Business Meeting: Transplants, Healthy Start, Stem Cell, Breast Health, ALS, FDA

This Senate Committee on Health, Education, Labor and Pensions will please come to order. Um I joke sometimes, my pillow talk with my wife is about health care. And so how do you lower costs, how do you improve innovation, how do you improve care? She's a doc, so it's not as strange as it might seem. But I say that because actually Americans expect us to find answers. And too often they see members of Congress shouting insults or wasting time on political games. And they get frustrated and they should be frustrated because we should be focused on how do we make their life better. We have eight bipartisan bills before us today. These will make their life better. Bills that help Americans get a lifesaving organ transplant, increase access to affordable drugs, Support mothers and babies through healthy pregnancy. And many of these should be easy bills moving through the quickly, moving through the committee quickly. Now, I don't know if they're gonna be offered, but my ranking member has introduced partisan amendments which are irrelevant to these bills. And that would have the effect to sabotage our bipartisan work. These bills, these amendments, if attached, will keep this legislation from passing the committee and the senate. Now I I don't know if my ranking member is actually going to offer them, but they've certainly been filed. And it's frustrating. Uh, in all due respect to my ranking member, it seems more about messaging. And it's grinding the committee to a halt. Rather than passing simple common sense bills that help the American people. Now the argument will be, will these help the American people? We're having a mark up in July. That's the appropriate time for these amendments. Not for this. And people on both sides say that they want regular order. It is the responsibility of people on both sides to do the activities, the hard activities, sometimes going against their leadership, in order to produce l- regular order. I'm leaving the Senate. I was asked earlier, what will be my legacy? I want part of my legacy is he tried to preserve the institution. But that is a responsibility of us all. And now, returning, I understand why Americans are frustrated with Congress. Remember, our original founders said we shouldn't have parties because they thought it would descend into partisanship. We should not accept this as our new reality. I will note as chair I have provided members of this committee a form to discuss topics of importance, to move legislation on multiple occasions. When democratic priorities were not being elevated to me for consideration, through normal mechanisms, this committee held the first ever member day hearing in the Senate. Now, the ranking member was not there, but colleagues in this room and other senators raved about how much they enjoyed this. Now we're trying to get ideas, act on ideas that came out of that hearing. that our colleagues raved about their opportunity to present. And I don't know if they're gonna be presented, but what we have filed now are partisan poison pill amendments to consider. We have other bills that Republicans and Democrat members have identified as priorities that I wish to mark up in July as I said. But if we can't get through this mark-up productively, we're not gonna be able to have that mark-up. There is a consequence for not having regular order. I'll remind my colleagues briefly of remarks from Senator the late Senator Mike Enzi's farewell address. And Enzi was loved. I gotta admit, of all of us if we're all loved by Mike, like Mike Enzi was loved, um um we all have a special place in heaven. He believed in the eighty twenty rule, and it's how he ran the committee. No senator got everything they wanted all the time, but bills got passed and laws were made. I've told Senator Sanders we'll continue to work together on his priorities. We've talked about this extensively. Of course we have disagreements. We can work through those disagreements. The public health extenders that are of great importance to him, are also of great importance to members of my side and of his side. We just recently increased and extended these programs. They have not lapsed. This committee is not going to finish this year without addressing them. I'm hopeful we can address them next month. That's my plan. But my colleagues on the democratic side have to make a choice. If they choose to support some of these poison pills amendments, no matter what, it will blow up the bills they want. The bipartisan bills that I have been called about will be denied the opportunity for mutual markups, fu- future markups, to help constituents for whom we know it is important. I suggest we put aside partisanship and do what is best for the American people. To my Republican colleagues, don't take the bait of political poison bill amendments. This just empowers bad behavior. Policy differences are fine, part of the process, but taking hostage is not. It is up to all of us to allow this committee to function as a normal committee. And we should all deny one member the ability to blow up a bipartisan mark-up when they don't get what they want. Let's do our jobs as legislators and legislate. And with that, I recognize Senator Sanders.

