Business Meeting on Price Transparency, Insulin, Food Safety, Workforce and More

The Senate Committee on Health, Education, Labor and Pensions will please come to order. I talk a lot about the high cost of health care and I come to this issue not only as a senator, but as a doctor who has practiced medicine in a hospital for the uninsured and underinsured for over twenty-five years. We're seeing the inability to afford health care is impacting the ability of small businesses to provide health insurance for their employees. The cost of being insured has gone up. Premiums are climbing, particularly for the sixty-two percent of Americans getting their insurance from a small business. And even those with insurance often have large deductibles before coverage truly kicks in. And so, a family delays care, or faces significant financial strain, or puts it on the credit card, and somehow they're never able to pay off that credit card balance. We owe it to our fellow Americans to help. And let's put aside feckless partisan politics, do our job, pass and pass legislation to make Americans' lives better. We are doing that today. The bills we are voting on will help families access affordable quality health care. The Patients Deserve Price Tags Act, championed by Senators Marshall and Hickenlooper, will make pricing information more easily available, empowering patients to compare prices and to pick the highest quality affordable option for care. So a mother, say, for example, Lafayette, Louisiana, has a child with an earache, pulls out her phone, and says, " Search urgent care center near me." "Which one has the best price?" And then she could go to that one, she could go to that one, and save her the money that can be quite substantial because we've made this information available. The bill also gives employers access to their data, allowing them to develop innovative plan designs, driving down cost and benefiting employees. The legislation is so important and something I've been touting as part of my money and value for patients, or the MVP agenda to lower cost for health insurance for families. The expedited access to biosimilars act by Senator Paul increases market competition, lowers drug prices, and increases access to more lifesaving treatments by eliminating costly and redundant clinical study requirements. The manager's amendment, uh manager's amendment includes a policy from Senator Moody to eliminate government government red tape that slows down FDA's review of biosimilars. The Insulin Act, sponsored by Senators Collins and Shaheen, caps how much patients pay for insulin, preserving access for the forty million Americans with diabetes. And the National Plan for Epsilepsy Act, led by Senators Schmidt and Klobuchar, will help the three point four million Americans living with epilep epilepsy improving research, diagnosis, care and treatment. The Title VIII Nursing Workforce Reauthorization Act from Senators Collins and Merkley, and the Empower for Health Act, Title VII, from Senators Murkowski and Reed, strengthens the health care workforce, addressing shortages that limit families' access to care, especially in rural areas. The Safe Drugs Act, championed by Senators Banks and Heinrich, and the Clear Labels Act from Senators Rick Scott and Gillibrand, include common sense policies to help patients understand what is in their drugs, whether they are compounded by the pharmacy down the street, or manufactured at a manufacturing plant, and help FDA and states better track when a problem occurs. The Making Families Food Safer Act from Senator Tuberville gives food safety regulators the ability to better respond to foodborne investigations, quite topical given the recent cyclospora outbreak. Many of these bills were raised as priorities by members of this committee, but also by other senators at our member day hearings in March, where off-committee senators could come and present their priorities. Today's mark-up shows the success we can have when we work together on shared priorities. In that spirit, we're also marking up Senator Sanders' Childhood Diabetes Reduction Act. This bill increases transparency for families around ultra-processed food, and restricts targeting of junk food ads towards kids. I don't think it's a perfect bill, but it's a starting bill for bipartisan changes we need to make to how food is regulated and allows us to have a productive mark-up today. I'll continue to work on other initiatives in this space, including the need for a national uniform standard for food regulations, than rather rather than a patchwork of widely different state laws, and I appreciate the ranking members' bipartisan ge- engagement. Lastly, lastly, but most importantly, I acknowledge the unbelievable amount of staff work in this Markup. In some cases, members of my staff have worked on a piece of legislation for over six months. These member priorities would not be moving forward without their expertise, commitment, and sacrifice. So I publicly thank Kristen Chytinski, I always have to work with that last name, Catherine Handler, Matthew Thomas, Romney Gripaldo, Dominic Travis, Carolyn Benson, and Liz Billick for their work in this market. Thank you, Senator Marshall. I appreciate my colleagues' efforts on these bills. advancing a pro-patient, pro-family, and pro-worker agenda. I look forward to supporting them. With that, I recognize Senator Sanders.

