[Congressional Record Volume 165, Number 53 (Wednesday, March 27, 2019)]
[Senate]
[Pages S2045-S2054]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
STATEMENTS ON INTRODUCED BILLS AND JOINT RESOLUTIONS
By Mr. WYDEN (for himself and Mr. Cotton):
S. 890. A bill to authorize the Sergeant at Arms to protect the
personal technology devices and accounts of Senators and covered
employees from cyber attacks and hostile information collection
activities, and for other purposes; to the Committee on Rules and
Administration.
Mr. WYDEN. Mr. President, today I, along with my colleague Senator
Cotton from Arkansas, am introducing the Senate Cybersecurity
Protection Act to defend the integrity of American democracy by
providing cybersecurity protection for the personal accounts and
electronic devices of Senators and and key members of their staff.
In 2016, hackers working for the Russian government broke into a
range of targets, including the network of the Democratic National
Committee and the email account of Senator Hillary Clinton's
presidential campaign manager, John Podesta. These widely publicized
breaches are only the tip of the iceberg. These hacks are widely known
today because the emails stolen from these accounts were subsequently
weaponized and used as part of a campaign to influence the outcome of
several elections--most publicly, the presidential race between Donald
Trump and Hillary Clinton, but also U.S. House of Representatives races
in Illinois, New Hampshire, New Mexico, North Carolina, Ohio, and
Pennsylvania. Senator Lindsey Graham also reported that his campaign's
email was successfully compromised.
While the Russian hacks in 2016 were a watershed moment, these are
merely the most visible and disruptive examples of foreign intelligence
services
[[Page S2046]]
using offensive cyber capabilities to target those involved in our
political process. Senior officials from the 2008 Obama and McCain
presidential campaigns have publicly confirmed that both organizations
were compromised by hackers. In 2017, the media reported that then-
White House Chief of Staff John Kelly's personal cell phone had been
compromised, possibly for as long as ten months before the malware was
discovered. And in 2018, media reports revealed that the personal email
accounts of senior congressional staffers had been targeted by the
notorious Russian hacking group ``Fancy-Bear.'' These and other events
clearly demonstrate the unique threats faced by Senators and their
staff. Unfortunately, as I revealed in a letter to Senate leadership
last year, the Sergeant At Arms (SAA), which is responsible for the
Senate's cybersecurity, informed me that it currently lacks the
authority to use official Senate resources to protect the personal
devices and accounts of Senators and key Senate staff, even when those
staff are being targeted by foreign governments.
Senators Cotton and I are not alone in recognizing the seriousness of
this national security threat.
Last year, then-Director of the National Security Agency Admiral
Michael Rogers acknowledged in a letter to me that personal devices and
accounts of senior U.S. government officials ``remain prime targets for
exploitation.'' Likewise, in written responses to post-hearing
questions from the Senate Intelligence Committee last year, Director of
National Intelligence Dan Coats wrote that ``[t]he personal accounts
and devices of government officials can contain information that is
useful for our adversaries to target, either directly or indirectly,
these officials and the organizations with which they are affiliated.''
The Appropriations Committee also noted last year in its report
accompanying the 2019 Legislative Branch Appropriations bill that it
``continues to be concerned that Senators are being targeted for
hacking and cyber attacks, especially via their personal devices and
accounts.''
Currently, Senators and staffers are expected to protect their own
devices and accounts from foreign government hackers. This is absurd.
Senators and the vast majority of their staff are not cybersecurity
experts, and certainly do not have the training our resources to defend
themselves from sophisticated foreign intelligence agencies. Eric
Rosenbach, who was formerly Chief of Staff to Secretary of Defense Ash
Carter, has endorsed the bill we are introducing today, observing that
``Senators and their staff should not be expected to go toe to toe with
some of the most sophisticated adversaries in cyberspace; authorizing
protection of personal accounts is a critical component of our cyber
defense efforts.'' Likewise, Bruce Schreier, a noted cybersecurity
expert has also endorsed the bill, stating that ``[i]t is ludicrous to
expect individual senators and their staff to to defend themselves from
spies and hackers. Hostile foreign intelligence services do not respect
the arbitrary line between work and personal technology. As such, the
U.S. government must extend its defensive cyber perimeter to include
legislators' personal devices and accounts.''
Our bill would permit the SAA to provide voluntary, opt-in
cybersecurity assistance to Senators and key Senate staff to secure
their personal devices and accounts. Any Senate staffer would be
eligible to receive assistance, provided that the Senator employing
them determines that they are highly vulnerable to cyber attacks and
information collection because of their position in the Senate.
There is precedent for extending cybersecurity protection to the
personal devices of government officials. Section 1645 of the 2017
National Defense Authorization Act permits the Secretary of Defense to
provide personal device cybersecurity assistance to officials whom the
secretary ``determines to be highly vulnerable to cyber attacks and
hostile information collection activities because of the positions
occupied by such personnel in the Department.'' The Senate
Cybersecurity Protection Act is also similar to provisions included in
the intelligence authorization bill approved by the Senate Select
Committee on Intelligence in 2018, which would permit the Director of
National Intelligence to protect the personal devices and accounts of
high-risk staff in the intelligence community.
Passage of this common sense, bipartisan legislation would provide
Senators and their staff with much-needed protection for their personal
accounts and devices, and with them, the integrity of American
democracy. I thank my colleague Senator Cotton for his efforts on this
bill, and hope the Senate will promptly pass this vital legislation.
______
By Mr. DURBIN (for himself, Mr. Blumenthal, Mr. Booker, Mr.
Cardin, Mr. Coons, Ms. Duckworth, Ms. Harris, Mr. Kaine, Ms.
Klobuchar, Mr. Markey, Mr. Whitehouse, Mr. Sanders, Mr. Schatz,
and Mr. Reed):
S. 894. A bill to authorize dedicated domestic terrorism offices
within the Department of Homeland Security, the Department of Justice,
and the Federal Bureau of Investigation to analyze and monitor domestic
terrorist activity and require the Federal Government to take steps to
prevent domestic terrorism; to the Committee on the Judiciary.
Mr. DURBIN. Mr. President, I ask unanimous consent that the text of
the bill be printed in the Record.
There being no objection, the text of the bill was ordered to be
printed in the Record, as follows:
S. 894
Be it enacted by the Senate and House of Representatives of
the United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Domestic Terrorism
Prevention Act of 2019''.
SEC. 2. FINDINGS.
Congress finds the following:
(1) White supremacists and other far-right-wing extremists
are the most significant domestic terrorism threat facing the
United States.
(2) On February 22, 2019, a Trump Administration United
States Department of Justice official wrote in a New York
Times op-ed that ``white supremacy and far-right extremism
are among the greatest domestic-security threats facing the
United States. Regrettably, over the past 25 years, law
enforcement, at both the Federal and State levels, has been
slow to respond. . . .Killings committed by individuals and
groups associated with far-right extremist groups have risen
significantly.''.
(3) An April 2017 Government Accountability Office report
on the significant, lethal threat posed by domestic violent
extremists explained that ``[s]ince September 12, 2001, the
number of fatalities caused by domestic violent extremists
has ranged from 1 to 49 in a given year.'' The report noted:
``[F]atalities resulting from attacks by far right wing
violent extremists have exceeded those caused by radical
Islamist violent extremists in 10 of the 15 years, and were
the same in 3 of the years since September 12, 2001. Of the
85 violent extremist incidents that resulted in death since
September 12, 2001, far right wing violent extremist groups
were responsible for 62 (73 percent) while radical Islamist
violent extremists were responsible for 23 (27 percent).''.
(4) An unclassified May 2017 joint intelligence bulletin
from the Federal Bureau of Investigation and the Department
of Homeland Security found that ``white supremacist extremism
poses [a] persistent threat of lethal violence,'' and that
White supremacists ``were responsible for 49 homicides in 26
attacks from 2000 to 2016 . . . more than any other domestic
extremist movement''.
(5) Fatal terrorist attacks by far-right-wing extremists
include--
(A) the August 5, 2012, mass shooting at a Sikh gurdwara in
Oak Creek, Wisconsin, in which a White supremacist shot and
killed 6 members of the gurdwara;
(B) the April 13, 2014, mass shooting at a Jewish community
center and a Jewish assisted living facility in Overland
Park, Kansas, in which a neo-Nazi shot and killed 3
civilians, including a 14-year-old teenager;
(C) the June 8, 2014, ambush in Las Vegas, Nevada, in which
2 supporters of the far-right-wing ``patriot'' movement shot
and killed 2 police officers and a civilian;
(D) the June 17, 2015, mass shooting at the Emanuel AME
Church in Charleston, South Carolina, in which a White
supremacist shot and killed 9 members of the church;
(E) the November 27, 2015, mass shooting at a Planned
Parenthood clinic in Colorado Springs, Colorado, in which an
anti-abortion extremist shot and killed a police officer and
2 civilians;
(F) the March 20, 2017, murder of an African-American man
in New York City, allegedly committed by a White supremacist
who reportedly traveled to New York ``for the purpose of
killing black men'';
(G) the May 26, 2017, attack in Portland, Oregon, in which
a White supremacist allegedly murdered 2 men and injured a
third after the men defended 2 young women whom the
individual had targeted with anti-Muslim hate speech;
[[Page S2047]]
(H) the August 12, 2017, attack in Charlottesville,
Virginia, in which a White supremacist killed one and injured
nineteen after driving his car through a crowd of individuals
protesting a neo-Nazi rally, and of which former Attorney
General Jeff Sessions said, ``It does meet the definition of
domestic terrorism in our statute.'';
(I) the July 2018 murder of an African-American woman from
Kansas City, Missouri, allegedly committed by a White
supremacist who reportedly bragged about being a member of
the Ku Klux Klan;
(J) the October 24, 2018, shooting in Jeffersontown,
Kentucky, in which a White man allegedly murdered 2 African
Americans at a grocery store after first attempting to enter
a church with a predominantly African-American congregation
during a service; and
(K) the October 27, 2018, mass shooting at the Tree of Life
Synagogue in Pittsburgh, Pennsylvania, in which a White
nationalist allegedly shot and killed 11 members of the
congregation.
