[Congressional Record Volume 165, Number 20 (Thursday, January 31, 2019)]
[Senate]
[Pages S802-S809]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
STATEMENTS ON INTRODUCED BILLS AND JOINT RESOLUTIONS
By Ms. ERNST (for herself, Mr. Grassley, Mr. Sasse, Mrs. Fischer,
Mr. Tillis, Mr. Thune, Mr. Cotton, Mrs. Hyde-Smith, Mr. Moran,
Mr. Cassidy, Mr. Inhofe, Mrs. Blackburn, Mr. Scott of South
Carolina, Mr. Cruz, Mr. Roberts, Mr. Perdue, and Mr. Cramer):
S. 285. A bill to require U.S. Immigration and Customs Enforcement to
take into custody certain aliens who have been charged in the United
States with a crime that resulted in the death or serious bodily injury
of another person, and for other purposes; to the Committee on the
Judiciary.
Ms. ERNST. Thank you, Mr. President.
Today I rise on the 3-year anniversary of the tragic death of a
constituent of mine, Sarah Root. On January 31, 2016, the same day as
her college graduation, Sarah was killed in nearby Omaha, NE, by an
illegal immigrant named Edwin Mejia. He was drag racing with a blood
alcohol level more than three times the legal limit.
Despite requests by local law enforcement, Immigration and Customs
Enforcement failed to detain Mejia because of a nonsensical policy that
allows ICE to use discretion when determining whether to detain an
illegal immigrant. He posted bond, he was released, and 3 years later
remains a fugitive. It has been 3 years, and he is still a fugitive,
denying Sarah's loved ones any sense of closure or justice.
As a mom, I can't fathom the grief her family and friends continue to
feel after such a devastating loss. My own daughter is approaching the
age at which Sarah was killed.
Just 21 years old, Sarah was bright, she was gifted, she was full of
life and ready to take on the world. What a talented young lady.
She had just graduated from Bellevue University with a 4.0 GPA. She
was dedicated to her community, and she wanted to pursue a career in
criminal justice. Sarah had her whole future ahead of her, but her
opportunity to make her mark on the world was taken away from her. Her
life was tragically cut short. Yet even in death, Sarah touched the
lives of others. Sarah saved six different individuals through her
organ donation.
Sadly, what happened to Sarah Root is not an isolated incident.
We have seen this story play out time and again in the 3 years since
Sarah's killing--innocent lives taken by criminals who entered the
United States illegally through a porous border. Crimes committed by
those here illegally are truly among the most heartbreaking and
senseless, and that is because these crimes are completely preventable,
as the perpetrators should not be in the United States in the first
place.
Although nothing can bring Sarah back to her family, we can ensure
that ICE never makes this same mistake again. That is why I rise today
and, again, join with my colleagues from Iowa and Nebraska, including
the Presiding Officer; thank you again for joining in this legislation.
We are introducing Sarah's Law again in honor of Sarah Root.
Sarah's Law would require that ICE take custody of a person who is in
the country illegally and who is charged with a crime that seriously
injures another person. Sarah's Law would also require better victim
notification and amend the law to require that the Federal Government
take custody of anyone who enters the United States legally but
violated the terms of their immigration status or had their visa
revoked and is later charged with a crime that resulted in the death or
harm of another person.
President Trump implemented parts of Sarah's Law through an Executive
order in 2017, and I commend him for that. It included directing the
Secretary of Homeland Security to prioritize the removal of criminals
who are here illegally. The Executive order also establishes an office
to implement notification requirements of Sarah's Law.
Despite provisions of Sarah's Law being put into place by President
Trump's order, it is critical that the Senate take up this legislation
in order to codify these enforcement priorities so that any future
administration cannot remove these provisions. No family should ever
have to endure such a tragedy, especially one that could have been
prevented. The fact remains that Sarah's killer would not have been in
our country if it weren't for our country's broken immigration system.
Sarah's Law is commonsense reform. It recognizes the simple fact that
all criminals should be held accountable for their actions. How much
more commonsense can this be, folks? Hold criminals accountable. We
should not allow them simply to slip back into the shadows.
I recognize that the immigration debate has become a political
football. We see that every day here in Washington, DC, but the
security of our borders and enforcement of our immigration laws is not
a game. We must honor the lives of these innocent victims and do
better. We must work to stop future crimes.
I look forward to continuing to work with my colleagues to fulfill
the promise I made to Sarah's loving parents, Michelle Root and Scott
Root. I will do everything I can to ensure that not one more parent has
to go through what the Roots have faced--the loss of their daughter and
the promise of justice.
Madam President, I thank you for joining me on this legislation. It
means a lot to this family and many others.
______
By Mrs. FEINSTEIN (for herself, Mr. Leahy, Mrs. Murray, Mr.
Wyden, Ms. Harris, Ms. Rosen, Mrs. Shaheen, Mr. King, Mr.
Carper, Ms. Duckworth, Mr. Sanders, Mr. Bennet, Mr. Coons, Mr.
Blumenthal, Ms. Klobuchar, Mr. Reed, Mr. Kaine, Ms. Hassan, Mr.
Markey, Mr. Murphy, Mr. Menendez, Ms. Cortez Masto, Mr.
Heinrich, Mr. Udall, Mr. Cardin, Mr. Booker, Mr. Whitehouse,
Mr. Merkley, Mr. Van Hollen, Mr. Casey, Ms. Hirono, Mrs.
Gillibrand, Ms. Cantwell, Ms. Warren, Ms. Stabenow, Ms.
Baldwin, Mr. Brown, Ms. Smith, Mr. Warner, Mr. Peters, Mr.
Jones, and Mr. Schatz):
S. 292. A bill to limit the separation of families at or near ports
of entry; to the Committee on the Judiciary.
Mrs. FEINSTEIN. Mr. President, I rise today to reintroduce
legislation that will finally put an end to the separation of families
at our southern border. I have believed from the outset that the
administration was wrong to pursue a zero tolerance policy of family
separation, which is cruel and detrimental to children and parents
alike.
The President claimed to end this policy in June by executive order,
but we have learned that the practice of separating families continues
today. In fact, the separations may have been broader in scope than we
previously knew.
Last year, the American people were rightly horrified when thousands
of children, including babies and toddlers, were taken from their
parents, to be separated for weeks and months. Dozens of these children
spent days and weeks in cages with nothing but thin mats and aluminum
blankets.
In response, people from all walks of life--Republicans, Democrats,
clergy, the medical community, business leaders, labor organizers--
stood up and
[[Page S803]]
said, ``enough is enough.'' Average Americans spoke out, marched, and
called their members of Congress pleading for us to stand up to the
President and demand he reverse his policy.
But we still may not know the full scope of the harm that was caused.
We still do not know just how many families were torn apart as a result
of the zero tolerance policy.
Litigation has identified over 2,700 children who were separated from
their parents by DHS, including nearly 100 children under the age of 5.
