[Congressional Record Volume 165, Number 172 (Wednesday, October 30, 2019)]
[Senate]
[Pages S6271-S6281]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




 COMMERCE, JUSTICE, SCIENCE, AGRICULTURE, RURAL DEVELOPMENT, FOOD AND 
  DRUG ADMINISTRATION, INTERIOR, ENVIRONMENT, MILITARY CONSTRUCTION, 
  VETERANS AFFAIRS, TRANSPORTATION, AND HOUSING AND URBAN DEVELOPMENT 
                        APPROPRIATIONS ACT, 2020

  The PRESIDING OFFICER. The clerk will report the bill by title.
  The legislative clerk read as follows:

       A bill (H.R. 3055) making appropriations for the 
     Departments of Commerce and Justice, Science, and Related 
     Agencies for the fiscal year ending September 30, 2020, and 
     for other purposes.

  Pending:

       Shelby amendment No. 948, in the nature of a substitute.
       McConnell (for Shelby) amendment No. 950, to make a 
     technical correction.

  The PRESIDING OFFICER. The Senator from Texas.


                               Healthcare

  Mr. CORNYN. Mr. President, so far, the 116th Congress has been full 
of a number of dubious measures, as I might characterize them, by our 
friends across the aisle as it relates to our healthcare system.
  For starters, our Democratic colleagues in the Senate and the House 
and on the Presidential campaign trail are hailing Medicare for All as 
the gold standard for healthcare in America.
  I was here during the debates over the Affordable Care Act, and I 
remember President Obama's saying, if you like your policy, you can 
keep it and that if you like your doctor, you can keep your doctor. 
Neither one of those proved to be correct and true. Yet, here, our 
Democratic colleagues have simply given up all pretense and have 
embraced a Medicare for All Program that would outlaw some 180 million 
Americans' private health insurance policies. In other words, the 
policy you get through your employer as part of the fringe benefits of 
your employment would no longer be available under Medicare for All. 
This is, of course, socialized medicine, which ensures long waits for 
substandard care.
  Yes, it is true that I have heard some say: ``Well, it is Medicare 
for All. Who would want it?'' and others say: ``No. I am for the public 
option.'' Both of these are slippery slopes into a single-payer, 
socialized medicine healthcare system that will deny consumers the 
choices they might prefer to make for themselves rather than to leave 
the government to make those choices for them. Not only would this 
trigger a lot of disruption, it would also lead to sharp increases in 
taxes to fund this, roughly, $30 trillion pipedream.
  Last month, Speaker Pelosi managed to take this debate on healthcare 
to the next level. It seems like controlling people's healthcare alone 
isn't enough. Now they want to run the drug industry too. Forget about 
choice. Forget about competition. Forget about innovation. One of the 
things that has characterized the American healthcare system is the 
lifesaving innovation of drugs. The Democrats want to now have the 
Federal Government determine what the formulary is, what drugs are 
available to you. They want to set the prices and ensure the 
bureaucrats rather than families are at the center of our healthcare 
system. They are churning out partisan healthcare bills, one after 
another, and taking their party further and further to the left with 
every move.
  I would like to think, ultimately, cooler heads will prevail in the 
Senate, where we have been working on bipartisan bills to bring down 
healthcare costs. For example, the Senate's Judiciary, Finance, and 
HELP Committees have each passed bipartisan packages of bills to end 
surprise billing so as to

[[Page S6272]]

create more transparency when it comes to pharmaceuticals and increased 
competition, but that doesn't mean this side of the Capitol is immune 
from some of the politics when it comes to our healthcare system.
  Rather than following the Speaker's lead in introducing partisan 
bills, the Democratic leader in the Senate has taken a different tack, 
that of blocking bipartisan consensus bills. For example, there is a 
bill I introduced earlier this year with our colleague from 
Connecticut, Senator Blumenthal, to bring down skyrocketing drug 
prices. Senator Blumenthal is a Democrat, and I am a Republican, but 
contrary to what you may see in the media, that doesn't mean we can't 
talk to each other or work together in the best interests of our 
constituents.
  Because Senator Blumenthal and I both sit on the Committee on the 
Judiciary, we have been looking at the price hikes that have been 
caused by people who game the patent system, specifically something 
called patent thicketing. Some drugmakers build a web of patents that 
is so intricate it is virtually impossible for competition to go to 
market even when the patent on the underlying drug has expired or will 
expire soon. They use these so-called patent thickets to hold 
competitors at bay and keep prices high for as long as possible.
  This is something Senator Blumenthal and I are trying to stop through 
our bill, the Affordable Prescriptions for Patients Act. This 
legislation would disarm those patent thickets and streamline 
litigation by limiting the number of patents companies can use so 
competition can go to market sooner.
  This legislation passed the Senate's Judiciary Committee in June 
without having a single member on either side of the aisle vote against 
it. It was unanimous, which is something that doesn't happen all that 
often in the Committee on the Judiciary. In the past, something with 
this level of support would have quickly sailed through the full Senate 
but not today, not on the minority leader's watch. According to a 
report in POLITICO, the minority leader is blocking this bipartisan 
bill.
  With the House Democrats' obsession of impeaching the President and, 
apparently, their interest in accomplishing nothing else, the odds of 
bipartisan legislation getting done around here are getting slimmer and 
slimmer each day. Rather than seizing the opportunity to pass a bill 
that will provide relief to the folks we represent who struggle with 
the high costs of prescriptions, it is politics 24/7. I am disappointed 
in our colleagues' single-minded obsession with undoing the 2016 
election and removing the President from office. One of the casualties 
of that, though, is the prevention of our being able to pass even 
bipartisan bills to help the American people, the people we represent.
  I ask here, publicly today, for the minority leader to reconsider his 
decision of blocking this bipartisan piece of legislation.
  I am afraid the vote our Democratic colleagues have just forced us to 
take this afternoon shows just how far they are willing to go to prove 
a point, even when the point is not well made, which leaves me with 
little optimism that the minority leader will have a change of heart.
  As we have heard, the Affordable Care Act has what is known as State 
innovation waivers. That is part of what we voted on just a moment ago. 
It is important to reiterate that these innovation waivers, which were 
a part of the Affordable Care Act, enable States to waive some of the 
law's burdensome requirements in pursuit of finding alternative means 
of coverage. States can apply for these waivers to change how insurance 
subsidies are used, for example, and select a combination that better 
fits their States' and their citizens' needs. What works in a State as 
big as mine, with 28 million citizens, isn't, maybe, going to work in 
the same way as in a smaller State--North Dakota or Delaware.
  Washington bureaucrats shouldn't be able to decide what best suits 
the needs of my constituents in Texas. That is why these waivers, which 
are part of the Affordable Care Act, are so important and why, last 
year, the administration gave the States more flexibility to tailor 
their insurance plans to suit their constituents' needs. This does not 
mean, as we have heard, that the States have an entirely free hand. It 
just gives them more flexibility to use Federal dollars where they are 
needed most. Unfortunately, our Democratic colleagues are opposed to 
these expanded innovation options.
  They claim they forced this vote to repeal the rule because it puts 
patients' coverage for preexisting conditions at risk, but that is not 
true. Section No. 1332 does not allow States to waive ObamaCare's 
preexisting conditions' coverage. In fact, these waivers give States 
the ability to provide enhanced support for those with preexisting 
conditions and high healthcare costs. So far, 13 States have been 
approved for these waivers.
  It is worth noting on this chart the 1332 waivers that have been 
issued this year. Colorado has seen a reduction in premiums by 16 
percent; Delaware by 13 percent; Montana by 8 percent; North Dakota by 
a whopping 20 percent; and Rhode Island by 6 percent.
  So with preexisting conditions covered, and with premiums actually 
going down, what is there to object to?
  Well, our Democratic colleagues are simply waging a war against a 
problem that does not exist, but I guess if you say it often enough and 
loudly enough, some people, somewhere, may just believe that coverage 
of preexisting conditions is somehow a partisan issue. It is not. They 
are grasping at straws as their party unfortunately has gone further 
and further to the left on healthcare.
  Well, 10 of the 13 States that received waivers are represented by at 
least one Democrat in the Senate. Why would you vote for a repeal of a 
rule consistent with existing law that would lower premiums for your 
constituents which would require coverage for preexisting conditions 
unless it is your good sense overcome by perhaps politics?
  Our Democratic friends make it seem like coverage of preexisting 
conditions is a partisan issue when it is not. We all agree that 
patients with preexisting conditions should receive health coverage, 
period.
  Earlier this year, I cosponsored a bill introduced by our friend, the 
Senator from North Carolina, Mr. Tillis, called the PROTECT Act, which 
would reaffirm our commitment that no American will ever be denied 
health coverage due to a preexisting condition. We believe that 
coverage for preexisting conditions shouldn't hang in the balance of a 
court decision. It would finally codify what every Member of this body 
says they agree with: That all Americans deserve access to health 
coverage, specifically to cover preexisting conditions.
  All this rule by the Trump administration does is provide the States 
with the flexibility to cater to their citizens' healthcare needs, and 
there simply was no reason to overturn it, and we did not.
  So I would encourage our colleagues to stop daydreaming about pie in 
the sky ideas like Medicare for All--simply unaffordable, absolutely 
unworkable--or a government-run pharmaceutical industry where the 
government sets the prices and says what drugs you or your family can 
get access to.
  Quit trying to fight the President at every turn and every step he 
wants to make. Try to find places where we can work together, and let's 
do that by moving bipartisan legislation that will lower out-of-pocket 
costs for drugs and improve people's quality of life and standard of 
living.
  Mr. President, I yield the floor.
  Mr. DURBIN. Mr. President, I listened carefully to the Senator from 
Texas, my colleague--and we have worked together and will continue to. 
For the record, there is something that I think needs to be mentioned.
  It was a year ago, maybe even longer, that the attorney general from 
his State of Texas initiated a lawsuit with more than a dozen 
Republican attorneys general to eliminate the Affordable Care Act--all 
of it, the protection when it came to preexisting conditions, lifetime 
limits, allowing members of the family to keep their children on their 
policy until they reach the age of 26.
  These States attorneys general, starting with his State of Texas, 
said: Get rid of all of it. Eliminate it. And then President Trump 
said: We will join in the lawsuit. Let's eliminate it completely.
  So when I hear these pleas on the floor that we are all for the 
principles

