[Congressional Record Volume 161, Number 101 (Tuesday, June 23, 2015)]
[Senate]
[Pages S4546-S4549]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




          STATEMENTS ON INTRODUCED BILLS AND JOINT RESOLUTIONS

      By Mr. GRASSLEY (for himself and Mr. Gardner):
  S. 1648. A bill to amend title XVIII of the Social Security Act to 
create a sustainable future for rural healthcare; to the Committee on 
Finance.
  Mr. GRASSLEY. Mr. President, I come to the floor today to discuss a 
bill I am introducing, the Rural Emergency Acute Care Hospital Act, or 
REACH Act.
  Since January 2010, 55 rural hospitals have closed their doors. It is 
even more troubling that the pace of rural hospital closures appears to 
be accelerating.
  As you can see from this chart, the number of hospital closures has 
increased each year over the past 5 years. These closures are creating 
a health care crisis for hundreds of thousands of Americans across the 
country.
  The REACH Act will create a new rural hospital model under Medicare 
that will enable struggling rural hospitals to keep their doors open 
and maintain the most critical hospital service: emergency medicine.
  When a rural hospital closes, the community loses the lifesaving 
capabilities of the emergency room. According to the National 
Conference of State Legislatures, 60 percent of trauma deaths in the 
United States occur in rural areas. After a traumatic event, access to 
an emergency room within 1

[[Page S4547]]

hour can make a big difference between life and death.
  Take, for example, Portia Gibbs from North Carolina. At 48, Portia 
suffered a heart attack 75 miles from the nearest emergency room. She 
later died while waiting for a helicopter to arrive that would have 
taken her over the State line to Virginia, where the closest hospital 
was located. If Portia's heart attack had occurred just 1 week earlier, 
Portia would have been transported to a hospital in Belhaven, NC, just 
30 miles away. Unfortunately, the facility in Belhaven had closed just 
6 days before Portia's heart attack, citing insurmountable financial 
struggles.
  Then there is the tragic story of 18-month-old Edith Gonzalez who 
choked on a grape in her hometown of Center, TX. Edith's frantic 
parents rushed her to their local hospital, Shelby Regional Medical 
Center, only to discover that it had closed just weeks earlier. By the 
time little Edith arrived at the next closest hospital, she had passed 
away.
  While we can't say with certainty that both Edith and Portia would 
have survived if their local hospitals had not closed, we know the 
earlier people access care, the better their chances are.
  The term used by emergency medical practitioners is the ``golden 
hour.'' The golden hour is the hour following a traumatic event when 
lifesaving intervention--like that which can be provided in an 
emergency room--has the best chance of impacting survival. In other 
words, the longer a patient has to wait to receive emergency medical 
care, the lower their chances will be for survival.
  Rural hospital closures mean patients have to travel longer distances 
to access emergency medical care. Ensuring that rural communities keep 
their emergency care resources could make the difference between life 
and death. Rural hospital closures also extend beyond the loss of 
emergency services to include economic consequences for rural 
communities. Hospital closures can mean the death of a rural community. 
Approximately 62 million Americans live in rural areas. Rural 
communities play an integral role in the economic stability of this 
country through their invaluable contributions in food production, 
manufacturing, and other vital industries.
  In addition to supporting the medical needs of those who participate 
in rural industry, rural hospitals also serve as the single largest 
employer in a rural community. The economic impacts of closing a 
hospital when no other hospital is close by are devastating. If we care 
about the physical and economic health of rural communities, we must 
make a change that will reverse the trend of accumulating rural 
hospital closures.
  iVantage Analytics compiled a report for the National Rural Health 
Association which identified 283 additional hospitals at risk of 
closure based upon performance indicators that matched those of the 53 
facilities that already closed.
  Allow me to direct the Presiding Officer's attention to this map. 
This map depicts the approximate locations of 53 of the 55 hospitals 
that have closed in the last 5 years.
  I would like to point out that between the printing of this chart and 
today, two additional rural hospitals have closed. That alone is a 
clear indication of the problem I am trying to convey.
  Now, imagine this same map depicting five times the number of 
hospital closures you see here. That is what is what will happen if we 
do not act to protect America's rural hospitals. Furthermore, the loss 
of those additional hospitals would not only impact local economies but 
would also result in a $10.6 billion loss in GDP. It must change, not 
only for the health of rural Americans but also for the health and 
stability of our economy.
  Payment cuts to hospitals are one contributing factor to rural 
hospital closures. More significant, however, is the current Medicare 
payment structure that supports rural hospitals. Today, the Medicare 
payment structure for hospitals is focused on inpatient volume. 
Emergency rooms act as a loss leader, and income is primary generated 
through inpatient stays.
  A RAND study published in 2013 found that the average cost of an 
inpatient stay is 10 times the cost of an emergency room visit. 
Researchers at the University of North Carolina found that many of the 
at-risk rural hospitals around the country have an average of two or 
fewer patients admitted to a hospital on any given day. These hospitals 
can have up to 25 inpatient beds, and if only 2 or fewer of those beds 
are filled every day, that is a utilization rate of 8 percent or less.
  Instead of letting these facilities close because they do not have 
the needed inpatient volume to generate enough revenue, why not let go 
of the underutilized inpatient services in favor of sustaining life-
saving emergency care. That is what the REACH Act does. It provides a 
voluntary pathway for rural hospitals to eliminate their underutilized 
inpatient services and ensure residents have access to emergency 
medical care that saves lives. A key component of the bill that allows 
the rural emergency hospital model to function is the requirement for 
these facilities to have protocols in place for the timely transfer of 
patients who require a higher level of care or inpatient admission.
  The value of the rural emergency hospitals in the case of a life-
threatening emergency will be their ability to administer lifesaving 
measures in order to stabilize a patient before they are transferred to 
a higher level of care.
  In addition to providing lifesaving emergency care, rural emergency 
hospitals will have the flexibility to provide a wide array of 
outpatient services, including observation care, skilled nursing 
facility care, infusion services, hemodialysis, home health, hospice, 
nursing home care, population health, as well as telemedicine services. 
This list is not all-inclusive but is just a sample of the outpatient 
services rural emergency hospitals could provide to their communities. 
The door is left open for rural emergency hospitals to design their 
outpatient services to match the needs of their communities.
  There are roughly 1,300 critical access hospitals in America, 
including 82 in Iowa, the second most just behind Kansas. I am not 
suggesting that 1,300 critical access hospitals will become rural 
emergency hospitals. Some hospitals may never consider giving up their 
inpatient beds, others may consider it in the future, but some critical 
access hospitals need this or something like it right now.
  The rural emergency hospital model, with its outpatient and emergency 
care services, will be good for the health of rural communities and our 
Nation because of the critical care it will provide when and where 
rural Americans need it. When there is a farm accident in the afternoon 
or a heart attack in the middle of the night, that emergency room can 
be the difference between life and death. Medicare needs a payment 
policy that recognizes that simple fact.
  I look forward to continuing to work with my cosponsor Senator 
Gardner, other colleagues, and stakeholders in building a sustainable 
future for rural health care.
                                 ______
                                 
