[Congressional Record Volume 162, Number 177 (Thursday, December 8, 2016)]
[Senate]
[Pages S6913-S6914]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                        21ST CENTURY CURES BILL

  Ms. CANTWELL. Mr. President, I wish to address the 21st Century Cures 
Act legislation, which the Senate passed yesterday with my support. I 
voted for this bill and support many of its provisions. However, I also 
have some serious concerns regarding the manner in which the bill is 
funded.
  I would like to congratulate two of my Senate colleagues for their 
remarkable commitment to this bill: the senior Senator from Tennessee, 
Lamar Alexander, and the senior Senator from Washington, Patty Murray, 
who worked long hours in good faith to forge a bipartisan compromise on 
both sides of the Capitol.
  Washington State is a laboratory for health care innovation. From 
Spokane to Seattle, my State has a culture of collaboration and 
inventiveness in which the entire health care community--including 
researchers, providers, insurers, employers, policymakers, and others--
come together to find better ways of preventing, managing, and treating 
disease. This collaboration makes my State unique and on the cutting 
edge of developing innovative health care delivery.
  That is why Washington is the original home of the Basic Health Plan, 
a State-run option that gives working people without employer-sponsored 
health care the negotiating leverage to get a better deal on health 
insurance.
  It is why the Boeing Company has partnered directly with health care 
providers like the Everett Clinic to reduce sick days and improve the 
health of its workers.
  It is why community leaders in Yakima and Spokane have banded 
together to break ground on new medical schools to fill unmet primary 
care needs in their regions.
  And it is why so many lifesaving medical discoveries and treatments, 
including immuno-oncology, dialysis, and the mapping of the brain have 
their roots in our State. Many of these discoveries started with NIH-
supported basic research at public research universities like the 
University of Washington and Washington State University.
  The 21st Century Cures legislation gives a big boost to Washington's 
health care innovators.
  First, the bill's investment in President Obama's Precision Medicine 
Initiative will help get the right treatment into the hands of 
patients, building on the longtime work of renowned

[[Page S6914]]

