[Congressional Record Volume 162, Number 171 (Wednesday, November 30, 2016)]
[Senate]
[Pages S6606-S6609]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
21ST CENTURY CURES BILL
Mr. ALEXANDER. Mr. President, the second subject I came here to talk
about is the 21st Century Cures Act and the mental health legislation,
both of which are being debated in the U.S. House of Representatives.
There will be a vote on that legislation this afternoon at about 5:30.
This is legislation that has the strong support of the President of
the United States, the active support of the Vice President of the
United States. House Speaker Ryan has said that it is an important part
of his agenda for health care for the future, and the majority leader,
Senator McConnell, has said he believes it is the most important piece
of legislation Congress could enact this year. One reason it has been
successful is that it has been so bipartisan in its making, both in the
House and in the Senate.
Let me begin by thanking President Obama and Vice President Biden for
their strong support and their interest. The President supports
precision medicine--the idea of personalized medicine. For example, if
the Senator from Pennsylvania and I each have the same disease, we
might not take exactly the same medicine because our genetics might be
different. We now know enough about it that if we can help doctors have
that information, they can prescribe medicines that will help us live
longer.
The President and the executive office of the President have issued a
Statement of Administration Policy that is one of the strongest I have
seen. I hope it persuades both Republicans and Democrats to be
supportive of this legislation.
Mr. President, I ask unanimous consent that at the conclusion of my
remarks, the Statement of Administration Policy be printed in the
Record.
Mr. President, I mentioned the bipartisan nature of the legislation,
and I will give two examples of that. My two colleagues, who are on the
floor, will give the second example, which is the mental health bill.
This has been complex, no doubt about it. Yesterday I spoke at length
on the floor about that. I ask that my colleagues recognize the core of
this legislation, which is the following: There were 19 different bills
that went through the Senate's Health, Education, Labor, and Pensions
Committee--22 Members of the Senate. After many hearings, the largest
number of recorded votes against any of those 19 bills was 2. We have a
very diverse committee. We have some of the most liberal Members and
some of the most conservative Members, and we were able to work out 19
bills that are the core of this legislation on a complex issue like
this, and the largest number of votes recorded against any of the 19
bills was 2.
Secondly, every single one of those 19 bills but one had a Democratic
sponsor and a Republican sponsor--usually more than one.
In addition to that, there is money attached to the bill. That is
very unusual because this is an authorization bill, but the House did
it, and we did it as well. We recognized the importance of this to the
American people, and we did it in a fiscally responsible way. It is
$6.3 billion. It doesn't add a penny to the overall budget because for
every increase in the discretionary budget, we reduced the same amount
in the mandatory budget.
What is the funding for? The National Institutes of Health will get
$4.8 billion for research on urgent matters; $1.8 billion for the
Cancer Moonshot that the Vice President is leading; $1.4 billion for
precision medicine; $1.6 billion for the BRAIN Initiative, including
Alzheimer's; and then $1 billion for State grants to help States fight
the opioid abuse epidemic. That money has been accelerated so that all
of this money is spent in the first 2 years and all of the Cancer
Moonshot money is spent in the first 5 years. Speaker Ryan arranged for
this money in the following way: While it has to be approved each year
by the Appropriations Committee, it cannot be spent on anything other
than what it has been designated for. So that $1 billion can be spent
only on opioid abuse.
I cannot imagine that the House of Representatives, if it
overwhelmingly passes the 21st Century Cures bill in a vote, will not
complete its promise to spend $1 billion on opioid abuse this year and
next year. I cannot imagine the U.S. Senate, which I also expect will
approve this by a large vote, doing the same. I also can't imagine
Democrats and Republicans going home and having to explain why they
would vote no on $1 billion worth of State grants for opioid money when
all year we have been talking about what an urgent epidemic it is or
having to explain why they voted no for $1.4 billion for Cancer
Moonshot when so many advances are being made or voting against $1.4
billion for precision medicine when the President so eloquently made
the case of why it is important or $1.6 billion for the BRAIN
Initiative at a time when Dr. Francis Collins, the head of the National
Institutes of Health, tells us that we are close to identifying
Alzheimer's before there are symptoms and we could have the medicine
that will permit us to retard its progression. Think of the grief that
will save millions of families. Think of the billions of dollars that
will save for our country.