However, in January the Inspector General for Health and Human Services
found that ``this number does not represent the full scope of family
separations.'' Indeed thousands--thousands--more children may have been
separated from their parents in 2017, before the start of the
accounting period required by the court.
We have also learned in recent weeks that this crisis is not over.
Families are still being separated from one another.
In June, the Trump administration issued an executive order that
ended the ``zero tolerance'' family separation policy. Despite that
order, the practice of family separation did not end.
Instead, the Inspector General for Health and Human Services reported
that separations are ongoing with little oversight or accountability.
In fact, at least 118 children were separated from their parents
between June 2018, when the executive order was issued, and early
November.
These family separations could not have happened if Republicans had
joined me and all Senate Democrats to pass the Keep Families Together
Act last Congress. The Keep Families Together Act prohibits Border
Patrol from separating children from their parents or legal guardians,
without good cause.
Good cause is defined with a focus on the best interest of the child,
and cannot be based on the parent's migration or crossing of the
border. No separation can be made without consulting a child welfare
specialist, and all presumptions are made in favor of family unity,
including unity of siblings.
The Keep Families Together Act includes vital oversight mechanisms
that will ensure that every child separated under the zero tolerance
policy is accounted for. These include a requirement for DHS to publish
transparent guidance on separations, as well as annual reporting
requirements and a requirement for a GAO report on criminal prosecution
of asylum seekers.
These are basic protections for children that should not be
controversial. Parents who try to protect their children from violence
and poverty abroad, should not be punished by having those children
ripped from their arms. Children should not be subjected to severe
trauma in the interest of deterring migration.
Instead, families should be kept together and given a fair chance to
present their cases for asylum. The Keep Families Together Act will
provide these fundamental necessities and protect children from further
harm. We have a fresh start in a new Congress. It is time to make these
vital protections a reality.
______
By Ms. COLLINS (for herself and Mr. Cardin):
S. 296. A bill to amend XVIII of the Social Security Act to ensure
more timely access to home health services for Medicare beneficiaries
under the Medicare program; to the Committee on Finance.
Ms. COLLINS. Mr. President, I rise to introduce legislation with my
colleague Senator Casey that would reauthorize the only federally
funded programs that are specifically designed to develop a health
provider workforce to care for our older Americans. The Geriatrics
Workforce Improvement Act would reauthorize the Geriatrics Workforce
Enhancement Program and also reinstate the Geriatrics Academic Career
Award Program.
The number of Americans aged 65 and older is growing rapidly. In my
State of Maine, we are reaching an aging milestone faster than are
other States. By 2020, the number of Maine seniors is projected to
exceed the number of Maine children. This is 15 years ahead of the
nationally projected date of 2035, at which point the number of
Americans aged 65 and older will outnumber those under the age of 18
for the first time in our Nation's history.
The United States is facing a critical shortage of geriatric health
professionals and direct service workers to support our aging
population. Today, we need 20,000 geriatricians. However, fewer than
7,300 of our Nation's nearly 1 million physicians are board certified
as geriatricians. By 2030, we will need 30,000 geriatricians and even
more geriatric health professionals and direct service workers. To
achieve this goal, we will need to train 1,600 geriatric specialists
per year over the next 12 years.
For the State of Maine, with an aging population of more than a
quarter million Mainers over the age of 65 and with only 40
geriatricians, there is an acute need to quickly train more geriatric
health professionals and direct service workers to meet the growing
demand. The University of New England, College of Osteopathic Medicine
has joined the University of Maine this year in proposing the ``Aging
Maine Transformation Collaborative.'' I was pleased to lend my support
to this collaboration earlier this year. If funded, AgingME would
become our State's first Geriatric Workforce Enhancement Program and
would bring with it much needed assistance to communities and families
throughout our State.
Nationwide, our bill would reauthorize this workforce enhancement
program at $45 million per year over the next 5 years and would
reinstate the Geriatrics Academic Career Award Program at $6 million
per year. Together, these programs would train the current workforce
and family caregivers while simultaneously developing a cadre of
emerging leaders in geriatric education in a variety of disciplines. By
doing both, we will ensure that older Americans will be cared for, for
decades to come, by a healthcare workforce that will be specifically
trained to meet their unique and complex healthcare challenges. This
training of using the most efficient and effective methods for older
adults will result in improved care while reducing unnecessary costs.
I am pleased to say that our legislation is supported by the leading
organizations in gerontology and geriatrics, including the Eldercare
Workforce Alliance, the American Geriatrics Society, the Alzheimer's
Impact Movement, and the National Association of Geriatric Education
Centers.
I ask unanimous consent that these letters of support be printed in
the Record.
There being no objection, the material was ordered to be printed in
the Record, as follows:
Eldercare Workforce Alliance,
Washington, DC, January 25, 2019.
Hon. Susan Collins,
Chair, Special Committee on Aging,
U.S. Senate, Washington, DC.
Hon. Bob Casey,
Ranking Member, Special Committee on Aging,
U.S. Senate Washington, DC.
Dear Senator Susan Collins and Senator Bob Casey: On behalf
of the Eldercare Workforce Alliance (EWA), we are writing to
express our support of the Geriatrics Workforce Improvement
Act.
EWA is a coalition of 32 national consumer, health care
professional, direct-care worker and family caregiver
organizations. The number of Americans over age 65 is
expected to reach 70 million by 2030, representing a 71%
increase from today's 41 million older adults. Today's health
care workforce is inadequate to meet the needs of older
Americans, many of whom have multiple chronic physical and
mental health conditions and cognitive impairments. Without a
national commitment to expand training and educational
opportunities, the workforce will be even more constrained in
its ability to care for the elderly population as the baby
boom generation ages.
This bipartisan bill supports two critical objectives.
First, it would formally establish funding for the Geriatrics
Workforce Enhancement Program (GWEP). Second, it would
reestablish the Geriatric Academic Career Awards (GACAs), a
previously funded program for developing clinician-educators.
By supporting the GWEP and the GACAs, the Geriatrics
Workforce Improvement Act would:
Foster education and engagement with family caregivers by
training providers who can assess and address their care
needs and preferences.
Promote interdisciplinary team-based care by transforming
clinical training environments to integrate geriatrics and
primary care delivery systems.
Improve the quality of care delivered to older adults by
providing education to families and caregivers on critical
care challenges like Alzheimer's disease and related
dementias.
Reach underserved and rural communities by ensuring
clinician-educators are prepared to train the geriatrics
workforce of today and tomorrow.
[[Page S804]]
This investment protects our most vulnerable elders and
invests in our country's future. We ask that you continue
your support for the programs at this crucial time, and thank
you for your leadership on this issue.
Sincerely,
Nancy Lundebjerg, MPA,
EWA Co-Convener.
Michele J. Saunders, DMD, MS, MPH,
EWA Co-Convener.
____
American Geriatrics Society,
New York, NY, January 25, 2019.