(6) In November 2018, the Federal Bureau of Investigation
released its annual hate crime incident report, which found
that in 2017, hate crimes increased by approximately 17
percent, including a 23-percent increase in religion-based
hate crimes, an 18-percent increase in race-based crimes, and
a 5-percent increase in crimes directed against LGBT
individuals. The total number of reported hate crimes rose
for the third consecutive year. The previous year's report
found that in 2016, hate crimes increased by almost 5
percent, including a 19-percent rise in hate crimes against
American Muslims; additionally, of the hate crimes motivated
by religious bias in 2016, 53 percent were anti-Semitic.
Similarly, the report analyzing 2015 data found that hate
crimes increased by 6 percent that year. Much of the 2015
increase came from a 66-percent rise in attacks on American
Muslims and a 9-percent rise in attacks on American Jews. In
all three reports, race-based crimes were most numerous, and
those crimes most often targeted African Americans.
(7) On March 15, 2019, a White nationalist was arrested and
charged with murder after allegedly killing 50 Muslim
worshippers and injuring more than 40 in a massacre at the Al
Noor Mosque and Linwood Mosque in Christchurch, New Zealand.
The alleged shooter posted a hate-filled, xenophobic
manifesto that detailed his White nationalist ideology before
the massacre. Prime Minister Jacinda Ardern labeled the
massacre a terrorist attack.
(8) In January 2017, a right-wing extremist who had
expressed anti-Muslim views was charged with murder for
allegedly killing 6 people and injuring 19 in a shooting
rampage at a mosque in Quebec City, Canada. It was the first-
ever mass shooting at a mosque in North America, and Prime
Minister Trudeau labeled it a terrorist attack.
(9) On February 15, 2019, Federal authorities arrested U.S.
Coast Guard Lieutenant Christopher Paul Hasson, who was
allegedly planning to kill a number of prominent journalists,
professors, judges, and ``leftists in general''. In court
filings, prosecutors described Lieutenant Hasson as a
``domestic terrorist'' who in an email ``identified himself
as a White Nationalist for over 30 years and advocated for
`focused violence' in order to establish a white homeland.''.
SEC. 3. DEFINITIONS.
In this Act--
(1) the term ``Director'' means the Director of the Federal
Bureau of Investigation;
(2) the term ``domestic terrorism'' has the meaning given
the term in section 2331 of title 18, United States Code,
except that it does not include acts perpetrated by
individuals associated with or inspired by--
(A) a foreign person or organization designated as a
foreign terrorist organization under section 219 of the
Immigration and Nationality Act (8 U.S.C. 1189);
(B) an individual or organization designated under
Executive Order 13224 (50 U.S.C. 1701 note); or
(C) a state sponsor of terrorism as determined by the
Secretary of State under section 6(j) of the Export
Administration Act of 1979 (50 U.S.C. 4605), section 40 of
the Arms Export Control Act (22 U.S.C. 2780), or section 620A
of the Foreign Assistance Act of 1961 (22 U.S.C. 2371);
(3) the term ``Domestic Terrorism Executive Committee''
means the committee within the Department of Justice tasked
with assessing and sharing information about ongoing domestic
terrorism threats;
(4) the term ``hate crime incident'' means an act described
in section 245, 247, or 249 of title 18, United States Code,
or in section 901 of the Civil Rights Act of 1968 (42 U.S.C.
3631);
(5) the term ``Secretary'' means the Secretary of Homeland
Security; and
(6) the term ``uniformed services'' has the meaning given
the term in section 101(a) of title 10, United States Code.
SEC. 4. OFFICES TO COMBAT DOMESTIC TERRORISM.
(a) Authorization of Offices To Monitor, Analyze,
Investigate, and Prosecute Domestic Terrorism.--
(1) Domestic terrorism unit.--There is authorized a
Domestic Terrorism Unit in the Office of Intelligence and
Analysis of the Department of Homeland Security, which shall
be responsible for monitoring and analyzing domestic
terrorism activity.
(2) Domestic terrorism office.--There is authorized a
Domestic Terrorism Office in the Counterterrorism Section of
the National Security Division of the Department of Justice--
(A) which shall be responsible for investigating and
prosecuting incidents of domestic terrorism; and
(B) which shall be headed by the Domestic Terrorism
Counsel.
(3) Domestic terrorism section of the fbi.--There is
authorized a Domestic Terrorism Section within the
Counterterrorism Division of the Federal Bureau of
Investigation, which shall be responsible for investigating
domestic terrorism activity.
(4) Staffing.--The Secretary, the Attorney General, and the
Director shall each ensure that the offices authorized under
this section in their respective agencies shall have adequate
staff to perform the required duties.
(b) Joint Report on Domestic Terrorism.--
(1) Annual report required.--Not later than 180 days after
the date of enactment of this Act, and each year thereafter,
the Secretary of Homeland Security, the Attorney General, and
the Director of the Federal Bureau of Investigation shall
submit a joint report authored by the domestic terrorism
offices authorized under paragraphs (1), (2), and (3) of
subsection (a) to--
(A) the Committee on the Judiciary, the Committee on
Homeland Security and Governmental Affairs, and the Select
Committee on Intelligence of the Senate; and
(B) the Committee on the Judiciary, the Committee on
Homeland Security, and the Permanent Select Committee on
Intelligence of the House of Representatives.
(2) Contents.--Each report submitted under paragraph (1)
shall include--
(A) an assessment of the domestic terrorism threat posed by
White supremacists and neo-Nazis, including White supremacist
and neo-Nazi infiltration of Federal, State, and local law
enforcement agencies and the uniformed services; and
(B)(i) in the first report, an analysis of incidents or
attempted incidents of domestic terrorism that have occurred
in the United States since April 19, 1995; and
(ii) in each subsequent report, an analysis of incidents or
attempted incidents of domestic terrorism that occurred in
the United States during the preceding year; and
(C) a quantitative analysis of domestic terrorism for the
preceding year, including the number of--
(i) domestic terrorism related assessments initiated by the
Federal Bureau of Investigation, including the number of
assessments from each classification and subcategory;
(ii) domestic terrorism-related preliminary investigations
initiated by the Federal Bureau of Investigation, including
the number of preliminary investigations from each
classification and subcategory, and how many preliminary
investigations resulted from assessments;
(iii) domestic terrorism-related full investigations
initiated by the Federal Bureau of Investigation, including
the number of full investigations from each classification
and subcategory, and how many full investigations resulted
from preliminary investigations and assessments;
(iv) domestic terrorism-related incidents, including the
number of incidents from each classification and subcategory,
the number of deaths and injuries resulting from each
incident, and a detailed explanation of each incident;
(v) Federal domestic terrorism-related arrests, including
the number of arrests from each classification and
subcategory, and a detailed explanation of each arrest;
(vi) Federal domestic terrorism-related indictments,
including the number of indictments from each classification
and subcategory, and a detailed explanation of each
indictment;
(vii) Federal domestic terrorism-related prosecutions,
including the number of incidents from each classification
and subcategory, and a detailed explanation of each
prosecution;
(viii) Federal domestic terrorism-related convictions,
including the number of convictions from each classification
and subcategory, and a detailed explanation of each
conviction; and
(ix) Federal domestic terrorism-related weapons recoveries,
including the number of each type of weapon and the number of
weapons from each classification and subcategory.
(3) Hate crimes.--In compiling a joint report under this
subsection, the domestic terrorism offices authorized under
paragraphs (1), (2), and (3) of subsection (a) shall, in
consultation with the Civil Rights Division of the Department
of Justice and the Civil Rights Unit of the Federal Bureau of
Investigation, review each hate crime incident reported
during the preceding year to determine whether the incident
also constitutes a domestic terrorism-related incident.
(4) Classification and public release.--Each report
submitted under paragraph (1) shall be--
(A) unclassified, to the greatest extent possible, with a
classified annex only if necessary; and
(B) in the case of the unclassified portion of the report,
posted on the public websites of the Department of Homeland
Security, the Department of Justice, and the Federal Bureau
of Investigation.
(c) Domestic Terrorism Executive Committee.--There is
authorized a Domestic Terrorism Executive Committee, which
shall--
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(1) meet on a regular basis, and not less regularly than 4
times each year, to coordinate with United States Attorneys
and other key public safety officials across the country to
promote information sharing and ensure an effective,
responsive, and organized joint effort to combat domestic
terrorism; and
(2) be co-chaired by--
(A) the Domestic Terrorism Counsel authorized under
subsection (a)(2)(B);
(B) a United States Attorney or Assistant United States
Attorney;
(C) a member of the National Security Division of the
Department of Justice; and
(D) a member of the Federal Bureau of Investigation.