This bill has had the participation of dozens of Members of the U.S.
Senate but none more effective and important than the Senator from
Louisiana, Mr. Cassidy, and the Senator from Connecticut, Chris Murphy.
Even though they are both relatively new to the Senate, they have taken
the mental health bill and navigated landmines as
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if they have been here 25 years. They have worked across the aisle with
each other, and they have worked with Democrats and Republicans in the
House of Representatives to produce a bill that passed overwhelmingly
in the House and will be added to the bill today by amendment. It has
also been approved by our Health, Education, Labor, and Pensions
Committee here, and I thought it would be helpful today--and an example
of the bipartisan support for the bill--to ask Senator Cassidy and
Senator Murphy to describe the mental health bill.
Senator McConnell says the 21st Century Cures bill is the most
important piece of legislation that Congress will enact and pass this
year. I believe that the mental health bill, which has three parts that
we will enact this year--a part from our committee and part from
judiciary--is the most significant piece of mental health legislation
in terms of reforms of programs that the Congress will have passed in
more than a decade.
There being no objection, the material was ordered to be printed in
the Record, as follows:
Executive Office of the President, Office of Management
and Budget,
Washington, DC, November 29, 2016.
Statement of Administration Policy
House Amendment to the Senate Amendment to H.R. 34--21st Century Cures
Act
The Administration strongly supports passage of the
bipartisan House Amendment to the Senate Amendment to H.R.
34, the 21st Century Cures Act, which dedicates more than $6
billion to implement key priorities such as the President's
proposal to combat the heroin and prescription opioid
epidemic; the Vice President's Cancer Moonshot; and the
President's signature biomedical research initiatives, the
Precision Medicine and Brain Research through Advancing
Innovative Neurotechnologies (BRAIN) Initiatives. It also
takes important steps to improve mental health, including
provisions that build on the work of the President's Mental
Health and Substance Use Disorder Parity Task Force, and
includes policies to further modernize the drug approval
process.
The legislation includes $1 billion over two years,
including $500 million in Fiscal Year 2017, to combat the
prescription opioid and heroin epidemic, consistent with the
President's budget request. More Americans now die every year
from drug overdoses than they do in motor vehicle crashes,
and the majority involve opioids. The opioid epidemic is
devastating families and communities and straining the
capacity of law enforcement and the healthcare system. The
resources included in the bill will allow states to expand
access to treatment to help individuals seeking help to find
it and to start the road to recovery, with preference given
to states with an incidence or prevalence of opioid use
disorders that is substantially higher relative to other
states.
The Administration is committed to taking immediate action
to lay the groundwork to ensure that the funds in the bill
would be disbursed quickly and effectively so we can begin to
address these important public health challenges.
The bill also includes $1.8 billion, including $1 billion
over the next three years, to support the Vice President's
Cancer Moonshot. The Moonshot aims to accelerate research
efforts and make new therapies available to more patients,
while also improving our ability to prevent cancer and detect
it at an early stage. The resources in this legislation will
support investment in promising new therapies like cancer
immunotherapy, new prevention tools, cancer vaccine
development, novel early detection tools, and pediatric
cancer interventions. As the Vice President and scientific
experts have said, we are at an inflection point in cancer
research and this investment could help seize this
opportunity.
The legislation also dedicates support for other key
research initiatives. In 2013, the President launched the
BRAIN Initiative with the goal of helping researchers find
new ways to treat, cure, and prevent brain disorders, such as
Alzheimer's disease, epilepsy, and traumatic brain injury. In
2015, he launched the Precision Medicine Initiative to
pioneer a new model of patient-powered research that promises
to accelerate biomedical discoveries and provide clinicians
with new tools, knowledge, and therapies to select which
treatments will work best for which patients. The bill
creates dedicated funding of $1.5 billion for the BRAIN
Initiative and $1.4 billion for the Precision Medicine
Initiative to continue these signature Presidential
Initiatives, which have broad bipartisan support, over the
next decade.