[[Page S6273]]

in the Affordable Care Act, not a single Republican Senator voted for 
it, and now there is an effort by the attorneys general and the Trump 
administration to do away with it.
  Is it because they have a better idea? No. I am sure you remember 
that moment not long ago when our departed colleague, John McCain, came 
to the well of the Senate and was the deciding vote to save the 
Affordable Care Act. The point he made is still valid. The Republicans 
have no alternative. I want to make sure the Affordable Care Act is 
better. There are some parts of it that need to be improved, but to 
eliminate it as this lawsuit would from the Trump administration? That 
is a step backwards.
  There are two other points that I would like to make. When it comes 
to our current healthcare system, it has many positive things: 
wonderful doctors and hospitals, amazing technology and medicine.
  But there are also some built-in flaws in the system. Let me give an 
example, one simple story. I met a woman the other day. Her sister is 
an OB/GYN. She got married, pregnant, about to have twins, couldn't be 
happier, but the babies came early. And so this doctor went to the 
hospital to deliver her babies, her twins, and they needed to be put in 
the neonatal intensive care unit of the hospital, which of course she 
did.
  Good news. Three or four weeks later, they were ready to come home. 
They came home, and of course, everyone was happy to receive them. But 
they weren't happy to receive the bill for hundreds of thousands of 
dollars. What was it for? It turns out that, at the hospital, the 
doctor was in network for the woman who was delivering the baby. The 
hospital was in the network for delivering the baby. But the NICU was a 
separate entity that even this doctor didn't know it wasn't in network.
  Her babies went to this lifesaving intensive care unit in the 
hospital, and she received a bill for hundreds of thousands of 
dollars--a surprise bill. Is that right? Of course, it is not. And here 
is a professional, a medical professional, who frankly could not ask 
all the right questions, obviously, and became a victim of the system.
  Let me tell you one other story, when we talk about the current state 
of the cost of medicine. I go to Rockford, IL, and I meet a young 
woman, and she introduces me to her mother. Her mother is a waitress, a 
hard-working lady, never took a day off in her life. But she did have 
some health insurance, and her health insurance covered her daughter 
until her daughter reached the age of 26, and then her daughter was on 
her own.
  The problem was her daughter is diabetic, and her mother understood 
that now the cost of insulin, which had been covered by the family 
health insurance, was an individual personal burden for her daughter to 
pay, and the cost of insulin had gone up dramatically during the girl's 
young life.
  In the last dozen years or so, the cost of insulin has gone from $39 
for a vial--one of the most commonly used types of insulin called 
Humalog made by Eli Lilly--from $39 a vial to $329. The mother was in a 
panic. Her daughter was working part-time and just getting started, 
still suffering from diabetes. Her mother was afraid she would not be 
able to afford the insulin, so her mother, a waitress, was taking her 
money and putting it aside to buy vials of insulin, so if her daughter 
started to run short, she would be able to provide her with the 
insulin.
  What is the cost of that same product in Canada? $39--$329 in the 
United States; $39 in Canada. What is the difference? It is the same 
drug made by the same company in the United States. The difference is 
the government of Canada stepped up and said: We are not going to let 
you do this. We are not going to let you run the cost of insulin to the 
high heavens at the expense of people who live in Canada. And Eli Lilly 
said: We will play by your rules, if that is what the Canadian 
Government says.

  So when I hear Senators, like my friend from Texas, get up and talk 
about this terrible invasion of government into our rights, that lady, 
that mother in Rockford would certainly like to have her government--
our government--step up and give her a chance to have affordable 
insulin so she could have peace of mind for her daughter. It is not too 
much to ask.


                             The RELIEF Act

  Mr. President, the reason I came to the floor is because I wanted to 
respond to my friend--because it is a critical topic--but the reason I 
came to the floor is to discuss an issue which is not uniquely 
American, but is truly American.
  For 528 years now in this place called America, we have immigrants 
coming to the shores of our Nation. Starting and following Christopher 
Columbus--if you buy that side of the story, and I do--we have had 
millions come to our shores and they have become part of America. With 
the exception of Native Americans and indigenous people, they have come 
from every corner of this earth to be part of what we call the United 
States.
  You would think, with that history, that we would have a pretty clear 
idea of what our policy should be when it comes to immigration. Sadly, 
you are wrong. We have the most broken immigration system imaginable. I 
have studied it for years and continue to. It is almost impossible to 
understand all of the twists and turns in our immigration system.
  Seven years ago, there were eight of us--four Democrats and four 
Republicans in the Senate--with the leadership of Senator McCain, 
Senator Schumer, and many others, who came together and rewrote the 
entire immigration code, the entire immigration body of law. It took us 
months of meeting every single night, hammering out compromises, 
agreeing to provisions. Then we went to the Judiciary Committee, and 
hundreds of amendments were offered. Senator Sessions of Alabama, I 
think he offered dozens by himself. He wasn't too happy with the bill.
  But we went through that lengthy process, came to the floor of the 
Senate, and faced even more amendments. At the end of the day, though, 
it passed. I believe it was 68 votes on the floor of the Senate. We 
passed comprehensive immigration reform, sent it to the House of 
Representatives, and unfortunately, the Republican leadership would not 
even consider it. They didn't even bring it up for a debate or for an 
amendment.
  So we are stuck today with a broken system, and we are also stuck 
with a system that is rife with politics. I would say, and I think no 
one would contradict us, no President before Donald Trump has really 
made such an issue of immigration--no one.
  It has been an issue in the past, but this President, from the 
beginning of his campaign until the current time, has hammered away at 
immigration constantly, calling those that came from Mexico murders and 
rapists and so many other things that he has done--I can go through the 
long litany of things that have happened. It is pretty clear that, when 
it comes to the policy of immigration, that this administration has 
fallen down and falls short when it comes to immigration.
  Today, I want to address one aspect of this. I am the ranking 
Democrat on the Immigration Subcommittee. Coincidentally, the chairman 
of that Subcommittee in Judiciary is the gentleman from Texas, Mr. 
Cornyn, who just left the floor.
  So far this year, 10 months into this year, our Subcommittee on 
Immigration, despite all the problems, all of the challenges, has had 
one hearing--one hearing. It is a good thing that we are not paid for 
the work that we do because, frankly, we have done little or nothing.
  The Senate Judiciary Committee in the same period of time has only 
voted on one immigration bill. The Republican majority limited debate 
to only 1 hour and didn't allow a single amendment to be offered. It is 
hardly an ambitious effort to make a body of law better.
  It is time for the Immigration Subcommittee to go back to work. 
Today, I sent a letter--joined by every Democrat on the Judiciary 
Committee--asking the Republican Chairman of the Immigration 
Subcommittee, the gentleman from Texas, to hold a hearing on one 
serious problem in our immigration system: the green-card backlog.
  In our broken immigration system, there are not nearly enough 
immigrant visas--legal visas known as green cards--available each year. 
As a result, many of the immigrants to this country are stuck in 
crippling backlogs for years, sometimes decades.

