[Congressional Record Volume 163, Number 80 (Tuesday, May 9, 2017)]
[Senate]
[Pages S2824-S2827]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]



                               TrumpCare

  Mr. President, now a word on healthcare. The bill the House of 
Representatives passed last week is devastating in so many ways and to 
so many groups of Americans--to older Americans, who would be charged 
five times as much as others; to middle-class Americans, who will be 
paying on average $1,500 a year more for their coverage in the next few 
years; to lower income Americans, who are struggling to make it into 
the middle class and who will be paying thousands of dollars more per 
year; to women, for whom pregnancy could now become a preexisting 
condition--amazing.
  Why are they making these cuts? For all too many on the other side of 
the aisle, it is for one purpose: to give a massive tax break to the 
wealthy--folks making over $250,000 a year. God bless the wealthy. They 
are doing well. They don't need a tax break at the expense of everyone 
else, especially when it comes to something as important as healthcare.

[[Page S2825]]

  Amazingly, this bill is even devastating to our veterans. That is 
what I would like to focus on for the remainder of my time this 
morning.
  You would think that when the House of Representatives was writing 
its bill, the House Members would be more careful to make sure that our 
veterans, who put their lives on the line for our country, wouldn't be 
hurt by their legislation. In their haste to cobble together a bill 
that could pass the House, the Republican majority actually prohibited 
anyone who is eligible for coverage at the VA from being eligible for 
the tax credits in this bill.
  I am sure my Republican friends who rushed to draft this bill thought 
that was a perfectly fine policy. After all, our veterans can get care 
at the VA. In fact, many veterans don't get their care from the 
Department of Veterans Affairs. Yes, they are eligible, but many live 
in rural communities that don't have a VA facility. Many can't go to 
the VA because of means testing. Some get treated at the VA for a 
specific injury related to their service but rely on private insurance 
for the rest of their healthcare. I am sure some veterans would simply 
prefer the choice to have private insurance rather than go through the 
VA.
  Under TrumpCare, any veteran who falls into one of these categories 
would be denied the tax credits they need to get affordable coverage. 
Let me repeat that. As many as 7 million veterans, possibly more, who 
qualify for VA healthcare wouldn't be eligible for the tax credits they 
need to get affordable insurance on the private market.
  For the sake of perspective, under TrumpCare, folks who make over 
$250,000 a year get a massive tax break while taxes and costs would go 
up for so many of our brave veterans.
  I am not sure it is possible for a bill, and for the party that 
passed it, to get its priorities more wrong than that. It is the 
shameful consequence of a slapdash, partisan bill that was thrown 
together at the last minute--a bill whose purpose, it seems, is not to 
provide better coverage or lower costs or even to provide better care 
for our veterans. Its purpose seems to be to provide tax breaks to the 
very wealthy.
  For the President, who lobbied for this bill down to the individual 
Member, it is another giant broken promise to the working people and, 
in this case, to our veterans.
  President Trump made improving the healthcare of our veterans a theme 
of his campaign. Just a few weeks ago, he said that ``the veterans have 
poured out their sweat and blood and tears for this country for so long 
and it's time that they are recognized and it's time that we now take 
care of them and take care of them properly.''
  His healthcare bill, TrumpCare, would deny the means of affording 
private insurance to as many as 7 million veterans and maybe more--
another broken promise, saying one thing and doing another. Many of the 
people who support Donald Trump don't want to embrace that idea, but it 
is happening in issue after issue. They will see it--saying one thing 
and doing another. That is another reason for Senate Republicans to 
scrap this bill, scrap repeal, and start working with Democrats on 
bipartisan ways to improve our healthcare system.
  Today, we Democrats will be sending a letter to the Republican 
leadership laying out our position on healthcare. All 48 Democrats and 
the two Independents who caucus with us have signed it. It has been our 
position all along: We are ready to work in a bipartisan, open, and 
transparent way to improve and reform our healthcare system.
  Look, we have made a lot of progress in the last few years. Kids can 