Mr. Chairman, thank you very much, and I want to applaud the staff on our side as well for their hard work, uh, and tell you that I intend to be supporting all of the bills that are before us this morning. But I do want to say in response to something that you did say, that at the end of the day, as a nation, we're gonna to ask ourselves one very simple question with regard to health care. Is health care a human right or is it not? And I would suggest, Mr. Chairman, that the overwhelming majority of the American people understand that health care is a human right whether you're rich, whether you're poor, young or old, people have a right to get the health care that they need. And I hope that the day will come sooner than later that the United States of America, our great country, the wealthiest nation, joins every other major country, guaranteeing health care to every man, woman and child. And by the way, despite the fact that eighty-five million Americans are uninsured or underinsured today, as the chairman well knows, we are spending close to double what other nations are spending on health care. And the issue that we are ultimately going to have to deal with is the function of healthcare to make the insurance companies and the drug companies phenomenally rich or do we provide quality care to all people as a human right mister chairman uh let me focus my remarks now uh on one of the pieces of legislation's uh that you met uh that you mentioned uh piece that i introduced called the childhood diabetes reduction act this legislation will require the f. d. a. to put strong warning labels on ultra-processed foods that are high in sugar, salt, and saturated fats. Importantly, it would also ban junk food ads targeted to children, similar to what Congress did to the tobacco industry nearly thirty years ago. Mr. Chairman, in America today we have an obesity epidemic and a diabetes epidemic. They are both directly related and they are both getting worse. More than thirty-five million Americans have type two diabetes, over ten percent of our population. Diabetes is not only a serious illness unto itself, but is a contributing factor to heart disease, stroke, amputations, blindness, and kidney failure. And the cost, the cost of treating that disease is staggering. According to the American Diabetes Association, the total cost of diabetes in the us is over four hundred billion dollars a year to treat diabetes four hundred billion dollars a year it's an extraordinary amount of money and when we talk about the type two diabetes epidemic and the huge increase in new cases we must also talk about the epidemic of obesity in america about about ninety percent of people with type two diabetes are overweight or obese These two epidemics go hand in hand. The time is long overdue for us to pose some very simple questions. How did it happen that according to a CDC report in twenty twenty two, the rate of childhood obesity in America has tripled since the nineteen seventies, tripled since the nineteen seventies. And it's gotten so bad that one out of every five kids in America is now obese. How is it happened that over forty percent of adults in our country today are obese? And in my view, the answers to these questions are not very complicated. For decades, Congress and the FDA have allowed large corporations to make huge profits by enticing children and adults to consume ultra-processed food and beverages, loaded up with sugar, salt, and saturated fat. We can begin to turn that around today by passing this legislation. There is growing evidence, including testimony before this committee a few years ago, that these foods are deliberately designed to be addictive, similar to cigarettes and alcohol, and lead to a higher risk of type two diabetes. Shockingly, according to a study published in the British Medical Journal in twenty twenty two, ultra-processed foods make up an incredible seventy-three percent of our nation's food supply. Bottom line, much of the food that we as Americans are now consuming are making us unhealthy and are contributing to the fact that our life expectancy is significantly lower than many other wealthy countries. Uh, none of this is happening by accident. The food and beverage industry is spending over eleven billion dollars a year on advertising, pushing these unhealthy products onto the American consumer. Even worse, nearly two billion dollars of this money is spent to directly advertise these unhealthy products to our kids in order to get them hooked at an early age. According to the Rood Center for Food Policy and Obesity, children and teens view about four thousand food and beverage ads on television each year and an average of ten advertisements each day last year for example coca-cola spent over five billion on advertising while it raked in over eleven billion in profits not one of their ads will tell you that a twenty ounce bottle of coke contains more than fifteen teaspoons of sugar fifteen teaspoons of sugar of a twice the recommended daily limit for kids Given this reality, which has been widely discussed by scientists and doctors for decades, the question then arises, what has the FDA done to address these epidemics, which have impacted the health of millions of Americans, and cost us hundreds of billions every year? And the answer is, not much. So, uh, Mister Chairman, uh, under the bill that we are now considering, the FDA would be required to put a warning label on sugary drinks that says, Food and Drug Administration warning, drinking beverages with added sugar can contribute to obesity, type two diabetes and tooth decay, not recommended for children. Similar warning labels we put on foods that are high in salt and saturated fats. This is not a radical idea. Uh, Chile implemented a similar law, Israel, Mexico, Peru also have similar laws. So, Mister President, the time is now for us to do two things. to put strong labels on the products, to protect our kids, and to make sure that TV advertising does not hook kids on unhealthy foods.

