[Congressional Record Volume 162, Number 171 (Wednesday, November 30, 2016)]
[Senate]
[Pages S6591-S6594]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
21ST CENTURY CURES BILL
Ms. WARREN. Mr. President, I am glad to be here with my colleagues
today to have a chance to talk about the 21st Century Cures bill. On
Monday I came to the Senate floor to speak against a deal that was
emerging in the House of Representatives around this bill.
When Congress first started working on this proposal 2 years ago, the
idea was for Democrats and Republicans to work together to improve
medical innovation and access to lifesaving cures. For over 2 years a
lot of people worked really hard on that effort. We had a chance to
bring down the cost of skyrocketing drugs. We had a chance to support
medical research so we could start to cure diseases such as Alzheimer's
and diabetes. We had a chance to help coal miners whose health care is
on the ropes and who are running out of time. Unfortunately, the Cures
bill introduced in the House last week didn't do any of those things.
Instead, it was a typical Washington deal--a deal that ignored what
voters want, and held a bunch of commonsense, bipartisan health
proposals hostage unless Congress also agreed to pass a giant giveaway
to drug companies.
So how did this happen? Lobbyists. Kaiser Health News estimated that
the new Cures bill has generated more lobbying than almost all of the
11,000 bills that have been proposed during this Congress. At one
point, there were about three lobbyists for every single Member of
Congress. Every one of those lobbyists wanted favors. Wow. Did they get
some doozies here: a provision to make it easier for drug companies to
commit off-label marketing fraud--taking pills that are approved for
one use and using them for a whole lot of other purposes--without any
evidence that it is either safe or effective, a provision making it
easier for drug companies to hide gifts they give to doctors who
prescribe certain drugs, a giveaway to a major super PAC donor who
stands to benefit financially through pushing regenerative therapies
through FDA, even if they don't meet the FDA's gold standard for safety
and effectiveness.
This bill is not about doing what the American people want. This bill
is about doing what drug companies and donors want. On Monday, I made
it clear that I oppose this. Since then, two things have happened.
First, since Monday, the public has gotten wind of this deal and they
don't like it. In the last 24 hours, more than 100,000 people
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have signed petitions calling on Congress to just reject the deal.
Second, since Monday, we have seen the bill changed a little.
Last night, after they got some heat, the House took out the
provision letting drug companies hide kickbacks to donors. Good. I
guess they were having a hard time explaining to anybody why it made
any sense to help drug companies cover up bribery. The lobbyists are
disappointed about that, but they are still pushing for the bill
because even though the kickbacks are out, letting drug companies get
away with fraud is still in.
Giveaways are bad in this bill, but that is not the only thing that
is a problem with this bill. What is not in the bill also hurts.
Seventy years ago, Congress promised to provide for the health and
welfare of American coal miners and their families. Now 120,000 coal
miners, their widows, and their families will see massive cuts to their
health benefits and retirement pensions. Why? Because the bipartisan
mine workers protection act was left out of this bill. Without it,
12,500 coal miners will lose their health insurance on December 31 of
this year. Another 10,000 will lose their coverage next year and on and
on into the future.
According to exit polls, 70 percent of voters say they think the
American economy and the lawmakers who oversee it are owned--owned by
big companies and special interests. Bills like the 21st Century Cures
Act are the reason why. There is so much we could do with this bill.
This Congress could step up for thousands of American coal miners.
For their entire lives, these coal miners have sacrificed everything
for their families, for their communities, and for this country. They
have literally sacrificed their health. They are running out of time.
We could help.
This Congress could step up to help millions of people who are
struggling with exploding drug prices. We could help bring down the
cost of drugs. This Congress could step up to help the millions of
families who have been touched by Alzheimer's, diabetes, cancer, and
other deadly disease.
We could help by providing more funding for the research that would
generate real cures. This Congress could step up to deal with drug
companies that think they are above the law, giant corporations that
think they can break the rules and then get Congress to do special
favors for them. We can just say: No, that is not what we are in
business to do. The American people are not clamoring for the Cures
bill, at least not this version.
Tens of thousands of people have asked us not to pass it. Even the
conservative group Heritage Action for America has come out strongly
against this deal. I don't agree with all of their objections, but they
explain, ``In Washington terms, backroom negotiators have turned the
Cures bill into a Christmas tree loaded with handouts for special
interests, all at the expense of the taxpayer.''