The legislation also includes bipartisan mental health
reforms. These include a renewed emphasis on evidence-based
strategies for treating serious mental illness, improved
coordination between primary care and behavioral health
services, reauthorization of important programs focused on
suicide prevention and other prevention services, and mental
health and substance use disorder parity provisions that
build on the work of the President's Mental Health and
Substance Use Disorder Parity Task Force.
In addition, the bill takes multiple steps to further the
progress made in this Administration in improving the drug
development process. It enhances the ongoing efforts to
better incorporate patients' voices into the Food and Drug
Administration's (FDA) decision-making processes; supports
FDA's efforts to modernize clinical trial design; and
improves FDA's ability to hire and retain scientific experts.
The legislation includes strong protections for individuals'
health data, as well as provisions preventing unnecessary
restrictions on the sharing of health information technology
data with patients and providers.
There are also provisions in the bill that raise concerns,
but that have been modified from previous versions to help
address concerns, such as provisions that allow for the
marketing of drugs to payors for off-label uses. In addition,
a number of effective dates will be challenging to meet,
especially without additional administrative funding. The
requirement to sell additional inventory from the Strategic
Petroleum Reserve, when added to the sale requirements of the
Bipartisan Budget Act and the FAST Act, continues a bad
precedent of selling off longer term energy security assets
to satisfy near term budget scoring needs.
That said, this legislation offers advances in health that
far outweigh these concerns. As such, the Administration
strongly supports passage of the House Amendment to the
Senate Amendment to H.R. 34, the 21st Century Cures Act.
The PRESIDING OFFICER. The Senator from Louisiana.
Mr. CASSIDY. Mr. President, I thank Senator Alexander for yielding
and for his leadership, and I thank Senator Murray for her leadership.
I thank Senator Murphy for his cooperation and collaboration in passing
this legislation.
I will speak to mental health as Senator, a doctor, a family member,
and as a friend of those with mental illness. Because of these
different hats, passing comprehensive mental health reform has been a
priority since day one. Senator Chris Murphy and I introduced the
Mental Health Reform Act in 2015, shortly after arriving in the Senate.
Since then, Senators Alexander and ranking member Murray have made
mental health reform a priority, and I thank them once more for their
vital work to include the provisions the four of us introduced in the
Mental Health Reform Act of 2016 in the 21st Century Cures Act.
In some way, everyone is affected by serious mental illness. This is
not a partisan issue. It crosses any division of age, gender,
demographics, and certainly political party. If I go to a townhall
meeting in Louisiana in an area that is not so wealthy and speak of the
need to address mental health, heads nod yes. If I go to another
townhall meeting in another area that is very wealthy and mention the
need to address mental health, all heads nod yes. Everyone nods their
head yes because mental health is an issue in the back of everyone's
mind.
Earlier I mentioned that everyone has a family member or friend who
has a serious mental illness--maybe not, but it might be that person
whom you went to high school with and her life turned out far
differently. Perhaps her marriage broke up, perhaps her children are in
foster care, or perhaps she is homeless. If you think--not even hard--
that person will come to your mind. The largest problem affecting
Americans with serious mental illness is lack of access to care.
Just a few weeks ago, I spoke to a neuropsychologist in Baton Rouge,
Dr. Paul Dammers. He said he sees 15 to 20 patients a day and is booked
up to 6 months in advance. If your loved one is having a mental health
crisis, they should not have to wait 6 months to receive treatment. He
stressed the significance of the barrier to treatment posed by the
shortage of mental health professionals. Thank God for Dr. Dammers and
for all the work he and the other mental health specialists do to help
those with mental illness return to wholeness, but they need help.
Access delayed is access denied, and access is hampered by a shortage
of mental health providers and too few beds for those with serious
mental illness who need to be hospitalized. Too often patients cannot
get the care they need, and too often they have a long delay between
diagnosis and treatment. Without appropriate treatment options,
prisons, jails, and emergency rooms become the de facto mental
facility.