[[Page S6274]]

  Close to 5 million future Americans are in line waiting for green 
cards. Many are living and working in the United States on temporary 
visas, while many are waiting abroad, separated from their families who 
are living in the United States.
  Under current law, only 226,000 family green cards and 140,000 
employment green cards are available each year. Children and spouses of 
lawful permanent residents count against these caps, which further 
limits the availability of green cards.
  The backlogs are really hard on families who are caught in 
immigration limbo. For example, children in many of these families 
``age out'' because they are no longer under the age of 21 by the time 
the green cards are available.
  That is why I have asked the Senator from Texas, Mr. Cornyn, to hold 
a hearing on this issue to consider several pending bills dealing with 
this green card backlog. I have asked him repeatedly. I have asked 
Senator Graham, and I have asked Senator Lee, who is engaged in this 
debate. This will help the Senate to understand the impact of each of 
these proposals before us, to try to reach an agreement.
  That is how the Senate, incidentally, is supposed to work, where the 
committees gather, bring in witnesses, have an open debate, agree on a 
bill, move it forward to the floor, open it to debate on the floor. In 
2013, as I mentioned, I was part of a bipartisan group that showed it 
can work. We need to show it again. Then, our bill went through 
extensive hearings and debate.
  Unfortunately, the senior Senator from Utah, my friend, Mr. Lee, has 
tried to avoid regular order on this question. He does not want it to 
go to committee. I hope he will reconsider. He has come to the floor 
several times to attempt to pass his legislation, S. 386, without any 
debate or chance to offer any amendments. Because he has chosen this 
approach, I have come to the floor today to speak about his legislation 
and mine.
  My concern with Senator Lee's bill is simple. The solution to the 
green-card backlog is obvious: Increase the number of green cards. But 
S. 386, Senator Lee's bill, includes no additional green cards. In 
fact, it has carve-outs for special interests--which are not in the 
original version of the bill that passed by the House--and that will 
cut the number of green cards that are available to reduce the backlog. 
Without any additional green cards, S. 386 will not eliminate the 
backlogs for the immigrants, particularly those from India--and there 
is a large number, over half a million, the nationality with the most 
people in the employment backlog. It will dramatically increase 
backlogs for the rest of the world if we go by Senator Lee's bill.

  Ira Kurzban is one of the Nation's experts on immigration law. He 
took a look at Senator Lee's bill, and he said the backlogs will be 
longer and larger because of it. In fact, over 165,000 Indian 
immigrants currently in line for these visas will still be waiting 10 
years from now.
  Mr. Kurzban has also made it clear that the Lee bill puts some Indian 
immigrants to the front of the line--because they have been waiting the 
longest--at the expense of every other country.

       From 2023 until well into 2030, there will be zero EB-22 
     visas for the rest of the world. None for China, South Korea, 
     Philippines, Britain, Canada, Mexico, every country in the EU 
     and all of Africa. Zero. It would choke off green cards for 
     every profession that isn't IT--healthcare, medical research, 
     basic science, all kinds of engineering; chemists, 
     physicists.

  That is why dozens of national organizations representing many 
immigrant communities oppose the bill introduced by Senator Lee. Groups 
representing Arabs, Africans, Asians, Canadians, Chinese, Greeks, the 
Irish, Italians, Koreans, South Asians, and many, many more have come 
out in opposition to the Lee bill. More than 20 of these groups sent a 
letter in opposition.
  In light of this attempt to pass the Lee bill and the problems it has 
run into, I am offering an alternative to this legislation. My 
alternative is basic and straightforward. It would eliminate the green 
card backlog and treat all immigrants fairly.
  The RELIEF Act, which I introduced with Senator Pat Leahy and Senator 
Mazie Hirono, will treat all immigrants fairly by eliminating 
immigration visa backlogs. The RELIEF bill is based on the same 
comprehensive immigration bill I described earlier. It would lift green 
card country caps, but, unlike S. 386, the RELIEF Act would increase 
the number of green cards to clear the backlogs for all immigrants 
waiting in line for green cards within 5 years. Compare that to S. 386, 
the Lee bill, where more than 165,000 Indian immigrants currently in 
line will still be waiting 10 years from now.
  The RELIEF Act will also keep American families together by treating 
children and spouses of legal permanent residents as immediate 
relatives, just as the children and spouses of citizens are, so they 
won't count against the green card cap. My bill would protect aging-out 
children who qualify for legal permanent resident status based on a 
parent's immigration status.


                   Unanimous Consent Request--S. 2603

  Mr. President, I ask unanimous consent that the Judiciary Committee 
be discharged of S. 2603, the RELIEF Act, and the Senate proceed to its 
immediate consideration; further, that the bill be considered read a 
third time and passed and the motion to reconsider be considered made 
and laid upon the time with no intervening action or debate.
  The PRESIDING OFFICER. Is there objection?
  The Senator from South Dakota.
  Mr. THUNE. Mr. President, the legislation to which the Senator from 
Illinois has referred, Senator Lee's bill--Senator Lee is not able to 
be here to object, so on his behalf, I object.
  The PRESIDING OFFICER. Objection is heard.
  The Senator from Illinois.
  Mr. DURBIN. Mr. President, I am sorry for this objection. I thank the 
Senator from South Dakota for coming to the floor on behalf of the 
Senator from Utah. I have been in communication with the Senator from 
Utah. I hope he will join me in asking for a hearing. This is an issue 
which literally affects hundreds of thousands of people living in this 
country, many of whom have been here for years and decades. Practicing 
physicians in my hometown of Springfield are affected by this debate. 
They want to know what their future will be and the future of their 
children.
  I am trying to find a reasonable way to work out a compromise on 
this, and I stand ready to do so. I hope Senator Lee will join me in 
asking Senators Graham and Cornyn to have a hearing before the 
Judiciary Committee. I want to extend this invitation to Senator Lee to 
join the Senate Judiciary Committee Democrats who signed a letter with 
me today requesting this hearing.
  I am happy to sit down and discuss this issue with the senior Senator 
from Utah or any other Senator. If we work together in good faith, I 
believe we can reach a bipartisan agreement on legislation that can 
pass both Chambers and be signed into law.
  I yield the floor.
  I suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The bill clerk proceeded to call the roll.
  Ms. ERNST. Mr. President, I ask unanimous consent that the order for 
the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.


                            Opioid Epidemic

  Ms. ERNST. Mr. President, just over a year ago, President Trump 
signed into law the most comprehensive and sweeping opioid response 
package in the Nation's history, a piece of legislation that passed 
this body with overwhelming bipartisan support--a rarity in gridlocked 
Washington. The reason we came together was simple: Opioid abuse is 
tearing apart families, straining our law enforcement and emergency 
services, and engulfing our communities. Young mothers with precious 
babies and young people in the prime of their lives are focused on 
fentanyl rather than finding their path toward success.
  This crippling epidemic has touched the lives of Iowans from all 
walks of life and from all areas of our State. We have seen the 
harrowing statistics and the ongoing struggles that many of our loved 
ones face. In Iowa, we also struggle with an ongoing meth epidemic that 
further threatens our communities. In just one of many statistics, the 
number of children put into foster

[[Page S6275]]