Hon. Susan Collins,
Chair, Special Committee on Aging,
U.S. Senate Washington, DC.
Hon. Bob Casey,
Ranking Member, Special Committee on Aging,
U.S. Senate Washington, DC.
Dear Senator Susan Collins and Senator Bob Casey: The
American Geriatrics Society (AGS), an organization devoted to
improving the health, independence and quality of life of
older adults, supports the Geriatrics Workforce Improvement
Act. The AGS is thankful for your support of the geriatrics
workforce training programs and for your efforts to improve
care of older Americans.
The Geriatrics Workforce Improvement Act would authorize
the Geriatrics Workforce Enhancement Program (GWEP) and the
Geriatrics Academic Career Awards (GACAs) program under Title
VII of the Public Health Service Act. The AGS believes that
both programs must be authorized and funded if all Americans
are to have access to high-quality, person-centered care as
we grow older.
The GWEP is currently the only federal program designed to
increase the number of providers, in a variety of
disciplines, with the skills and training to care for older
adults. The GWEPs educate and engage the broader frontline
workforce including family caregivers and focus on
opportunities to improve the quality of care delivered to
older adults, particularly in underserved and rural areas.
The GACA program is an essential complement to the GWEP
program. GACAs ensure we can equip early career clinician
educators to become leaders in geriatrics education and
research.
The introduction of this important legislation follows
announcements of related funding opportunities from the
Health Resources and Services Administration (HRSA) in
November 2018. Authorization of the GWEPs and GACAs as
outlined in the Geriatrics Workforce Improvement Act will
help ensure that HRSA receives the funding necessary to carry
these critically important workforce training programs
forward.
At a time when our nation is facing a severe shortage of
both geriatrics healthcare providers and faculty with the
expertise to train these providers, the AGS believes the
number of educational and training opportunities in
geriatrics and gerontology should be expanded, not reduced.
Thank you for your leadership on this issue.
Sincerely,
Laurie Jacobs, MD, AGSF,
President.
Nancy E. Lundebjerg, MPA,
Chief Executive Officer.
____
Alzheimer's Impact Movement,
Washington, DC, January 31, 2019.
Hon. Susan Collins,
Chairman, Senate Committee on Aging,
Washington, DC.
Hon. Bob Casey,
Ranking Member, Senate Committee on Aging,
Washington, DC.
Dear Chairwoman Collins and Ranking Member Casey: On behalf
of the Alzheimer's Association and the Alzheimer's Impact
Movement (AIM), including our nationwide networks of
advocates, thank you for your continued leadership on issues
and legislation important to Americans living with
Alzheimer's and other dementias, and to their caregivers. The
Alzheimer's Association and AIM are pleased to support the
Geriatrics Workforce Improvement Act.
More than 5 million Americans are living with Alzheimer's
and, without significant action, nearly 14 million Americans
will have Alzheimer's by 2050. Today, another person develops
the disease every 65 seconds; by 2050, someone in the United
States will develop the disease every 33 seconds. This
explosive growth will cause Alzheimer's costs to increase
from an estimated $277 billion in 2018 to $1.1 trillion in
2050 (in 2018 dollars). These mounting costs threaten to
bankrupt families, businesses and our health care system.
Unfortunately, our work is only growing more urgent.
The Geriatrics Workforce Improvement Act would develop a
workforce capable of providing complex, high-quality care
that improves health outcomes and reduces costs for a diverse
and growing aging population. It would reauthorize the
Geriatrics Workforce Enhancement Program (GWEP), and
reinstate the Geriatrics Academic Career Awards (GACAs)
Program, a previously funded program for developing
clinician-educators, two critical objectives to ensure
communities across the nation have access to health
professionals and other critical supports, improving care for
all of us as we age. By supporting the GWEP and GACAs the
Geriatrics Workforce Improvement Act would, foster education
and engagement with family caregivers by training providers
who can assess and address care needs and preferences, reach
underserved and rural communities by ensuring clinician-
educators are prepared to train the geriatrics workforce of
today and tomorrow, and improve the quality of care delivered
to older adults by providing education to families and
caregivers on critical care challenges.
The Alzheimer's Association and AIM deeply appreciate your
continued leadership on behalf of all Americans living with
Alzheimer's and other dementias. We look forward to
continuing to work with you and your colleagues to improve
care and support for individuals and families affected by
Alzheimer's disease and other dementias. If you have any
questions about this or any other legislation, please contact
Rachel Conant, Senior Director of Federal Affairs.
Sincerely,
Robert Egge,
Chief Public Policy Officer, Executive Vice President,
Government Affairs, Alzheimer's Association.
____
National Association of
Geriatric Education Centers,
January 25, 2019.
Hon. Susan Collins,
Chair, Special Committee on Aging,
U.S. Senate, Washington, DC.
Hon. Bob Casey,
Ranking Member, Special Committee on Aging,
U.S. Senate, Washington, DC.
Dear Chairman Collins and Ranking Member Casey: On behalf
of the HRSA Title VII and Title VIII funded Geriatrics
Workforce Enhancement Programs (GWEPs) across the country,
thank you for your past support of geriatric education and
for introducing the Geriatrics Workforce Improvement Act. The
National Association for Geriatric Education (NAGE) is
pleased to offer our support for the Geriatrics Workforce
Improvement Act, which will reauthorize the GWEP and once
again make the Geriatrics Academic Career Award program
(GACA) a part of the effort to prepare the geriatrics
workforce for the aging of our population. We and the growing
numbers of older adults, caregivers, and clinicians caring
for elders will urge Congress to move quickly to pass your
bill and provide the resources to address our nation's
growing demand for geriatric care.
We appreciate the many discussions that your staff
facilitated with NAGE, as well as with the Eldercare
Workforce Alliance, the American Geriatrics Society, and The
Gerontological Society of America during the process of
developing this legislation. This authorization and related
funding are needed for the development of a health care
workforce specifically trained to care for older adults and
to support their family caregivers. Currently there are only
44 GWEP sites in 29 states. The modest increase in the
authorization in your bill will have an important impact on
training in geriatric care. Likewise, the funds you have
authorized for the GACA program complement the GWEP, and
support faculty that will teach and lead geriatrics programs.
The bill will also assist in ensuring that rural and
underserved areas will have geriatrics education programs.
NAGE is a non-profit membership organization representing
GWEP sites, Centers on Aging, and Geriatric Education Centers
that provide education and training to health professionals
in the areas of geriatrics and gerontology. Our mission is to
help America's healthcare workforce be better prepared to
render age-appropriate care to today's older Americans and
those of tomorrow.
Thank you for your continued support for geriatric
education programs.
Sincerely,
Catherine Carrico, PhD,
President NAGE/NAGEC, Associate Director, Wyoming Geriatric
Workforce Enhancement Program, Wyoming Center on Aging,
Clinical Assistant Professor, College of Health Sciences,
University of Wyoming.