      By Mr. BROWN (for himself, Ms. Collins, Ms. Warren, Ms. Hirono, 
        Mr. Blumenthal, Mr. Vitter, Ms. Murkowski, Mr. Whitehouse, Mr. 
        Reed, Ms. Baldwin, Mr. Franken, Mr. Udall, and Mr. Heller):
  S. 1651. A bill to amend title II of the Social Security Act to 
repeal the Government pension offset and windfall elimination 
provisions; to the Committee on Finance.
  Mr. BROWN. Mr. President, I rise today to address America's 
retirement savings crisis. A 2013 survey conducted by the Governors of 
the Federal Reserve System found that roughly 31 percent of Americans 
have no retirement savings or access to a defined-benefit pension. In 
addition, 19 percent of respondents nearing retirement--those aged 55 
to 64--reported having zero savings or pension to rely on in the coming 
years.
  In light of these figures it is more important than ever that 
Congress ensure America's seniors have access to the Social Security 
benefits they have earned. Yet provisions such as the Windfall 
Elimination Provision, WEP, and the Government Pension Offset, GPO, 
prevent millions of Americans--including teachers, firefighters, and 
police officers--from receiving their full benefits. It is time 
Congress repealed them.
  This afternoon, I, along with Senator Collins and a number of my 
Senate colleagues from both sides of the aisle,