(d) Focus on Greatest Threats.--The domestic terrorism
offices authorized under paragraphs (1), (2), and (3) of
subsection (a) shall focus their limited resources on the
most significant domestic terrorism threats, as determined by
the number of domestic terrorism-related incidents from each
category and subclassification in the joint report for the
preceding year required under subsection (b).
SEC. 5. TRAINING TO COMBAT DOMESTIC TERRORISM.
(a) Required Training and Resources.--The Secretary, the
Attorney General, and the Director shall review the anti-
terrorism training and resource programs of their respective
agencies that are provided to Federal, State, local, and
Tribal law enforcement agencies, including the State and
Local Anti-Terrorism Program that is funded by the Bureau of
Justice Assistance of the Department of Justice, and ensure
that such programs include training and resources to assist
State, local, and Tribal law enforcement agencies in
understanding, detecting, deterring, and investigating acts
of domestic terrorism and White supremacist and neo-Nazi
infiltration of law enforcement agencies. The domestic-
terrorism training shall focus on the most significant
domestic terrorism threats, as determined by the quantitative
analysis in the joint report required under section 4(b).
(b) Requirement.--Any individual who provides domestic
terrorism training required under this section shall have--
(1) expertise in domestic terrorism; and
(2) relevant academic, law enforcement, or other experience
in matters related to domestic terrorism.
(c) Report.--
(1) In general.--Not later than 1 year after the date of
enactment of this Act and once each year thereafter, the
Secretary, the Attorney General, and the Director shall each
submit an annual report to the committees of Congress
described in section 4(b)(1) on the domestic terrorism
training implemented by their respective agencies under this
section, which shall include copies of all training materials
used and the names and qualifications of the individuals who
provide the training.
(2) Classification and public release.--Each report
submitted under paragraph (1) shall be--
(A) unclassified, to the greatest extent possible, with a
classified annex only if necessary; and
(B) in the case of the unclassified portion of each report,
posted on the public website of the Department of Homeland
Security, the Department of Justice, and the Federal Bureau
of Investigation.
SEC. 6. COMBATTING DOMESTIC TERRORISM THROUGH JOINT TERRORISM
TASK FORCES AND FUSION CENTERS.
(a) In General.--The joint terrorism task forces of the
Federal Bureau of Investigation and State, local, and
regional fusion centers, as established under section 210A of
the Homeland Security Act of 2002 (6 U.S.C. 124h), shall
each, in coordination with the Domestic Terrorism Executive
Committee and the domestic terrorism offices authorized under
paragraphs (1), (2), and (3) of section 4(a) of this Act--
(1) share intelligence to address domestic terrorism
activities;
(2) conduct an annual, intelligence-based assessment of
domestic terrorism activities in their jurisdictions; and
(3) formulate and execute a plan to address and combat
domestic terrorism activities in their jurisdictions.
(b) Requirement.--The activities required under subsection
(a) shall focus on the most significant domestic terrorism
threats, as determined by the number of domestic terrorism-
related incidents from each category and subclassification in
the joint report for the preceding year required under
section 4(b).
SEC. 7. INTERAGENCY TASK FORCE.
Not later than 180 days after the date of enactment of this
Act, the Attorney General, the Director, the Secretary, and
the Secretary of Defense shall establish an interagency task
force to combat White supremacist and neo-Nazi infiltration
of the uniformed services.
SEC. 8. AUTHORIZATION OF APPROPRIATIONS.
There are authorized to be appropriated to the Department
of Justice, the Federal Bureau of Investigation, the
Department of Homeland Security, and the Department of
Defense such sums as may be necessary to carry out this Act.
______
By Mr. THUNE (for himself and Ms. Stabenow):
S. 895. A bill to provide for a permanent extension of the
enforcement instruction on supervision requirements for outpatient
therapeutic services in critical access and small rural hospitals; to
the Committee on Finance.
Mr. THUNE. Mr. President, I ask unanimous consent that the text of
the bill be printed in the Record.
There being no objection, the text of the bill was ordered to be
printed in the Record, as follows:
S. 895
Be it enacted by the Senate and House of Representatives of
the United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Rural Hospital Regulatory
Relief Act of 2019''.
SEC. 2. PERMANENT EXTENSION OF ENFORCEMENT INSTRUCTION ON
SUPERVISION REQUIREMENTS FOR OUTPATIENT
THERAPEUTIC SERVICES IN CRITICAL ACCESS AND
SMALL RURAL HOSPITALS.
Section 1834 of the Social Security Act (42 U.S.C. 1395m)
is amended by adding at the end the following new subsection:
``(x) Permanent Extension of Enforcement Instruction on
Supervision Requirements for Outpatient Therapeutic Services
in Critical Access and Small Rural Hospitals.--On and after
the date of the enactment of this subsection, the Secretary
shall continue to apply the enforcement instruction described
in the notice of the Centers for Medicare & Medicaid Services
entitled `Enforcement Instruction on Supervision Requirements
for Outpatient Therapeutic Services in Critical Access and
Small Rural Hospitals for CY 2013', dated November 1, 2012
(providing for an exception to the restatement and
clarification under the final rulemaking changes to the
Medicare hospital outpatient prospective payment system and
calendar year 2009 payment rates (published in the Federal
Register on November 18, 2008, 73 Fed. Reg. 68702 through
68704) with respect to requirements for direct supervision by
physicians for therapeutic hospital outpatient services) and
extended by section 1 of Public Law 113-198, section 1 of
Public Law 114-112, section 16004(a) of the 21st Century
Cures Act (Public Law 114-255), and section 51007 of the
Bipartisan Budget Act (Public Law 115-123), and reinstated
for calendar years 2018 and 2019 under the final rule
entitled `Medicare Program: Hospital Outpatient Prospective
Payment and Ambulatory Surgical Center Payment Systems and
Quality Reporting Programs' published on December 14, 2017
(82 Fed. Reg. 59216).''.
______
By Mr. KAINE (for himself and Mr. Carper):
S. 899. A bill to limit the authority of the President to modify duty
rates for national security reasons and to limit the authority of the
United States Trade Representative to impose certain duties or import
restrictions, and for other purposes; to the Committee on Finance.
Mr. KAINE. Mr. President, today Senator Carper and I introduced the
Reclaiming Congressional Trade Authority Act of 2019. Enacting this
bill would restore the role on Congress in overseeing international
trade matters.
I have been outspoken against the abuse of executive authorities that
have been delegated to the President. Congress has a Constitutional
power to oversee international trade. We have recently seen an abuse of
this power, as with other executive authorities. This bill would
mandate expanded Congressional involvement in international trade
decisions by requiring the Trump Administration--and future
Administrations--to further analyze, communicate, and justify tariff
actions to Congress. Congress would then review new tariffs and if the
Administration used national security to justify the tariffs' need,
Congress would be required to approve them.
I am advocating for my colleagues to consider supporting this bill,
especially as the damaging effects of the ongoing trade war continue.
It's time for Congress to step in and act on our Constitutional duty.
______
By Mr. DAINES (for himself and Mr. Tester):
S. 900. A bill to designate the community-based outpatient clinic of
the Department of Veterans Affairs in Bozeman, Montana, as the ``Travis
W. Atkins Department of Veterans Affairs Clinic''; to the Committee on
Veterans' Affairs.
Mr. DAINES. Mr. President, I ask unanimous consent that the text of
the bill be printed in the Record.
There being no objection, the text of the bill was ordered to be
printed in the Record, as follows:
S. 900
Be it enacted by the Senate and House of Representatives of
the United States of America in Congress assembled,
SECTION 1. DESIGNATION OF TRAVIS W. ATKINS DEPARTMENT OF
VETERANS AFFAIRS CLINIC IN BOZEMAN, MONTANA.
(a) Designation.--The community-based outpatient clinic of
the Department of Veterans Affairs located at 300 North
Willson
[[Page S2049]]
Avenue, Bozeman, Montana, shall after the date of the
enactment of this Act be known and designated as the ``Travis
W. Atkins Department of Veterans Affairs Clinic'' or the
``Travis W. Atkins VA Clinic''.
(b) Reference.--Any reference in any law, regulation, map,
document, paper, or other record of the United States to the
community-based outpatient clinic referred to in subsection
(a) shall be considered to be a reference to the Travis W.
Atkins Department of Veterans Affairs Clinic.
______
By Mrs. FEINSTEIN (for herself and Mrs. Capito):
S. 906. A bill to improve the management of driftnet fishing; to the
Committee on Commerce, Science, and Transportation.
Mrs. FEINSTEIN. Mr. President, I am pleased to re-introduce the
``Driftnet Modernization and Bycatch Reduction Act.'' This legislation
would update the Magnuson-Stevens Fishery Conservation and Management
Act to phase out the use of harmful drift gillnets and replace them
with more sustainable fishing gear. I would like to thank my colleague,
Senator Capito, for once again co-leading this important bill.
Drift gillnets, which are approximately one to one and a half miles
long, are intended to catch swordfish and thresher shark off the coast
of California. Tragically, nearly 60 other species are frequently
caught and killed in the nets, including dolphins, porpoises, whales,
sea lions, and sea turtles. These are known as bycatch.
While some of these species can be sold, most are wastefully thrown
back into the ocean either dead or seriously injured.
