[Congressional Record Volume 166, Number 133 (Tuesday, July 28, 2020)]
[Senate]
[Pages S4534-S4536]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]





                               HEALS ACT

  Mr. CORNYN. Mr. President, as I said, the number of COVID-19 cases 
has surged in recent weeks in the Rio Grande Valley, South Texas, and 
throughout the State as well. Just a couple of weeks ago, Texas 
reported more than 10,000 new cases in a single day, and that happened 
5 days in a row.
  It certainly was a wake-up call for many who had not had taken the 
most effective precautions seriously--things like social distancing, 
good personal hygiene, the wearing of masks if you can't socially 
distance, and staying home if you are sick. It is amazing what we can 
do as individuals to stop the spread of this virus by doing those 
simple things. Unfortunately, some people let their guard down and 
didn't follow those protocols, so we saw a huge uptick in the number of 
cases. Thankfully, though, I think the message has been received and 
understood, and we have recently seen a gradual and encouraging decline 
in cases.
  Yet, as the war against COVID-19 wages on, we can't afford to lose 
any additional ground whether from a public health perspective or from 
an economic recovery perspective. So I believe it is time for Congress 
to pass additional legislation to strengthen our fight. That is why my 
colleagues and I introduced the HEALS Act yesterday. This legislation 
builds on the significant progress we have made already in four 
bipartisan bills that have already passed the Congress and have been 
signed into law by President Trump that will sustain our effort to 
defeat this virus and recover economically.
  This legislation will ensure that workers who had the rug pulled out 
from under them earlier this year will continue to receive enhanced 
unemployment benefits.
  It will provide funding to help K-12 schools, colleges, and 
universities safely and effectively educate their students this fall 
whether that means there being a combination of online or in-person 
instruction
  It will send additional and needed assistance to our farmers, 
ranchers, and producers who are keeping our families fed in the midst 
of the pandemic, and it will give States and local governments the 
flexibility they have requested and that they need to use CARES Act 
funding where it is needed the most.
  In the coming days, I will talk more about how this legislation 
supports the workers and institutions that have been hit the hardest by 
this virus, but, today, I would like to focus on the ways it bolsters 
our fight against the virus itself.
  One of the most important ways we can do that is through testing. The 
ability to identify positive cases as early as possible is the key to 
stopping the spread of the virus. Yet, as we have learned, there are 
massive numbers of people who have the virus who don't even know it and 
don't experience any symptoms. In short, they don't even feel sick. 
What we have seen, whether it be in multigenerational households or 
with the people who are most vulnerable to this virus--mainly, the 
elderly and the people with underlying health problems--is that they 
cannot be properly isolated unless we can identify the people who are 
carrying the virus even though they themselves may not be suffering any 
symptoms.
  The first coronavirus package we passed made testing free. It removed 
the cost barrier that could prevent those who needed a test from 
receiving one. At the time, if you were asymptomatic, the CDC--Centers 
for Disease Control and Prevention--didn't recommend your getting a 
test. Some of that was because of the constraints on the numbers of 
tests that were available. The fact is, if you are not suffering from 
any symptoms, you are probably not highly motivated to go get a test 
because you may not even know you have the virus, and you may not know 
you need one.
  We are testing a lot more now than we were back then. Congress has 
provided another $26 billion to scale up testing, and we have gone from 
conducting an average of 145,000 tests a day nationwide in early April 
to more than 780,000 per day in mid-July. So that has been a dramatic 
improvement. What we know is there is more we need to do.
  The HEALS Act, which we introduced yesterday, will provide an 
additional $16 billion to support testing efforts. When combined with 
the approximately $9 billion that still exists from the previous bills, 
it will make another $25 billion available to strengthen our testing 
nationwide. This will help to improve our testing strategy and capacity 
and reduce the backlog that has left some Texans waiting more than 2 
weeks for test results. These tests are not very useful if it takes 2 
weeks to get the results.
  Because we ramped up the number of people who were tested, the lab 
companies that were analyzing the tests ended up getting backlogged. 
Now we have taken corrective measures in cities like Dallas to make 
other testing available and bring that number down, but this has been a 
constant challenge. It needs to be as quick and easy as possible for 
folks not only to get tests but to get the results, and this funding 
helps to make sure there will be serious strides in support of that 
goal.
  I know there are testing protocols that are being analyzed right now 
that may make this easier and may even make the results quicker. I 
know, for example, in the Texas A&M University System, Chancellor Sharp 
said he has contracted for 15,000 tests a month for students who will 
return on campus. Now, in his view, he said those students will 
probably be safer on campus than they will be back home, especially if 
they end up going to bars or other social venues and do not properly 
social distance or wear masks.
  Beyond testing, we need additional support for the healthcare 
providers who have been on the frontlines. In my State, I know the 
Governor has asked a number of hospitals in the hardest hit areas to 
defer elective surgeries. As I have come to learn and as the Presiding 
Officer, no doubt, knows, that is how hospitals pay the bills. Many of 
the people who show up either get charity care or the payment through 
Medicaid or Medicare is less than that from private health insurance, 
so hospitals need a mix of elective surgeries and other treatments so 
they will have full insurance coverage in order to balance their books 
overall.
  Congress has already provided $175 billion for a healthcare provider 
relief fund, which has given hospitals, clinics, and physicians the 
resources they need to continue treating COVID-19 patients and stay 
afloat financially. So far, more than 20,000 hospitals and healthcare 
providers in my State alone have benefited from that funding, with over 
$4.1 billion coming to Texas.
  The HEALS Act will supplement that fund with an additional $25 
billion to help these providers navigate the surge in cases and 
maintain critical supplies like masks, gloves, and ventilators. If our 
hospitals don't have the personal protective equipment to protect the 
frontline staff, the resources to treat patients, or the funding to 
keep their doors open, we will be in bad, bad shape. This legislation 
will go a long way to making sure we don't ever reach that point.
  In addition to supplementing the healthcare provider relief fund, 
this legislation will also support some of our most critical health 
resources. We know our community health centers are an important part 
of the safety net when it comes to accessing healthcare. This bill will 
provide $7.6 billion to our community health centers, which usually 
serve people on a sliding scale based on their ability to pay. Some 
people have full insurance coverage; others are covered by Medicare or 
Medicaid; and some simply don't have the means to pay at all, but all 
are welcome and are treated at our community health centers.
  We also send $4.5 billion to mental health, suicide prevention, and 
substance use disorder services. We all know that the mitigation 
efforts we have all been engaged in by staying in our homes and not 
leaving for a period of time, as instructed by public health and other 
government officials, has exacted a very difficult toll on families, 
particularly on people who have had nowhere to go to escape somebody 
who has been abusing them in domestic violence scenarios or on people 
who are simply feeling a sense of isolation and a challenge to their 
mental health as they wonder how they are going to pay the bills and 
take care of their families. Maybe they have loved ones who are in 
nursing homes--the elderly are particularly vulnerable--whom they 
haven't been able to see because of the isolation efforts.
  And then we know people will self-medicate with alcohol or drugs. So 
this