Thank you, Mr. Chairman. I would say that I agree with one point that you made. The American people certainly are frustrated with Congress. Uh, I think we are somewhere ahead of Iran right now in terms of favorability, Uh, and why is that? The reason for that is that all over this country, people are hurting. And I don't know about my Republican colleagues, so I think the answer will be the same, but I do talk to a lot of democratic candidates. And they tell me that we're out there, on the campaign trail, in the whole town meetings, the issue that comes up probably more often than anything else is the understanding that our healthcare system today is broken it is dysfunctional and it is wildly expensive and the american people are saying does anybody in congress know that do they know that i can't afford to send my kid to a doctor i can't afford prescription drugs for my parents so today the so called let me say a word about the so called poison pills that i will be offering to address some some of the crises that we face. And I want the American people to decide whether or not these they think these are poison pills, outrageously bipartisan efforts, trying to sabotage the work of the chairman. First thought, as bad as our overall health care system is, and by the way, as everybody on this committee knows, we spend twice as much per capita on health care as the people of any other nation over fifteen thousand dollars and yet eighty five million Americans are uninsured underinsured some sixty thousand people a year die because they can't afford to go to a doctor maybe we wanna be addressing that issue now as bad as the overall health care system is the primary health care system is in even worse shape in america today tens of millions of people live in communities where they cannot find a doctor a dentist or a psychologist even when they have decent insurance i know that's true in vermont i suspect that it's true in every state in this country and if we do not get our act together given the enormous shortage of doctors dentists and psychologists we have right now the situation will only get worse in the future we are facing a shortage of four hundred thousand nurses over the next two years alone. So, Mister Chairman, you think this is a poison pill that we talk about, the need to make sure that we have nurses and doctors all over this country. It doesn't seem to me to be a poison pill. It seems to be to be something we should have addressed years ago and we should have addressed now. Over the next twelve years, we faced a shortage of a hundred and eighty thousand doctors. and four hundred thousand mental health practitioners while over sixty million Americans live in districts where they can't find a dentist. Every major medical organization agrees that our investment in primary health care is woefully inadequate and I suspect that every member of this committee understands that as well. There is a reason why most other major countries spend over twice as much as we do on primary health care and end up with far lower capital costs than we do. They invest in keeping people healthy, keeping them out of emergency rooms, out of the hospital, and that makes sense to me. The backbone of our current primary health care system, as weak as it is, is the federally qualified community health center program, the FQHC program, an issue that I have worked on for many years. Today, more than thirty million men, women and children receive high quality primary health care at community health centers. in more than sixteen thousand neighborhoods located in every state in America. Many of these centers also provide dental care, mental health counseling, and low-cost prescription drugs. Unfortunately, George Washington University projects that community health centers will lose nearly forty-two billion in revenue over the next five years. So, Mister Chairman, if you think it's a poison pill that we begin to address that issue right now, I would The National Association of Community Health Centers estimates that health centers will see an increase of four million uninsured patients in the coming years. And that is why, Mister Chairman, the first amendment I will be proposing would increase community health center funding from four point six billion this year to five point eight billion next year. Given the fact that a majority of centers senators on this committee have already voted in favor of this funding bill, funding level, I hope it will pass. But that's not the only amendment that I'm gonna offer. This amendment would also provide loan forgiveness and scholarships so that we get more doctors and nurses into underserved areas. Mister David, as Vanessa uh this uh this amendment would provide a hundred and twenty million dollars over a three year period so that every state in America has a teaching health center in their state teaching health center's enormously important way to make sure that we have doctors and nurses in rural areas. So, Mister Chairman, I do not agree with you that these are poison pills. I would say that every amendment that I am offering is widely uh supported by the American people, Democrats, Republicans and Independents. I hope you will support them.

A couple things for clarity. You said that this, you're sabotaging the work of the Chairman. Actually, this is the work of our colleagues. Bipartisan work of our colleagues. These amendments are not germane and they were filed Tuesday. Now there's a process, a process by which there's full consideration of a bill of an amendment that comes before us and then we take that processed amendment so that we all understand it we all have a an ability to understand it if you drop a non germane amendment which by the way is not paid for two days beforehand you gonna have histrionics about how millionaires and billionaires are ripping off the american people but there is a process here and the congress works better as a process

mr. chairman did i get these amendments in on time according to the process

absolutely And are they paid for? Are they paid for, Senator Sanders?

They will be paid for.

They will be paid for.

Let's work on it.

Well, let's work on it.

Yeah, that's right.

In the future.

Well, it's past, it's a work on it.