____
Ms. COLLINS. Mr. President, I urge all of my colleagues to support
this bipartisan bill that would ensure geriatric education for our
current workforce while it would optimize resources to bolster academic
careers in geriatrics and help to attract the best and the brightest
into this field. Together, these programs would develop exactly the
kind of highly qualified workforce that we need to care for Americans
as our Nation grows older.
I thank the Presiding Officer.
______
By Ms. COLLINS (for herself, Mr. Tester, Mrs. Capito, Mr. Jones,
Mr. Boozman, Mr. Manchin, and Ms. Harris):
S. 304. A bill to reauthorize section 340H of the Public Health
Service Act
[[Page S805]]
to continue to encourage the expansion, maintenance, and the
establishment of approved graduate medical residency programs at
qualified teaching health centers, and for other purposes; to the
Committee on Health, Education, Labor, and Pensions.
Mr. President, I rise today to introduce legislation with my
colleague from Montana, Senator Tester, to fund Teaching Health
Centers, a time-tested model for success to train the next generation
of primary care doctors in communities where they are needed the most.
I am pleased that Senators Capito, Jones, Boozman, Manchin, and Harris
have joined us as cosponsors.
Over the next decade, the severe shortage of primary care doctors
could reach crisis levels in a growing number of rural and underserved
communities in Maine and across our Nation. Alarmingly, these
communities are often those hardest hit by the opioid epidemic. By
2030, we will need an estimated 120,000 physicians to meet the growing
demand for health care services across the Country. In clinics and
health centers in Northern Maine, I frequently hear stories about
vacancies forcing Mainers to travel many miles simply to see a primary
care doctor or dentist.
For the past eight years, one program, the Teaching Health Centers
Graduate Medical Education Program, has worked to fill these gaps. This
program trains medical residents in community-based settings, including
low-income, underserved rural and urban neighborhoods. For example,
since its inception in 2011, the Penobscot Community Health Care Center
has trained 34 residents and served more than 15,000 dental patients in
Bangor, Maine.
Nationwide, this program has produced real results. Since the program
began, 632 new primary care physicians and dentists have graduated and
entered the workforce, and the number of Americans served is in the
millions. Those who train at teaching health centers are very likely to
practice primary care and remain in underserved or rural communities.
Last Congress, this Committee considered and successfully passed my
legislation to fund teaching health centers for two years. As a result,
for the 2017-2018 academic year, this program supported the training of
732 residents in 57 primary care residency programs, across 24 states.
The legislation I have introduced today would reauthorize the
Teaching Health Centers Graduate Medical Education Program for five
years and provide additional funding for expansion and the creation of
new programs. This bill is widely supported by leading community health
and physician organizations, including the American Association of
Teaching Health Centers, National Association of Community Health
Centers, American Academy of Family Physicians, American Association of
Colleges of Osteopathic Medicine, and Council of Academic Family
Medicine.
In the face of nationwide physician shortages, our legislation would
provide a solution for communities today and a path forward to train
the physicians of tomorrow. I urge all of my colleagues to join in
support of this important legislation, the Training the Next Generation
of Primary Care Doctors Act of 2019.
Mr. President, I ask to include these letters into the Record.
Mr. PRESIDENT: With no objection so ordered.
Council of
Academic Family Medicine,
January 28, 2019.
Hon. Susan Collins,
U.S. Senate, Washington, DC.
Hon. Shelley Capito,
U.S. Senate, Washington, DC.
Hon. Doug Jones,
U.S. Senate, Washington, DC.
Hon. Jon Tester,
U.S. Senate, Washington, DC.
Dear Senators Collins, Jones, Capito, and Tester: On behalf
of the Council of Academic Family Medicine (CAFM), including
the Society of Teachers of Family Medicine, Association of
Departments of Family Medicine, Association of Family
Medicine Residency Directors, the North American Primary Care
Research Group, we thank you for introducing the Training the
Next Generation of Primary Care Doctors Act of 2019. This
legislation is an important step to providing sustainable
funding and growth for a critical program that helps address
the primary care physician shortage in our country. We
appreciate your leadership on this issue and give you our
whole-hearted support for the legislation.
To help sustain this important graduate medical education
program your legislation provides suitable funding for
current Teaching Health Center Graduate Medical Education
(THCGME) programs to help address the crisis-level shortage
of primary care physicians. The funding level included in the
bill will allow for a per resident amount to be paid for
training that is on par with the Health Resources and
Services Administration (HRSA) funded study identifying a
median cost of approximately $157,600 per trainee. It allows
for programs to regain previous losses of residency positions
due to lower funding levels and instability. We are
particularly pleased that the legislation would provide a
five year reauthorization, giving the program some much
needed financial stability.
In addition, we are gratified that the proposed legislation
supports and funds the creation of new programs and/or
centers, with a priority for those serving rural and
medically underserved populations and areas. Evidence shows
that the THC program graduates are more likely to practice in
rural and medically underserved communities. Recognizing the
importance of growing this successful program to help address
geographic maldistributions of physicians across the country
is significant.
The current authorization for this vital program expires at
the end of this fiscal year. Without legislative action, the
expiration of this program would mean an exacerbation of the
primary care physician shortage, and a lessening of support
for training in underserved and rural areas. Your efforts in
support for this program since its inception have been key to
keeping it alive. We are grateful to all of you for your
exceptional leadership in supporting and sustaining this
vital program by introducing this bill and helping to
shepherd it toward enactment.
The CAFM organizations and our members are pleased to work
with you to secure this legislation's enactment.
Sincerely,
Beat Steiner, MD,
President, Society of Teachers of Family Medicine.
Fred Miser, MD,
President, Association of Family Medicine, Residency
Directors.
Judith Belle Brown, PhD,
President, North American Primary Care Research Group.
____
Joint Statement for the Record
Hearing of the Health, Education, Labor, and Pension Committee on
Access to Care: Health Centers and Providers in Underserved
Communities, January 29, 2018
On behalf of the more than 145,000 osteopathic physicians
and medical students we represent, we applaud the committee's
leadership and bipartisan effort to address the shortage in
our health care workforce. We are thankful for the Chairman
and Ranking Member for introducing legislation that would
reauthorize the Teaching Health Centers Graduate Medical
Education Program (THCGME) In anticipation of the upcoming
hearing, Access to Care: Health Centers and Providers in
Underserved Communities, we would like to highlight the need,
and encourage the committee, to support funding for growth in
the reauthorization of the THCGME program to help address the
shortage in our health care workforce.
The majority of THCGME programs are currently accredited by
the AOA or are dually accredited (DO/MD) programs, supporting
nearly 800 osteopathic resident physicians through their
training since the program's inception. Located in 27 states
and the District of Columbia, THCGME programs train residents
in much-needed primary care fields that have the largest
shortages nationally, including family medicine, internal
medicine, pediatrics, obstetrics and gynecology, psychiatry,
geriatrics, and dentistry. It is a vital source of training
for primary care residents to help expand access to care in
rural and underserved communities throughout the country.
