[Congressional Record Volume 165, Number 176 (Tuesday, November 5, 2019)]
[Senate]
[Pages S6376-S6378]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]



                               Healthcare

  Mr. DURBIN. Madam President, I come to the floor today to discuss an 
issue that is important in my State and I think in every State.
  Illinois, which I represent and am proud to represent, is a State 
with the great American city of Chicago but with many other towns and 
cities of a variety of different sizes.
  I actually was born in downstate Illinois, 300 miles away from 
Chicago. Between the great city of Chicago and the rest of our State, 
there are many small towns and rural areas. When you go into these 
areas and talk about the quality of life and living in a small town or 
rural America, there are a lot of challenges.
  Just a few weeks ago I was in Calhoun County, one of the smallest in 
our State. We had an assembly of kids in middle school and grade 
school, and we announced that the local electric cooperative, the 
Illinois Electric Cooperative, was finally going to bring that level of 
access to the internet for which Calhoun County--the people who live 
there and those students--have been waiting for a decade or longer. It 
took longer for it to reach there.
  I am glad the electric cooperative led the fight. Historically, the 
electric cooperatives literally brought electricity to rural America. 
Now they are bringing high-speed internet to rural America, and it is 
critically important for students to learn, along with all of the other 
services that many people living in big cities take for granted come 
with the internet.
  That is one example, but another one you run into all the time is the 
comments of people in smalltown America about access to healthcare. You 
see, across our State we have millions of people who live in smaller 
towns, rural towns, who don't have the same quality healthcare nearby, 
whether it is a hospital or a doctor or even a dentist. Across 
Illinois, 5 million people live in areas with shortages, and 2 million 
live in areas without a dentist. Almost all of them live in an area 
without access to mental health providers--counselors, psychologists.
  The consequences speak for themselves. Only 1 in 10 people with 
substance abuse disorders get the care that they need in these areas, 
and 43 percent of rural Americans do not have access to dentists--43 
percent.
  Well, there is a Federal program that has been addressing it for a 
long time, and, coincidentally, the Presiding Officer from Tennessee is 
the cosponsor of legislation I am going to address at this moment.
  Today there is a Federal program in place called National Health 
Service Corps. It provides loan forgiveness to entice doctors and other 
healthcare professionals to serve in places with healthcare needs. In 
total, 10,000 doctors, dentists, behavioral health specialists, and 
nurses use the National Health Service Corps and treat 11 million 
Americans each year in hospitals and community clinics.
  We entice them to come to these underserved areas by paying off their 
loans. As you probably know, doctors and dentists and nurses and others 
end up graduating with a lot of student loans.
  Illinois has more than 550 of these National Health Service Corps 
clinicians, but fewer than 75 of them serve in rural areas. As we face 
an opioid epidemic that touches every corner of America--no city too 
large, no town too small, no suburb too wealthy to have escaped it--we 
need that kind of professional healthcare across the board in urban 
areas as well as rural areas. That is why I have teamed up with the 
Presiding Officer, Senator Blackburn of Tennessee, on a bipartisan 
piece of legislation that we call the Rural America Health Corps Act.
  Our bill will expand the current Corps program to provide new loan 
forgiveness funding for providers who will serve in rural areas in 
Tennessee, in Illinois, and across the Nation. It provides funding for 
5 years rather than the usual 2 to ensure that doctors, dentists, and 
nurses plant their roots in rural America.
  With the National Health Corps up for reauthorization this year, 
Senator

[[Page S6377]]