Let's work on it. Let's work on it. We're actually gonna have a hearing in July in which we can pay for it. And I told you that. And that's when we're gonna do this. Uh, and that's the way the Congress is supposed to work, and that is fair to the American people. Not moonbeams and flatus somehow finding a way to pay for things.

Chairman, the Congress does not work.

Well, clearly it's not working with that, but it can work and that's my mission. So let's move on. We'll begin consideration of today's bills. For the awareness of all senators and staff, we intend to vote on amendments as they are raised, but will hold the vote on final passage of both bills until the end of session. We'll keep members and staff updated on the timing of the vote for final passage. As a reminder, when discussing an amendment, identify the amendment you're discussing by name and number. We'll begin with consideration of S seventeen eighty-two, the Charlotte Woodward Organ Transplant Discrimination Prevention Act. I'd like to thank Senator Moody for her leadership. She has taken up the mantle of former Senator, but now Secretary of State Marco Rubio, who championed this legislation in the last two Congresses. I thank Senator Hassan, who has remained a steadfast partner in this bill, and has consistently in her time on the committee spoken passionately for those who are disabled. This legislation is another example of the important work achievable, working in a bipartisan manner, and a critical step in improving and restoring trust in the US transplant system. We have a manager's amendment S seventeen eighty-two. I move to adopt it in the nature of a substitute, and to have it considered original text for the purpose of future amendments. All those in favor, please say aye. Aye. Opposed, say nay. The ayes have it, the motion is agreed to. Before we offer any amendments, do any members wish to speak on the bill?

Chairman Cassidy, if I might.

Senator Moody.

Thank you, Chairman Cassidy. I know you have worked really hard to get us where we are today. Senator Hassan, thank you. I know you were calling a lot of folks last night, asking them to withhold amendments that might derail this bill. I I even thank uh Senator uh Kane. I know he was considering offering an amendment. I'm hoping that he has understood that this is so important. It's been coming for a long time. We even have your constituent, Charlotte Woodward, in the room with us today. Uh and all of the senators that um have cosponsored this. I'd also like to thank representative Kat Kamek over in the house. Uh, she really has rolled up her sleeves and helped us, uh, get this, uh, to where we are today. Um, baby Zion, who I consider my forever constituent, would have had his fifth birthday Monday, had he received the lifesaving heart transplant he so desperately needed after forty days in the NICU. So many love and miss Zion, who was born with Down syndrome and passed away in October of twenty twenty one. And that story reminds us that barriers to transplant still exist in our healthcare system. And people with intellectual disabilities shouldn't be discriminated against for something as vital as an organ transplant. And today we are happy uh to have Charlotte Woodward with us in the room. This bill is bipartisan. It passed the House unanimously just last year. Uh we, as we vote today, will be thinking of Charlotte and baby Zion and all those who will benefit from this legislation. Uh, and I urge my colleagues to vote in favor of this bill to protect people like them, from discrimination moving forward. Thank you again, Chairman.

Senator Sanders.

This is an important bill and I hope we can pass it.

Senator Hassan.

Uh, thank you, I am also really grateful that we have Charlotte uh here with us today as we consider this bill and I'm grateful to Senator Moody for her taking up uh leadership on this bill as she came to the Senate no one should be discriminated against. because they experience disabilities and on few and few issues um have stakes as high as whether somebody receives a lifesaving transplant or not. So I urge my colleagues to support the bill and I uh would uh love to see it moved forward separately. Thank you.

Senator Kain.

Um I'd like to call up and discuss K and amendment one to this bill. And and let me describe it, and then I uh the Chairman and I will chat a little bit about it. I'm very glad that that Miss Woodward is here. This is a good bill. I'm a co-sponsor of it. I really like it. The timing of the bill, this is the one bill on the list that deals with the rights of folks with disabilities. And the timing is sort of exquisite in in a way maybe kind of exquisitely bad, because of the announcement by the administration this week that they're forcing the special ed functions of the department of ed to be pushed over to hhs