now stay on their parents' plan until they are 26. Women are no longer 
charged more for the same coverage. There are more Americans insured 
than ever before. These are good things. We ought to keep them and then 
build on our progress.
  To our Republican friends we say this. Drop this idea of repeal. Drop 
this nightmare of a bill, TrumpCare, which raises costs on our 
veterans, and come work with us on ways to reduce the cost of premiums, 
the cost of prescription drugs, and other out-of-pocket costs. We can 
find ways to make our healthcare system better if we work together. 
TrumpCare is not the answer.
  I want to thank my friend from Massachusetts for the courtesy.
  I yield the floor back to the Senator.
  The PRESIDING OFFICER. The Senator from Massachusetts.
  Mr. MARKEY. Mr. President, I thank our leader for his great 
leadership on all of these national security and healthcare issues. I 
think he has injected some common sense into how the American people 
should be viewing each and every one of those very important issues. 
His national leadership is greatly appreciated.
  Let me turn now and yield to the great Senator from the State of New 
Hampshire, where this opioid epidemic has hit hardest of all, Senator 
Hassan.
  The PRESIDING OFFICER. The Senator from New Hampshire.
  Ms. HASSAN. I thank Senator Markey.
  Mr. President, I, too, want to thank Leader Schumer for his remarks 
and his work on national security and on healthcare and, in particular, 
on the opioid, heroin, and fentanyl epidemic, which is the greatest 
public health and safety challenge that the State of New Hampshire 
faces and which I know many other States face as well.
  I rise today to oppose the nomination of Dr. Scott Gottlieb to serve 
as the Commissioner of the Food and Drug Administration. It is the 
responsibility of the Food and Drug Administration, starting with its 
Commissioner, to protect consumers and stand up for public health.
  I have serious concerns about Dr. Gottlieb's record. I also have 
additional concerns from his nomination hearing about his stances on 
critical priorities for people in New Hampshire and across the Nation.
  As I mentioned, and as Senator Markey has detailed, as well, the most 
pressing public health and safety challenge facing New Hampshire is the 
heroin, fentanyl, and opioid crisis. I want to thank the Senator from 
Massachusetts for his leadership and work in helping to identify the 
root causes of this terrible epidemic.
  Yesterday, I was in New Hampshire, and I met with the Drug 
Enforcement Agency leaders and personnel there. I heard updates from 
those on the frontlines about the latest developments in the substance 
misuse crisis. We discussed the spread of the dangerous synthetic drug 
carfentanil, which is 100 times stronger than the already deadly drug 
fentanyl.
  A report released this week by New Futures showed the economic impact 
of alcohol and substance misuse costs. It costs New Hampshire's economy 
now over $2 billion a year. It is clear that we need to take stronger 
action to combat this crisis.
  We have to continue partnering together with those on the frontlines 
and at every level of government. We need to be developing new tools 
and leveraging the ones we have to combat this crisis.
  What we cannot afford to do is to institute policies that would take 
us backward. Unfortunately, Dr. Gottlieb has been opposed to the 
creation of one of the key tools that the FDA has at its disposal--risk 
evaluation and mitigation strategies, otherwise known as REMS. The 
agency uses REMS--including, as a strategy, prescriber training--to try 
to stem the risks associated with certain medications.
  The FDA should be making REMS stronger and making sure that all 
opioid medications have REMS. We don't need a Commissioner who opposed 
the very creation of the REMS program, as Dr. Gottlieb did. In the 
midst of a public health challenge as serious as this epidemic, we 
should be taking--and we have to take--an all-hands-on-deck approach. 
The fact that Dr. Gottlieb was opposed to the very creation of REMS 
raises questions about what strategies the FDA would support under his 
leadership.
  There is another issue involved in this nomination of deep concern to 
the people of New Hampshire. I am concerned about Dr. Gottlieb's record 
of putting politics ahead of science when it comes to women's health. 
To compete economically on a level playing field, women must be able to 
make their own decisions about when and if to start a family. To fully 
participate not only in our economy but also in our democracy, women 
must be recognized for their capacity to make their own healthcare 
decisions, just as men are. They must also have the full independence 
to make their own healthcare decisions, just as men do.