Blackburn and I are pleading with our friends, Chairman Lamar Alexander 
of Tennessee and Ranking Member Patty Murray of Washington, to promote 
this rural focus.
  It isn't the only thing I have looked at when it comes to rural 
America. I recently introduced a bill with Senator Roberts of Kansas. 
Senator Roberts is chairman of the Senate Agriculture, Nutrition, and 
Forestry Committee, and he agreed to include in the farm bill something 
called the SIREN Act.
  The SIREN Act provides funding to support rural fire and EMS agencies 
with training and recruiting staff and purchasing equipment--everything 
from naloxone to power stretchers.
  I recently visited Nauvoo, IL. Students of history may recognize the 
name of this town, but Nauvoo, IL, is where a man by the name of Mr. 
Kennedy came forward and told me about the need for new, modern 
equipment on their ambulances in this rural Hancock County area.
  Because of what he told me, I introduced the bill. It passed as part 
of the farm bill, and we are going to start making money available in 
rural parts of America for these emergency management specialists to 
have the right training and the right equipment to respond when needed.
  These bipartisan bills are important for rural healthcare, but we 
also have to maintain the structure of our key health programs.
  Thankfully, Illinois has expanded the Medicaid Program through the 
Affordable Care Act, which has provided a funding lifeline to keep many 
of our rural hospitals from the brink of closure. It also expanded 
health insurance to 1 million people in Illinois.
  Ten years ago, when we passed ObamaCare, the Affordable Care Act, too 
many Americans did not have health insurance.
  If you have ever been in a moment in your life when you were the 
father of a sick child who desperately needed medical care and you had 
no health insurance, you will never forget it as long as you live. I 
know. I have been there. It made an impression on me as a young father 
that I have never forgotten.
  So when this bill, the Affordable Care Act, passed and I saw so many 
Americans finally getting health insurance, I knew it was giving them 
peace of mind and access to affordable, quality, accessible healthcare.
  This week marks the beginning of the open enrollment period to sign 
up for healthcare under the Affordable Care Act, which ends on December 
15. It is vital to make sure that everyone signs up at 
``healthcare.gov'' if you are not currently covered and you want to 
know what is available to you. Most patients will find the premiums are 
less than $100 a month, and if you are in certain income categories you 
will get a lot of help in making the premium payment.
  But the No. 1 thing that I hear from constituents--and it has nothing 
to do with what I just mentioned. I listened to my friend from Iowa, 
Republican Senator Chuck Grassley, on the floor a few minutes ago 
talking about an issue that each of us runs into in every State in the 
Union. Here is the question: If you ask the American people what is the 
issue that you are concerned about from an economic viewpoint that you 
think the Congress can do something about, 90 percent of Democrats, 90 
percent of Republicans, 90 percent of Independents all come back with 
the same answer. Do you know what it is? The cost of prescription 
drugs. People understand that these prescription drugs are so 
expensive, they are beyond the reach of many people who desperately 
need them.
  Now, there was a Senator from Wisconsin years back named William 
Proxmire. He used to issue monthly recognitions of the most flagrant, 
excessive examples of waste in the Federal Government. He called it the 
``Golden Fleece.'' Earlier this year, I launched a series of awards to 
carry on Senator Proxmire's work, with the focus on the pharmaceutical 
industry, the people who make the drugs.
  This month, I had this sign produced. This month, the Pharma Fleece 
award is going to the drug industry's trade group, PhRMA, and the Trump 
administration, I am afraid, for a giveaway in the new NAFTA trade 
bill. What does a trade bill have to do with PhRMA or the price of 
prescription drugs? It turns out that PhRMA--boy, they are good--
managed to slip in a provision in this trade bill that most Members of 
Congress are not even aware of.
  This new trade agreement, as you might expect, involving Canada, 
Mexico, and the United States, covers a wide range of issues. My 
farmers are very excited about it. The men and women in labor unions 
are concerned about it. But it falls far short when it comes to labor 
and environmental protections. There is a lot of work that needs to be 
done.
  But the one provision that I want to highlight today is tucked inside 
this sprawling document. It is a provision that guarantees monopoly 
protection for pharmaceutical companies by blocking competition, 
generic drug competition. It means that these companies can continue to 
call for sky-high prescription drug costs.
  This is just another example of an issue that the President said 
during his campaign was a high priority and we all talk about on the 
floor of the Senate that is being sneaked into this new NAFTA trade 
bill. Let's remember, the top four drug companies avoided paying $7 
billion in taxes last year--$7 billion--and were able to buy back 
another $30 billion in stock thanks to President Trump's tax reform 
package. It was very kind to PhRMA, not that they needed it.
  Americans already pay, incidentally, the highest prices in the world 
for prescription drugs, four times what is paid in Canada or Europe. So 
why would the administration agree to put a provision for PhRMA to 
guarantee high prices into the new NAFTA trade bill?
  Listen to the story. In 2017, for example, Canadians can purchase a 
year's supply of Humira--recognize the name? You should. It is the most 
heavily advertised prescription drug on television, Humira, made by 
AbbVie, a company in Illinois--it is used for a disease called 
psoriatic arthritis. Canadians can buy a year's supply for $20,000--not 
cheap. You know what Americans pay for exactly the same drug they buy 
from exactly the same company? Over $40,000, more than twice as much as 
the Canadians.
  Why? The Canadian Government cares. They said to AbbVie and to 
Pharma: We are not going to let you overcharge Canadians. We are going 
to protect our Canadian families and our Canadian healthcare system. 
The United States doesn't. Often, Big Pharma charges as much as it can 
get away with by manipulating our patent and exclusivity rules to avoid 
competition.
  Drugs known as biologics, like Humira, Rituxan, and Remicade, are 
medicines made from living organisms. They are known as biologics. They 
make up 2 percent of all the prescriptions sold, but they count for 37 
percent of the cost of prescription drugs--very expensive drugs.
  Those three biologics have all been on the market for more than 17 
years, and yet they are still the top seven highest grossing drugs in 
America due to the fortress of monopoly protections that Pharma has 
created.
  Now, listen closely. Under U.S. law, biologics like the ones I 
mentioned--Humira is one of them--are given a 12-year exclusivity 
period once the FDA approves their application. What does that mean? No 
one can compete with them. They own the market. They set the price.
  That means that a cheaper generic competitor cannot be approved by 
the Food and Drug Administration in the United States for more than 10 
years, while the brand-name company is free to charge whatever it 
wants. Wonder why prices are high? There is no competition.
  I believe the standard is too high and have cosponsored legislation 
to reduce this period to no more than 7 years. Canada's exclusivity 
period is 8 years. Mexico does not have one.
  But now let's go to the new NAFTA trade agreement and look closely at 
the fine print that PhRMA included in that. The administration wants to 
enshrine our Pharma-friendly laws by setting a 10-year exclusivity 
floor for all three countries. It is a virtual guarantee that PhRMA, 
when it comes to biologics, will be able to charge whatever they wish 
for 10 years or more in Canada, Mexico, and the United States.