Thank you, Senator Sanders. We'll now begin consideration of today's bill. 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 the session. we will keep members and staff updated on the timing of the vote on final passage. I will ask colleagues to limit remarks to two minutes when discussing either of the bills or offering an amendment as there are a lot of amendments to process. As a reminder, when discussing an amendment, please identify which amendment you are discussing by its name and number. We were gonna do the um price tags bill first, but Senator Marshall has had to leave and so we're gonna hold that until he returns. We'll begin now with consideration of S fourteen fourteen the expedited access to biosimilars act i thank senator paul for his work on this legislation to improve access to affordable biosimilar medications i thank senator moody who championed legislation incorporated into this bill via the manager's amendment at our april hearing on the biosimilar and generic drug market we heard how biosimilars lack regulatory certainty and have exorbitant development cost in the fifteen years the biosimilar regulatory framework was created, we've learned a lot about how to ensure they are safe and work for patients, but laws have not kept up. This bill addresses these problems by reducing data required under law, that in many cases is unnecessary. And it aligns with the FDA's common practice to provide clearer rules for biosimilar developers. It establishes a clear, consistent process for when FDA needs to require additional studies. It also eliminates a redundant that multiple fda offices review each biosimilar before approved i'm glad to see this legislation progress through committee i encourage colleagues to support we have a manager's amendment to s fourteen fourteen i move to adopt the manager's amendment in the nature of a substitute and to have it considered original text for the purpose of further amendments all in favor say aye aye opposed no the ayes have it the motion is agreed to do any members wish to speak on the bill Senator Paul.

Prescription drug uh spending is mainly concentrated on biologic drugs like hormone therapy cancer treatments and monoclonal antibodies biologics are only five percent of prescriptions but account for fifty-one percent of spending. My bill seeks to reduce the cost of biologic drugs by removing the blanket requirement for comparative efficacy trials in biosimilar development, which are often unnecessary. These trials are like stage three trials that attempt to gauge whether biosimilar and the reference biologic are equally effective. But a review of over six hundred studies published in the journal, Pharmaceuticals, found that no biosimilar with proven analytical similarity has ever failed, a comparative efficacy study. The average cost of biosimilar development is a hundred to three hundred million, and comparative efficacy studies generally cost twenty to thirty million. Removing these unnecessary studies, as they have already done in uh Europe and in England, would reduce uh development costs by ten percent. Additionally, the studies can also take up to three years to complete, and biosimilar development can take up to nine years. Delaying treatments for the sake of conducting unnecessary studies harms the very people we intend to help. The FDA has realized that these burdensome nature of these studies and in its recent guidance the agency waived comparative efficacy studies for therapeutic proteins like monoclonal antibodies we've worked with the FDA on this bill because when a biosimilar

Does anyone else wish to speak? The officer raises his hand, but I'm thinking that no, he's just uh checking his uh earpiece.

Shh.