[[Page S2826]]

  Unfortunately, this administration has made clear that it is focused 
on an agenda that restricts women's access to critical health services, 
including family planning.
  Dr. Gottlieb's record has demonstrated that he supports this backward 
agenda. During his time in the Bush administration, Dr. Gottlieb was 
involved in a controversial and unscientifically based delay in 
approving the emergency contraceptive Plan B for over-the-counter use.
  I am concerned that under his leadership, the FDA will play political 
games with women's health once again. I am afraid that he will 
disregard science-based decisions under pressure from this 
administration. Dr. Gottlieb's nomination raises too many questions 
about whether he will put political interests ahead of science and 
ahead of the safety of consumers.
  I hope that he has learned about the priorities of Senators and the 
constituents they represent throughout the nomination process and that 
he proves to be a stronger Commissioner than his record suggests. But 
in voting today, I cannot overlook that record, so I will vote against 
his nomination, and I urge my colleagues to do the same.
  I yield the floor.
  The PRESIDING OFFICER (Mr. Strange). The Senator from Massachusetts.
  Mr. MARKEY. Thank you, Mr. President.
  I thank Senator Hassan for all of her great leadership as Governor of 
New Hampshire and now the Senator from New Hampshire. The epidemic has 
hit New Hampshire very hard, harder than any other place. Her 
leadership is absolutely outstanding. I thank her for all of her 
leadership on this nomination as well.
  As we look at this issue, we realize that a whole epidemic was being 
created, but that epidemic was being created because of approvals of 
``abuse-deterrent'' opioids since 2010. I put ``abuse-deterrent'' in 
quotes because it was extremely deceptive because too many people felt 
``abuse-deterrent'' meant they could not ultimately become addicted to 
the medicine. The damage has now been done. The prescription painkiller 
abuse became rampant across the country. We had become the United 
States of Oxy, and the opioid issue was well on its way to becoming an 
opioid epidemic because when those who were addicted to Oxy could no 
longer afford $60 for a 60-milligram pill, they opted for low-priced 
heroin, which is why we should not be surprised that of those 
individuals who began abusing heroin in the 2000s, 75 percent reported 
that their first opioid was a prescription drug.
  Taking advantage of the new demand for heroin, an incredibly 
sophisticated network of drug traffickers from Mexico set up franchises 
in the United States, and now they are responsible for nearly half of 
this Nation's heroin supply and are branching out from large urban 
areas into our suburbs. These systems collided in a perfect storm that 
has caused the epidemic we are experiencing today: the overprescription 
of opioid painkillers that were approved by the FDA, the over-the-top 
sales and marketing programs by a deceptive and deep-pocketed 
pharmaceutical giant that went unimpeded for years, and an 
overabundance of heroin flowing into the United States from Mexico and 
South America. All of that has led us here.
  We know that nationally opioid overdoses kill more people than gun 
violence or auto accidents. Every single day in America, we lose more 
than 91 people to an opioid-related overdose. Nationally, nearly half 
of all opioid overdose deaths involve a prescription opioid that was 
approved by the FDA and often prescribed by a physician. In 
Massachusetts, in 2016, 2,000 people died from an opioid overdose.
  Who is the typical victim of an opioid overdose? Who is the typical 
substance abuser? The answer is that there is none. This epidemic does 
not discriminate on the basis of age or gender or race or ethnicity or 
economic status. It does not care if you live in a city or in the 
suburbs. It does not care if you have a white-collar or a blue-collar 
job. The 50-year-old White male attorney is just as likely to become 
addicted to prescription drugs or heroin as the 22-year-old Latina 
waitress. Opioid addiction is an equal opportunity destroyer of lives.