Sheriff Greg Champagne from St. Charles Parish, LA, and past
President of the National Sheriffs' Association quotes a statistic that
sheriffs are the No. 1 providers of mental health services in any
parish or county in the
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country. Incarceration has become our top mental health treatment
strategy. More than three times as many mentally ill are housed at any
one time in prisons and jails than being treated in hospitals.
Now, it is clear it is time to fix our broken mental health care
system. The 21st Century Cures Act provides incentives to build an
adequate and skilled mental health workforce to expand access to mental
health care, providing quick and effective diagnosis and treatment. Our
goal is that the person who has her first psychotic episode when she is
18 will be restored to wholeness so that when she is 50, she looks back
upon that as a distant memory but not as a life-defining event.
This bill also addresses privacy issues that keep some patients from
receiving the best treatment possible. As an effect of the government
regulation HIPAA--an important law protecting patient privacy--
nonetheless, when it comes to a patient with mental illness as an
adult, the doctor feels as if she or he is not allowed to share vital
information for their care with a third party, even if that third party
is their caregiver. A woman I went to high school with has an adult son
with serious mental illness, and she relates that she is the one who
brings him to the hospital and she is the one who gives him his
medicines. Yet, when he is discharged, she is not told what medicines
he takes. She is not told when he takes them, and she is not told when
to bring him for follow up.
Privacy is important, but when government regulation gets in the way
of a doctor and a patient and a family trying to make sure their loved
one is cared for, something needs to change.
This legislation also provides incentives to build an adequate and
skilled mental health workforce but also to train that workforce to
better understand these rules of disclosing patient information. This
allows doctors to better serve their patients and ensure they are
getting the proper care they need. It also--again, as a physician, this
next provision just matters so much to me--promotes access to services
through the integration of primary and behavioral health. Right now, if
someone with a serious mental illness goes to see their psychiatrist
and the psychiatrist notes that their hypertension is out of control
and she wants to send the patient down the hallway to see her
colleague, the family practitioner, the Federal program won't pay for
that. She refers the patient to the emergency room instead. Conversely,
the family practitioner treating the hypertension knows that the
patient is psychotic. They are not allowed to send the patient down to
the psychiatrist on the same day.
Now, in private insurance programs, this is not an issue. It has only
been an issue in Medicaid. This law begins to change that. I will note
that patients with psychiatric illness die 20 years younger than do
patients who have a physical illness but do not have a psychiatric
illness. We must do better by those with serious mental illness.
Another thing this bill does is to establish a grant program focused
on intensive early intervention for children who demonstrate the first
signs that may evolve into serious mental illness later in life. Drs.
Howard Osofsky and Joy Osofsky of the Health Science Center in New
Orleans did research after Hurricane Katrina and found that you can
detect from ages 0 to 3 evidence of a child who may have a problem with
mental illness later in life. This bill provides grants for early
intervention for the infants and children, which will address the
effects of trauma and the adverse experiences that up to 10 to 15
percent of children under the age of 5 have. A second grant program
supports pediatricians consulting with mental health teams. This is
modeled after successful programs in Massachusetts and Connecticut.
This legislation does many important things to change how we treat
mental illness. By expanding access to mental health resources,
clarifying the rules on disclosure of patient information with family
caretakers, and integrating primary and behavioral health, the 21st
Century Cures Act will begin to fix our broken mental health system and
prevent more people affected by mental illness from being denied the
care they need.
Thank you, and I yield the floor.
The PRESIDING OFFICER. The Senator from Connecticut.
Mr. MURPHY. Mr. President, I wish to thank Senator Cassidy and
Senator Alexander for being such amazing partners in bringing this
legislation from its introduction last summer to the floor of the House
and soon to the floor of the Senate. I will say a little bit more about
them and their teams, but it really has been a pleasure. I have learned
a lot, especially from Senator Alexander, about how to overcome some
tough obstacles and pitfalls while bringing something this big and this
meaningful through the process.
I accept the premise that there is something fundamentally broken
about the way things work here in Washington, DC. Cable news fame and
getting ready for the next election all matter way too much here, and
it means that there are a lot of big issues, like immigration reform
and entitlement reform and infrastructure, that don't get done because
politics get in the way. But there are, frankly, a lot more
breakthroughs that happen here than most Americans know about, and a
lot of them happen on the HELP Committee. There are, more often than
one would think, moments where politics get put to the side or
temporarily squeezed out of the way and something really important
happens here. This is one of those moments.