According to the National Marine Fisheries Service, these harmful
nets account for 90% of whale and porpoise species killed in West Coast
Fisheries. In the 1980s, Congress enacted legislation to end the
domestic use of driftnets approximately 1.5 miles or longer. Under
President George H.W. Bush, the United States entered binding
international agreements banning such nets worldwide.
Driftnets are prohibited or are not utilized off the United States'
Atlantic and Gulf coasts as well as in Washington State, Oregon,
Alaska, and Hawaii. Mexico permanently banned the use of these nets in
the Gulf of California in 2017.
However, neither domestic nor international law currently includes
the drift gillnets used in Federal waters off the coast of California
to catch swordfish and thresher shark, despite their significant impact
on protected marine life. This California-based fishery is the last
place in the United States where these deadly driftnets are allowed.
Last year, the California legislature passed a bill, subsequently
signed into law by Governor Jerry Brown, to phase out these large-mesh
drift gillnets in State waters and establish a buyout program over a
four-year period.
The State law requires the California Department of Fish and Wildlife
to establish a voluntary ``permit transition program'' by March 2020
that will compensate fishermen during this transition process.
California has already dedicated $1 million for the program and another
$1 million is being sought through a public-private partnership.
Now that these nets are banned in State waters, our legislation to
ban the nets in Federal waters is more timely than ever. The ``Driftnet
Modernization and Bycatch Reduction Act'' would phase out the use of
drift gillnets over the five years after enactment. The bill also
authorizes the Department of Commerce to assist fishermen in
transitioning from driftnets to more sustainable gear types, which
studies have shown actually increase profitability.
Updated fishing gear that could replace driftnets is available and
has been successfully deployed in the Atlantic Ocean and in trials in
the Pacific Ocean. Deep-set buoy gear, for example, allows fishermen to
more accurately target swordfish and other marketable species in deep,
cold water. The gear alerts fishermen immediately when they have fish
on the line, so the fish can be retrieved and delivered to market
quickly, thereby garnering a higher price.
In a 2016 poll, California voters overwhelmingly supported efforts to
end the use of drift gillnets to catch swordfish, with 87 percent of
those surveyed in a poll commissioned by The Pew Charitable Trusts
agreeing that fishermen should use less harmful gear.
Our bill enjoys support from a wide range of commercial fishing
companies, sportfishing groups, and environmental organizations,
including: the American Sportfishing Association, the International
Game Fish Association, Coastal Conservation Association of California,
Yamaha USA, Okaiwa Corporation, the Pew Charitable Trusts, Oceana, Sea
Legacy, and Mission Blue.
Our ``Driftnet Modernization and Bycatch Reduction Act'' will protect
valuable marine life unique to the West Coast, including several
endangered species. This bill will also help fishermen to provide
fresher, more profitable, and more sustainable seafood to American
consumers.
I look forward to working with my colleagues to pass the ``Driftnet
Modernization and Bycatch Reduction Act.'' Thank you, Mr. President. I
yield the Floor.
______
By Mr. SCHUMER (for himself and Mrs. Gillibrand):
S. 908. A bill to provide for an equitable management of summer
flounder based on geographic, scientific, and economic data and for
other purposes; to the Committee on Commerce, Science, and
Transportation.
Mr. SCHUMER. Mr. President, I ask unanimous consent that the text of
the bill be printed in the Record.
There being no objection, the text of the bill was ordered to be
printed in the Record, as follows:
S. 908
Be it enacted by the Senate and House of Representatives of
the United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Fluke Fairness Act of
2019''.
SEC. 2. FINDINGS.
Congress finds the following:
(1) Summer flounder is an important economic fish stock for
commercial and recreational fishermen across the Northeast
and Mid-Atlantic United States.
(2) The Magnuson-Stevens Fishery Conservation and
Management Act (16 U.S.C. 1801 et seq.) was reauthorized in
2006 and instituted annual catch limits and accountability
measures for important fish stocks.
(3) That reauthorization prompted fishery managers to look
at alternate management schemes to rebuild depleted stocks
like summer flounder.
(4) Summer flounder occur in both State and Federal waters
and are managed through a joint fishery management plan
between the Council and the Commission.
(5) The Council and the Commission decided that each
State's recreational and commercial harvest limits for summer
flounder would be based upon landings in previous years.
(6) These historical landings were based on flawed data
sets that no longer provide fairness or flexibility for
fisheries managers to allocate resources based on the best
science.
(7) This allocation mechanism resulted in an uneven split
among the States along the East Coast which is problematic.
(8) The fishery management plan for summer flounder does
not account for regional changes in the location of the fluke
stock even though the stock has moved further to the north
and changes in effort by anglers along the East Coast.
(9) The States have been locked in a management system
based on data collected from 1981 to 1989, thus, the summer
flounder stock is not being managed using the best available
science and modern fishery management techniques.
(10) It is in the interest of the Federal Government to
establish a new fishery management plan for summer flounder
that is based on current geographic, scientific, and economic
realities.
SEC. 3. DEFINITIONS.
In this Act:
(1) Commission.--The term ``Commission'' means the Atlantic
States Marine Fisheries Commission.
(2) Council.--The term ``Council'' means the Mid-Atlantic
Fishery Management Council established under section 302(a)
of the Magnuson-Stevens Fishery Conservation and Management
Act (16 U.S.C. 1852(a)).
(3) National standards.--The term ``National Standards''
means the national standards for fishery conservation and
management set out in section 301(a) of the Magnuson-Stevens
Fishery Conservation and Management Act (16 U.S.C. 1851(a)).
(4) Secretary.--The term ``Secretary'' means the Secretary
of Commerce.
(5) Summer flounder.--The term ``summer flounder'' means
the species Paralichthys dentatus.
SEC. 4. SUMMER FLOUNDER MANAGEMENT REFORM.
(a) Fishery Management Plan Modification.--Not later than 1
year after the date of enactment of this Act, the Council
shall submit to the Secretary, and the Secretary may approve,
a modified fishery management plan for the commercial
management of summer flounder under title III of the
Magnuson-Stevens Fishery Conservation and Management Act (16
U.S.C. 1851 et seq.) or an amendment to such plan that--
[[Page S2050]]
(1) shall be based on the best scientific information
available;
(2) establishes commercial quotas in direct proportion to
the distribution, abundance, and location of summer flounder
as reflected by fishery independent surveys conducted by the
National Marine Fisheries Service and State agencies;
(3) considers regional, coastwide, or other management
measures for summer flounder that comply with the National
Standards; and
(4) prohibits the establishment of commercial catch quotas
for summer flounder on a State-by-State basis using
historical landings data that does not reflect the status of
the summer flounder stock, based on the most recent
scientific information.
(b) Consultation With the Commission.--In preparing the
modified fishery management plan or an amendment to such a
plan as described in subsection (a), the Council shall
consult with the Commission to ensure consistent management
throughout the range of the summer flounder.
(c) Failure to Submit Plan.--If the Council fails to submit
a modified fishery management plan or an amendment to such a
plan as described in subsection (a) that may be approved by
the Secretary, the Secretary shall prepare and consider such
a modified plan or amendment.
SEC. 5. REPORT.
Not later than 1 year after the date of the approval under
section 4 of a modified fishery management plan for the
commercial management of summer flounder or an amendment to
such plan, the Comptroller General of the United States shall
submit to Congress a report on the implementation of such
modified plan or amendment that includes an assessment of
whether such implementation complies with the National
Standards.
______
By Mr. DURBIN (for himself, Ms. Duckworth, Mr. Blumenthal, Mr.
Van Hollen, Mr. Merkley, Mr. Brown, Mr. Sanders, Ms. Smith, and
Mr. King):
S. 916. A bill to improve Federal efforts with respect to the
prevention of maternal mortality, and for other purposes; to the
Committee on Finance.
Mr. DURBIN. Mr. President, I ask unanimous consent that the text of
the bill be printed in the Record.
There being no objection, the text of the bill was ordered to be
printed in the Record, as follows:
S. 916
Be it enacted by the Senate and House of Representatives of
the United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Mothers and Offspring
Mortality and Morbidity Awareness Act'' or the ``MOMMA's
Act''.
SEC. 2. FINDINGS.
Congress finds the following:
(1) Every year, across the United States, 4,000,000 women
give birth, about 700 women suffer fatal complications during
pregnancy, while giving birth or during the postpartum
period, and 70,000 women suffer near-fatal, partum-related
complications.
(2) The maternal mortality rate is often used as a proxy to
measure the overall health of a population. While the infant
mortality rate in the United States has reached its lowest
point, the risk of death for women in the United States
during pregnancy, childbirth, or the postpartum period is
higher than such risk in many other developed nations. The
estimated maternal mortality rate (per 100,000 live births)
for the 48 contiguous States and Washington, DC increased
from 18.8 percent in 2000 to 23.8 percent in 2014 to 26.6
percent in 2018. This estimated rate is on par with such rate
for underdeveloped nations such as Iraq and Afghanistan.
(3) International studies estimate the 2015 maternal
mortality rate in the United States as 26.4 per 100,000 live
births, which is almost twice the 2015 World Health
Organization estimation of 14 per 100,000 live births.
(4) It is estimated that more than 60 percent of maternal
deaths in the United States are preventable.