mmm

and so what this amendment would do would be to block shifting the functions of the office of special ed and rehab services to other federal agencies let me explain why i think this is so important and not a poison pill and something i hope we can work on together president trump was elected president and he promised that he wanted to get rid of the department of education so that's what he said now if you wanna do it i would disagree but he has a majority in both houses and so the way to do that would be to get congress to approve getting rid of the department of education and change the law that's not what the president has done instead he's treated the department of education as if it's a going out of business sale as a of a discount furniture outlet and handed off willy-nilly the responsibilities of that agency. Just to remind folks, student loan portfolio. Let's give that to the Small Business Administration. They didn't want it, they weren't staffed up to do it, and they weren't competent to do it. So now they're trying to hand it over to the Department of Treasury. Career and Technical Education, let's give that to the Department of Labor. The Department of Labor melted down because of the scandal prone nature of the secretary that i sadly voted for and and that agency has hurt itself but on this one this this was the core mister chair of the doe that we cared the most about that we asked secretary McMahon about when she was here for her confirmation hearing who's gonna have the backs of american kids that have disabilities and special needs and so given that this is the only bill in this that deals with disabilities i file this amendment and then you and i have chatted about it and so um i would like to call it up or find an acceptable way to deal with this issue so that the committee can try to block these services from being put in the hands of an hhs headed by a cabinet secretary that many of us have lost confidence in

so you're offering so you're offering ok um

i'm offering it as an amendment but

i mean The amendment is unrelated to the underlying bill, which is a bipartisan measure intended to insure that health care providers and the organ transplant centers may not deny or restrict access to organ transplant solely on the basis of an individual's physical or mental disability. The Office of Special Education and Rehab Services, OSHR OSHRs, and the Kane Amendment would not be moved to HRSA or OCR, which are the only two agencies at HHS implicated by the underlying bill. This amendment would prevent passage of a thoughtful balanced bipartisan bill supported by disability advocates like Charlotte Woodward sitting in the audience. Uh um, for the record, I will share with everyone, I agree that that should not be moved to HHS. Let me just put that on the record. And um uh if an IIIA IAA is signed, I think it should be with DOL. better served to provide rehabilitative services to introduce people with disabilities into the mainstream. But I will say to my colleagues, this is not the time and place to address the issue. But I asked my colleague to withdraw the amendment, and I will publicly commit to working with him for the next mark-up in July at finding something which is an accommodation for everyone's concern.

Mister Chair, let me say I I appreciate that and I think that's a a good faith offer so here's what i would would like to do i will withdraw the amendment to the charlotte woodward bill if i get a commitment that at the the july mark up um i will get a vote either on a bipartisan solution that we reach or on this amendment which i would i will introduce a stand alone legislation and i would i would ask i hope we can find a bipartisan accord and i think we can cause i think there's members on both sides of the aisle that don't want this put in hhs isn't it so i think we can find a bipartisan agreement

you are united states senator and you have the right to offer that and i'll protect that right and you have my commitment

ok so either we we we'll have a vote either on a bipartisan accord or on this amendment that i will file a separate legislation at the next mark up which will be before the august recess

yes

in that case i withdraw the amendment

ok

Uh, anyone else? Mm. Um. When I begin with consideration of S three zero one four, the ensuring timely access to generic stuff, I thank Senator Collins and Baldwin for their work in this legislation to help Americans access to these drugs more efficiently and to the best of their ability.

Lower cost generic medications. I am committed to making healthcare more affordable. And the high cost of healthcare is multifaceted, which means it takes more than one approach. so i urge my colleagues to support this bill i'm gonna take the chair's prerogative and call up first sanders number six as we begin consideration of s thirty fourteen

mister mister chairman

uh see sanders number six will add portions of senators collins and Shaheen's insulin act to s thirty fourteen legislation to address the abuse of fda processes processes that delay the entry of cheaper generic drugs Before we proceed to debate, there are few things that should be noted for the record. First, S thirty fourteen is identical to a version of the insuring timely access to generics act that the help committee passed last congress on a bipartisan basis, when ranking member Sanders was the chair. This twenty twenty three mark-up occurred after Senator Shaheen and Collins first introduced the insulin act, but at the time the ranking member did not file an amendment to incorporate the policy or otherwise attach it to this bill. i will also note that during the time that senator sanders served as the chairman there was no vote scheduled on the insulin act instead he publicly disparaged ceos of insulin manufacturers and pharmacy benefit managers at a hearing but there was no vote on the insulin act senator sanders even titled the hearing the need to make insulin affordable for all americans