Senator Cassidy really explained the contours of this bill very well.
So I want to provide just a little bit of the context for it. I have
been working on this issue of mental health since I was 25 years old,
in the Connecticut State legislature, and I ran for Congress in part
because I knew that I couldn't fix what was broken in Connecticut's
mental health system without addressing the myriad of Federal funding
sources, laws, and regulations that create today what is kind of
currently a dystopian web of uncoordinated, misaligned behavioral
health care in this country.
The consequences of this failed health care system are all around us,
and they are just increasingly impossible to ignore. Senator Cassidy
spoke about some of them. But it is personal because every single one
of us knows someone in our family or our next door neighbor who
suffered from a serious mental illness and failed to get the care they
need. All of us recognize that this suicide crisis is spiraling out of
control. We have seen a 25-percent increase in suicides in just the
last 15 years. When we visit our hospitals, no matter what State we are
in, we all notice that one of the major building campaigns that is
happening is additions to the emergency departments to take care of
this tsunami of mentally ill patients who are walking into these ERs
because they have absolutely nowhere else to go.
Lastly, for as much back-patting as we have done for ourselves in the
last 50 years because of our decision to close mental institutions all
across the country, we have essentially just recreated these
institutions all over again. They are now called prisons. A recent
article in the Boston Globe by the now famous Spotlight investigative
team found that prisoners in that State essentially had to self-
mutilate themselves in prison in order to get any mental health care.
The Spotlight team concluded that ``there may be no worse place for
mentally ill people to receive care than prisons.'' Yet we have
essentially decided in this country to exchange the old insane asylums
for new ones.
Mainly, though, I stay awake thinking about a meeting that I had
earlier this year with moms--with a bunch of mothers in West Hartford,
CT. These were moms that were at their wit's end. They were fairly
affluent. They were well educated. They had learned the ins and outs of
this broken system. Yet they still had no answers about what to do with
their deeply mentally ill children. Many of them were adults. So,
technically, they were not under the supervision of their parents any
longer. They were petrified--petrified that their kids would end up in
those prisons or, worse, that they would end up dead because there was
no way for them to find proper care for their children's mental
illness. These moms told the story dozens of times, courageously so.
They wept and they trembled with me as they were telling these horror
stories.
Yet, of course, for all of the disaster that exists in our under-
resourced, uncoordinated behavioral health system,
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there is lots of hope. Why? Because recovery is possible. Check that,
actually. It is not possible, it is actually probable, if you can find
the right therapy, the right set of supports, and perhaps the right set
of medications needed.
Over the last 20 years of public service, I have met plenty of people
who have beaten this disease, who have trained their minds to work
differently, and who are leading full and happy lives. The simple
problem is that the resources here are just too far out of reach and
sometimes nonexistent for millions of constituents living with mental
illness.
So that brings us to this moment and how this place actually does
work for good sometimes. Two years ago, I approached Senator Cassidy
right here on this very floor, just days after his swearing in, and I
told him that I had heard that when he was a House Member, he would
come to hearings on mental illness in the House with a dog-eared,
wornout copy of a book called ``Crazy'' by Pete Early. I don't agree
with everything in that book, but it is a story of a father who had the
same story to tell as all of those moms in West Hartford. I asked Bill
if his enthusiasm for this book meant that he was interested in working
on mental health policy, and he said: Absolutely. For the next 6
months, he and I worked together to meet with everybody we could find,
both nationally and in our States, who could tell us what was wrong
with our mental health system, and we decided to do something big.
A lot of us work with Members of the other party on small bills. They
are meaningful pieces of legislation, but they are kind of one-offs.
They fix one problem here or there. We decided to write a big, sweeping
bill--one that would tackle as many problems in the behavioral health
system as we could all at once. We had a head start because of our
friend in the House of Representatives, Representative Tim Murphy, had
already introduced a comprehensive reform bill. So in August of that
year, after hundreds of these meetings and forums, we introduced our
own version of Tim Murphy's bill--the Mental Health Reform Act. Today,
about 16 months after introduction, the House is going to pass this
bill as a major component of the Cures package, as Senator Alexander
said. My hope is that we will have a bipartisan vote here some time
very soon.