(5) According to the Centers for Disease Control and
Prevention, the maternal mortality rate varies drastically
for women by race and ethnicity. There are 12.7 deaths per
100,000 live births for White women, 43.5 deaths per 100,000
live births for African-American women, and 14.4 deaths per
100,000 live births for women of other ethnicities. While
maternal mortality disparately impacts African-American
women, this urgent public health crisis traverses race,
ethnicity, socioeconomic status, educational background, and
geography.
(6) African-American women are 3 to 4 times more likely to
die from causes related to pregnancy and childbirth compared
to non-Hispanic White women.
(7) The findings described in paragraphs (1) through (6)
are of major concern to researchers, academics, members of
the business community, and providers across the obstetrical
continuum represented by organizations such as March of
Dimes; the Preeclampsia Foundation; the American College of
Obstetricians and Gynecologists; the Society for Maternal-
Fetal Medicine; the Association of Women's Health, Obstetric,
and Neonatal Nurses; the California Maternal Quality Care
Collaborative; Black Women's Health Imperative; the National
Birth Equity Collaborative; Black Mamas Matter Alliance;
EverThrive Illinois; the National Association of Certified
Professional Midwives; PCOS Challenge: The National
Polycystic Ovary Sundrome Association; and the American
College of Nurse Midwives.
(8) Hemorrhage, cardiovascular and coronary conditions,
cardiomyopathy, infection, embolism, mental health
conditions, preeclampsia and eclampsia, polycystic ovary
syndrome, infection and sepsis, and anesthesia complications
are the predominant medical causes of maternal-related deaths
and complications. Most of these conditions are largely
preventable or manageable.
(9) Oral health is an important part of perinatal health.
Reducing bacteria in a woman's mouth during pregnancy can
significantly reduce her risk of developing oral diseases and
spreading decay-causing bacteria to her baby. Moreover, some
evidence suggests that women with periodontal disease during
pregnancy could be at greater risk for poor birth outcomes,
such as pre-eclampsia, pre-term birth, and low birth weight.
Furthermore, a woman's oral health during pregnancy is a good
predictor of her newborn's oral health, and since mothers can
unintentionally spread oral bacteria to their babies, putting
their children at higher risk for tooth decay, prevention
efforts should happen even before children are born, as a
matter of pre-pregnancy health and prenatal care during
pregnancy.
(10) The United States has not been able to submit a formal
maternal mortality rate to international data repositories
since 2007. Thus, no official maternal mortality rate exists
for the United States. There can be no maternal mortality
rate without streamlining maternal mortality-related data
from the State level and extrapolating such data to the
Federal level.
(11) In the United States, death reporting and analysis is
a State function rather than a Federal process. States report
all deaths--including maternal deaths--on a semi-voluntary
basis, without standardization across States. While the
Centers for Disease Control and Prevention has the capacity
and system for collecting death-related data based on death
certificates, these data are not sufficiently reported by
States in an organized and standard format across States such
that the Centers for Disease Control and Prevention is able
to identify causes of maternal death and best practices for
the prevention of such death.
(12) Vital statistics systems often underestimate maternal
mortality and are insufficient data sources from which to
derive a full scope of medical and social determinant factors
contributing to maternal deaths. While the addition of
pregnancy checkboxes on death certificates since 2003 have
likely improved States' abilities to identify pregnancy-
related deaths, they are not generally completed by
obstetrical providers or persons trained to recognize
pregnancy-related mortality. Thus, these vital forms may be
missing information or may capture inconsistent data. Due to
varying maternal mortality-related analyses, lack of
reliability, and granularity in data, current maternal
mortality informatics do not fully encapsulate the myriad
medical and socially determinant factors that contribute to
such high maternal mortality rates within the United States
compared to other developed nations. Lack of standardization
of data and data sharing across States and between Federal
entities, health networks, and research institutions keep the
Nation in the dark about ways to prevent maternal deaths.
(13) Having reliable and valid State data aggregated at the
Federal level are critical to the Nation's ability to quell
surges in maternal death and imperative for researchers to
identify long-lasting interventions.
(14) Leaders in maternal wellness highly recommend that
maternal deaths be investigated at the State level first, and
that standardized, streamlined, de-identified data regarding
maternal deaths be sent annually to the Centers for Disease
Control and Prevention. Such data standardization and
collection would be similar in operation and effect to the
National Program of Cancer Registries of the Centers for
Disease Control and Prevention and akin to the Confidential
Enquiry in Maternal Deaths Programme in the United Kingdom.
Such a maternal mortalities and morbidities registry and
surveillance system would help providers, academicians,
lawmakers, and the public to address questions concerning the
types of, causes of, and best practices to thwart, pregnancy-
related or pregnancy-associated mortality and morbidity.
(15) The United Nations' Millennium Development Goal 5a
aimed to reduce by 75 percent, between 1990 and 2015, the
maternal mortality rate, yet this metric has not been
achieved. In fact, the maternal mortality rate in the United
States has been estimated to have more than doubled between
2000 and 2014. Yet, because national data are not fully
available, the United States does not have an official
maternal mortality rate.
(16) Many States have struggled to establish or maintain
Maternal Mortality Review Committees (referred to in this
section as ``MMRC''). On the State level, MMRCs have lagged
because States have not had the resources to mount local
reviews. State-level reviews are necessary as only the State
departments of health have the authority to request medical
records, autopsy reports,
[[Page S2051]]
and police reports critical to the function of the MMRC.
(17) The United Kingdom regards maternal deaths as a health
systems failure and a national committee of obstetrics
experts review each maternal death or near-fatal childbirth
complication. Such committee also establishes the predominant
course of maternal-related deaths from conditions such as
preeclampsia. Consequently, the United Kingdom has been able
to reduce its incidence of preeclampsia to less than one in
10,000 women--its lowest rate since 1952.
(18) The United States has no comparable, coordinated
Federal process by which to review cases of maternal
mortality, systems failures, or best practices. Many States
have active MMRCs and leverage their work to impact maternal
wellness. For example, the State of California has worked
extensively with their State health departments, health and
hospital systems, and research collaborative organizations,
including the California Maternal Quality Care Collaborative
and the Alliance for Innovation on Maternal Health, to
establish MMRCs, wherein such State has determined the most
prevalent causes of maternal mortality and recorded and
shared data with providers and researchers, who have
developed and implemented safety bundles and care protocols
related to preeclampsia, maternal hemorrhage, and the like.
In this way, the State of California has been able to
leverage its maternal mortality review board system, generate
data, and apply those data to effect changes in maternal
care-related protocol. To date, the State of California has
reduced its maternal mortality rate, which is now comparable
to the low rates of the United Kingdom.
(19) Hospitals and health systems across the United States
lack standardization of emergency obstetrical protocols
before, during, and after delivery. Consequently, many
providers are delayed in recognizing critical signs
indicating maternal distress that quickly escalate into fatal
or near-fatal incidences. Moreover, any attempt to address an
obstetrical emergency that does not consider both clinical
and public health approaches falls woefully under the mark of
excellent care delivery. State-based maternal quality
collaborative organizations, such as the California Maternal
Quality Care Collaborative or entities participating in the
Alliance for Innovation on Maternal Health (AIM), have formed
obstetrical protocols, tool kits, and other resources to
improve system care and response as they relate to maternal
complications and warning signs for such conditions as
maternal hemorrhage, hypertension, and preeclampsia.
(20) The Centers for Disease Control and Prevention reports
that nearly half of all maternal deaths occur in the
immediate postpartum period--the 42 days following a
pregnancy--whereas more than one-third of pregnancy-related
or pregnancy-associated deaths occur while a person is still
pregnant. Yet, for women eligible for the Medicaid program on
the basis of pregnancy, such Medicaid coverage lapses at the
end of the month on which the 60th postpartum day lands.
(21) The experience of serious traumatic events, such as
being exposed to domestic violence, substance use disorder,
or pervasive racism, can over-activate the body's stress-
response system. Known as toxic stress, the repetition of
high-doses of cortisol to the brain, can harm healthy
neurological development, which can have cascading physical
and mental health consequences, as documented in the Adverse
Childhood Experiences study of the Centers for Disease
Control and Prevention.
(22) A growing body of evidence-based research has shown
the correlation between the stress associated with one's
race--the stress of racism--and one's birthing outcomes. The
stress of sex and race discrimination and institutional
racism has been demonstrated to contribute to a higher risk
of maternal mortality, irrespective of one's gestational age,
maternal age, socioeconomic status, or individual-level
health risk factors, including poverty, limited access to
prenatal care, and poor physical and mental health (although
these are not nominal factors). African-American women remain
the most at risk for pregnancy-associated or pregnancy-
related causes of death. When it comes to preeclampsia, for
example, which is related to obesity, African-American women
of normal weight remain the most at risk of dying during the
perinatal period compared to non-African-American obese
women.
(23) The rising maternal mortality rate in the United
States is driven predominantly by the disproportionately high
rates of African-American maternal mortality.
(24) African-American women are 3 to 4 times more likely to
die from pregnancy or maternal-related distress than are
White women, yielding one of the greatest and most
disconcerting racial disparities in public health.
(25) Compared to women from other racial and ethnic
demographics, African-American women across the socioeconomic
spectrum experience prolonged, unrelenting stress related to
racial and gender discrimination, contributing to higher
rates of maternal mortality, giving birth to low-weight
babies, and experiencing pre-term birth. Racism is a risk-
factor for these aforementioned experiences. This cumulative
stress often extends across the life course and is situated
in everyday spaces where African-American women establish
livelihood. Structural barriers, lack of access to care, and
genetic predispositions to health vulnerabilities exacerbate
African-American women's likelihood to experience poor or
fatal birthing outcomes, but do not fully account for the
great disparity.