yep

i will think intuitively that if the ranking member believed the insulin act was the way to solve the problem As chair, he would have brought the bill before the committee the last time we considered the ensuring timely ask access to generics act. But that brings us to today. I'm fully committed to affordable insulin. I am on the record in support of thirty five dollar insulin. The rebate pass through part of insulin act was signed into law in January as part of our larger PBM reform efforts. Uh, S thirty fourteen is also part of the insulin act as introduced this congress. I commend uh, I commend Senators Collins and Shaheen for tireless work advocating on behalf of patients who need insulin to survive. Partly because of their efforts, most commercial insurance companies voluntarily cover insulin for only thirty-five dollars out of pocket Trump, Rx and other direct-to-consumer platforms make insulin available for twenty-five dollars today. The insulin act as introduced has twenty-five bipartisan co-sponsors, including nine from the committee. I venture to say that the math suggests that the amendment will pass. But I'll let senators know that transparently. when senator sanders was chair this was never addressed it suggests to me that the amendment today was not sincere nor done properly particularly since it contains text of matters that have already been signed into law it has not been scored by the cbo nor does it have technical assistance from hhs it's easy to speak about how we need to have something for the american people but to get that something done there's a process you go through and that includes getting a score from cbo and getting technical assistance from hhs. I plan to move to table this amendment, but understand that senators may choose to vote differently. Regardless of the outcome, i'm committed to working with senators collins and Shaheen to refine their legislation and thank them for the long time work in this space. But before I make a motion to table, senator uh collins has requested to speak, and i'm sure senator sanders and others may as well. Senator collins.

Thank you, Mister Chairman. First, let me thank you for including the insuring timely access to generics act on today's mark-up agenda this is a bill that i first introduced in twenty nineteen with senator schahin and senator baldwin both of whom have been very committed to it i just want to explain a little bit about how this bill works it increases competition from generic drugs through better oversight of the FDA citizen petition process. Brand name manufacturers were behind roughly eighty-six percent of all citizen petitions filed between twenty sixteen and twenty nineteen. Overwhelmingly, these petitions did not raise legitimate safety concerns which is why the fda rejected more than nine out of ten of these petitions. despite the low success rate, petitions are still able to delay generic drug entry and can unfairly consume fda resources. our bill, our bipartisan bill, would strengthen the fda's ability to reject citizen petitions if it believes that the primary purpose of the petition is to delay approval of the lower priced generic competitor. If enacted, this bipartisan bill would improve competition, save patients money, and also, according to the late assessment from the CBO, save taxpayers forty nine million dollars. i find it extremely interesting that the ranking member has proposed nine amendments to this common sense bill he has not proposed amendments to any other bill i think it's pretty easy to figure out what the motivation is here i am pleased that the ranking member finally supports the insulin bill and has proposed it as an amendment to this bill. I've worked alongside with Senator Shaheen, my co-chair of the Senate Diabetes Caucus, on legislation to lower the cost of insulin since twenty nineteen. And before that, I held a hearing in the Aging Committee on the cost. That's what led us to the Insulin Act, which has many components, including the ensuring timely access to act. This bill, there was one that before us now, uh passed out of the help committee. I would know that when Senator uh Sanders was chair in twenty twenty three, he had absolutely no interest in adding the ensuring timely access to the generics act to the insulin act. Thank you.

Senator Sanders.

Um, chairman uh it is true that when i was chair we brought the ceos of the major pharmaceutical companies before us that's absolutely true as you recall we did that because they are charging the american people by far the highest prices in the world for prescription drugs in some cases ten times more and i and the american people wanted a simple answer why do you charge us ten times more than our Canadian friends or people in Europe. And out of that hearing, among other things, what we did get is a commitment which has been carried through to lower the outrageous then outrageous cost of asthma inhalers. Millions and millions of people have asthma, they buy inhalers, cost them hundreds of dollars. The price now is thirty five dollars. That's what we did in this committee. And furthermore, in the Inflation Reduction Act, and I worked hard on that as Chairman the budget committee at that time we now pay seniors now will not pay more than thirty five dollars for insulin in medicare so i think we did have some significant uh success and once again mister chairman i think the issues that you consider to be poison pills are amendments that the vast majority of the american people support they are amendments without technical assistance and without a cbo score Mister Chair.

I'm in for the discussion on Sanders Amendment six.

Mister Chair, just quickly,

Mister

I also just wanna um recognize Senator Shaheen. Her name has been mentioned. She's not a member of the committee, but this is a a very important priority for hers. And I just wanted to underline that she's worked really hard on this issue.