[[Page S4548]]

introduced the Social Security Fairness Act. This bipartisan bill will 
repeal both the WEP and GPO provisions which Congress enacted in 1983 
and 1977, respectively. In December 2014, these unfair provisions 
chipped away at more than 2 million Americans' Social Security 
benefits. That same month, in my State of Ohio, more than 200,000 
Ohioans had their Social Security benefits reduced because of these 
provisions.
  Over the past 35 years, fewer and fewer workers have been given 
access to defined-benefit plans, and, today, only about half of the 
total U.S. workforce is covered by an employer-sponsored retirement 
plan. That is why Social Security is critical for so many. Congress 
should make sure that every American has access to all the Social 
Security benefits he or she has earned. Repealing these provisions is 
an important step in that direction.
  I ask my colleagues to join me in repealing the WEP and GPO by 
cosponsoring this legislation.
  Ms. COLLINS. Mr. President, I rise to speak about the Social Security 
Fairness Act of 2015, which I am joining my colleague from Ohio in 
introducing today. This bill would repeal both the windfall elimination 
provision, WEP, and the government pension offset, GPO. We believe that 
these two provisions in the Social Security Act unfairly penalize 
certain individuals for holding jobs in public service when the time 
comes for them to retire.
  The WEP affects individuals who have worked in both the private 
sector and in public sector jobs for which Social Security taxes were 
not withheld. For such individuals, the WEP applies a special formula 
to calculate benefits, reducing them compared to what would otherwise 
be paid.
  The GPO affects retired public employees whose spouses are entitled 
to Social Security benefits. When these individuals apply for Social 
Security spousal or survivor benefits, the GPO applies an offset, 
reducing the Social Security benefit based on the amount of that 
individual's public pension. In some cases, the spouse will not be 
entitled to any spousal or survivor benefit because of the GPO.
  The WEP and the GPO have enormous financial implications for many of 
our teachers, police officers, firefighters, postal workers and other 
public employees. Given their important responsibilities, it is simply 
unfair to penalize them when it comes to their Social Security 
benefits. These public servants--or their spouses--have all paid taxes 
into the Social Security system. So have their employers. They have 
worked long enough to earn their Social Security benefits. Yet, because 
of the GPO and WEP, they are unable to receive all of the Social 
Security benefits to which they otherwise would be entitled.
  The impact of these two provisions is most acute in 15 States, 
including Maine, which have state retirement plans that lack a Social 
Security component. However, it is important to point out that the GPO 
and WEP affect public employees and retirees in every state, including 
our emergency responders, other Federal employees, and postal workers. 
Nationwide, more than \1/3\ of teachers and educating employees, and 
more than \1/5\ of other public employees, are affected by the GPO and/
or the WEP.
  As of 2013, one and a half million people were affected by the WEP 
and 615,000 people had their benefits reduced by the GPO. Many more 
public employees across the country stand to be harmed in the future. 
Moreover, at a time when we should be doing all that we can to attract 
qualified people to public service, this reduction in retirement 
benefits makes it even more difficult for our federal, state and local 
governments to recruit and retain the public servants who are so 
critical to the safety and well-being of our families.
  What is most troubling is that this offset is most harsh for those 
who can least afford the loss: lower-income women. In fact, of those 
affected by the GPO, more than 80 percent are women. According to the 
Congressional Budget Office, the GPO reduces benefits for more than 
200,000 individuals by more than $3,600 a year--an amount that can make 
the difference between a comfortable retirement and poverty.
  Many Maine teachers, in particular, have talked with me about the 
impact of these provisions on their retirement security. They love 
their jobs and the children they teach, but they worry about the future 
and about their financial security.
  Roxie Brechlin of Bar Harbor, Maine, is one of many examples of the 
effect that the GPO and the WEP have on our teachers when they retire. 
Mrs. Brechlin first began paying into Social Security when she took her 
first summer job at age 16. After graduation, she continued to pay into 
Social Security for 18 more years before getting her first teaching 
job. Mrs. Brechlin worked as a teacher for 23 years, and for 14 of 
those years she worked full-time at another job during the summer, 
paying more and more into Social Security each year.
  Mr. Brechlin recently contacted my office to explain the effect that 
the WEP and GPO will have on his wife. Mrs. Brechlin recently retired. 
When she applied for Social Security benefits, the WEP applied, and her 
benefit was reduced by two thirds. Mr. Brechlin is more concerned about 
what would happen to his wife if he were to predecease her. Normally, a 
widow would be eligible to continue to collect 100 percent of her 
husband's benefit. Mrs. Brechlin, however, would not be able to collect 
any survivor benefit, due to the application of the GPO. Not only does 
this fact worry Mr. Brechlin, he also sees it as unfair.
  It is time for us to take action, and I urge all of my colleagues to 
join us in cosponsoring the Social Security Fairness Act to eliminate 
these two unfair provisions.
                                 ______
                                 