Osteopathic physicians (DOs) are fully-licensed to practice
in all specialty areas of medicine, with nearly 57% of active
DOs in primary care. Our training emphasizes a whole-person
approach to treatment and care, where we partner with our
patients to help them get healthy and stay well. Osteopathic
medical education also has a long history of establishing
educational programs for medical students and residents that
target the health care needs of rural and underserved
populations. Given this strong presence in primary care,
osteopathic medicine aligns naturally with the mission and
goals of the THCGME program that has proven successful in
helping address the existing gaps in our nation's primary
care workforce.
Residents who train in THC programs are far more likely to
specialize in primary care and remain in the communities in
which they have trained. Data shows that, when compared to
traditional postgraduate trainees, residents who train at
THCs are more likely to practice primary care (82% vs. 23%)
and remain in underserved (55% vs. 26%) or rural (20% vs. 5%)
communities. It is clear that a well-designed THCGME program
not only plays a vital role in training our next generation
of primary care physicians, but helps to bridge our nation's
physician shortfall. The program also tackles the issue of
[[Page S806]]
physician maldistribution, and helps address the need to
attract and retain physicians in rural areas and medically
underserved communities. In the 2016-2017 academic year,
nearly all residents received training in primary care
settings and 83% of residents trained in Medically
Underserved Communities.
However, reauthorizing the THCGME program at its current
level funding, for the next five years, would lead to a
reduction of approximately 70 residency slots from the
currently funded 737 residency positions.
We respectfully ask the committee to consider legislation
by Senators Susan Collins (R-ME), Doug Jones (D-AL), Shelley
Moore Capito (R-WV), and John Tester (D-MT) the ``Training
the Next Generation of Primary Care Doctors Act of 2019.'' In
addition to reauthorizing the THCGME program for the next
five years, this bill also provides funding and a pathway for
growth in the number of residents trained in underserved
rural and urban communities. This represents a much needed
expansion to address the physician shortages in our country.
We would also like to briefly highlight the broader role
osteopathic physicians have in reducing our nation's
physician shortage. Since 2010, the number of DOs has
increased by 54%. Today, more than 65% of all DOs are under
the age of 45, and if current enrollment trends continue, DOs
are projected to represent more than 20% of practicing
physicians by 2030. Because of the whole-person approach to
patient care that is inherent in osteopathic medicine, the
increasing share of DOs in the physician workforce, and the
number of DOs in primary care specialties, we have a unique
and important perspective on the needs of our nation's health
care workforce and would welcome the opportunity to
contribute to your work on this issue.
We appreciate your bipartisan effort to address the
shortage in our country's health care workforce, and we stand
ready to assist in your effort.
Sincerely,
American College of Osteopathic Family Physicians.
American College of Osteopathic Internists.
American College of Osteopathic Obstetricians and
Gynecologists.
American College of Osteopathic Neurologists and
Psychiatrists.
American College of Osteopathic Pediatricians.
American Osteopathic Association.
____
American Academy of
Family Physicians,
January 28, 2019.
Hon. Susan Collins,
U.S. Senate,
Washington, DC.
Hon. Shelley Moore Capito,
U.S. Senate,
Washington, DC.
Hon. Doug Jones,
U.S. Senate,
Washington, DC.
Hon. Jon Tester,
U.S. Senate,
Washington, DC.
Dear Senators Collins, Jones, Capito, and Tester: On behalf
of the American Academy of Family Physicians (AAFP), which
represents 131,400 family physicians and medical students
across the country, I write to support your legislation to
reauthorize the Teaching Health Center Graduate Medical
Education (THCGME) program Thank you for your commitment to
this important, innovative program.
The AAFP is pleased to support the Training the Next
Generation of Primary Care Doctors Act because it updates the
THCGME program for five years, authorizes adequate and
sustainable funding for existing residency programs, and
supports expansion into rural and underserved communities In
addition, the legislation maintains the program's strong
transparency and accountability requirements. The THCGME
program directly addresses three major physician workforce
challenges: the serious shortage of primary care physicians,
geographic maldistribution of physician training, and the
need to increase health care access for medically-underserved
populations. Recognizing the importance of supplying well-
trained primary care physicians into communities that need
them most, we look forward to working with you to update and
expand the THCGME program early this year.
Again, we are pleased to support this important
legislation. For more information, please contact Sonya Clay,
Government Relations Representative.
Sincerely,
Michael L. Munger, MD,
FAAFP Board Chair.
____
American Academy of Family Physicians, American
Association of Colleges of Osteopathic Medicine,
American Association of Teaching Health Centers, The
American College of Obstetricians of Gynecologists,
American Osteopathic Association, Council of Academic
Family Medicine, National Association of Community
Health Centers.
[January 29, 2019]
Physicians, Medical Educators, Community Health Centers Strongly
Support Training the Next Generation of Primary Care Doctors Act of
2019
Our organizations applaud the introduction of the Training
the Next Generation of Primary Care Doctors Act of 2019 and
urge the Senate to quickly pass this important legislation.
We thank Senators Susan Collins (R-ME), Doug Jones (D-AL),
Shelley Moore Capito (R-WV), Jon Tester (D-MT), and John
Boozman (R-AR) for their commitment to ensuring that our
nation has a strong and robust primary care workforce.
Furthermore, we thank Senate HELP Committee Chairman Lamar
Alexander (R-TN) and Ranking Member Patty Murray (D-WA) for
their leadership in introducing the Community and Public
Health Programs Extension Act, which will extend for five
years federal funding for the Teaching Health Center Graduate
Medical Education (THCGME) Program, community health centers,
the National Health Service Corps, and two other federal
health programs. These programs are set to expire at the end
of the fiscal year.
The THCGME Program, established in 2010 and reauthorized in
2015 and 2018 has been, by any measure, an overwhelming
success. In the 2017-2018 academic year, the program
supported the training of 732 residents in 57 primary care
residency programs, across 24 states. Since 2011, the program
has supported the training of over 630 new primary care
physicians and dentists that have graduated and entered the
workforce. Importantly, physicians trained in teaching health
center programs are more likely to practice in underserved
communities, increasing access to care for the country's most
vulnerable patient populations.
The value of primary care is well documented. In fact,
individuals who have a continuous relationship with a primary
care physician are more likely to be healthier and use fewer
health care resources. Research shows that our nation faces a
primary care physician workforce shortage. The THCGME Program
has proven its ability to efficiently increase the number of
primary care physicians trained.
This highly successful and impactful program is set to
expire on September 30, 2019 unless Congress takes action to
reauthorize and fund it. The legislation introduced today not
only reauthorizes the program, but also provides enhanced
funding and a pathway for increasing the number of residents
trained. Most important, the legislation will continue to
build the primary care physician pipeline necessary to reduce
costs, improve patient care, and support underserved rural
and urban communities.