Anyone else? I make a motion to table Amendment six. Uh, I shall be voting yes to table. Will the clerk call the roll, please?

Mr. Chairman.

Senator Sanders.

uh i oppose the motion to table and urge my colleagues to vote no i wanna make clear to members that this vote is really a vote on my amendment i urge a no vote on the motion to table

it is on sanders amendment six it is not on the underlying bill so clerks will call the roll

senator paul

uh by proxy yes

senator collins

no

senator mckoski

no

senator marshall center scott center holly center tuberville center banks center houston

yes

center moody center armstrong

by proxy yes well now uh clerk

center center sanders

no

center murray

uh no by proxy

center baldwin

no

senator murphy

no by proxy

senator kane senator hassan

no

senator hickenlooper

no by proxy

senator markey

no by proxy

senator kim

no

senator blunt rochester senator ulster brooks

no by proxy

chairman cassidy

cassidy cassidy is yes

out of eight eyes fifteen no's

uh so we are not tabling so now we'll vote on adoption of the amendment uh i shall be voting no uh the clerk shall call the roll

i'm sorry which amendment

sorry

uh that's

uh sanders sanders sanders six this will be the the one we just discussed we shall now vote on passage

six

ok

we did not table so we're voting to pass

right

clerk shall call the roll

senator paul

no by proxy

senator collins senator morkoski senator marshall senator scott senator hawley senator tuberville senator banks senator houston senator moody senator armstrong

no by proxy

senator sanders

yes

senator murray

yes by proxy

senator baldwin senator murphy

yes by proxy

senator kane senator haslam senator hickenlooper senator markey

yes by proxy

senator kim senator blount rochester senator also brooks senator also brooks

oh sorry yes by proxy

chairman cassidy

uh cassidy is a no

have fifteen eyes eight nays

the amendment passes i ask unanimous consent to consider sanders's amendments one through five and amendment seven eight and nine en bloc

no uh no object

ok

mr. chairman i call up sanders's amendment one

part

ok mr. chairman um

let me let me begin please we now um wait where is my comments in a minute you go ahead bert oh i'm sorry please send it out

uh mr. chairman i think it is no secret to anybody on this committee that we have a crisis in primary healthcare i don't need to go through a long explanation everybody knows that is the case uh everybody here has community health centers in their districts, and I think most of the people on this committee, if not all, are proud of the work that those federally qualified community health centers are doing. I think every member of this committee understands that these community health centers I know in Vermont and I expect in every state are under a lot of pressure now, for a lot of reasons. They need help. And as I mentioned earlier, and I don't think anybody disagrees, if we wanna cut healthcare costs, if we wanna ease human suffering, we gotta make healthcare available to people, when they need it they need access to doctors and access to psychologists access to low-cost prescription drugs and that is what community health centers do so what this bill does are three basic things it increases funding for community health centers from four point six billion to five point eight billion second of all it does something which again i think everybody in this committee understands is important this concept of teaching health centers where medical school residents can now practice uh in primary health care facilities uh fqac's other type of facilities rather than just uh teaching health centers that will bring more young doctors into rural areas underserved areas and into primary health care there are now a number of states we have expanded funding for this program recently but there still remain a number of states alaska kansas kentucky maine south carolina indiana vermont new hampshire virginia colorado new jersey and delaware that do not have one teaching health center that it is addressed in this bill uh and lastly what this bill does this amendment does is at a time when we have a massive shortage of doctors and nurses in this country it substantially increases funding for the national health service corps helps uh young doctors and nurses pay off their student debt if they agree uh to practice in underserved areas so i The problems are real. I think there's nobody in this room who disagrees with it. Let's do it. Uh, thank you, Mr. Chairman.

Mr. Chairman.

Go ahead.