care in the United States due to parental drug use nearly doubled from 
2000 to 2017.
  I have heard so many heartbreaking stories from families who have a 
loved one battling addiction.
  A mom from Polk County shared with me her son's 7-year battle with 
addiction and how the vicious disease affects all levels of society, 
including our friends, our neighbors, and in her case, her family. She 
concluded by pleading with Congress to act to end, in her words, ``this 
horrific situation and serious threat to our nation's future.'' 
Families like this are desperate for their loved ones to reach recovery 
and good health before their story ends in tragedy. As is sometimes 
quoted, ``Addiction is a family disease. One person may use, but the 
whole family suffers.''
  It is these heartbreaking stories that propelled me and my colleagues 
to take action. This bipartisan package named the ``SUPPORT Act'' 
expanded treatment and recovery options for opioid addiction, created 
new tools for prevention and enforcement, supported safe disposal of 
opioids, strengthened first responders' training, and provided for the 
safe disposal of unused drugs. It has produced real results for Iowans 
and for folks all across the country.
  Just last week, I had the chance to join the First Lady of the United 
States, Melania Trump, Secretary of Health and Human Services Alex 
Azar, and a number of other administration officials to discuss the 
progress made on opioid abuse, including efforts to reduce the number 
of women using opioids during pregnancy.
  This President and this Republican-led Senate are tackling the opioid 
crisis in a meaningful and thoughtful way, and I couldn't be prouder to 
be associated with this work. In Iowa alone, for instance, we have seen 
the number of deaths from opioids decrease by 19 percent. In September, 
the administration announced $932 million in awards for State opioid 
response grant funding, including over $11 million for Iowa.
  This past Saturday, Iowans from across the State participated in 
another National Take Back Day to raise awareness and encourage the 
safe disposal of unused prescription drugs. Earlier this year, in 
April, when we had another Take Back Day, in my home State of Iowa, 88 
law enforcement officers worked at 135 collection sites throughout the 
State and collected 11,680 pounds of unused prescription drugs. More 
than 135,255 pounds of unused drugs have been collected in Iowa since 
the beginning of the drug take back program.
  I am humbled to say that my bipartisan Access to Increased Drug 
Disposal Act, which was part of the package we passed last year, led 
directly to resources being awarded in Iowa for events like these.
  We should be encouraged by the impact the SUPPORT Act, combined with 
the Trump administration's efforts, have made in the lives of Iowans in 
just 1 year.
  As we continue in our fight, I feel hopeful and determined--hopeful 
that we can help Americans rise above the chains of addiction and 
determined all the more to keep making progress on behalf of families 
across this country.
  I yield the floor.
  The PRESIDING OFFICER (Mr. Perdue). The Senator from Ohio.
  Mr. PORTMAN. Mr. President, I wish to thank my colleague from Iowa 
for her comments and also for her organizing this event this afternoon. 
This is an opportunity for us to talk not only about some of the things 
we have done in the U.S. Congress that are positive in terms of 
addressing the largest drug crisis we have ever faced in our country 
but also about what we need to do going forward and how we need to keep 
our eye on the ball to be sure that we don't see more addiction coming, 
that we don't see some of these new dangers--like crystal meth and 
other drugs--coming up.
  Again, I thank my colleague from Iowa. Iowa has been hard-hit; so has 
Ohio. In fact, in 2017, our opioid overdose rate was about three times 
the national average. We have, unfortunately, been in the top five in 
terms of overdose deaths for most of the last 10 years. We have had 
nearly a dozen Ohioans dying from these dangerous drugs every single 
day. This has now surpassed car accidents as the No. 1 cause of death 
in my home State of Ohio.
  What has happened is, since 2017, with a lot of work from a lot of 
people on the ground, with some help from Washington--about $4 billion 
in new funding that this body has approved and taken the lead on--we 
have begun to make progress.
  Last year, in 2018, Ohio had a 22-percent reduction in overdose 
deaths. This leads the country in reductions, and we are proud of that 
because of the lives that have been saved. But we also realize that we 
came from such a high mark, high watermark, that it is important for us 
to keep the pressure on to continue to make progress.
  What has happened in Ohio is what is happening around the country, 
which is the SUPPORT Act, which was signed into law by the President 
just about 1 year ago, and other legislation, like the Comprehensive 
Addiction and Recovery Act--the CARA legislation--and also the State 
Opioid Response grants, have started to work.
  I see the Senator from Missouri is on the floor today. What they have 
done in the Appropriations Committee to fund these projects is making a 
huge difference back home. I have spent a lot of my time working with 
the community organizations, talking to addicts and recovering addicts. 
I have talked to a couple thousand in the last couple of years alone. I 
will tell you, it is working. What is working are more innovative 
programs back home to close some of these gaps.
  Recently, I had the opportunity to go out with the RREACT team in 
Columbus, OH. They are being funded with a grant of about $800,000 from 
the Comprehensive Addiction and Recovery Act, the CARA legislation. 
Again, this has been funded by the Appropriations Committee, actually, 
at above its authorized level.
  It is working. They are closing an obvious gap, which was that people 
were overdosing, getting Narcan. Our brave first responders were saving 
their lives, and then those people were going back to the community 
they were from--back to the same family or the same group of friends--
and, unfortunately, with the addiction not having been addressed, they 
were overdosing again and, sometimes, again and again and again.
  Often, these first responders--the firefighters back home--will tell 
you: We were saving the same person time and again. Some of that is 
still happening, but what the RREACT team does when there is an 
overdose and when Narcan is supplied--this miracle drug to reverse the 
effects of the overdose--then there is followup. Of course, we should 
have done it years ago, but we are now doing it. I am proud to say, in 
my home town of Cincinnati, OH, Colerain Township, much of this was 
started, but now it is spreading around the country.
  The Columbus RREACT team is one of the best. They go out with 
firefighters, EMS personnel, with law enforcement, plainclothes, with 
social workers, with treatment providers, to the family, to the home--
and I have gone out with them; I have gone to the homes and met with 
these addicts--and they say: Look, we are here to help. We are not here 
to arrest you, but we are here to say that you need to get into 
treatment.
  Unbelievably--and a lot of people are skeptical of this. Here is an 
addict; why would they come forward? But in about 80 percent of the 
cases, in terms of the RREACT team, these individuals say: Do you know 
what? OK, I will try it.
  That is the first step. That is the critical first step--to get into 
treatment and then longer term recovery and begin to turn that person's 
life around, as well as that person's family and that person's 
community because it has devastated all of the above.
  This is what is happening with the Federal legislation funding 
innovative projects back home to close these gaps and to make a 
difference. I am very appreciative of what our team has done here--
Republicans and Democrats alike.
  In the more recent legislation that was just passed, the SUPPORT Act, 
we also included something that focuses exclusively on fentanyl. This 
is really important. It is called the STOP Act. In my subcommittee, we 
did an 18-month investigation of this. We spent a lot of time on it. We 
worked hard to make it bipartisan but also to be sure

[[Page S6276]]

it was something that would actually work. We found out that fentanyl, 
which is the worst of the drugs and the most dangerous, is killing more 
people than any other drug. Even today, with our success on opioids, 
this synthetic opioid is coming almost exclusively from China, and at 
the time we passed the legislation a couple of years ago, it was almost 
exclusively coming through our U.S. mail system--our U.S. mail system. 
This deadly drug was coming into post office boxes and to people's 
homes.
  What we said to the post office was: You have to put some screening 
in place, much like FedEx does or DHS does or DHL or other private 
sector entities. Guess what. They are starting to do that, and it is 
making a big difference. They are now requiring advance electronic data 
from these packages, showing where they are from, where they are going, 
what is in them. This allows law enforcement to target those packages 
and to stop some of this fentanyl coming in.
  Unfortunately, the post office is not doing all it should do. Under 
the legislation, they are supposed to have 100 percent of packages from 
China, as an example, being flagged, being screened, and they are not.
  Right now, we think they are identifying from China about 88 percent 
of the packages. It is not 100 percent yet. Let's get to 100 percent.
  We have also found that the Postal Service, based on a 2019 audit 
this year by the inspector general, identified and pulled about 88 
percent of the packages from China that were flagged. That leaves, of 
course, many packages that are not being flagged. So over 10 percent of 
these packages, the post office can't even find.
  Let's do better. We can do better. It is critical that we continue to 
hold the post office accountable because this is poison coming into our 
communities. That is in this legislation.
  One kilogram of this fentanyl is powerful enough to kill about one-
half million people. That is how powerful this is. It is a true life-
and-death issue.
  We have introduced new legislation in Congress called the FIGHT 
Fentanyl Act in the last week. Why? Because, otherwise, fentanyl, which 
is currently listed as a substance on schedule I--a schedule I drug and 
therefore illegal--is going to come off that list in February of next 
year. We can't let that happen, of course. Let's not do a short-term 
extension. Let's put fentanyl on as a scheduled drug permanently.
  I see more of my colleagues have come to talk about this issue.
  My point, I guess, is very simple. We have done some great things in 
this body to help our governments back home at our State and local 
levels and the nonprofits and people in the trenches who are doing the 
hard work. Let's keep it up. Let's be a better partner. Let's continue 
to provide support through the Comprehensive Addiction and Recovery 
Act, through the Opioid Response grants, through the STOP Act, and 
through other things to be able to give folks back home the tools they 
need to push back against this scourge, against this addiction that is 
devastating our families, our communities. Now we see, with the opioid 
progress having been made, other drugs coming in--particularly, crystal 
meth--directly from Mexico. So it is not just about this; it is about 
being flexible enough to be able to approach that as well. We have new 
legislation on meth that we should also be working on to provide that 
flexibility.