Senator Cassidy and I will be the first to admit that it doesn't come
close to solving all the problems that people with mental illness
confront. Most importantly, it doesn't include new Medicaid or Medicare
money to address some of these huge shortages that patients and
families face. But it does require insurance companies to stop
discriminating against people with mental illness by rejecting claims
for mental health at a rate that is much higher than they do for
physical health. This strengthening of our Nation's mental health
parity law is probably the bill's most important provision in my mind.
I am convinced it is going to result in hundreds of millions of dollars
in new care for people with mental illness. I wish to thank Senator
Alexander and Senator Murray for supporting this provision, even though
it was at times controversial.
The bill also elevates the place of mental illness within the
Department of Health and Human Services by creating a new assistant
secretary who is going to oversee all of this funding that often is
done in a really uncoordinated way. It creates new programming to
assist young children who show the first signs of mental illness. We
get at it early. It reauthorizes important suicide prevention programs
that have been shown to work, and it clarifies that parents don't need
to be totally cut out of their adult child's care--that doctors can
share information with parents if it is in the best interests of the
patient to do so.
Frankly, that is just the tip of the iceberg. Senator Cassidy went
much deeper. There are a lot of other provisions in this bill that will
make it less likely that people with mental illness face continued
barriers to care.
Over the past 2 years, this bill has faced a lot of uncertain
moments, and that is where Senators Alexander and Murray come in. They
have really helped us navigate through some tough waters. I give a lot
of credit as well to Senator Cornyn. Senator Franken contributed a big
section of this bill that reforms the way the mentally ill are treated
in the criminal justice system. Senator Cornyn, in particular, helped
us overcome a major hurdle in this bill this fall.
Finally, I just want to thank all of the staff people who have worked
on this. I want to thank Brenda Destro in Senator Cassidy's office. I
want to thank Mary Sumpter Lapinski and Laura Pence in Senator
Alexander's office; Evan Schatz, Nick Bath, and Colin Goldfinch in
Senator Murray's office. First and foremost, I want to thank Joe Dunn
in my office, who in many ways is the parent of this bill from
beginning to end, and all the people in our office who worked
underneath him.
When and if the Senate approves this bill and the President signs it
into law, maybe the most important thing that will happen here is that
we will show that this place can work together to address a big problem
that really has no partisanship to it. Mental illness doesn't care if
you are a Republican or if you are a Democrat. Mental illness doesn't
care if you voted for Hillary Clinton or Donald Trump, and it doesn't
care if you think you are not the kind of person who could suffer from
mental illness. It doesn't discriminate. Yet we do. We continue to push
those with mental illness into the shadows. Our unwillingness to fund
the better coordinated care system that we know we need is a clear
message to these patients that they are something less inside our
health care system.
That begins to change with the passage of this legislation. I think,
accurately described by Senator Alexander, it is probably the most
significant piece of mental health legislation we have passed in over a
decade. I can say that maybe there is nothing I have worked on in my 20
years of elected office of which I am more proud. I commend this bill
to all of my colleagues.
I yield the floor.
The PRESIDING OFFICER. The Senator from Tennessee.
Mr. ALEXANDER. Mr. President, once again, I want to thank Senator
Murphy and Senator Cassidy for their exceptional passion, leadership,
and professionalism on a big issue. We all will have a chance to
support their work when the bill comes over from the House on Monday as
a part of the 21st Century Cures legislation.
I want to reiterate what Senator Murphy said about Mr. Cornyn, the
Senator from Texas. He played a key role in developing parts of the
legislation that came through the Judiciary Committee and he, like
Senator Murphy and Senator Cassidy, had to negotiate a few landmines in
order for the bill to be considered and included as it has been. I want
to pay my respects to Senator Cornyn and thank him for his leadership
on the bill.
I yield the floor.
The PRESIDING OFFICER. The Senator from South Dakota.
____________________