We'll now begin consideration of S forty one eighty nine, the insulin act of twenty twenty six. I thank Senators Collins as well as her co-leads, Senator Shaheen, Kennedy and Warnock for their leadership on this piece of legislation. I appreciate their efforts to help make life-saving insulin more uh uh more affordable. Uh, I recognize that this legislation may need more refinement, and may encounter policy and procedural hurdles beyond this committee. I am pleased that we were able to advance it to the next stage of the legislative process. We have a manager's amendment S forty one eighty nine. i move to adopt the manager's amendment and the nature of a substitute and have it considered original text for the purpose of further amendments all in favor please say aye

aye

all opposed say nay the ayes have it the motion is agreed to do any members wish to speak on the bill senator collins

thank you mr. chairman first i wanna thank senator Shaheen for our long-standing partnership on this bill as co-chairs of the Senate Diabetes Caucus, which I founded in nineteen ninety seven to increase research funding and promote better health care for people with diabetes. I also want to thank Senators Kennedy and Warner for their contributions. Beginning in twenty fifteen, I chaired eight hearings on prescription drug prices when I chaired the Senate Aging Committee. We heard countless stories from Americans who are struggling to afford the medicine they needed, and the unaffordable cost of insulin was featured prominently at almost every single hearing. The bill we're marking up today is the culmination of these efforts. While recent decisions by manufacturers to cut their list prices on insulin is encouraging, there is still more work to be done. Our bill would cap the cost of insulin at thirty-five dollars a month for individuals who are on commercial insurance plans. According to the American Diabetes Association, nearly forty percent of people with diabetes have rationed or skipped insulin doses, due to the cost. One of my constituents, Beck Hoskins from Chelsea, Maine, skipped doses of insulin when she was unable to afford it and ended up in the emergency room. The insulin act would help people like Bec afford the insulin that they need to survive. The bill not only caps out-of-pocket costs for patients, but addresses perverse incentives in the market and the lack of biosimilar competition that contributes to high list price for insulin. although uh the bill has some other issues in it that i'd like to go through including a citizen petitions which are largely backed by brand name manufacturers who were behind eighty six percent of them which is why fdi denied more than nine out of ten of them i am mindful of the chairman's uh request that we keep our uh remarks brief. So I would like to end by thanking our committee co-sponsors on this of this bill, Senators Murkowski, Tuberville, Banks, Baldwin, Kane, Blount Rochester, Hickenlooper and also Brooks. I wanna also thank all the patient groups that have endorsed our bill. Thank you.

Senator S-

Senator Paul.

Um, I respect the intentions and motives of those who had like to see lower insulin prices in the bill but historically price controls don't work if you wanna see examples of where we have extensive price controls, look to venezuela look to the soviet union the old story in the soviet union was a guy goes into the store and he says uh are you the store that doesn't have eggs and the guy says no no no where this that's across the street uh where the store doesn't have toilet paper because they were so used to having shortages of things you want people to have stuff you want people to have the basics of life you want food so you know do we have a right to food and healthcare as the ranking member would say well you know you can say that then you can set prices but it doesn't work what happens in capitalism as you have a freely fluctuating price now are pharmaceuticals freely fluctuating prices no most of it's uh interrupted by an intermediary the government in over half the cases is the intermediary and then the insurance companies are the uh intermediaries and others obstructing the real true price the only real true price of drugs in our country applies to about three or four percent of people that have absolutely no insurance, not something i'm recommending, but they're the only people who really care, almost all the prices are already set throughout the system. So while i think this is well-intentioned, i think the history of price controls is not a good one and i will oppose it.

Senator Baldwin.

amendments? um

no Does anybody else wish to speak on the bill? K. do any members wish to offer an amendment?