We are extremely pleased that members of both parties are
working together to extend this vital program that brings
health care to medically underserved communities across the
nation. Our organizations strongly support Training the Next
Generation of Primary Care Doctors Act of 2019 and call on
the House of Representatives and Senate to ensure that the
THCGME Program is reauthorized and appropriately financed by
September 30.
____
American Association of
Colleges of Osteopathic Medicine,
January 28, 2019.
Hon. Susan Collins,
U.S. Senate,
Washington, DC.
Hon. Shelley Moore Capito,
U.S. Senate,
Washington, DC.
Hon. John Boozman,
U.S. Senate,
Washington,DC.
Hon. Doug Jones,
U.S. Senate,
Washington, DC.
Hon. Jon Tester,
U.S. Senate,
Washington, DC.
Dear Senators Collins, Jones, Capito, Tester, and Boozman:
On behalf of the American Association of Colleges of
Osteopathic Medicine (AACOM), thank you for your unceasing
bipartisan commitment and leadership in championing the
Health Resources and Services Administration's Teaching
Health Center Graduate Medical Education (THCGME) Program by
introducing the Training the Next Generation of Primary Care
Doctors Act of 2019. We offer our strong support of this
legislation.
AACOM represents the 35 accredited colleges of osteopathic
medicine in the United States. These colleges are accredited
to deliver instruction at 55 teaching locations in 32 states.
In the current academic year, these colleges are educating
more than 30,000 future physicians--25 percent of all U.S.
medical students. Six of the colleges are public and 29 are
private institutions. AACOM was founded in 1898 to support
and assist the nation's osteopathic medical schools, and to
serve as a unifying voice for osteopathic medical education.
The association leads and advocates for the osteopathic
medical education community to improve the health of the
public.
With your introduction of the Training the Next Generation
of Primary Care Doctors Act of 2019, the osteopathic medical
education community commends your bipartisan efforts to
support this critical program that produces primary care
physicians in medically underserved communities across our
country by reauthorizing it for five years
[[Page S807]]
and providing enhanced funding and a pathway for growth in
the number of residents trained.
Established in 2010 and reauthorized in 2015 and 2018, the
THCGME Program has been a notable success. In the 2017-2018
academic year, the program supported the training of 732
residents in 57 primary care residency programs, across 24
states. Since 2011, the program has supported the training of
over 630 new primary care physicians and dentists that have
graduated and entered the workforce. Importantly, physicians
trained in THC programs are more likely to practice in
underserved communities, increasing access to care for the
country's most vulnerable patient populations.
As you know, the continuation of this program is vital to
addressing primary care physician workforce shortages and
delivering health care services to vulnerable patients in
need. It has encouraged greater connections and services
between traditionally underserved areas and the emerging
physician workforce by creating opportunities for medical
students to carry out their required training where their
services are most needed. The THCGME Program has been highly
effective in transitioning residents into medically
underserved areas, with more than 80 percent remaining in
primary care practice and over half remaining in high-need
communities.
On behalf of the nation's osteopathic medical schools and
the students they train, thank you for your steadfast
leadership, and I look forward to continuing our work
together to support a health care system that will enable
osteopathic medical students and future physicians to provide
primary health care to the patients they serve. We look
forward to working together on this important legislation.
Respectfully,
Stephen C. Shannon, DO, MPH,
President and CEO.
______
By Mrs. FEINSTEIN (for herself and Ms. Harris):
S. 308. A bill to direct the Secretary of the Interior to convey
certain Federal lands in San Bernardino County, California, to the San
Bernardino Valley Water Conservation District, and to accept in return
certain non-Federal lands, and for other purposes; to the Committee on
Energy and Natural Resources.
Mrs. FEINSTEIN. Mr. President, I am pleased to reintroduce the
``Santa Ana River Wash Plan Land Exchange Act.'' This legislation would
help implement a consensus-driven regional land management plan by
directing the Bureau of Land Management to exchange land with the San
Bernardino Valley Water Conservation District in San Bernardino,
California.
Before I continue, I would like to thank Senators Lisa Murkowski and
Maria Cantwell, as well as their staffs, for their hard work to move
this bill forward last Congress. With their assistance, this
legislation passed out of the Senate Energy and Natural Resources
Committee in August 2018 and was included in a bipartisan public lands
package.
I thank Senator Murkowski for introducing a bipartisan lands package
bill this Congress and including this legislation in it. I look forward
to working once again with Senator Murkowski, as well as the newly
designated Ranking Member, Senator Manchin, to maintain our momentum
and pass this bill as quickly as possible.
I also would like to express my gratitude to Representative Paul Cook
and his staff for their continuing work and collaboration on this
legislation. Lastly, I welcome working with Representative Cook and
Representative Aguilar who are cosponsoring companion legislation in
the House of Representatives. Lastly, I thank Senator Harris for
cosponsoring this legislation.
This bill is an excellent example of how smart, sustainable, land
planning can be accomplished through interagency cooperation. Federal
and State agencies, private industry, and municipalities representing
mining, flood control, water supply, wildlife conservation, and other
interests all came to the table to develop a land management plan that
accounts for the array of land uses in this area.
The land exchange facilitated by this bill is broadly supported,
including by: County of San Bernardino, City of Redlands, City of
Highland, San Bernardino Water Conservation District, San Bernardino
Valley Municipal Water District, East Valley Water District, Endangered
Habitats League, CEMEX Construction Materials Pacific, Robertson's
Ready Mix, Inland Action.
This diverse group of entities formed the ``Wash Committee'' in 1993
to address mining and land management in the upper Santa Ana River wash
area.
I applaud the Committee, along with federal, state and local
stakeholders, for working together to develop a strategy for
comprehensive land management planning for the area. This group has
shown that through cooperation, it is possible to both protect the
environment and support local business and community interests.
The land exchange between the San Bernardino Water Conservation
District and the Bureau of Land Management will consolidate open space
for conservation purposes and optimize the efficiency of mining
operations and water conservation efforts.
The exchange will also set aside new land for conservation purposes
near land already managed by BLM.
This bill will lead to increased habitat protection, groundwater
recharge, and public access while allowing for the continued use of
land and mineral resources.
I look forward to working with my colleagues to pass the ``Santa Ana
River Wash Plan Land Exchange Act'' as soon as possible.
Thank you Mr. President, I yield the floor.
______
By Mr. SANDERS:
S. 309. A bill to amend the Internal Revenue Code of 1986 to
reinstate estate and generation-skipping taxes, and for other purposes;
to the Committee on Finance.
Mr. SANDERS. Mr. President, all across our country--in Vermont, in
Illinois, in California--all across this country, people are asking a
very simple question. That question is, How does it happen that in the
midst of the extraordinary wealth that exists in our country--how does
it happen that so many people continue to hurt financially and struggle
desperately to keep their heads above water economically?
Today, despite unemployment being relatively low, some 40 million
Americans continue to live in poverty. We don't talk about poverty very
much here in the Senate, but we have 40 million Americans living in
poverty. Many of them are struggling to adequately feed their kids.