researchers like Dr. Leroy Hood and the Institute for Systems Biology. 
Tools like big data and sophisticated blood analysis can predict 
effective therapies based on a patient's unique biology, reducing 
ineffective prescriptions, and lowering health costs over time.
  Second, the bill's funding commitment to Vice President Biden's 
Cancer Moonshot will advance groundbreaking research at organizations 
like the Fred Hutchinson Cancer Research Center. By directing the 
body's own immune system to attack cancer cells, new cancer treatments 
can save lives for patients who may not respond to traditional 
interventions.
  Third, the bill's support for President Obama's Brain Research 
through Advancing Innovative Neurotechnologies, BRAIN, Initiative will 
continue the leadership of organizations like the Allen Institute for 
Brain Science in unlocking the mysteries of the brain. Neuroscience is 
one of the final frontiers of medicine, and future revelations in this 
field hold immense promise to better treat conditions affecting the 
brain, such as Alzheimer's and traumatic brain injury.
  In addition to my strong support for research into future medical 
miracles, many of my constituents need treatment for acute and chronic 
conditions now.
  That is why I am encouraged that the 21st Century Cures legislation 
takes positive steps to combat the dual crises of mental health care 
and opioid addiction.
  The legislation includes a $1 billion funding commitment to combat 
the opioid and heroin epidemic. In recent years Washington has 
experienced a doubling in heroin-related deaths, according to data from 
the Washington State Department of Health. Earlier this year, PBS's 
``Frontline'' profiled the courageous stories of some of my 
constituents who are battling addiction, as well as new public 
responses that municipalities like the city of Seattle are deploying to 
address this public health crisis.
  The reality in too many Washington communities is that needed 
addiction services are simply out of reach for those in the throes of 
acute withdrawal, relapse, or in need of ongoing recovery supports. The 
Cures legislation helps by authorizing much-needed State grants for 
treatment services, prescription drug monitoring, prevention, and 
health professional training programs, which will bolster efforts by 
public health departments like the Spokane Regional Health District to 
meet urgent community needs. This funding is far from sufficient, given 
that 90 percent of people who need addiction treatment in the United 
States do not receive it, according to the Substance Abuse and Mental 
Health Services Administration, SAMHSA. However, given that Senate 
Democrats have been calling for real money for the opioid epidemic 
throughout this Congress, the funding in Cures is indeed welcome.
  The 21st Century Cures legislation also contains positive new 
policies that aim to improve access to mental health care, including 
efforts to better integrate mental health and physical health as well 
as strengthen rules to ensure health insurance companies cover mental 
and physical health equally. Unfortunately, many of these policies are 
not funded and require future appropriations.
  Washington communities continue to confront a severe mental health 
treatment shortage at all levels of the care continuum, including 
community clinics and psychiatric units. A 2015 report by Mental Health 
America, a national advocacy group, ranked Washington State 48th in the 
Nation when it comes to mental health treatment, due to a high 
prevalence of mental illness and poor access to care. In the face of 
overwhelming emergency room admissions and a State legal ruling on 
psychiatric ``boarding,'' community partnerships like the Alliance for 
South Sound Health in Pierce County have stepped up to build more 
treatment capacity. And Governor Jay Inslee and the State of Washington 
have announced ambitious goals to integrate mental health with chemical 
dependency and physical health.
  I will continue to fight for real money for mental health, including 
policies to ease the Medicaid Institutions for Mental Diseases, IMD, 
exclusion, an archaic barrier to needed inpatient care for people in 
crisis, as well as policies to improve mental health delivery.
  I am also pleased that the 21st Century Cures legislation includes a 
provision I sponsored, S. 2261, the Rural ACO Provider Equity Act, to 
drive coordinated health care in medically underserved areas, as well 
as legislation I have cosponsored to preserve access to vital 
outpatient therapeutic services at small rural hospitals. Medical 
facilities in these remote communities--such as Forks, Brewster, and 
Newport--need our support to keep essential health services accessible 
in the face of doctor and clinical staff shortages. I thank the senior 
Senator from South Dakota for his partnership and support on these 
important issues.
  While I supported the Cures legislation, the package incorporates 
troubling budget offsets that are concerning.
  First, the Cures legislation finances itself in part by selling 
millions of barrels of oil from the Strategic Petroleum Reserve.
  The use of this budget offset steadily weakens the energy security of 
the United States and again uses the reserve as a piggy bank to pay for 
nonenergy priorities. In its November 29, 2016, Statement of 
Administration Policy on the Cures legislation, the White House Office 
of Management and Budget concurred, noting this offset ``. . . 
continues a bad precedent of selling off longer term energy security 
assets to satisfy near term budget scoring needs.''
  Second, the Cures legislation pays for its investments in part by 
cutting disease prevention funding. While I appreciate current 
legislative realities, this policy approach is not sustainable 
especially in light of dwindling public health resources throughout my 
State.
  Third, the final version of the Cures legislation omits a widely 
supported and bipartisan child welfare reform bill, the Family First 
Preventive Services Act, which I have been proud to cosponsor with my 
colleague Senator Ron Wyden. Washington State is currently using a 
Federal waiver, which I helped secure, to do a better job of keeping 
families together and reducing unnecessary foster care placements. This 
approach is better for kids and families, and it can save States money. 
The Senate's failure, up to this point, to pass this bill is a lost 
opportunity for children in Washington and throughout the Nation.
  Last, I note that the funding authorized by the Cures legislation 
must be appropriated by future Congresses. I will continue to work with 
my colleagues on the Appropriations Committee to fund these important 
health care priorities.
  I view the funding and policies in the Cures legislation as a step 
forward that continues to support Washington's health care innovation 
and pave the way for future medical breakthroughs. The mental health 
and opioid response provisions in the legislation are welcome in 
addressing these crises, but are far from sufficient. Moving forward, I 
will work to ensure that appropriators make good on the funding 
commitments in Cures, and I will fight to open up greater access to 
health care for Washingtonians.

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