  In the meantime, again, the Appropriations Committee is doing its 
work, sending the funding that is making a difference to save lives in 
our communities.
  I yield back my time.
  The PRESIDING OFFICER. The Senator from Missouri.
  Mr. BLUNT. Mr. President, I want to thank Senator Portman for his 
comments about what we have tried to do to provide the money, but let 
me tell you, having been involved in that part of it, really, before we 
began to pass legislation, nobody was more vigorously active than 
Senator Portman to try to continue to point out the size of this 
problem and that something had to be done. He was out there talking 
about how big a problem this was for the country before other people 
were.
  Thanks to Senator Ernst for bringing this group together today to 
talk about this critical issue as we figure out better ways to deal 
with this terrible scourge of addiction and activity that preys on 
people who have become addicted.
  More than 47,000 lives were lost due to opioids in the United States 
in 2017--47,000 people. More people died of opioid overdoses than died 
in car accidents. The No. 1 cause of accidental deaths changed 
dramatically in the last handful of years. For everybody who died, 
there were hundreds of others who were risking their lives by misusing 
prescription drugs or illegal drugs or, even worse, illegal drugs that 
they had no idea what was in them.
  The fentanyl challenge is so big and so dangerous. It seems to me it 
would be a pretty poor business model to try to have a drug so 
powerful, a product so powerful, that there is a good chance the person 
you are selling it to will never be a customer again because they are 
going to die from taking this drug, often knowing it is an incredibly 
dangerous moment to try to get on a drug-induced high that defies 
anything that has happened to them before. Of course, once you cross 
that line, there is no other line to cross because you are no longer a 
customer. Your life is gone. Your dependency on these drugs, no matter 
how it began, whether it was a high school cheerleading accident or a 
car accident or a running accident or a dental appointment--all kinds 
of ways--and in past decades, people believed prescribing these opioids 
had no danger of addiction and, boy, did we find out that was wrong.
  Now, 3.4 percent of our entire gross domestic product--almost $700 
billion--was impacted and lost by the ongoing opioid crisis in 2018. 
Every State has a problem. Our State, Missouri, has a problem. We have 
seen a steady increase in synthetic opioid use over the last several 
years. This seemed to be moving from east to west, and I was hoping 
that by the time it got to us we would have more information, more 
thinking about it. I think that actually may have happened, but it is 
still bad. We had a 40-percent increase in fentanyl-related overdoses 
from 2016 to 2017.
  Health and Human Services Secretary Azar and I were in Kansas City 
together at the Truman Medical Center to talk about this epidemic--
Truman Medical, the No. 1 provider of uncompensated care in our State. 
We went to the neonatal area and saw babies who had neonatal abstinence 
syndrome, which is affecting a number newborns now, and looked at how 
they were dealing with newborns who were born addicted.
  Truman doctors and leaders there, as well as leaders in other area 
health centers in Kansas City, talked to us about how they were dealing 
with this. We have learned, even in the context of one urban area, that 
there is not necessarily a one-size-fits-all way to deal with this, 
which is why we have tried to focus our money at the Federal level on 
giving States the maximum flexibility they could have, within their 
State and in their State, to come up with what worked in the 
communities they were trying to work with.
  We have provided the money. We haven't found every solution yet, but 
we are on the way, I think, to doing that. We have included flexibility 
for the States to use in funding for treatment, funding for prevention, 
funding for recovery from opioids, and other stimulants.
  In Missouri, Federal funding in the last year has treated 4,000 
people who wouldn't have been treated otherwise. Narcan is more and 
more available at workplaces and other places.
  There is simply more work to do. We need to continue our focus on 
targeting resources toward opioid addiction but also toward behavioral 
health issues. I have said a number of times as we have dealt with this 
that if you don't have a behavioral health problem before you are 
addicted, you absolutely will have one after you are addicted.
  One of the things we have found to be a big advantage in our State is 
that we had the good fortune to be part of this eight-State pilot 
program in which, in a number of locations in our State, regarding 
excellence in mental health, we are treating behavioral health, mental 
health, as we would treat any other health problem. That means you 
would treat it as long as it needs to be treated. There is no 14-day 
limit or 28-day limit. You can be treated just as you would for a 
kidney problem or another cancer problem or any other

[[Page S6277]]

problem, as long as you need it. We are finding great success in 
combining not only the medicated assisted therapy with getting off 
opioids but also the ability to have that mental health component as 
long as it needs to be there.
  We are hoping to continue to work on the facts we have put together 
to determine what happens when you treat behavioral health issues like 
all other health issues, to determine other healthcare costs that 
people have. We are hoping to extend that pilot another 2 years, not to 
make it a permanent Federal responsibility but to be sure that States 
and communities in the future will have the level of evidence they need 
to look at, that there will be enough evidence compiled to show what 
really happens because everybody understands that treating mental 
health like all other health is the right thing to do.
  I think these pilot projects are compiling the evidence to show you 
that not only is it the right thing to do, but actually it is the 
financially responsible thing to do as well.
  Attacking this problem from all levels is critical. We are way beyond 
where we were 5 years ago. We are not where we need to be yet. States 
are trying things, sharing things that work and sharing things that 
don't work and why they didn't work in the communities that tried them. 
So we are going to continue to move forward with this.
  I know Senator Capito is going to speak after me. She is also one of 
the early advocates for doing something about what she saw were 
significant problems that had developed in her State. I was grateful to 
have her advice and her driving this discussion in the way she did.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from West Virginia.
  Mrs. CAPITO. Mr. President, I think it is very impactful for us to be 
discussing today a problem that has hit all of our States.
  Senator Blunt, in his great work not just on the Appropriations 
Committee but in his State of Missouri, has been very active. I think 
we all have. It is a problem that knows no political boundaries.
  Certainly, my State of West Virginia has one of the deepest, 
strongest, and toughest problem. We have the highest rate of opioid-
related deaths per capita. It is not something we wear proudly, but it 
is something that has really forced us to try many innovative things 
and to try to be the leader in the solutions.
  That is a lot of what I am going to talk about today because a lot of 
what we have seen in the SUPPORT Act, from all of our individual 
States, has been incorporated into a national response to what is an 
epidemic around our country that is frightening, scary, and, in my 
view, could almost lead us to losing a generation. This powerful 
reaction we have had to the three pieces of legislation is absolutely 
critical.
  We passed the SUPPORT Act. It was signed into law a little bit over a 
year ago. That was really as an add-on to the Comprehensive Addiction 
and Recovery Act that we passed several years before that, but as my 
part of this discussion today, I want to share the successes that have 
worked in our State and how I think they have been able to be 
incorporated around the country.
  After CARA, we realized that while we did great with money for rehab 
facilities and helping our first responders with Narcan and other more 
immediate problems, there were other things we didn't focus on that we 
really needed to focus on in order to have a comprehensive solution, 
and that is the children--the children who are impacted in a home of 
addiction or exposure to addiction and also the jobs that are being 
lost because of it. So we went back to the drawing board, and we came 
up with the SUPPORT Act, which is landmark legislation where we are 
seeing real results.
  For instance, in my State of West Virginia, the State opioid response 
grants are the grants that really go to every State in a formula 
fashion, where you are supporting treatment centers, drug courts, and 
other responses to the addiction issue, but under the old rule, the 
money was divided up according to your population size. So I started 
talking with Senator Shaheen from New Hampshire--a small State impacted 
more critically, like our State of West Virginia--and saying: Wait a 
minute. Our smaller States are really not getting enough in the State 
opioid response grants to make an impact and to be part of the 
solution. So we pushed hard to change this funding so States that are 
more acutely affected, that have smaller populations, like Montana, 
West Virginia, and New Hampshire, are able to get more funding so we 
can attack the problem where it is the deepest and the most acute.
  It helps with our WVU Comprehensive Opioid Addiction Treatment, the 
COAT, Program, the model they have put together at WVU for medication-
assisted treatment made. It helps with our peer recovery coaches, and 
it has also had a lot of impact on our children and our families.
  What we have also found, like every State here, I am sure--in the 
State of Arkansas, you probably have more kids in foster care than you 
have had in the past because of this issue. According to our West 
Virginia Bureau of Children and Families, approximately 82 percent of 
the children who are in foster care are there because of parents with 
substance abuse-related issues. That is 82 percent of our children, and 
we have thousands more in foster care. It is directly attributable to 
this issue. It doesn't even mention all the grandparents and great-
grandparents, in some cases, who are raising children.
  How do we tackle the ripple effects of this issue? Well, you can 
create something that was also created in West Virginia called the 
Martinsburg Initiative. It is spearheaded by the Martinsburg Police 
Department--a small city very close to DC, the West Virginia part that 
is close to DC--the Berkeley County Schools, and Shepherd University. 
It is a partnership with the Boys & Girls Club of the Eastern 
Panhandle.
  This is based on a CDC study that shows that when children have 
adverse childhood experiences--called ACES--if you can categorize 
children who have adverse childhood experiences, if you can identify 
those children and pay special attention to them through things like 
the Martinsburg Initiative, you can maybe head off issues that could 
come into their future.
  So police officers come to the schools. They mentor the children. I 
met them at the Boys & Girls Club of the Eastern Panhandle and talked 
about the positive influence a police officer, combined with the 
schools, combined with a college student, can have on a young person's 
life--and, in some cases, the most trusted person in their life--if 
they are subject to a home that is filled with drug and opioid 
addiction. We saw the success of this.