Uh, I think, let me comment first, please, Dr. Marshall. This amendment is unrelated to the underlying bill on generic drugs and adopting it would prevent this bill from advancing at today's mark-up. Think about what I said at the outset. if we want congress to work we have to work to make it work. And having a bill which creates unrealistic increases in funding for some programs, but for some reason strangely ignores the special diabetes program, which is a bipartisan priority of health members, and includes the insulin act, which we just passed, indicates it is not well thought through. I repeat that. We are supposed to be deliberative here, we're not supposed to just be doing political punches. Earlier this year we increased funding with pay-fors for all of the public health extenders in a bipartisan fashion. So to to to to to say that we're not doing this is to ignore the work we've already done. There's some six point six billion in this new spending, which is not offset. It takes other members' priorities and inserts them into an unrelated bill in bad faith. The ranking member had months to engage with me on these priorities. I approached him first to cut for a list of bills uh for a mark-up two months ago. Instead, we get something on Tuesday without technical assistance, without a score. Um, which by the way hurts the ability of us to pass the underlying legislation, which is bipartisan, bipartisan Democrat and Republican priorities. We should all be frustrated with this. i'm committed to working towards a positive outcome in the public health extender funding. we can address these issues and we will address them when we have technical assistance when we just do the blocking and tackling that we have to do i urge my colleagues to oppose this poison pill effort i make a motion to table the amendment.

mr. chairman

do we

well there's just we can vote first

go ahead

mr. chairman i i think that many of us on this side of the aisle have supported community health centers and certainly wanna continue to support them. But I do think we need to go back and measure twice and cut once here. Uh, we've thrown a lot of money at them. Um, unfortunately, if you've seen one community health center, you've seen one community health center. There's no, they're they're not measuring success in any uniform fashion yet. And I beg them to come back to me and say, here's what we're gonna measure. We have these eight chronic diseases that, that are spending, we're spending ninety percent of our money in treating those diseases. The community health center is the perfect place to, to treat those chronic diseases. But, but they need to find out how to, how to measure it. I feel like sometimes we're just throwing money at it, and we're not solving the problem. And certainly wanna continue to work with the ranking member on how to best fund these community health centers, how to fund more, you know, nurses out out there. All those things, a lot of the same. goals we share together, but I'll have to vote no, or I'll vote yes on tabling for for today.

Senator Collins.

Thank you, Mister Chairman. Mister Chairman, the Sanders amendment excludes, as you point out, the special diabetes program. Perhaps the ranking members unimpressed with that program. I can tell you it is absolutely essential to children, teens and others with type one diabetes. and also with native for native americans and native alaskans who have a disproportionately high rate of type two diabetes along with senator Shaheen i've long been a champion for the special diabetes program i cofounded the senate diabetes caucus and now serve as co-chair with senator shaheen In February, as chair of the Appropriations Committee, I secured a two hundred million dollar reauthorization of the special diabetes program which expires in December thirty-first of this year. We increased funding by forty million, that's the highest funding level in the program's history. It has driven remarkable progress in preventing treating and managing diabetes while sporting critical research. It is inexplicable that other programs are being extended, but the ranking member, either deliberately or by mistake, did not include the special diabetes program. For that reason, I will vote to table this amendment.

Mister Chairman.

Senator Sanders.

This amendment does not solve every aspect of the healthcare crisis in America. I concede that. I concede the community health centers in America are not perfect. But, Mister Chairman, the American people understand that our current healthcare system where we are today is broken is dysfunctional. Let me repeat According to some very good studies, some sixty thousand Americans die every year unnecessarily because they can't afford to go into a doctor's office. Community health centers are the best tool that we have at this moment. I'm delighted to work with the senator from Kansas. Let's improve community health centers. But right now they are in desperate financial shape. They need help. So again, all this bill does, it doesn't solve every health care crisis in America. It addresses the major tools that we have for primary health care, that is, community health centers. It allows them to serve more people. It helps us get doctors and nurses into rural and underserved areas by increasing the National Health Service Corps. And it also allows us to get more doctors and nurses through the teaching health center program, a very important provision. Doesn't solve all the problems. It is a major step forward in giving access to millions of Americans who desperately need health care.

Anyone else who wishes to comment on this? I'll just point out that we will consider these same bills in July at our mark-up, when they've been fully vetted, had technical assistance, and scored. This remains a bipartisan priority for us all, but there is a process that you have to go through in order to make Congress work. You don't just drop them in on Tuesday. We shall now vote to table. The chair shall be voting yes to table. Clerk shall call the roll. Yes, yes, yes. Uh, I'm sorry? Vote yes to table. yeah i'll vote yes did i say yes yes yeah

yep

yeah

yes

the chair shall we vote a yes

yeah senator paul

a yes by proxy

senator collins

yes

senator mccoskey senator marshall senator scott senator holey

um i don't have a proxy on him uh he's a yes yes by proxy

right uh senator tuberville center banks

yes

center houston

aye