Many of them are forced to go, despite working, to emergency food
shelters just to stay alive.
Despite the United States having a GDP--gross domestic product--of
more than $20 trillion, we in this country embarrassingly continue to
have the highest rate of childhood poverty of almost any major country
on Earth. We don't talk about that either. Children are obviously the
future of America, and we continue to have one of the highest rates of
childhood poverty of any major country, and that includes 29 percent of
African-American children who live in poverty.
How does it happen that in a so-called booming economy--and we hear
from President Trump every other day about how the economy is booming--
the bottom 40 percent of our population does not have $400 in cash in
order to address a financial emergency? Think about that. The bottom 40
percent--almost half of Americans--don't have $400 in their pocket, in
the bank to address a financial emergency. Maybe the car breaks down,
maybe the kid gets sick, maybe one loses one's job, maybe one undergoes
a divorce; something happens, and 40 percent of the American people
don't have $400 in the bank to address that crisis.
In other words, today--and we saw this in the recent government
shutdown; today in America, many, many millions of families live
paycheck to paycheck in order to survive. That should not be happening
in the wealthiest country on Earth, and it is time we begin to talk
about that. It is not good enough to talk about a so-called booming
economy, forgetting about tens of millions of families who are not
seeing that booming economy but, in fact, are living under incredible
financial stress.
How does it happen that, in the so-called booming economy, tens of
millions of American workers today are working for wages that are so
low they cannot afford the escalating cost of housing? Some of them are
spending 40, 50 percent of their limited incomes on housing. For many
of these people, there is no health insurance available; the idea of a
vacation for the family is something not even to be thought about; and
the idea of being able to send one's kids to college is something that
is also not on the table. By the
[[Page S808]]
way, many of these individuals are working two or three jobs, 50, 60,
70 hours a week, just to survive.
This, again, is the wealthiest country in the history of the world.
Yet 30 million Americans today, as we speak, have zero health
insurance--no health insurance at all; 41 million people are
underinsured--which means their deductibles and their copayments are so
high that even though they have insurance, they still can't afford to
go to the doctor, and one out of five Americans today cannot afford the
prescription drugs their doctors prescribe.
In my view--a view I have held for a very, very long time, and it is
a view shared by people not only in this country in wide numbers, but
all over the world--healthcare is a human right, not a privilege.
Whether you are rich or whether you are poor, you have the right to go
to a doctor when you get sick, and you have the right to know that if
you end up in a hospital, you are not going to go bankrupt or suffer
from financial distress.
We are an aging population--no great secret there. We are an aging
population. In this Congress, instead of dealing with government
shutdowns precipitated by the President, we should be talking about how
we respond to the reality of an aging population. Yet what we don't
talk about is that about half of older Americans--half of older
Americans, those 55 and older--have no retirement savings and no idea
about how they will retire with dignity.
Think about what that means. Somebody is 60 years of age, they are
coming to the end of their work-life, and they have no money--or
virtually no money--in the bank. Maybe all they are going to get is
Social Security. They turn on the TV, and they hear folks around here
talking about cutting Social Security. Talk about why people in this
country are angry and why they are stressed out.
Here is the bottom line. We are the wealthiest country on Earth. In
fact, we are the wealthiest country in the history of the world, but
despite that wealth, a significant percentage of our population--our
children, our elderly people, our working men and women--struggle each
and every day to keep their heads above water economically. Not only
are they struggling, I think the pain they are feeling has to do with
the worry they have about the future for their kids because they know,
as many of us know, that unless we make some bold changes in our
economy, the younger generation today will have a lower standard of
living than their parents.
Imagine that--a so-called booming economy, yet we are looking at a
situation where the younger generation may well have a lower standard
of living than their parents.
I want to also say a word about another reality that currently
exists. While so many of our people are struggling, while so many of
our children are living in poverty, while 20 percent of folks on Social
Security are trying to live on less than $13,000 a year, there is
another pervasive reality in American society today; that is, the
people on top--the very wealthiest people in this country--have never
had it better, and the gap between the very, very rich--I am not just
talking about the rich; I am talking about the very, very rich--is
growing wider.
Here is the simple truth, a truth that we virtually never talk about
here in the Senate, a truth that is not heard much in the corporate
media; that is, the United States of America today has the most unequal
distribution of wealth and income of almost any major country on Earth,
and that level of inequality is worse today than at any time since the
1920s, the so-called Gilded Age of American society.
Today, if you can believe it, the three wealthiest people in this
country--three--own more wealth than the bottom half of America, 160
million people. Let me repeat that. The three wealthiest people in this
country own more wealth than the bottom half of America, 160 million
people. Today, the top one-tenth of 1 percent--not 1 percent; one-tenth
of 1 percent--own almost as much wealth as the bottom 90 percent.
Today, and since the Wall Street crash in 2008, about 46 percent of all
new income goes to the top 1 percent. Roughly speaking, half of all new
income goes to the bottom 99 percent, and half goes to the top 1
percent, and our great task here in the U.S. Senate is to keep the
government open while Trump tries to shut it down. Maybe, just maybe,
we should be talking about those issues. Maybe, just maybe, we should
be talking about an economy that works for all of us, not just the
people on top.
Today, the top 25 hedge fund managers on Wall Street--25 hedge fund
managers--earn nearly double the income of all 140,000 kindergarten
teachers in America.
What all of the psychologists tell us is that the most important
years of a human being's development are 0 to 4. Those are the most
impressionable years in terms of how we develop intellectually and
emotionally, and our childcare workers, our kindergarten teachers play
a very important role. Does anybody think it makes sense that you have
25 hedge fund managers on Wall Street who, today, earn nearly double
what 140,000 of our kindergarten teachers make? By the way, public
teachers in America are falling further and further behind other
occupations.
Having stated that reality--the fact that the middle class is
struggling and the fact that the people on top are doing phenomenally
well--I think it is fair to ask what the views are of the Republican
leadership here in the Senate--Republicans control the Senate--and what
our Republican President, President Trump, is proposing to address
these massive levels of injustice and inequality. Three people own more
wealth than the bottom half of America. What does the President and
what does Leader McConnell have to say about that? The sad truth is
that the Republican leadership today wants to make an embarrassingly
bad situation even worse.
After passing a $1 trillion tax giveaway for the top 1 percent and
large corporations last year, Republican leadership is coming back and
saying: Hey, we only gave 83 percent of the tax benefits to the 1
percent. That is not good enough. That is not good enough. We have to
do even better for our billionaires and corporate sponsors.
This time, the Republican leadership and the President want a tax
break of hundreds of billions of dollars that would go exclusively to
the wealthiest of the wealthy. I am not talking about the wealthy; I am
talking about the wealthiest of the wealthy--the top one-tenth of 1
percent, the wealthiest 1,700 families in America.