  I joined with Senator Durbin--again, across the aisle--to ensure that 
the SUPPORT Act created some of this. We are now taking it the next 
step forward to address these issues in the RISE from Trauma Act, which 
would help us to build the trauma-informed workforce--we don't have 
enough people working in this area--and increase those resources in our 
communities.
  Senator Blunt talked about how important it is to work with babies 
who are born with exposure to drugs. This is also a part of the 
solution that has come from West Virginia, where the baby is taken out 
of the hospital setting to try to address the issues of that first 
trauma in the first days of their life, to try to wean them off of not 
just the exposure to drugs but also to incorporate the family into this 
so they can see what kind of pediatric recovery is needed and what the 
long-term effects might be.
  Senator Portman has been an incredible leader, trying to get rid of 
the fentanyl that comes in that is killing people. Over half of the 
people who die, die of a fentanyl overdose. He is trying to work with 
China and to work with the post office to get the tools to prevent 
illegal fentanyl from entering this country. We have had some success, 
but it is still frustrating. There is too much getting in.
  I chair the Homeland Security Subcommittee on Appropriations. This is 
a big issue for our Border Patrol and our ICE agents to be able to make 
sure we are giving our post office the tools.
  Another thing we did was we passed the INTERDICT Act, which the 
President signed, which will help the CBP and also the post office be 
able to detect fentanyl. It comes in these little packages because it 
is so very lethal.
  A lot of what we have done is Federal funding, but a lot of what we 
have done

[[Page S6278]]

is listen to what our local communities are doing and listen to how 
they are solving problem in States that are highly affected.
  One of our communities of Huntington has really been a leader in 
this. One of the most effective strategies that Huntington has had--and 
Huntington had the highest overdose rate in our State--was to create 
these quick response teams. This is when a person comes into the 
emergency room with an overdose and is discharged, they are then 
contacted within 72 hours by a quick response team from the community. 
A plainclothes police officer, with a health officer or a social 
worker, and, in some cases, a faith-based respondent comes in and says: 
Are you ready for recovery? When you are ready for recovery, this is 
where you go. We are your community. We want to help you. We understand 
where you are. We understand your issues. We are your neighbors, and we 
want to help you.
  This has really already had a very good effect in the city of 
Huntington, in Cabell County, because the overdose rate in that area 
has gone down 26 percent since they instituted the quick response team 
concept. So it is going across the country, and part of that is because 
it is in the SUPPORT Act.
  I have hope for what we have done in West Virginia, but there are way 
too many people and families who are affected by this. There are too 
many lost lives, too much lost time, and too much lost love, quite 
frankly. There are parents of children who can't sleep at night. The 
only night they sleep is when they know their child is incarcerated 
because they don't know if they are going to wake up the next morning. 
There is story after story of just tragedies.
  We are all working together. I think we have a long way to go. I 
think we have hit on some good solutions. We need to keep the ones that 
are working, and the ones that don't work, send them on down the road 
because we know there is no one solution to this very difficult 
problem.
  I am going to continue to fight with my colleagues here today for 
every single person and all those folks whose lives are touched by this 
crisis.
  Do you know what? We are all touched by it. If I ask for a show of 
hands in a townhall meeting and say: Who knows somebody who has been 
touched by this crisis, it is almost unanimous. Everybody raises their 
hands.
  We are going to emerge stronger. I am optimistic, but this is a long 
fight. I am really pleased to join with so many of my colleagues in 
this fight.
  I think my colleague from Arkansas, who has worked hard on this as 
well, is the next one up.
  Thank you.
  The PRESIDING OFFICER. The Senator from Arkansas.
  Mr. BOOZMAN. Thank you, Mr. President.
  I say a special thanks to Senator Capito and all she has done, not 
only in this area but in so many things that affect rural America, 
certainly, being the cochair of the Rural Broadband Caucus. The list 
goes on and on. We do appreciate her leadership.
  Our Nation's opioid epidemic is, unfortunately, a subject we have 
spoken about all too often here and in so many other places. It does 
feel, however, that the tone and tenor of our remarks reflect a much 
more hopeful outlook than many of our previous discussions have had. 
That is because we are making progress in the fight.
  Around this time last year, we came together to overwhelmingly pass a 
comprehensive legislative package that was signed into law by President 
Trump, Democrats and Republicans working together.
  There has been a noticeable difference as a result of this 
comprehensive reform. Law enforcement is now better equipped to stop 
illegal opioids from reaching our communities, and efforts are being 
stepped up at the border to cut off the influx of fentanyl from China. 
More first responders have been trained to administer naloxone, which 
has prevented opioid overdoses from claiming more lives in our 
communities.
  Most importantly, we have saved lives by increasing access to mental 
health and addiction treatment services for those struggling to 
overcome opioid dependence.
  The treatment and recovery aspect of our strategy is the key. Federal 
resources are being deployed nationwide to break the cycle of 
addiction.
  These grants are invaluable for the facilities that give those 
struggling with addiction and their families new hope in the fight 
against opioid abuse. From what I have seen firsthand at treatment 
facilities in Arkansas, these efforts are indeed making a difference. 
They are helping tremendously.
  The impact of this national epidemic has been felt acutely in the 
Natural State. According to the CDC, Arkansas had the second-highest 
prescribing rate over recent years, enough for each Arkansan to have 
one opioid prescription in his or her name.
  It has taken a conscious effort by the State's medical community to 
drive those numbers down by 12 percent over a 4-year period. Limiting 
the amount of dangerous pain pills in circulation is a very positive 
and much needed step, but what about all the expired, unused, and 
unnecessary medications already in circulation?
  That is where Arkansas Take Back comes in. Arkansas Prescription Drug 
Take Back Day events happen twice a year at locations across the State. 
These events are an opportunity for Arkansans to safely dispose of 
unused or expired medications with no questions asked. They also serve 
as an opportunity to further educate the public on the opioid epidemic 
and the importance of proper disposal of medications.

  The 18th Arkansas Take Back this past weekend was another in a long 
line of successful events. According to Arkansas drug director Kirk 
Lane, over 27,000 pounds of pills were collected at the nearly 200 
event day locations and the 200-plus permanent drop boxes across the 
State.
  These events are a heavy lift on the part of many Arkansans. We 
greatly appreciate the efforts of law enforcement agencies across the 
State, as well as their partners--Rotary clubs, prevention resource 
centers, Arkansas Department of Health, and so many others that carry 
out Take Back Day events.
  The hard work to organize these opportunities to properly dispose of 
prescription medications is certainly worthwhile. Research has found 
that the majority of opioid abusers get their drugs from friends and 
family, often lifting pills from a familiar medicine cabinet. When you 
tally the results from the previous events in the State, Arkansas ranks 
third nationally in pounds collected per capita through Take Back. That 
means there are fewer homes in Arkansas where unsecured medications can 
get in the wrong hands.
  I thank my colleagues for sharing similar success stories from events 
in their States. It is important that we highlight these programs. 
Anything we can do to get these dangerous drugs out of circulation 
certainly can help save lives. It is also a valuable reminder that we 
will all have a role to play in the fight to end the opioid crisis. 
Prescription Drug Take Back Day is an easy way each one of us can 
certainly do our part.
  I yield the floor to my good friend Senator Hoeven, whose leadership 
is also very important.
  The PRESIDING OFFICER. The Senator from North Dakota.
  Mr. HOEVEN. Mr. President, I thank the Senator from Arkansas for his 
work and also my other colleagues, those who have already spoken and 
the good Senator from Montana, who is going to speak right after. This 
really has been a bipartisan effort to make a difference, and I 
appreciate all my colleagues who are here today and who have done so 
much to advance this work, as well as the Senator from Kansas, who I 
believe will be speaking here in just a minute.
  I join my colleagues today to discuss our Nation's effort to battle 
the opioid abuse epidemic that has taken far too many lives and has 
affected communities both large and small. Our first responders, law 
enforcement officers, healthcare professionals, and medical facilities 
are fighting this crisis on the frontlines. That is why we worked to 
advance a comprehensive approach that assists these key players and 
empowers States and localities to combat this public health emergency.
  Last year, Congress passed and the President signed into law 
bipartisan legislation--the SUPPORT Act--to help families and 
communities impacted by addiction. This law supports