[[Page S4535]]

$4.5 billion is important to help provide the mental health, suicide 
prevention, and substance use disorder services that are going to be 
needed not only right now but in the indefinite future.
  We also provide an additional $15 billion to the National Institutes 
of Health for research and an additional $26 billion for vaccine 
research.
  We know our frontline healthcare providers have gotten much, much 
better and saved many more lives by coming up with treatments that 
actually have been effective. Some of these are common prescription 
drugs that are used for other purposes that have been repurposed for 
treatment of COVID-19 symptoms.
  We know that convalescent plasma, taken from people who have had the 
virus, who have developed immunities, when they donate blood, that 
plasma can actually be used to help treat patients with serious COVID-
19 symptoms.
  And we know that there are other treatments in progress, along with 
the race to get a vaccine. Ultimately, we know that the vaccine is 
going to be important to our ability to defeat and live with this 
virus.
  But in the meantime, we know we need to learn to live with this virus 
in a way that protects our public health and allows us to safely reopen 
our economy.
  So the last thing I want to mention is liability protection. Why is 
this so important?
  Well, as many nonprofits or businesses think about reopening, 
thinking about kids going back to school safely--whether online and 
then transitioning to in person, or colleges and universities--we know 
that there are going to be a lot of lawsuits filed, second guessing why 
people didn't do something different, when, in fact, this pandemic has 
surprised all of us in so many ways.
  And what this does is provide a safe harbor from legal liability for 
those individuals who followed government guidance in good faith. It 
can't be the fact that you would subject a frontline healthcare worker 
who had no choice but to put on personal protective equipment and go to 
work to treat patients--it would be a cruel joke to say: Now we are 
going to come back and file lawsuits against you and sue you for money 
damages because you didn't somehow know exactly what you were dealing 
with.
  We know that frontline healthcare workers are performing a physically 
and mentally taxing job, made only more difficult by the fact we didn't 
understand exactly what we were dealing with, with this novel virus, 
and we are still learning more.
  Well, I learned, for example, about a rural hospital where test kits 
are in short supply. In fact, it was especially true in the early days 
as testing infrastructure was being stood up, and I mentioned that a 
moment ago.
  I learned about a hospital in a rural community outside Wichita Falls 
that only had 12 tests available. Because of limited resources, a 
physician made the difficult decision not to test an ER patient for 
COVID-19 because the patient didn't meet the criteria set out by the 
Centers for Disease Control. The following day, that same patient went 
to Wichita Falls and received a test, and several days later found out 
that they tested positive.
  Now, imagine you are that physician. You followed the CDC guidelines 
for testing; you tried to conserve the limited resources available in 
your community; but there is nothing stopping the patient from heading 
to the nearest lawyer's office and filing a lawsuit against you for 
somehow refusing them a test.
  All of a sudden, you are scrambling to defend yourself in a lawsuit 
that, quite frankly, should not have been filed in the first place.
  But I have spent enough time in courtrooms to know that many times 
lawsuits are not filed with the goal of actually prevailing on the 
merits; they are filed in order to gain a settlement because the cost 
of defending yourself can be large, indeed. And, in fact, if you are a 
business that has been hanging on by a thread, just the threat of that 
kind of litigation and the expense and energy it takes to defend that 
case, even though it lacks merit, could well cause you to throw in the 
towel or put you out of business.
  So we have introduced, as part of this HEALS Act, legislation that 
will provide that safe harbor. It will not provide blanket immunity; it 
will not protect against intentional or reckless misconduct; but it 
would establish clear guardrails like those in a number of States. As a 
matter of fact, 30 different States have passed similar protections for 
their healthcare workers. Other States have done it in other 
categories, but it is important, I believe, for us to provide clear 
authority so people know what they are dealing with.