Boy, got that one right. This kind of backroom dealing that helps
those with money and connections and leaves scraps for everyone else is
why people hate Washington. It is the reason I will oppose this bill.
The PRESIDING OFFICER (Mr. Sasse). The Senator from Illinois.
Mr. DURBIN. Mr. President, I thank the Senator from Massachusetts for
calling us together on the floor to discuss this important bill, the
21st Century Cures Act. It is a bill I followed closely because I
started off introducing the American Cures Act.
My goal in medical research was inspired by Dr. Francis Collins at
the NIH. He just told me point blank: If you want to increase the
output of medical research, find cures for diseases and help innocent
people, increase the spending at the NIH by 5 percent real growth a
year for 10 years, and I will light up the scoreboard.
That is what I set out to do. That is what the American Cures Act set
out to do, including the Centers for Disease Control and the Department
of Defense medical research. As is usually the case in Congress, it is
no surprise when someone sees an idea and thinks they can do it a
little differently and a little better so, in the House of
Representatives, Congressman Fred Upton and Congresswoman Diana DeGette
introduced the 21st Century Cures Act.
Theirs was a different approach. I guess it reflected a difference in
philosophy. What we see today is what has happened to an originally
good idea as it worked its way through the House of Representatives
over a long period of time. The simple concept of increasing medical
research spending at NIH by 5 percent a year has now become a very
complicated formula.
Frankly, it is one I have very mixed feelings over. I look at it and
think: It would have been so simple for us to make a national
commitment on a bipartisan basis to increase NIH funding by 5 percent a
year and to do it over 10 years. I know we would see the difference.
Just to put things in perspective so we understand them, there are
certain diseases now which are costing us dearly: Alzheimer's. We know
about that, don't we. There is hardly a family in America who does not
have someone in their family or a friend who has been stricken by
Alzheimer's. Think of this for a moment. An American is diagnosed with
the Alzheimer's disease once every 67 seconds--once every 67 seconds.
Twenty percent--twenty percent of all the money we spend on Medicare
in America is spent for Alzheimer's and dementia--one out of five
dollars--but you add to that, one out of three dollars in Medicare is
spent on diabetes, so between diabetes and Alzheimer's, over half of
our Medicare budget is going to those patients.
When we talk about the need to develop new drugs to intervene and,
with God's blessing, to cure some of these diseases, we are talking
about not only alleviating human suffering, we are talking about the
very real cost of government and health care--the very real cost that
we bear as individuals, as families, as businesses, as a government,
and as taxpayers.
In this bill are some positive things, this 21st Century Cures bill.
I do want to highlight them because they are worthy; the fact that we
are now going to commit ourselves to deal with issues such as opioids.
The opioid-heroin epidemic in America is real, and we are not investing
in what we need to treat it and deal with it. We need to have substance
abuse treatment--much, much more than we have today.
One out of six or eight people who are currently addicted are
receiving treatment. We need to do dramatically better. This bill puts
money into that. It also includes language, including some parts I
offered as an amendment, that will deal with mental illness. Mental
illness and substance abuse treatment are basically on the same track
in terms of helping people. This bill addresses that. I am glad it
does. I think that is very positive.
What is disappointing about this bill--there are several things.
First, the money we are spending in this bill largely comes from one
source, prevention--health care prevention funding in the Affordable
Care Act. How important is that? Do you know how that money is being
spent? We have something called the 317 vaccination program. What it
says is, if you come from one of the poorest families in America, we
will pay for our children to be vaccinated so they don't have to worry
about the diseases that can change the life or even take the life of an
infant.
The 317 vaccine program, half of the money comes from the prevention
funds we are raiding for medical research. Does that make sense; that
we are going to take money away from prevention and vaccination to
invest in new drugs to treat diseases? We can prevent these diseases in
the first place with adequate vaccinations.
It is a warped sense of justice in America that we would eliminate
the health care prevention funds to pay for health care research funds.
It is a zero sum as far as I am concerned. It is not just a matter of
vaccinations. When you look at other things: 43 percent of the money
that is spent on diabetes in America--prevention of diabetes in
America--is through the prevention fund in the Affordable Care Act.
That figure tells us that if we can invest on getting people to
change their lifestyles, sometimes very slightly, or to take certain
drugs, they can avoid the onset of diabetes. So we are cutting the
prevention funds for diabetes in order to pay for more research for
cures for diabetes. Does that make sense?