      By Mr. REED (for himself, Mr. Durbin, Mr. Markey, Mr. Whitehouse, 
        and Mr. Leahy):
  S. 1654. A bill to prevent deaths occurring from drug overdoses; to 
the Committee on Health, Education, Labor, and Pensions.
  Mr. REED. Mr. President, today, in an effort to decrease the rate of 
drug overdose deaths, I am pleased to be joined by Senators Durbin, 
Whitehouse, Markey, and Leahy in introducing the Overdose Prevention 
Act. Representative Donna Edwards is introducing this bill in the other 
body.
  Throughout the country, the death rate from drug overdoses has been 
rapidly climbing. According to the Centers for Disease Control and 
Prevention, CDC, drug overdose death rates have more than tripled since 
1990, and more than 110 Americans died each day from drug overdoses in 
2011. More than half of these deaths are attributable to opioids, like 
prescription pain relievers or heroin. Indeed, this tragic epidemic has 
hit particularly hard in my home state of Rhode Island, where in 2014, 
239 individuals died from drug overdoses.
  Americans aged 25 to 64 are now more likely to die as a result of 
drug overdose than from injuries sustained in motor vehicle traffic 
crashes. While overdoses from illegal drugs persist as a major public 
health problem, fatal overdoses from prescribed opioid pain medications 
such as oxycodone account for more than 40 percent of all overdose 
deaths.
  It is clear that we must do more to stop these often preventable 
deaths. Fortunately, the drug naloxone, which has no side effects and 
no potential for abuse, is widely recognized as an important tool to 
help prevent drug overdose deaths. Naloxone can rapidly reverse an 
overdose from heroin and opioid medications if provided in a timely 
manner. Overdose prevention programs, including those that utilize 
naloxone, have been credited with saving more than 26,000 lives since 
1996, according to the CDC.
  Opioid abuse and overdose is not an abstract threat found in far-off 
corners. It is a national public health crisis and it's taking place 
right here at home in our communities and our neighborhoods.
  Rhode Island is taking steps to combat this scourge and is leading 
the way in adopting innovative solutions. Through a ``collaborative 
practice agreement,'' some Rhode Island pharmacies are dispensing 
naloxone, along with training about its proper use, to anyone who walks 
in and requests the treatment, no prescription necessary. In addition, 
the Rhode Island State Police carry naloxone in every cruiser.
  The Overdose Prevention Act, which we are introducing today, would 
complement these efforts and take important steps towards addressing 
this

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issue nationally and increasing access to naloxone in our communities. 
The legislation aims to establish a comprehensive response to this 
epidemic that emphasizes collaboration between state and federal 
officials and employs best practices from the medical community, as 
well as programs and treatments that have been proven effective to 
combat this startling national trend. This is an emergency and it 
requires a coordinated and comprehensive response.
  Specifically, the bill would authorize the U.S. Department of Health 
and Human Services, HHS, to award funding through cooperative 
agreements to eligible entities--like public health agencies or 
community-based organizations with expertise in preventing overdose 
deaths. As a condition of participation, an entity would use the grant 
to purchase and distribute naloxone, and carry out overdose prevention 
activities, such as educating and training prescribers, pharmacists, 
and first responders on how to recognize the signs of an overdose, seek 
emergency medical help, and administer naloxone and other first aid.
  As rates of overdose deaths continue to spike, public health 
agencies, law enforcement, and others are struggling to keep up without 
clear and timely information about the epidemic. Therefore, the 
Overdose Prevention Act would also require HHS to take steps to improve 
surveillance and research of drug overdose deaths, so that public 
health agencies, law enforcement, and community organizations have an 
accurate picture of the problem.
  It would also establish a coordinated federal plan of action to 
address this epidemic. The Overdose Prevention Act seeks to bring 
together first responders, medical personnel, addiction treatment 
specialists, social service providers, and families to help save lives 
and get at the root of this problem.
  I am pleased that the Overdose Prevention Act has the support of the 
American Association of Poison Control Centers, the Drug Policy 
Alliance, the Harm Reduction Coalition, and the Trust for America's 
Health. I look forward to working with these and other stakeholders, as 
well as our cosponsors to urge the rest of our colleagues to join us in 
supporting this crucial legislation.

                          ____________________