We have 127 million families in our country--a population of some 320
million people. As I have indicated, many of these families are
struggling. Many of these families are hurting. Today, many of these
families are wondering how they are going to pay their rent, pay their
mortgage, keep their lights on. Yet the legislation to repeal the
estate tax that Senator McConnell and President Trump are proposing
would benefit less than the top one-tenth of 1 percent of them--99.9
percent would see no tax reduction from the legislation.
Can anyone actually imagine bringing forward a piece of legislation
that does not help the bottom 99.9 percent? Can you imagine that? The
middle class are struggling. The gap between the rich and the poor is
growing wider. There are 30 million people without health insurance.
Our infrastructure is crumbling. And they come forward with a piece of
legislation that is designed to protect and benefit the top one-tenth
of 1 percent. The legislation would be of no benefit to 99.9 percent of
the people of this country.
I think it is clear that when the people of this country look at
Congress and say ``Those folks in Washington are not representing me.
They are representing their wealthy campaign contributors. They are
representing the billionaire class,'' there can be no clearer example
of that reality than this proposed legislation.
Once again, with all of the economic problems, all of the inequality
we face, imagine legislation that comes forward from the Republican
leadership and the President that benefits the top one-tenth of 1
percent--the 1,700 wealthiest families in this country.
It is no secret that our infrastructure--our roads and our bridges,
water systems, airports, wastewater plants--is crumbling all over this
country. All over this country, there are major infrastructural
problems. But I hear over and over again: We don't have the
[[Page S809]]
funding to rebuild our crumbling infrastructure and put millions of
Americans to work at good-paying jobs rebuilding that infrastructure.
We just don't have the money.
Our schoolteachers are underpaid, but we don't have the money to
provide attractive salaries in order to get the best and the brightest
to do the most important work in this country; that is, teaching our
young people.
Today, we have veterans--people who put their lives on the line--
sleeping on the streets, but we don't have the money to house them.
Families in America cannot afford childcare, and public schools are
underfunded.
We don't have the money to address those crises, but somehow we do
have hundreds of billions of dollars available to provide tax breaks
for the top one-tenth of 1 percent.
We apparently have enough money to provide the Walton family--the
wealthiest family in America, the folks who own Walmart, the people who
pay their own employees starvation wages--by repealing the estate tax,
as Senator McConnell and President Trump would like to do, we have
enough money to provide the Walton family, the wealthiest family in
America, with a tax break of up to $63 billion. Veterans sleep out on
the street, teachers are underpaid, and 30 million Americans have no
health insurance. We can't address those issues, but we do have
legislation that would provide up to $63 billion in tax breaks for one
family.
We have, apparently, enough money available to provide the Koch
brothers--a family who spent some $400 million during the midterm
election to help elect Republican candidates; the Koch brothers, one of
the wealthiest, most politically active families in America--we have
enough money to provide them with up to a $39 billion tax break.
Under this legislation, we can provide a tax break of up to $27
billion to the Mars candy bar family and up to a $13.4 billion tax
break to the Cox cable family.
In other words, at a time of massive needs in this country, we don't
have enough money available to protect working families and the middle
class, but we certainly have more money than we know what to do with in
order to give incredible tax breaks to the richest people in this
country.
The estate tax that we are going to be proposing does not give
massive tax breaks to the wealthiest people in this country--quite the
contrary. It says to those people that at a time of massive income and
wealth inequality, instead of repealing the estate tax, we must
substantially increase this tax on the multimillionaires and
billionaires of this country and in doing that, not only come up with
much needed revenue to address the needs of working families but also
to reduce wealth inequality in America.
That is why this week I will be introducing legislation for an estate
tax bill that would do exactly the opposite of what my Republican
colleagues propose to do. Let me briefly explain what is in the
legislation I am offering.
Under my bill, anytime someone inherits an estate in America of $3.5
million or less, that person will not pay one penny in estate taxes.
They will get to keep that inheritance tax-free. That population
includes 99.8 percent of the American people. The legislation I am
proposing would not raise taxes by a penny on 99.8 percent of the
American population.
If you are in the top two-tenths of 1 percent of the population--the
population that inherits over $3.5 million--your taxes will, in fact,
be going up, and they should be going up.
My legislation establishes a 45-percent tax on the value of an estate
between $3.5 million and $10 million, a 50-percent tax on the value of
an estate between $10 million and $50 million, a 55-percent tax on the
value of an estate in excess of $50 million, and a 77-percent tax on
the value of an estate above $1 billion. In other words, this bill
begins to create a progressive tax system in America, which is based on
ability to pay.
I know some may think otherwise, but the truth is, this is not a
radical idea. From 1941 through 1976, the top estate tax rate was, in
fact, 77 percent on estate values above $50 million. Back to 1976, the
top estate tax rate was 77 percent.
This bill would also close tax loopholes that have allowed
billionaire families, such as the Waltons, to pass fortunes from one
generation to the next without paying their fair share of taxes.
Under this legislation, the families of all 588 billionaires in our
country, who have a combined net worth of over $3 trillion, would pay
up to $2.2 trillion in estate taxes.
Let me make a confession here. This idea, this approach, was not
developed by Bernie Sanders. It is not a new idea. More than a century
ago, a good Republican President named Teddy Roosevelt fought for the
creation of a progressive estate tax to reduce the enormous
concentration of wealth that existed during the Gilded Age.
What is really quite remarkable is that what Teddy Roosevelt talked
about over 100 years ago during the Gilded Age of the 1920s, when
little children were working in factories and fields and the wealthiest
people were enjoying incredible wealth and luxury--the idea Teddy
Roosevelt proposed then is as relevant today as it was back then. Let
me quote what Teddy Roosevelt said more than 100 years ago:
The absence of effective state, and, especially, national
restraint upon unfair money-getting has tended to create a
small class of enormously wealthy and economically powerful
men, whose chief object is to hold and increase their power.
The prime need is to change the conditions which enable these
men to accumulate power. Therefore, I believe in a graduated
inheritance tax on big fortunes, properly safeguarded against
evasion and increasing rapidly in amount with the size of the
estate.
That was Teddy Roosevelt over 100 years ago. What Roosevelt said then
is absolutely true for today.
From a moral and an economic perspective, our Nation will not thrive
when so few people have so much wealth and power and so many people
have so little wealth and power. This wealth and income inequality is
not only unjust and unfair; the truth is, it is a real threat to our
economy and our democracy.
We need a tax system in this country that tells the billionaire class
that they are going to have to pay their fair share of taxes so that we
do not have 30 million people without health insurance, so that we do
not have young people graduating college $50,000, $100,000 in debt, so
that we do not have an infrastructure that is crumbling, and so that we
do not see our great country moving toward an oligarchic form of
society where a handful of families enjoy incredible wealth and power
at the expense of everybody else.
In my view, the fairest way to reduce wealth inequality, to invest in
the middle class and working families of our country, and to preserve
our democracy is to enact a progressive estate tax on the inherited
wealth of multimillionaires and billionaires. That is exactly what I
will be proposing.
____________________