  Why is that in the trade agreement? If all of us agree that 
prescription drug prices are too high, why are we putting

[[Page S6378]]

in the NAFTA trade agreement a sweetheart deal for PhRMA so that they 
can charge higher prices, not just in the United States, but in Canada 
and Mexico?
  This new NAFTA has provisions that will encourage drug companies to 
obtain excessive numbers of secondary patents that delay generic 
competition and keep prices high.
  So when my farmers come to me and say: Why are you not for NAFTA? And 
I say to them, if it was just about farmers, it would be one thing. But 
it is about American families, Canadian families, families even in 
Mexico paying higher prices for prescription drugs because of the trade 
agreement that the President wants us to approve. We should be working 
to bring lower-cost products to market sooner, not allowing Pharma to 
sneak in a payday into a trade package at the expense of American 
families.
  It should come as no surprise that the main coalition running ads 
supporting the approval of NAFTA is the pharmaceutical industry of the 
United States. In fact, PhRMA and BIO, the two largest pharmaceutical 
associations, have already spent $30 million lobbying Congress to pass 
this new NAFTA. Now, we know why.
  For all the President's talk, this provision in this trade agreement 
is a Trojan horse giveaway for Big Pharma at the expense of American 
patients. I guess we should not being surprised, but I will say this: 
If Members of Congress, Democrats and Republicans, House and Senate, 
are listening to the people they represent back home about the cost of 
prescription drugs, they will not fall for this new Pharma fleece.
  Madam President, I suggest the absence of a quorum.
  The PRESIDING OFFICER. The Clerk will call the roll.
  Mr. JONES. Madam President, I ask unanimous consent that the order 
for the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.