  Those addicted to opiates are too often stealing from their friends, 
their families and neighbors, or complete strangers to fuel their 
addiction. Cars are broken into, and valuable stereo systems are left 
intact, while a few dollars in change are stolen. Homes are broken 
into, and flat-screen television sets remain untouched, while 
children's piggy banks go missing.
  The impacts of opioid addiction are also causing immeasurable harm to 
the families of those in the unbreakable grip of opioids. Too often, I 
hear the stories of parents who have drained their entire life savings 
to provide the treatment and recovery programs necessary to beat this 
addiction. Many times, it results in bankruptcy filings that were 
unimaginable only a few short years ago.
  The opioid crisis is robbing people of their friends and their 
families. It is robbing them of their livelihood. It is robbing them of 
their freedom as they look out from behind prison bars. All too often, 
it is robbing them of their lives.
  If we don't act now, we could lose an entire generation of people. As 
this opioid crisis explodes in my State of Massachusetts and in every 
State in the country, we need an FDA leader who will understand that 
universal healthcare does not mean that every American should have 
access to a bottle of prescription opioids.
  Last year, more than 33,000 mothers, fathers, children, and loved 
ones were robbed of their potential when they died of an opioid 
overdose, but Dr. Scott Gottlieb has openly questioned the value of the 
Drug Enforcement Administration's enforcement against doctors and 
pharmacists to prevent prescription opioids from entering the illicit 
market. The DEA is our prescription drug cop on the beat, but Dr. 
Gottlieb wants to give that role to bureaucrats at the Department of 
Health and Human Services, an agency that has consistently failed at 
any kind of enforcement.
  At the same time, Dr. Gottlieb has also publicly stated his 
opposition to the FDA's risk plans, so called REMS--meaning risk 
evaluation and mitigation strategies--for the use of these opioids. 
That is what is used to address the safety of opioid painkillers. These 
vital tools that the FDA has to manage the risk should be made 
stronger, but Dr. Gottlieb argues that they should not exist at all. 
Risk evaluation and mitigation strategies--he says they should not 
exist at all. With the overwhelming majority of heroin users reporting 
that their addiction began with prescription opioids, Dr. Gottlieb 
believes drug safety does not need strong oversight. That is simply 
irresponsible.
  We are suffering this public health epidemic because Big Pharma 
pushed pills they knew were dangerous and addictive. The FDA approved 
them, often without expert counsel, and doctors, because they do not 
have mandatory education on these drugs, prescribed them to innocent 
families all across our country. It is a vicious and deadly cycle that 
has turned this Nation into the United States of Oxy, and it must stop.
  Dr. Gottlieb's Big Pharma formula is simple: Take away the DEA 
oversight over prescription opioids and give that authority to the FDA. 
Then, at the same time, limit the FDA's ability to utilize its full 
oversight authority over these addictive products. That would leave a 
mostly unregulated marketplace for big pharmaceutical companies and 
their opioid painkillers to thrive, while American families pay the 
highest price they can: the life of someone in their family.
  Perhaps most alarming is Dr. Gottlieb's connection to a specific 
pharmaceutical company called Cephalon. Last month, a Washington Post 
story was published that detailed Dr. Gottlieb's work on behalf of one 
company, Cephalon, to raise the amount of the addictive opioid fentanyl 
that the company could market at the same time the prescription 
painkiller epidemic was exploding. The Washington Post story detailed 
how Dr. Gottlieb advocated for the DEA--the Drug Enforcement 
Administration--to raise the quota of fentanyl that Cephalon could 
manufacture and put on the market, even while the company was under 
investigation for pushing doctors to prescribe the addictive painkiller 
for headaches and back pain when it was meant for late-stage cancer 
patients.