mr. chairman

senator baldwin

i i wanna start by expressing how excited i am to have the uh insulin act on this mark up today this bill will make insulin more accessible for millions of americans and significantly reduce the cost of insulin no one should have to go without the medication they need to stay healthy and that's why i introduced my amendment baldwin collins number one uh this bipartisan amendment uh would uh restore a pilot program for uninsured patients to access insulin for thirty five dollars a month and a resource center to help patients afford and access affordable insulin both of these policies were in the original text of the insulin act but unfortunately are not in the manager's amendment before us today so i ask for the support of all of my colleagues on this amendment to ensure that patients without insurance are not left behind and that patients have access to resources to help them find information about access to insulin and mister chairman i ask for a vote on uh my amendment baldwin one two s four one eight nine

ok um i commend senators collins and sheeheen for their tireless work advocating on those who need insulin to survive And partly, perhaps largely because of their efforts, most commercial insurance companies now voluntarily cover insulin for only thirty-five dollars out of pocket. While I support the core policy of the Insulin Act, I cannot support creating new duplicative grant programs that exacerbate the problems in our health care system that drive health care cost. Community health centers already provide deeply discounted insulin to patients, regardless of insurance status or ability to pay. Community health centers, and many others, receive billions in both mandatory and discretionary funding to support their mission by participating in the three forty B program. Any three forty B provider is getting insulin for pennies on the dollar. These savings are supposed to be passed on to the uninsured or low income patients to pay for insulin and other treatments on a sliding fee scale. There are real transparency and oversight concerns that prevent three forty B from translating to better access and lower cost for patients. So, rather than holding covered entities accountable to insure that existing resources are being used as Congress intended, this amendment amendment creates another source of funding and enables diversion, further diversion of three forty B revenue away from that which Congress originally intended. I will note that the trump administration strongly opposes this provision. I acknowledge that members on both sides of the aisle may support the amendment. And I share the goal, having practiced medicine in a hospital for the uninsured and the uninsured, um, to have affordable insulin. But I'll say the hospital where I practiced used three forty B the way it was supposed to be used and actually gave the medicine for free to those who came in. And I would say that this amendment is giving cover for three forty B entities, which is not using the program the way that we intended it to. They're using it as a money grab. Now I can urge my uh colleagues to oppose this amendment, um, and allow others to speak or make my motion?

Could I uh Mr. Chairman?

Senator uh Senator Sanders.

Thank you. Uh, Mr. Chairman, I strongly support capping the out-of-pocket cost for insulin at thirty-five dollars for Americans. The underlying legislation as we know uh does that for americans who have insurance uh but it does not do that for the uninsured and that is what this amendment uh addresses uh as i think we all know several years ago as part of the inflation reduction act we were able to make sure that people on medicare medicare do not pay more than thirty five dollars we also had success in substantially lowering the cost of asthma and ocd inhalers bottom line we are making success having success in making uh insulin available to those who need it this is an important amendment let's support it

mister chairman

senator collins

mister chairman i support this amendment and am pleased to be the principal cosponsor the original bill that we reintroduced in this congress had this provision in it in an attempt to move the bill along uh we agreed to take it out and decide it at the committee level but i think it's important that we not leave this population the most vulnerable population behind thank you

does does anyone else wish to speak I now make a motion to table the amendment I shall be voting to table the clerk should call the roll

senator paul

aye

senator collins

no

senator mccoskey center marshall

aye

twelve

center scott

uh no

center holy

aye

center tuberville

aye

center banks

aye

center houston

aye

center moody

no

center armstrong

no

center sanders

no

center murray

no by proxy

center baldwin

no

center murphy

All by proxy.

Senator Cain.

All by proxy.

Senator Hassan.

No.

Senator Hickenlooper.

No.

Senator Markey.

All by proxy.

Senator Kim.

No, all by proxy.

Senator Blunt-Rochester.

No.

Senator Altser-Brooks.

All by proxy.

Chairman Cassidy.

Chairman Cassidy is a yes, and notes that Senator Scott is yes by proxy.

And Moody is a yes, I thought we were voting on the amendment, I apologize.

On the on the amendment?

Yes.

I thought I thought we were voting on something else, so I'll change my vote.

i apologize

and so you change it too

uh yes

yes

uh yes and armstrong is a yes by proxy and merkowski is not voting

ok i have ten eyes twelve nays

the motion is not agreed to

it's not not tabled

this is not tabled

it is tabled

i now

it's a no it isn't

the motion is not tabled correct

it's not tabled

no

it's not tabled

ok i now move I now move to vote on adopting the amendment. The clerk shall call the roll. I shall be voting no.