Let me ask you about this: tobacco. A lot of my career in Congress
has been focused on tobacco, the No. 1 avoidable
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cause of death in America today. Tobacco cessation programs pay off
many times over. They are paid for by the prevention funds we are now
raiding for medical research. We are taking away the funds to prevent
tobacco addiction, and we are going to put more investment in trying to
find cures for lung disease. There is something wrong with this
thinking--completely wrong with this thinking.
At the outset, I would say going to the prevention programs to pay
for research programs is not clear thinking on the part of the people
that are putting this together. We are told: Well, you better do it
because the Republicans will take control of the White House and
Congress next year and they are going to wipe out all of the prevention
funds. They want to do away with the Affordable Care Act. We will pay a
heavy price for that. We are starting to make that payment today.
The second thing I want to say is, I am totally underwhelmed by the
amount of money in this bill. When you take a look at the amount of
money that is being spent here, it has dramatically changed as we have
debated this bill. Originally, this was a $9.3 billion program for
medical research, pretty hefty. Over a 5-year-period of time, this
would have had a dramatic impact in a short period of time.
Well, that changed. It is about half of that now. It is spread over
10 years. So the amount of money actually going to the National
Institutes of Health any given year is interesting--$400 million, $500
million--but it does not match what was originally promised in the 21st
Century Cures Act. Of course, the question is, if this money is put in
out of prevention funding, will it be additive? Will it be more?
Let me close by saying this. I know there are many who have strong
feelings about this bill. I think it is a step in the right direction,
but as Senator Warren has told us, it is at a hefty cost when it comes
to some of the favors included in this bill for people who have friends
in high places when it comes to the Congress.
Here is what I can tell you with certainty. We have been able, for 2
successive years in the appropriations process, to do something
important and historic. Let me tip a hat to my colleague from Missouri,
Senator Roy Blunt, a Republican, who took up this cause in the
Appropriations Committee and provided 5-percent real growth in spending
for the National Institutes of Health last year and would do it again
this year if the Republican leadership would allow us to bring his
appropriations bill to the floor.
We know we can make substantial new investments in NIH medical
research. We have a bipartisan will to achieve it. We have the
Appropriations Committee ready to act. Instead, what I am afraid of is
this bill, which is a modest investment in medical research, will be
the end of the conversation for many Members of Congress.
When the time comes months from now, whether this passes or not--it
probably will pass--but when the time comes months from now for us to
debate medical research, many will say: Oh, we already checked that
box. We have already done that with the 21st Century Cures bill.
This bill is a pale imitation of the original bill. It is only a
fraction of the funding which the Appropriations Committee has already
put in to enhance medical research at the NIH. It overpromises and
underdelivers. Some of the aspects of it--the troubling aspects--are
off-label drugs and special favors for the contributors when it comes
to medical treatment are out of place here.
If we did not learn any lesson in this last election about draining
the swamp, well, shame on us because the American people told us do it
differently--do it openly. Bring in transparency and honesty in this
effort. When it comes to medical research, we should expect nothing
less.
I yield the floor.
The PRESIDING OFFICER. The Senator from Oregon.
Mr. MERKLEY. Mr. President, I am delighted to join my colleagues from
Massachusetts and Illinois to express strong objections to the 21st
Century Cures Act, a bill that is being considered in the House today
and will be considered in the Senate.
This bill proceeds to make effective $6.3 billion in cuts to programs
while laying out a vision of what might possibly be spent in the future
to assist in medical research. This is very much an imbalance. Real
cuts--and as I will point out, those cuts hit things that matter with a
promise of some of future possible action. We have seen these promises
made and broken time and time and time again in this Chamber. If you
are going to make a real commitment, then why isn't the real commitment
in this bill?
I ask my colleagues from across the aisle: Why isn't the real
commitment to these programs in this bill? Why isn't the spending in
this bill? Why isn't the spending on precision medicine that is
promised to be considered in the future in this bill? Why isn't the
funding for the Cancer Moonshot promised to be considered at some point
in the future actually in this bill? Why isn't the program to help
address an understanding of and pursue cures for Alzheimer's, which is
actually just a promise to be considered in the future--why isn't that
actually in this bill? Why isn't the work promised to be considered in
the future for adult stem cell research, which could have application
to multiple cures and multiple diseases, actually in this bill?