(26) African-American women are twice as likely to
experience postpartum depression, and disproportionately
higher rates of preeclampsia compared to White women.
(27) Racism is deeply ingrained in United States systems,
including in health care delivery systems between patients
and providers, often resulting in disparate treatment for
pain, irreverence for cultural norms with respect to health,
and dismissiveness. Research has demonstrated that patients
respond more warmly and adhere to medical treatment plans at
a higher degree with providers of the same race or ethnicity
or with providers with great ability to exercise empathy.
However, the provider pool is not primed with many people of
color, nor are providers (whether student-doctors in training
or licensed practitioners) consistently required to undergo
implicit bias, cultural competency, or empathy training on a
consistent, on-going basis.
SEC. 3. IMPROVING FEDERAL EFFORTS WITH RESPECT TO PREVENTION
OF MATERNAL MORTALITY.
(a) Technical Assistance for States With Respect to
Reporting Maternal Mortality.--Not later than one year after
the date of enactment of this Act, the Director of the
Centers for Disease Control and Prevention (referred to in
this section as the ``Director''), in consultation with the
Administrator of the Health Resources and Services
Administration, shall provide technical assistance to States
that elect to report comprehensive data on maternal
mortality, including oral, mental, and breastfeeding health
information, for the purpose of encouraging uniformity in the
reporting of such data and to encourage the sharing of such
data among the respective States.
(b) Best Practices Relating to Prevention of Maternal
Mortality.--
(1) In general.--Not later than one year after the date of
enactment of this Act--
(A) the Director, in consultation with relevant patient and
provider groups, shall issue best practices to State maternal
mortality review committees on how best to identify and
review maternal mortality cases, taking into account any data
made available by States relating to maternal mortality,
including data on oral, mental, and breastfeeding health, and
utilization of any emergency services; and
(B) the Director, working in collaboration with the Health
Resources and Services Administration, shall issue best
practices to hospitals, State professional society groups,
and perinatal quality collaboratives on how best to prevent
maternal mortality.
(2) Authorization of appropriations.--For purposes of
carrying out this subsection, there is authorized to be
appropriated $5,000,000 for each of fiscal years 2019 through
2023.
(c) Alliance for Innovation on Maternal Health Grant
Program.--
(1) In general.--Not later than one year after the date of
enactment of this Act, the Secretary of Health and Human
Services (referred to in this subsection as the
``Secretary''), acting through the Associate Administrator of
the Maternal and Child Health Bureau of the Health Resources
and Services Administration, shall establish a grant program
to be known as the Alliance for Innovation on Maternal Health
Grant Program (referred to in this subsection as ``AIM'')
under which the Secretary shall award grants to eligible
entities for the purpose of--
(A) directing widespread adoption and implementation of
maternal safety bundles through collaborative State-based
teams; and
(B) collecting and analyzing process, structure, and
outcome data to drive continuous improvement in the
implementation of such safety bundles by such State-based
teams with the ultimate goal of eliminating preventable
maternal mortality and severe maternal morbidity in the
United States.
(2) Eligible entities.--In order to be eligible for a grant
under paragraph (1), an entity shall--
(A) submit to the Secretary an application at such time, in
such manner, and containing such information as the Secretary
may require; and
(B) demonstrate in such application that the entity is an
interdisciplinary, multi-stakeholder, national organization
with a national data-driven maternal safety and quality
improvement initiative based on implementation approaches
that have been proven to improve maternal safety and outcomes
in the United States.
(3) Use of funds.--An eligible entity that receives a grant
under paragraph (1) shall use such grant funds--
(A) to develop and implement, through a robust, multi-
stakeholder process, maternal safety bundles to assist States
and health care systems in aligning national, State, and
hospital-level quality improvement efforts to improve
maternal health outcomes, specifically the reduction of
maternal mortality and severe maternal morbidity;
(B) to ensure, in developing and implementing maternal
safety bundles under subparagraph (A), that such maternal
safety bundles--
(i) satisfy the quality improvement needs of a State or
health care system by factoring in the results and findings
of relevant data reviews, such as reviews conducted by a
[[Page S2052]]
State maternal mortality review committee; and
(ii) address topics such as--
(I) obstetric hemorrhage;
(II) maternal mental health;
(III) the maternal venous system;
(IV) obstetric care for women with substance use disorders,
including opioid use disorder;
(V) postpartum care basics for maternal safety;
(VI) reduction of peripartum racial and ethnic disparities;
(VII) reduction of primary caesarean birth;
(VIII) severe hypertension in pregnancy;
(IX) severe maternal morbidity reviews;
(X) support after a severe maternal morbidity event;
(XI) thromboembolism;
(XII) optimization of support for breastfeeding; and
(XIII) maternal oral health; and
(C) to provide ongoing technical assistance at the national
and State levels to support implementation of maternal safety
bundles under subparagraph (A).
(4) Maternal safety bundle defined.--For purposes of this
subsection, the term ``maternal safety bundle'' means
standardized, evidence-informed processes for maternal health
care.
(5) Authorization of appropriations.--For purposes of
carrying out this subsection, there is authorized to be
appropriated $10,000,000 for each of fiscal years 2019
through 2023.
(d) Funding for State-based Perinatal Quality
Collaboratives Development and Sustainability.--
(1) In general.--Not later than one year after the date of
enactment of this Act, the Secretary of Health and Human
Services (referred to in this subsection as the
``Secretary''), acting through the Division of Reproductive
Health of the Centers for Disease Control and Prevention,
shall establish a grant program to be known as the State-
Based Perinatal Quality Collaborative grant program under
which the Secretary awards grants to eligible entities for
the purpose of development and sustainability of perinatal
quality collaboratives in every State, the District of
Columbia, and eligible territories, in order to measurably
improve perinatal care and perinatal health outcomes for
pregnant and postpartum women and their infants.
(2) Grant amounts.--Grants awarded under this subsection
shall be in amounts not to exceed $250,000 per year, for the
duration of the grant period.
(3) State-based perinatal quality collaborative defined.--
For purposes of this subsection, the term ``State-based
perinatal quality collaborative'' means a network of
multidisciplinary teams that--
(A) work to improve measurable outcomes for maternal and
infant health by advancing evidence-informed clinical
practices using quality improvement principles;
(B) work with hospital-based or outpatient facility-based
clinical teams, experts, and stakeholders, including patients
and families, to spread best practices and optimize resources
to improve perinatal care and outcomes;
(C) employ strategies that include the use of the
collaborative learning model to provide opportunities for
hospitals and clinical teams to collaborate on improvement
strategies, rapid-response data to provide timely feedback to
hospital and other clinical teams to track progress, and
quality improvement science to provide support and coaching
to hospital and clinical teams; and
(D) have the goal of improving population-level outcomes in
maternal and infant health.
(4) Authorization of appropriations.--For purposes of
carrying out this subsection, there is authorized to be
appropriated $14,000,000 per year for each of fiscal years
2020 through 2024.
(e) Expansion of Medicaid and CHIP Coverage for Pregnant
and Postpartum Women.--
(1) Requiring coverage of oral health services for pregnant
and postpartum women.--
(A) Medicaid.--Section 1905 of the Social Security Act (42
U.S.C. 1396d) is amended--
(i) in subsection (a)(4)--
(I) by striking ``; and (D)'' and inserting ``; (D)''; and
(II) by inserting ``; and (E) oral health services for
pregnant and postpartum women (as defined in subsection
(ee))'' after ``subsection (bb))''; and
(ii) by adding at the end the following new subsection:
``(ee) Oral Health Services for Pregnant and Postpartum
Women.--
``(1) In general.--For purposes of this title, the term
`oral health services for pregnant and postpartum women'
means dental services necessary to prevent disease and
promote oral health, restore oral structures to health and
function, and treat emergency conditions that are furnished
to a woman during pregnancy (or during the 1-year period
beginning on the last day of the pregnancy).
``(2) Coverage requirements.--To satisfy the requirement to
provide oral health services for pregnant and postpartum
women, a State shall, at a minimum, provide coverage for
preventive, diagnostic, periodontal, and restorative care
consistent with recommendations for perinatal oral health
care and dental care during pregnancy from the American
Academy of Pediatric Dentistry and the American College of
Obstetricians and Gynecologists.''.
(B) CHIP.--Section 2103(c)(5)(A) of the Social Security Act
(42 U.S.C. 1397cc(c)(5)(A)) is amended by inserting ``or a
targeted low-income pregnant woman'' after ``targeted low-
income child''.
(2) Extending medicaid coverage for pregnant and postpartum
women.--Section 1902 of the Social Security Act (42 U.S.C.
1396a) is amended--
(A) in subsection (e)--
(i) in paragraph (5)--
(I) by inserting ``(including oral health services for
pregnant and postpartum women (as defined in section
1905(ee))'' after ``postpartum medical assistance under the
plan''; and
(II) by striking ``60-day'' and inserting ``1-year''; and
(ii) in paragraph (6), by striking ``60-day'' and inserting
``1-year''; and
(B) in subsection (l)(1)(A), by striking ``60-day'' and
inserting ``1-year''.