[[Page S6279]]

prevention, treatment, recovery, and law enforcement efforts.
  Additionally, the SUPPORT Act contains language that I was able to 
cosponsor to prevent the sale and shipment of illicit and dangerous 
drugs. This aligns with the goals of my Illegal Synthetic Drug Safety 
Act, which closes a loophole that has enabled bad actors to circumvent 
the law to distribute synthetic variations of drugs, like the powerful 
drug fentanyl, by labeling the products as ``not for human 
consumption.'' While these variations are technically different, they 
hold the same dangerous risks as the original drug.
  The law also includes the Synthetic Tracking and Overdose Prevention 
Act, or STOP Act--another measure I cosponsored that requires shipments 
from foreign countries sent through the U.S. Postal Service to provide 
electronic data. This enables CBP to better target illegal substances 
like fentanyl and prevent them from being shipped into our country from 
places like China and other countries.
  These measures are important steps in keeping deadly drugs like 
fentanyl out of our communities; nevertheless, there is more to do, and 
we continue working to combat the opioid abuse epidemic from all sides. 
Just this week, I co-led a letter with Senator Shaheen encouraging the 
FAA to work with airlines to get opioid overdose reversal drugs like 
Naloxone included in the airlines' emergency medical kits.
  As chairman of the Senate Ag-FDA Appropriations Subcommittee, I 
worked to secure $20 million in our fiscal 2020 funding legislation to 
support telemedicine grants that will help rural communities to combat 
opioid abuse as well.
  Additionally, as a member of the Senate Appropriations Committee, I 
have supported the good work of Senator Blunt, the chair of the Labor-
HHS-Education Appropriations Subcommittee, to provide strong support 
for opioid abuse prevention, treatment, and recovery initiatives 
through the Department of Health and Human Services. The Labor-HHS-
Education bill provides $3.9 billion for such efforts, including $800 
million for the National Institutes of Health to develop pain 
management alternatives to opioids, as well as to study opioid 
addiction, and $200 million to support the great work done by our 
community health centers, to enable them to expand prevention and 
treatment services and provide access to opioid overdose-reversal 
drugs.
  Also, these bills include language I helped author that places a 
focus on addressing the challenges facing rural communities struggling 
with this ongoing crisis. The bill gives States greater flexibility in 
how they can use opioid abuse funds, including allowing some resources 
to be used to address stimulants like meth, which remains a substance 
of high concern in many of our rural States, including my own.

  We need to move forward with the Labor-HHS appropriations bill and 
the other full-year funding bills, including the Defense appropriations 
bill, which I believe we will be voting on this week, because they are 
vital to our national security and provide certainty for our military 
and our servicemembers.
  Passing these full-year appropriations bills will ensure that we fund 
important priorities, from national security to vital support for our 
ag producers, to combatting the opioid abuse epidemic we are talking 
about here today.
  We worked hard to pass the SUPPORT Act to provide our healthcare 
providers, first responders, and law enforcement with the tools to 
prevent drug abuse, treat those suffering from addiction, and assist 
those in recovery.
  While progress is being made, we need to continue working together to 
advance full-year funding bills to keep moving the ball forward in the 
fight against opioid abuse. We can combat the epidemic, stem its tide, 
and save lives.
  I again want to commend my colleagues and will defer to my colleagues 
from Montana and Kansas.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Montana.
  Mr. DAINES. Mr. President, just over a year ago, President Trump 
signed into law a major bipartisan bill, the SUPPORT Act, to help 
combat the opioid and drug epidemic that is devastating this country. I 
call that a very good first step in this long fight, and now we must 
continue working to do even more.
  Drug overdoses are now the leading cause of death for those under age 
50 in the United States. Our country is in the middle of a major opioid 
and meth crisis, and the sad reality is, this epidemic isn't slowing 
down anytime soon. It has been said that meth is the next wave of the 
opioid crisis.
  Sadly, in my home State of Montana, that wave is already reality. 
Meth is destroying Montana families and communities. As I travel across 
Montana, I hear far too many heartbreaking stories of addiction and 
tragedy. From Great Falls to Wibaux, to the Flathead and across Indian 
Country, the stories are all too real.
  We need to do more to put an end to the tragic stories we are seeing 
in the news--no more stories of babies being born addicted to meth; no 
more stories of meth breaking up families; no more stories of babies 
being left in the forest--literally left in the forest--because their 
parents were high on meth. These stories are real, and their impacts 
are real.
  Montana's meth crisis is claiming lives, breaking up families, and 
leaving our foster care systems overcrowded and sometimes overloaded. 
It is leading to a significant rise in violent crime. In fact, from 
2011 to 2017, there was a 415-percent increase in meth cases in 
Montana, with meth-related deaths rising 375 percent during those same 
years.
  In Montana, the meth crisis is disproportionately impacting Native 
American Tribes. Enough is enough. That is why I fought to include my 
legislation, the Mitigating METH Act, which strengthens Indian Tribes' 
ability to combat drug use, in the SUPPORT Act that was signed into law 
just last year.
  That historic and comprehensive legislation was a great first step, 
but there is a lot more work that needs to be done, and tangible things 
can be done.
  In Montana--we are a northern border State, but we have a southern 
border crisis. I say that for a very clear reason. There is no denying 
the fact that the meth that is invading Montana and that is devastating 
Montana is Mexican cartel meth. It is not homegrown meth anymore; it is 
Mexican cartel meth that is smuggled across the southern border.
  Mexican meth is cheaper and more potent. In fact, several years ago, 
the meth we saw in Montana was homegrown meth. It had potency levels 
around 25 percent. Today, the Mexican cartel meth has a potency level 
of over 90 percent. That results in a much more dangerous form of meth. 
It is much more widespread, and the price has dropped.
  I have met with Montanans across our State--whether it is law 
enforcement, doctors, nurses, treatment facility professionals--to come 
together, to work together, and to help combat the meth crisis we see 
in Montana. I am committed to fighting for more resources that give law 
enforcement and Border Patrol the tools they need to fight this 
epidemic. I will also continue to advocate for stronger support for 
treatment and care for our most vulnerable. Those who are addicted to 
meth need help, and they need compassion.
  One thing we absolutely must do to help combat the drug epidemic is 
to secure our southern border because without secure borders, these 
illegal drugs and meth will continue to come across that southern 
border and have easy access into our country and into States like 
Montana. I won't stand by and let this be the norm.
  Earlier this summer, I was honored to welcome Vice President Pence 
and Karen Pence to Billings. They got to see this crisis firsthand. 
They got to hear directly from law enforcement and Montana families 
impacted by the crisis. I saw Vice President Pence and Mrs. Pence 
sitting around a table inside a facility that is helping moms who are 
addicted to meth and who are working with moms and their children to 
get better. They were telling their stories about how they have gotten 
better through treatment at the Rimrock Foundation facility there in 
Billings and starting out a much brighter chapter in their lives 
because of the help provided from Rimrock.
  I stand with President Trump. I stand with his administration as we

[[Page S6280]]