Well, I will tell you what is in this bill. What is in this bill is a
provision that loosens the rules governing how companies market their
drugs and the anti-fraud laws that go along with them--headache pills
being advertised on television as a cure for the common cold and hair
loss, perhaps. This is just what Big Pharma wants: freedom, freedom to
mislead consumers about what drugs actually have been proven to do.
I will tell you what else is in this bill. It allows people to sell
untested treatments and drugs without final FDA approval that has
demonstrated the treatments are safe. Two big factors deregulating
responsible provisions for Big Pharma are in this bill. But all of
those rainbows, all those stars promised--those are for future
consideration, to dress up special interest provisions for Big Pharma.
I will tell you what else is in this bill. There are special interest
provisions for Big Tobacco, taking away $3.5 billion in prevention
funds from the public health fund, $3.5 billion real dollars in
prevention. The tobacco companies hate prevention programs because they
make their money from addicts. Their goal in life is to get people
addicted. This prevention fund is to prevent people from getting
addicted. As you ponder all the diseases that stem from the use of
tobacco--cancer of the lungs, cancer of the esophagus, heart disease in
one form or another, all kinds of forms of decimation due to the daily
inhaling of these toxins--that is what the tobacco industry thrives on,
and they thrive on it from addiction.
Here we have a fund designed to help people avoid the addiction that
takes away from their quality of life, often for decades of their time
on our beautiful, blue-green planet, and, instead, encourages a process
through which people will not only suffer personally but have massive
medical bills, driving up the cost of health care in America for
everyone, driving up the cost of insurance for everyone in America.
Since its launch in 2012, the Tips campaign has helped more than
400,000 smokers quit for good. According to the Centers for Disease
Control and Prevention, it saved 50,000 lives. At a cost of less than
$400 for each year of life saved, in public health circles it is
considered a best buy, dollars well spent that improve the quality of
thousands of people's lives and reduce costs in the health care system.
That is a win-win.
But what is in this bill? An assault on that win-win to help the
tobacco companies get more addicts.
The chronic diseases and unhealthy behaviors the prevention fund is
intended to address impose tremendous costs. Tobacco use alone costs
about $170 billion a year. Last year in health care expenses, more than
60 percent of it was paid by taxpayers through Medicare and Medicaid,
so we all feel the impact of this.
What else gets cut? Oh, Medicare funding gets cut. If you are for
taking apart the preeminent health care system so that our seniors can
retire without the stress of worrying about access to health care, then
vote for this bill. This is an assault on Medicare--big favors for Big
Pharma, big favors for Big Tobacco, and an assault on Medicare.
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It doesn't trim some Medicare programs that maybe are not as effective
as others and help the others be stronger, more effective. No, it just
takes away from Medicare.
Those are the things that are in this act, but what is not in this
act? The mine workers protection act championed by my colleague from
West Virginia, Senator Manchin. The mine workers protection act isn't
in here, but the provisions expire for thousands of mine workers in the
near future. There are 12,500 coal miners who will lose their health
insurance on December 31. Another 10,000 will lose their health
coverage next year and on into the future if we don't restore this
program. If this bill is about health care, why isn't the coal miners'
provision in here? I think it should be, but it is not.
What else isn't in here? Senator Wyden's provision to help children
who are foster children gain access to programs to help them address
mental health and addiction. That was in here yesterday. That would
have been a positive talking point for this bill yesterday, but it was
stripped out last night. This bill isn't ready, not just for prime
time; it is not ready for consideration at all.
If we are going to cut real programs to fund other real programs such
as the Moonshot and Alzheimer's research, strengthening NIH, then get
it into this bill. Don't just put in the real cuts and then say there
is some promise and an invitation to chase a rainbow down the road. Put
it in the bill.
The things that are in here are powerful, deregulatory giveaways to
Big Pharma and Big Tobacco, making the lives of our citizens worse, not
better. That is why we should kill this bill.
Thank you.
Mr. President, I suggest the absence of a quorum.
The PRESIDING OFFICER. The clerk will call the roll.
The legislative clerk proceeded to call the roll.
Mr. KAINE. Mr. President, I ask unanimous consent that the order for
the quorum call be rescinded.
The PRESIDING OFFICER. Without objection, it is so ordered.
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