(3) Extending medicaid coverage for lawful residents.--
Section 1903(v)(4)(A) of the Social Security Act (42 U.S.C.
1396b(v)(4)(A)) is amended by striking ``60-day'' and
inserting ``1-year''.
(4) Extending chip coverage for pregnant and postpartum
women.--Section 2112(d)(2)(A) of the Social Security Act (42
U.S.C. 1397ll(d)(2)(A)) is amended by striking ``60-day'' and
inserting ``1-year''.
(5) Maintenance of effort.--
(A) Medicaid.--Section 1902(l) of the Social Security Act
(42 U.S.C. 1396a(l)) is amended by adding at the end the
following new paragraph:
``(5) During the period that begins on the date of
enactment of this paragraph and ends on the date that is five
years after such date of enactment, as a condition for
receiving any Federal payments under section 1903(a) for
calendar quarters occurring during such period, a State shall
not have in effect, with respect to women who are eligible
for medical assistance under the State plan or under a waiver
of such plan on the basis of being pregnant or having been
pregnant, eligibility standards, methodologies, or procedures
under the State plan or waiver that are more restrictive than
the eligibility standards, methodologies, or procedures,
respectively, under such plan or waiver that are in effect on
the date of enactment of this paragraph.''.
(B) CHIP.--Section 2105(d) of the Social Security Act (42
U.S.C. 1397ee(d)) is amended by adding at the end the
following new paragraph:
``(4) In eligibility standards for targeted low-income
pregnant women.--During the period that begins on the date of
enactment of this paragraph and ends on the date that is five
years after such date of enactment, as a condition of
receiving payments under subsection (a) and section 1903(a),
a State that elects to provide assistance to women on the
basis of being pregnant (including pregnancy-related
assistance provided to targeted low-income pregnant women (as
defined in section 2112(d)), pregnancy-related assistance
provided to women who are eligible for such assistance
through application of section 1902(v)(4)(A)(i) under section
2107(e)(1), or any other assistance under the State child
health plan (or a waiver of such plan) which is provided to
women on the basis of being pregnant) shall not have in
effect, with respect to such women, eligibility standards,
methodologies, or procedures under such plan (or waiver) that
are more restrictive than the eligibility standards,
methodologies, or procedures, respectively, under such plan
(or waiver) that are in effect on the date of enactment of
this paragraph.''.
(6) Information on benefits.--The Secretary of Health and
Human Services shall make publicly available on the Internet
website of the Department of Health and Human Services,
information regarding benefits available to pregnant and
postpartum women and under the Medicaid program and the
Children's Health Insurance Program, including information
on--
(A) benefits that States are required to provide to
pregnant and postpartum women under such programs;
(B) optional benefits that States may provide to pregnant
and postpartum women under such programs; and
(C) the availability of different kinds of benefits for
pregnant and postpartum women, including oral health and
mental health benefits, under such programs.
(7) Federal funding for cost of extended medicaid and chip
coverage for postpartum women.--
(A) Medicaid.--Section 1905 of the Social Security Act (42
U.S.C. 1396d), as amended by paragraph (1), is further
amended--
(i) in subsection (b), by striking ``and (aa)'' and
inserting ``(aa), and (ff)''; and
(ii) by adding at the end the following:
``(ff) Increased FMAP for Extended Medical Assistance for
Postpartum Women.--Notwithstanding subsection (b), the
Federal medical assistance percentage for a State, with
respect to amounts expended by such State for medical
assistance for a woman who is eligible for such assistance on
the basis of being pregnant or having been pregnant that is
provided during the 305-day period that begins on the 60/th/
day after the last day of her pregnancy (including any such
assistance provided during the month in which such period
ends), shall be equal to--
``(1) 100 percent for the first 20 calendar quarters during
which this subsection is in effect; and
[[Page S2053]]
``(2) 90 percent for calendar quarters thereafter.''.
(B) CHIP.--Section 2105(c) of the Social Security Act (42
U.S.C. 1397ee(c)) is amended by adding at the end the
following new paragraph:
``(12) Enhanced payment for extended assistance provided to
pregnant women.--Notwithstanding subsection (b), the enhanced
FMAP, with respect to payments under subsection (a) for
expenditures under the State child health plan (or a waiver
of such plan) for assistance provided under the plan (or
waiver) to a woman who is eligible for such assistance on the
basis of being pregnant (including pregnancy-related
assistance provided to a targeted low-income pregnant woman
(as defined in section 2112(d)), pregnancy-related assistance
provided to a woman who is eligible for such assistance
through application of section 1902(v)(4)(A)(i) under section
2107(e)(1), or any other assistance under the plan (or
waiver) provided to a woman who is eligible for such
assistance on the basis of being pregnant) during the 305-day
period that begins on the 60th day after the last day of her
pregnancy (including any such assistance provided during the
month in which such period ends), shall be equal to--
``(A) 100 percent for the first 20 calendar quarters during
which this paragraph is in effect; and
``(B) 90 percent for calendar quarters thereafter.''.
(8) Effective date.--
(A) In general.--Subject to subparagraph (B), the
amendments made by this subsection shall take effect on the
first day of the first calendar quarter that begins on or
after the date that is one year after the date of enactment
of this Act.
(B) Exception for state legislation.--In the case of a
State plan under title XIX of the Social Security Act or a
State child health plan under title XXI of such Act that the
Secretary of Health and Human Services determines requires
State legislation in order for the respective plan to meet
any requirement imposed by amendments made by this
subsection, the respective plan shall not be regarded as
failing to comply with the requirements of such title solely
on the basis of its failure to meet such an additional
requirement before the first day of the first calendar
quarter beginning after the close of the first regular
session of the State legislature that begins after the date
of enactment of this Act. For purposes of the previous
sentence, in the case of a State that has a 2-year
legislative session, each year of the session shall be
considered to be a separate regular session of the State
legislature.
(f) Regional Centers of Excellence.--Part P of title III of
the Public Health Service Act is amended by adding at the end
the following new section:
``SEC. 399V-7. REGIONAL CENTERS OF EXCELLENCE ADDRESSING
IMPLICIT BIAS AND CULTURAL COMPETENCY IN
PATIENT-PROVIDER INTERACTIONS EDUCATION.
``(a) In General.--Not later than one year after the date
of enactment of this section, the Secretary, in consultation
with such other agency heads as the Secretary determines
appropriate, shall award cooperative agreements for the
establishment or support of regional centers of excellence
addressing implicit bias and cultural competency in patient-
provider interactions education for the purpose of enhancing
and improving how health care professionals are educated in
implicit bias and delivering culturally competent health
care.
``(b) Eligibility.--To be eligible to receive a cooperative
agreement under subsection (a), an entity shall--
``(1) be a public or other nonprofit entity specified by
the Secretary that provides educational and training
opportunities for students and health care professionals,
which may be a health system, teaching hospital, community
health center, medical school, school of public health,
dental school, social work school, school of professional
psychology, or any other health professional school or
program at an institution of higher education (as defined in
section 101 of the Higher Education Act of 1965) focused on
the prevention, treatment, or recovery of health conditions
that contribute to maternal mortality and the prevention of
maternal mortality and severe maternal morbidity;
``(2) demonstrate community engagement and participation,
such as through partnerships with home visiting and case
management programs; and
``(3) provide to the Secretary such information, at such
time and in such manner, as the Secretary may require.
``(c) Diversity.--In awarding a cooperative agreement under
subsection (a), the Secretary shall take into account any
regional differences among eligible entities and make an
effort to ensure geographic diversity among award recipients.
``(d) Dissemination of Information.--
``(1) Public availability.--The Secretary shall make
publicly available on the internet website of the Department
of Health and Human Services information submitted to the
Secretary under subsection (b)(3).
``(2) Evaluation.--The Secretary shall evaluate each
regional center of excellence established or supported
pursuant to subsection (a) and disseminate the findings
resulting from each such evaluation to the appropriate public
and private entities.
``(3) Distribution.--The Secretary shall share evaluations
and overall findings with State departments of health and
other relevant State level offices to inform State and local
best practices.
``(e) Maternal Mortality Defined.--In this section, the
term `maternal mortality' means death of a woman that occurs
during pregnancy or within the one-year period following the
end of such pregnancy.
``(f) Authorization of Appropriations.--For purposes of
carrying out this section, there is authorized to be
appropriated $5,000,000 for each of fiscal years 2019 through
2023.''.
(g) Special Supplemental Nutrition Program for Women,
Infants, and Children.--Section 17(d)(3)(A)(ii) of the Child
Nutrition Act of 1966 (42 U.S.C. 1786(d)(3)(A)(ii)) is
amended--
(1) by striking the clause designation and heading and all
that follows through ``A State'' and inserting the following:
``(ii) Women.--
``(I) Breastfeeding women.--A State'';
(2) in subclause (I) (as so designated), by striking ``1
year'' and all that follows through ``earlier'' and inserting
``2 years postpartum''; and
(3) by adding at the end the following:
``(II) Postpartum women.--A State may elect to certify a
postpartum woman for a period of 2 years.''.
(h) Definitions.--In this section:
(1) Maternal mortality.--The term ``maternal mortality''
means death of a woman that occurs during pregnancy or within
the one-year period following the end of such pregnancy.
(2) Severe maternal morbidity.--The term ``severe maternal
morbidity'' includes unexpected outcomes of labor and
delivery that result in significant short-term or long-term
consequences to a woman's health.