work together to secure our borders and protect our communities from 
illegal drugs and to end this crisis.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Kansas.
  Mr. ROBERTS. Mr. President, I thank all of my colleagues and 
especially Senator Daines for pointing out what is happening in rural 
and smalltown America. As a matter of fact, most of my colleagues--
Senator Hoeven, Senator Capito, Senator Daines, Senator Boozman, 
Senator Blackburn--all represent large States, and we represent cities, 
of course, but also rural and smalltown America. I thank them for their 
concerted efforts. We have all been working together.
  I thank Senator Hoeven more particularly for his work on funding, as 
he is the distinguished chairman of the Senate Agriculture 
Appropriations Subcommittee, and I echo his support for getting these 
appropriations bills done.
  I just want to talk and add to their comments about this national 
issue of immediate concern, substance abuse and opioid addiction. I 
think it is timely because just 1 year ago, the President of the United 
States signed the SUPPORT for Patients and Communities Act into law. 
This was the legislation that was the culmination of months of 
bipartisan work. I emphasize the word ``bipartisan.'' We talk about it 
a lot but seldom see it. This is one effort that we got done. This 
moved across several committees and both Chambers of Congress. So I 
think it is something we can take great pride in, showing folks back 
home that we can actually do something together.
  I am proud to be part of this effort on behalf of both the Finance 
and HELP Committees in the Senate. The legislation included a bill I 
introduced to encourage the use of electronic prior authorization in 
Medicare Part D, which would help overcome one of the primary 
challenges to patients receiving their medications, including 
treatments for substance abuse disorders and non-opiate alternatives to 
treating pain.
  The SUPPORT Act also included our language that would help shed light 
on the best practices and the barriers to using telehealth for treating 
substance abuse disorders in children who are covered under Medicaid. 
It will also focus on how we can utilize telehealth to help children in 
rural and underserved areas, including how treatment can be offered in 
school-based settings. All of us who have spoken on this issue have the 
same problem.
  In last year's farm bill, the Senate Agriculture Committee, of which 
I am proud to be chairman, also included provisions to help those 
suffering from substance abuse disorders, primarily in our rural areas. 
We prioritized funding in the community facilities and distance 
learning telemedicine programs for projects focused on treating 
addiction, including opiates.
  I am proud of these efforts, but there is so much work left to do to 
combat addiction. This is a real epidemic as has been stressed by my 
colleagues.
  Real progress starts at the local level. In my home State of Kansas, 
we continue to need assistance in preventing meth use, as was so 
eloquently discussed by my colleague from Montana, Senator Daines.
  We still have use and abuse taking a heavy toll on many communities 
throughout the State. Patients suffering from addiction in rural parts 
of the country face many challenges in accessing the clinical services 
they really need. We have heard from many Kansans who have to travel 
long distances, sometimes across State lines, in order to access 
substance abuse treatments.
  I recently spoke with many Kansas district attorneys for a second 
year in a row. Last year they came in, and I thought they were going to 
talk about the criminal justice act that we had just passed. No, they 
wanted to talk about meth. I said: Well, wait a minute, I thought we 
made some real progress in eliminating the meth labs in Kansas.
  That is the case, but for a second year in a row, they pointed out 
again the meth coming in from Mexico, which was demonstrated by Senator 
Daines. There was a tremendous concern over this kind of meth, which is 
so much more powerful. Their No. 1 concern was individuals in many 
parts of the State who were suffering from addiction and constantly 
cycling through the court system and clogging up the courts. These 
individuals often do not have access to substance abuse treatments that 
can help control their addiction and keep them out of the criminal 
justice system.
  That is why I introduced this year the Meth Addiction Act. All of us 
have individual acts, and we also hope that we can meld them together. 
This is a bill to extend the reach of these treatments to more people 
who so desperately need them. Our bill would allow our community mental 
health and addiction treatment facilities to connect patients via 
telehealth to physicians who are authorized to prescribe the controlled 
substances that treat addiction. This would help to empower local and 
rural providers to use every tool necessary to combat this epidemic.
  In addition, last year, I had the privilege of attending a drug take-
back event in Kansas, hosted by Walgreens and Blue Cross and Blue 
Shield of Kansas. This is the kind of local initiative that is 
especially important, as we have consistently heard about the 
importance of preventing diversion as one way of combating this 
epidemic.
  At the same time, we must be careful and make sure that efforts to 
address the problem do not deny patients the controlled substances if 
they have a legitimate and clinical need for these treatments. That is 
why safe disposal of these medications is such an important tool in 
solving this very complex issue. This initiative offers people year-
round options to help to prevent diversion of addictive medications to 
their friends and loved ones, without limiting access to treatment.
  Finally, I would like to recognize that 2 weeks from now, the city of 
Topeka, KS, the capital of Kansas, is hosting the Kansas Opioid 
Conference. The people who are truly on the frontlines of the opioid 
crisis in Kansas will be in attendance to address these issues through 
all sorts of collaborative efforts at the State level and the local 
level. They are the ones who will help us find the solution that will 
help us make real and lasting progress against this epidemic.


                      Unanimous Consent Agreement

  Mr. President, I have this important message from a very important 
staff member.
  I ask unanimous consent that the Senate now recess from 3 until 4 
p.m. today for a briefing.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  The Senator from Oregon.


                         Remembering Kay Hagan

  Mr. MERKLEY. Mr. President, I am deeply saddened to hear the news on 
Monday of the death of our former colleague, Kay Hagan.
  She is the sister, the wife, and the aunt of Navy veterans; daughter-
in-law to a two-star Marine Corps general; daughter of a former Florida 
mayor; and niece to a former U.S. Senator and Governor. Service was in 
Kay Hagan's veins.
  She spent an early career in financial services, but it was only a 
matter of time until she decided to get directly engaged in public 
policy.
  In office, she was a fierce and unwavering advocate for our men and 
women in uniform, a staunch fighter for the right of every American to 
have healthcare, and a warrior for women and children. The people of 
North Carolina and the people of the United States are far better off 
because of her years of service in the North Carolina Senate and the 6 
years in the U.S. Senate.
  When she was here she worked on so many different issues. She 
immersed herself in trying to assist our military personnel. She was 
the founding member of the Military Family Caucus. She championed the 
program that offers education support for military spouses. She 
cosponsored the repeal of don't ask, don't tell, and she drove the 
investigation of the contamination of water at Camp Lejeune and 
legislation to rectify that.
  She introduced the Hire a Hero Act to try to enable our veterans to 
get jobs and make that transition from military service to civilian 
life. She led the effort for overdue recognition of African-American 
marines who were forced to train at a separate camp outside Camp 
Lejeune, and that led them to being awarded the Congressional Gold 
Medal.

[[Page S6281]]

  When it came to women and children, she was there every day in that 
fight--the fight for a stronger Violence Against Women Act and the 
fight for the Lilly Ledbetter Fair Pay Act, so women can be paid 
commensurate with their male colleagues. She authored the Newborn 
Screening Saves Lives Act to maintain and continue the support for 
mandatory screening for newborns.
  She fought for workers and middle-class America and manufacturing 
jobs for Americans and for equal opportunity by sponsoring the 
Employment Nondiscrimination Act, which passed on the Senate floor 6 
years ago.
  She proceeded to work on banking and financial issues. She was the 
lead on the SAFE Act Confidentiality and Privilege Enhancement Act, 
which had to do with some of the nitty-gritty of mortgage licensing. 
She worked to ensure that groups like Habitat for Humanity could lend 
money on a zero-interest loan to their homeowners and be able to do so 
without violating the legal precepts of American law. It was issue 
after issue.
  When I think of her journey, I think about the parallel structure 
between her life and mine, in that she ran for the legislature in North 
Carolina the same year that I ran for the legislature in Oregon. I won 
a seat in the Oregon House and she won a seat in the North Carolina 
Senate. We both spent 10 years there. We both then decided that we 
should attempt to take our philosophy of fighting for the people to the 
U.S. Senate. We threw our hats into the ring at the same moment, 
running campaigns against incumbent Senators, and we both won.
  I recall how every time I checked on how she was doing, she was 
always doing 5 to 10 points better than I was, and I just kept 
thinking: I just have to follow Kay Hagan's example. Then, before the 
campaign was over, she called me up one day, and we hadn't actually met 
much or talked much, and she said: I just want to check in on how you 
are doing.
  We connected and bonded over our parallel paths and the fight we were 
in, which was such an intense effort of campaigning with the desire and 
determination to make this country a better place.
  Of course, as I have noted, when she got here, she threw herself into 
so many aspects of our national life and our legal structure. I was 
pleased that we were both assigned by Senator Kennedy to the Health, 
Education, Labor, and Pensions Committee. We were able to work on the 
ACA, or the Affordable Care Act, to try to greatly increase health 
coverage and make it more affordable and available throughout America--
really important for the people of North Carolina, the citizens of my 
State, and citizens across this country.
  Then, we were both assigned to the Banking Committee, and it was 
Dodd-Frank. We worked on questions such as how do we end some of the 
predatory lending practices? Both of us worked on payday-loan predatory 
actions, where interest rates could be 500 percent. We knew the damage 
done to our families across the country. We didn't succeed on that 
particular piece of legislation--the payday loan piece--but we were 
stemming in this fight from the same place. I so applaud her 
determination to end predatory practices and lending.

  Many of the things that we were fighting for did get into Dodd-Frank 
in terms of fairness and mortgages so that homeownership would be a 
dream of homeownership that would result in equity for middle-class 
Americans rather than a nightmare of homeownership, in which interest 
rates would double after 2 years, and the family would go bankrupt, and 
they would be foreclosed on and could lose their house.
  Apart from all of that, Kay was such a beautiful voice and spirit in 
this Chamber--cheerful, determined, thoughtful, gracious. She just made 
you enjoy being here.
  I also think about her, as when she served, she was the healthiest 
Member of this Chamber. She paid a lot of attention to the diet she 
ate, the food she ate, how she exercised, how she brought balance to 
her life. That, too, was an inspiration to us.
  Here we find that our journeys on this planet are pretty precarious. 
We never know what is going to happen on the next day or the next week. 
I think it is a reminder to all of us to use our moments wisely, to 
treat each other with the sort of graciousness she exemplified--this 
sort of spirited fighting for ``we the people,'' the people of the 
United States for whom she was determined to deploy and champion on the 
floor of the Senate.
  Her illness and her death are a real loss to all of us. It is 
important that we carry her in our hearts. She certainly has a place 
solidly secured in my heart and, I think, the hearts of everyone who 
served with her.

                          ____________________