care options: centers, home-based providers, nonprofits, for-profits, and the care from family or neighbors. It updates reimbursement rates using a cost estimation model so providers are paid based on what they actually take to deliver care in today's economy. And it creates a new subgrant program to expand supply, support innovation, and invest in infrastructure. I also want to address recent fraud concerns raised in several states, including Minnesota. These incidents are serious, and I appreciate this committee's recent hearing focused on program integrity. That discussion made clear two things. First, child care remains a bipartisan priority. And second, we must strengthen oversight to prevent fraud and hold bad actors accountable without undermining a program that is essential to both families and providers. Across our states, we consistently hear about three core challenges: limited supply, workforce shortages, and high costs for families. The Child Care Modernization Act directly addresses each of these. While there is no single solution to our child care challenges, this bill builds on a proven bipartisan program and it makes it stronger for families who rely on it. I want to close by emphasizing that Senator Gillibrand and our co-leads, Senators Collins and Hickenlooper, and I welcome collaboration. We invite our colleagues to join us as co-sponsors and encourage the committee to consider this bill in a bipartisan markup in the months ahead. Thank you, Mr. Chairman.

Thank you, Senator Fischer. For the people in the audience, we'll wait just a few minutes because a few others in Judiciary Committee tied up who we think are going to come. So. I wish to enter statements from the following senators into the record: Senator Durbin, Senator Reed, Senator Peters, Senator Van Hollen, Senator Daines, Senator Booker, Senator Coons, and Senator King. For any senator wishing to enter additional statements, statements for the record will be due 5:00 p.m. Thursday, April 2. Thank you again for the members who came today. Thank you for my staff for the suggestion and their excellent work to make this successful. The committee stands adjourned.