[[Page S2827]]

  These aggressive and off-label promotion tactics were out of the 
Perdue Pharma playbook that got us into this opioid crisis in the first 
place.
  Cephalon ultimately pleaded guilty in 2008 to illegally promoting the 
fentanyl drug and paid a $425 million fine. This relationship is deeply 
disturbing.
  Dr. Gottlieb seems to believe that pharmaceutical profits are more 
important than the public's health. When the prescription opioid 
epidemic was taking deadly hold, Dr. Gottlieb advocated to put even 
more addictive fentanyl onto the market when it was not appropriate or 
necessary.
  Dr. Gottlieb said during his confirmation hearing that the FDA 
unwittingly fueled the opioid epidemic, but he is guilty of 
intentionally pushing an addictive prescription opioid onto the 
American public just to benefit one company instead of working to 
prevent this massive public health crisis. Dr. Gottlieb's actions could 
have made the opioid crisis worse.
  Serious questions remain about Dr. Gottlieb's association with 
Cephalon, which was fined hundreds of millions of dollars for violating 
FDA rules.
  After his tenure at the FDA, Scott Gottlieb was then hired by a law 
firm as an expert witness used to defend the actions of Cephalon in 
court.
  In advance of this floor vote, I and a group of other Senators 
questioned Dr. Gottlieb on this work and the extent of his historical 
and financial relationship with Cephalon, but we received nothing that 
shed any light on his relationship with the company.
  We cannot have a leader at the FDA who has worked on behalf of a 
company that aided and abetted the prescription drug and heroin 
epidemic.
  Sadly, Dr. Gottlieb is yet another example of President Trump's lack 
of commitment to address the opioid crisis. President Trump believes 
that if we just build a border wall, well, we will end this opioid 
crisis.
  We don't need a wall, President Trump, we need treatment.
  President Trump's support for the repeal of the Affordable Care Act 
and the legislation the House passed just last week means coverage for 
opioid-use disorders for 2.8 million people could be ripped 
away. President Trump has proposed slashing the research budget of the 
National Institutes of Health by 18 percent, undercutting our ability 
to better understand addiction and come up with alternative, less 
addictive pain medication.

  If President Trump and his Republican allies are committed to 
combating the opioid crisis, they should release their plan for 
addressing this crisis, including committing to quickly release the 
remaining $500 million authorized last year in the 21st Century Cures 
Act, and plan for investing more Federal dollars into understanding, 
preventing, and treating this debilitating disease of addiction. The 
crisis is wearing families down to the bone and we need to give them 
hope. That is what a comprehensive strategy to address this crisis is 
all about, and strong leadership at the FDA is a critical component of 
any plan.
  We need the FDA to be a tough cop on the beat, not a rubberstamp 
approving the latest big pharma painkillers that are the cause of this 
deadly scourge of addiction in overdoses. We need to stop the 
overprescription of pain medication that is leading to heroin addiction 
and fueling this crisis. The United States has less than 5 percent of 
the world population, but we consume 80 percent of the global opioid 
painkillers and 99 percent of the global supply of hydrocodone and the 
active ingredients inside of Vicodin.
  We also need to ensure that prescribers are subject to mandatory 
education responsible for prescribing practices. Anyone who prescribes 
opioid pain medication and other controlled substances must undergo 
mandatory medical education so we are sure these physicians know what 
they are doing. The FDA would be in a position to be the primary 
enforcer of this critical education.
  We also shouldn't allow companies to continue to promote their 
opioids as abuse deterrents. It is misleading. Fifty percent of all 
physicians believe the ``abuse deterrent'' that is on the label means 
the drug is not addictive. Physicians don't even know this is 
addictive, and we know through Purdue Pharma that this is just not the 
case.
  The FDA is in a prime position to ensure the terminology used for 
promoting a drug is not confusing or misleading. At this time of 
crisis, we need a leader at the FDA who recognizes the dangers of 
prescription painkillers, who will stand up to big pharma and reform 
the FDA to prevent addiction before it takes hold. Dr. Scott Gottlieb 
is not that individual.
  Dr. Gottlieb's nomination signals a continuation of FDA policy that 
has cultivated and fueled the opioid epidemic. I strongly oppose Dr. 
Gottlieb's nomination and call on my colleagues to join me in voting 
no.
  Mr. President, I yield back the floor.
  The PRESIDING OFFICER. The Senator from Maryland is recognized.