Senator Paul.

No.

Senator Collins.

Aye.

Senator Mikalski.

Not voting.

Senator Marshall.

Aye.

Senator Scott. Senator Hawley.

No, by proxy.

Senator Hawley. Senator Tuberville.

No.

Senator Banks.

this for the

for this for the amendment

this is

for the amendment

adoption of the amendment

adoption of the amendment

it's not for the bill it's for the adoption of the amendment

senator houston

no

senator moody senator armstrong

no by proxy

senator sanders

aye

senator murray

aye by proxy

senator baldwin senator murphy

aye by proxy

eric hayne

aye by proxy

senator hassen

do you have these down

senator hickenlooper senator markey

aye by proxy

senator kim

aye by proxy

senator blount rochester senator altserbrooks

aye by proxy

chairman cassidy

um

oh ok

and senator cassidy has a no

i have twelve ayes ten nays

the uh the amendment is adopted

We will now begin with consideration of S twenty three fifty five, the Patients Deserve Price Tags Act. I thank Senator Marshall and his colleague, Senator Hickenlooper, for their efforts on this legislation aimed at increasing transparency in health care cost. This bill has undergone extensive bipartisan negotiations over, I think, six months. Stakeholder engagement, multiple rounds of technical feedback, from the administration from from i think three to four agencies i'm proud of the process this legislation is going through and the bipartisan staff work that has gone along with it it is an example of the important work we can achieve in improving the us healthcare system when we work together in a bipartisan fashion we have a manager's amendment s twenty three fifty five i move to adopt the manager's amendment in the nature of a substitute and have it be considered original text for the purpose of further amendments All those in favor please say aye. Aye. All opposed say nay. The ayes have it. The motion is agreed to, to any members wish to speak on the bill.

Yeah, Mr. Chairman.

Senator Marshall.

Yeah. Well, thank you, Mr. Chairman, and and ranking member Sanders as as well, and to my colleagues, Senator Hickenlooper and and all your teams who've worked so hard on this bill. Five hundred comments we've went through from HHS, Department of Labor, Treasury, eighty red lines, but Look, patients deserve price tags, not surprise billing. Once and for all we'll force transparency and competition i- into healthcare. Could you imagine going to the grocery store, standing in front of the of the meat locker, and and you're a, you're living credit card to credit card, you're on social security, and you can't know what the price is between beef and chicken and and pork. Could you imagine that? Could you imagine checking out and then still not knowing what the price was and maybe three months later someone tells you what the price is. Healthcare is the only business in the world that's allowed this to go on. You know, this um has been a really a fifteen year journey for me to to work on this concept. And then eight years uh we've been working on it, staff is working on it, making this bill better, better, and and better. It's not perfect, but it's gonna close so many loopholes, force health care providers to show you the price tag up front. Not an estimate, it's gonna show you the price up front. Yo, think about this. You you need an MRI of your knee. In one place it might be three hundred dollars, another place it might be three thousand dollars, and it's the same uh care given at both places. A hip replacement might cost fifteen thousand dollars one location, and eighty thousand dollars in another. When when families have five, seven thousand dollars deductible, price tags matter. So, again, I just can't say enough how hard our staff has worked on this and, and certainly just appreciate Senator Hickenlooper's efforts a as well, and then all of our co-sponsors for uh bringing this across the finish line today. Thank you so much.

Thank you, Senator Marshall, and also thank you for staying within two minutes. I've had a light gavel to this date, Senator Collins, but I shall start trying to enforce the two minute rule. Uh, and starting of course with Hickenlooper.