SEC. 4. INCREASING EXCISE TAXES ON CIGARETTES AND
ESTABLISHING EXCISE TAX EQUITY AMONG ALL
TOBACCO PRODUCT TAX RATES.
(a) Tax Parity for Roll-your-own Tobacco.--Section 5701(g)
of the Internal Revenue Code of 1986 is amended by striking
``$24.78'' and inserting ``$49.56''.
(b) Tax Parity for Pipe Tobacco.--Section 5701(f) of the
Internal Revenue Code of 1986 is amended by striking
``$2.8311 cents'' and inserting ``$49.56''.
(c) Tax Parity for Smokeless Tobacco.--
(1) Section 5701(e) of the Internal Revenue Code of 1986 is
amended--
(A) in paragraph (1), by striking ``$1.51'' and inserting
``$26.84'';
(B) in paragraph (2), by striking ``50.33 cents'' and
inserting ``$10.74''; and
(C) by adding at the end the following:
``(3) Smokeless tobacco sold in discrete single-use
units.--On discrete single-use units, $100.66 per
thousand.''.
(2) Section 5702(m) of such Code is amended--
(A) in paragraph (1), by striking ``or chewing tobacco''
and inserting ``, chewing tobacco, or discrete single-use
unit'';
(B) in paragraphs (2) and (3), by inserting ``that is not a
discrete single-use unit'' before the period in each such
paragraph; and
(C) by adding at the end the following:
``(4) Discrete single-use unit.--The term `discrete single-
use unit' means any product containing tobacco that--
``(A) is not intended to be smoked; and
``(B) is in the form of a lozenge, tablet, pill, pouch,
dissolvable strip, or other discrete single-use or single-
dose unit.''.
(d) Tax Parity for Small Cigars.--Paragraph (1) of section
5701(a) of the Internal Revenue Code of 1986 is amended by
striking ``$50.33'' and inserting ``$100.66''.
(e) Tax Parity for Large Cigars.--
(1) In general.--Paragraph (2) of section 5701(a) of the
Internal Revenue Code of 1986 is amended by striking ``52.75
percent'' and all that follows through the period and
inserting the following: ``$49.56 per pound and a
proportionate tax at the like rate on all fractional parts of
a pound but not less than 10.066 cents per cigar.''.
(2) Guidance.--The Secretary of the Treasury, or the
Secretary's delegate, may issue guidance regarding the
appropriate method for determining the weight of large cigars
for purposes of calculating the applicable tax under section
5701(a)(2) of the Internal Revenue Code of 1986.
(f) Tax Parity for Roll-your-own Tobacco and Certain
Processed Tobacco.--Subsection (o) of section 5702 of the
Internal Revenue Code of 1986 is amended by inserting ``, and
includes processed tobacco that is removed for delivery or
delivered to a person other than a person with a permit
provided under section 5713, but does not include removals of
processed tobacco for exportation'' after ``wrappers
thereof''.
(g) Clarifying Tax Rate for Other Tobacco Products.--
(1) In general.--Section 5701 of the Internal Revenue Code
of 1986 is amended by adding at the end the following new
subsection:
``(i) Other Tobacco Products.--Any product not otherwise
described under this section that has been determined to be a
tobacco product by the Food and Drug Administration through
its authorities under the Family Smoking Prevention and
Tobacco Control Act shall be taxed at a level of tax
equivalent to the tax rate for cigarettes on an estimated per
use basis as determined by the Secretary.''.
(2) Establishing per use basis.--For purposes of section
5701(i) of the Internal Revenue Code of 1986, not later than
12 months after the later of the date of the enactment
[[Page S2054]]
of this Act or the date that a product has been determined to
be a tobacco product by the Food and Drug Administration, the
Secretary of the Treasury (or the Secretary of the Treasury's
delegate) shall issue final regulations establishing the
level of tax for such product that is equivalent to the tax
rate for cigarettes on an estimated per use basis.
(h) Clarifying Definition of Tobacco Products.--
(1) In general.--Subsection (c) of section 5702 of the
Internal Revenue Code of 1986 is amended to read as follows:
``(c) Tobacco Products.--The term `tobacco products'
means--
``(1) cigars, cigarettes, smokeless tobacco, pipe tobacco,
and roll-your-own tobacco, and
``(2) any other product subject to tax pursuant to section
5701(i).''.
(2) Conforming amendments.--Subsection (d) of section 5702
of such Code is amended by striking ``cigars, cigarettes,
smokeless tobacco, pipe tobacco, or roll-your-own tobacco''
each place it appears and inserting ``tobacco products''.
(i) Increasing Tax on Cigarettes.--
(1) Small cigarettes.--Section 5701(b)(1) of such Code is
amended by striking ``$50.33'' and inserting ``$100.66''.
(2) Large cigarettes.--Section 5701(b)(2) of such Code is
amended by striking ``$105.69'' and inserting ``$211.38''.
(j) Tax Rates Adjusted for Inflation.--Section 5701 of such
Code, as amended by subsection (g), is amended by adding at
the end the following new subsection:
``(j) Inflation Adjustment.--
``(1) In general.--In the case of any calendar year
beginning after 2018, the dollar amounts provided under this
chapter shall each be increased by an amount equal to--
``(A) such dollar amount, multiplied by
``(B) the cost-of-living adjustment determined under
section 1(f)(3) for the calendar year, determined by
substituting `calendar year 2017' for `calendar year 2016' in
subparagraph (A)(ii) thereof.
``(2) Rounding.--If any amount as adjusted under paragraph
(1) is not a multiple of $0.01, such amount shall be rounded
to the next highest multiple of $0.01.''.
(k) Floor Stocks Taxes.--
(1) Imposition of tax.--On tobacco products manufactured in
or imported into the United States which are removed before
any tax increase date and held on such date for sale by any
person, there is hereby imposed a tax in an amount equal to
the excess of--
(A) the tax which would be imposed under section 5701 of
the Internal Revenue Code of 1986 on the article if the
article had been removed on such date, over
(B) the prior tax (if any) imposed under section 5701 of
such Code on such article.
(2) Credit against tax.--Each person shall be allowed as a
credit against the taxes imposed by paragraph (1) an amount
equal to $500. Such credit shall not exceed the amount of
taxes imposed by paragraph (1) on such date for which such
person is liable.
(3) Liability for tax and method of payment.--
(A) Liability for tax.--A person holding tobacco products
on any tax increase date to which any tax imposed by
paragraph (1) applies shall be liable for such tax.
(B) Method of payment.--The tax imposed by paragraph (1)
shall be paid in such manner as the Secretary shall prescribe
by regulations.
(C) Time for payment.--The tax imposed by paragraph (1)
shall be paid on or before the date that is 120 days after
the effective date of the tax rate increase.
(4) Articles in foreign trade zones.--Notwithstanding the
Act of June 18, 1934 (commonly known as the Foreign Trade
Zone Act, 48 Stat. 998, 19 U.S.C. 81a et seq.), or any other
provision of law, any article which is located in a foreign
trade zone on any tax increase date shall be subject to the
tax imposed by paragraph (1) if--
(A) internal revenue taxes have been determined, or customs
duties liquidated, with respect to such article before such
date pursuant to a request made under the 1st proviso of
section 3(a) of such Act, or
(B) such article is held on such date under the supervision
of an officer of the United States Customs and Border
Protection of the Department of Homeland Security pursuant to
the 2d proviso of such section 3(a).
(5) Definitions.--For purposes of this subsection--
(A) In general.--Any term used in this subsection which is
also used in section 5702 of such Code shall have the same
meaning as such term has in such section.
(B) Tax increase date.--The term ``tax increase date''
means the effective date of any increase in any tobacco
product excise tax rate pursuant to the amendments made by
this section (other than subsection (j) thereof).
(C) Secretary.--The term ``Secretary'' means the Secretary
of the Treasury or the Secretary's delegate.
(6) Controlled groups.--Rules similar to the rules of
section 5061(e)(3) of such Code shall apply for purposes of
this subsection.
(7) Other laws applicable.--All provisions of law,
including penalties, applicable with respect to the taxes
imposed by section 5701 of such Code shall, insofar as
applicable and not inconsistent with the provisions of this
subsection, apply to the floor stocks taxes imposed by
paragraph (1), to the same extent as if such taxes were
imposed by such section 5701. The Secretary may treat any
person who bore the ultimate burden of the tax imposed by
paragraph (1) as the person to whom a credit or refund under
such provisions may be allowed or made.
(l) Effective Dates.--
(1) In general.--Except as provided in paragraphs (2)
through (4), the amendments made by this section shall apply
to articles removed (as defined in section 5702(j) of the
Internal Revenue Code of 1986) after the last day of the
month which includes the date of the enactment of this Act.
(2) Discrete single-use units and processed tobacco.--The
amendments made by subsections (c)(1)(C), (c)(2), and (f)
shall apply to articles removed (as defined in section
5702(j) of the Internal Revenue Code of 1986) after the date
that is 6 months after the date of the enactment of this Act.
(3) Large cigars.--The amendments made by subsection (e)
shall apply to articles removed after December 31, 2019.
(4) Other tobacco products.--The amendments made by
subsection (g)(1) shall apply to products removed after the
last day of the month which includes the date that the
Secretary of the Treasury (or the Secretary of the Treasury's
delegate) issues final regulations establishing the level of
tax for such product.
____________________