Thank you, Mr. Chair, uh, and Ranking Member Sanders, um, for months we've been working alongside Senator Marshall and his staff, uh, Chairman Cassidy, Ranking Member Sanders, to push forward this Patients Deserved Price Tags Act. Uh, in twenty twenty five Americans spent five point seven trillion dollars on health care. In the last twenty five years, health care inflation has risen by a hundred and twenty one percent. That's forty percent more than the cost of living's gone up. Too frequently, there's no way of knowing what you need to pay for medical care, what what the cost is. Patients, often while sick or or in severe pain, have the added mental anguish that comes from a totally dark opaque system. Uh, Journal of American Medical Association has estimated that about twenty-five percent of our health care spend, is on administrative processes, pricing failures, waste inefficiency. I mean, even assuming ten percent of that is is legitimate, uh administrative costs, it it provides the opportunity for hundreds of billions of dollars of savings. The the gaming and confusion in our health care system drives people crazy. And we can put a stop to it. The lack of transparency in our health care system is the proverbial elephant in the room it's almost unique among other services and goods that Americans pay for every day no single company in this system is a monopoly but without transparency health care is an aggregated monopoly. This makes it almost impossible for people to make financially sound decisions about their health care. It hurts the hundred and eighty million Americans whose health insurance are sponsored by their employers, who they also don't have access to critical information. Even our nation's largest employers won't be able to see what they're paying for. Hundred and eighty million Americans have tr- amazing purchasing power. Let's be clear. Preliminary non-partisan economic consulting firms estimate seventy-five dollars in additional tax revenue. Savings and reduction of costs would be dramatically more than that. And we need to ensure that Americans can seek medical care without the risk of being bankrupt. I will yield, but only after I thank Colin Goldfinch and Romney Gripato, Lily Ryan, Max Seltzer, uh, Patients Rights Advocate, uh, our own staffer, Hannah Burner, for all their time and effort to get this bill in tip-top shape. Uh, we know that there's a better future for healthcare and sunlight is the best disinfectant. Amen.

Thank you.

I yield back.

Senator Paul.

I commend the authors for their intentions on this. I think that it mistakes the problem for being transparency and the problem is actually the prices are fixed. So if you're on Medicare, that's about half the people in the country, forty, forty five percent of people on Medicare, and we tell you what the price is, and we make the hospital publish it everywhere, does your price change? No, it's fixed. If you're on Medicaid, and we force the hospital to publish the prices and all these things, and we push it out there, is that gonna change the price of Medicaid? No, the price is fixed. If we force the hospitals to put the price of your insured care out there, and they do all the work and it's labeled everywhere, will the price of your insured care change? No, it's all it's all fixed. There is only a very small amount of this market that cares about this, and these people don't have insurance. Once again, that's the true market place. I'm not saying it's a great thing, but in the true market place people care. There are apps, and there are people beginning to ask that. I know at our local hospital if you'll pay immediately towards either deductible or if you don't have insurance you get a twenty five discount so i think people are aware of these problems but i don't want people to think that this fixes the problem when you mandate transparency on prices that are fixed doesn't change the situation the goal and the what we need to try to strive to is where we have more patients that are in the situation where pay where prices are fluctuating where prices are fixed transparency won't help

would anyone else wish to speak ok we will now move on to the s forty nine seventy four um make the making america's food safer act i thank senator tubberville for his work to advance food safety given the food and drug administration the tools to better inspect food facilities and to respond to foodborne illnesses is essential for americans to have access to safe foods this bill also gives fda the ability to destroy unsafe food at ports of entry we have numerous examples of unsafe products including active seafood and illegal E cigarettes entering the market without the ability to seize and destroy I also thank Senator Marshall for his work on ingredient safety ensuring that what goes into our food is safe is also important to improve our own health and I look forward to working with him on this in the future. We have a manager's amendment S forty nine seventy four I'm moved to adopt the manager's amendment and the nature of a substitute and have it considered original text for the purpose of the amendments. All those in favor please say aye. Aye. All opposed say nay. The ayes have it, the motion is agreed to. Do any members wish to speak on the bill?

Thank you, Mr. Chairman.

Senator Tuberville.

Uh, first I'd like to thank Senator Kaine on this. Uh, this is, this is really important. Especially those that have ports. You know, it's a common sense target approach. It modernizes our food safety system. It removes outdated statutory restrictions, allowing the FDA to leverage accredited third-party cert cert certificates programs data from both domestic and foreign facilities to prioritize inspections to help our supply chain. The bill grants FDA authority to immediately share vital unredacted food safety data with state, local, and tribal and territorial health officials when public health is on the line. And finally, it grants the HHS secretary authority to order the destruction of unsaved food imports that present a significant public health concern, preventing dangerous illegal products from simply turning around and re-entering supply chains, while preserving full due process rights for owners. This is a bipartisan step forward for public health's supply chain efficiencies and American farmers. Basically what this does is when it, when bad food comes into our ports and is turned around by our food inspectors, it goes right back out into the waters and goes to another port. And hopefully they get by with the, with the, murder so to speak. So, we wanna be able to destroy this food, and not allow it into our country. So, I urge my colleagues to support this bill.

Um, I wanna thank Senator Tuberville for, uh, roping me into working with him on this one. Um, I, I very much appreciate this bill. I have a unique perspective that I share with Hickenlooper. In the history of the United States, only thirty people have been mayors, governors, and US senators. And the reason that number is so small is that being mayor will kill you. Um, but but this, one part of this bill that's really good is the data sharing between state local and federal health agencies with respect to this particular issue of food safety because there's a lot of data that exists in silos and when it doesn't get shared then we can't do what we need to do to keep people safe and so I really appreciate the portion of this that during tough times and when there are challenges, the data can be shared between the agencies at the local, state and federal level. And I appreciate uh my colleague for bringing this forward and glad to support it.

Anyone else wish to speak? Um, OK, we shall now go to uh, do any members wish to offer an amendment? Senator Baldwin.

Uh, Mister Chairman, I would like to uh speak briefly to my amendment Baldwin one two S forty nine seventy four, I will offer and withdraw, and not ask for a vote on this. This contains um this amendment contains the codifying useful regulatory definitions or curd act. The curd act is a bipartisan bill with my colleague from Wisconsin, Senator Johnson that would establish a definition of natural cheese for dairy processors and provide consumer clarity. While I will not be offering the bipartisan Kurd Act amendment today, I wanna thank uh the Chairman and ranking member for committing to work with me and with Senator Johnson to find a path forward for this legislation. Thank you.

Thank you, Senator Baldwin. Uh, thanks for offering the amendment. It's important that food labeling is accurate and does not mislead. I believe that the FDA currently has the regulatory ability to make the changes in this amendment. and that congress should not continuously weigh in on standards of identity. However, I commit to working with Senators Baldwin and Johnson on advancing this policy in other legislative vehicles later this year. Are there any other amendments?

I'll be back.

Seeing no other amendments. Did you remember? No. Uh, let's move on. Uh, we'll now consider S thirty seven eighty eight, the Clear Ables Act. Clear Labels Act. I thank Senator Rick Scott and his co-lead, Senator Gillibrand, for this, their work on this legislation. I acknowledge Senators Tuberville, Moody and Armstrong, who are cosponsors for their contributions. As Chair of the Aging Committee, Senator Rick Scott has brought increased attention to the vulnerabilities of our global supply chain. Congress must help address these challenges. Customs and border protection already requires pharmacies, to provide drug country of origin information to patients. But pharmacies don't have this information, so they can't comply. This bill addresses that gap by requiring drug manufacturers to provide information about API suppliers and other key steps in the supply chain so that pharmacies know where the products they provide to patients come from. Having this information provided through a drug label will also help fill gaps in FDA's information. Right now, FDA knows how much API gets imported every year, and it knows which suppliers a drug manufacturer uses, but, FDA cannot tell you who manufactured the specific ingredients used in the pills that we take. This is common sense policy. I encourage colleagues to support the legislation. We have manager's amendment S thirty-seven eighty-eight. I move to adopt the manager's amendment and the nature of a substitute, and have it considered original text for the purpose of further amendments, All in favor say aye. Aye. Opposed say nay. The ayes have it. The motion is agreed to. Do any members wish to speak on the bill? Senator Hassan.