  I would note, for example, that some of these same guardrails are 
very similar to those enacted by Executive order in the minority 
leader's home State of New York. I know the legislature has now sent 
Governor Cuomo another bill, basically, with the same framework, and he 
has not yet made a decision to sign that.
  But overall the HEALS Act will help provide the resources Texas 
hospitals, clinics, and healthcare providers need to sustain and win 
this fight, while protecting our heroic healthcare workers from a 
second epidemic in the courtroom.
  So I hope both sides of the aisle will work together, as we have in 
the past on COVID-19 response legislation, and make sure we can get a 
bill to the President's desk on a timely basis that delivers these and 
other necessary changes at a critical time for our country
  I suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The legislative clerk proceeded to call the roll.
  Mr. LANKFORD. Madam President, I ask unanimous consent that the order 
for the quorum call be rescinded.
  The PRESIDING OFFICER (Ms. McSALLY). Without objection, it is so 
ordered.
  Mr. LANKFORD. Madam President, Senator Durbin and I have worked for 
months on an issue on rural healthcare. Whether it is in rural Illinois 
or it is in rural Oklahoma, there is a challenge dealing with rural 
hospitals and sustaining their viability.
  So Senator Durbin and I partnered together to determine what is the 
best way to get a solution that is a long-term solution to what they 
are currently facing with COVID-19.
  While COVID-19 has impacted all types of businesses, rural hospitals 
have uniquely dealt with some very difficult challenges. Getting PPE 
early on in the process was much more challenging for rural hospitals 
than it was for urban--keeping doctors, managing separation, getting 
airflow areas in hospitals to manage the flow of the virus through 
areas, and also managing just patient count, where, for many rural 
hospitals, they just shut down because all elective surgery was stopped 
and such, and so they lost all of that income, though they still had 
all the employees. It was an exceptionally challenging thing, but it is 
challenging on top of the challenge that they have already faced for 
decades in just surviving in rural America.
  So what Senator Durbin and I have brought is a reasonable, 
nonpartisan solution to how we can deal with not only COVID-19 but to 
help rural hospitals long term.
  Decades ago, Congress established something called the critical 
access hospital and made sure that those hospitals that were designated 
``critical access hospitals'' would receive proper reimbursement from 
the Federal Government for healthcare services.
  Many individuals in rural areas--in fact, the dominant proportion in 
many rural areas receiving healthcare are receiving it through Medicaid 
or Medicare. We want to make sure that those providers providing those 
high-need areas are reimbursed appropriately.
  But, in 2006, Congress shifted the designation for critical access 
hospitals and took away something called the necessary provider, giving 
the flexibility to the States.
  As a result of that action in 2006, we have seen the closure of 118 
rural hospitals nationwide since that time period. The ``critical 
access hospital'' designation was created because of a string of 
hospital closures in the 1980s and early 1990s. Yet we have not 
responded in the way that we should from the change in statute in 2006.
  Simply what we are trying to do is to give that flexibility back to 
States again. If they have a hospital in a rural area that is the only 
provider in that community that is a Medicare-dependent hospital or is 
a very small hospital

[[Page S4536]]

with fewer than 50 beds, that area has to be an area that is designated 
as a rural area. It can't just be any suburban area or any other type 
of hospital. It has to be a rural hospital in particular. It has to 
have a high percentage relative to the national average of individuals 
with income below the poverty line. Those hospitals in those locations 
could be designated by their States as a necessary provider and be 
treated as if they are a critical access hospital. What would that do? 
That would be a lifeline for reimbursement because now we have some 
rural hospitals designated as critical access and some hospitals that 
meet all the other criteria, but they may be 34 miles away from another 
hospital, so that hospital in that county dies while the other hospital 
survives. In my State, we have a critical access hospital 34 miles away 
from a hospital across the border in Texas, so the hospital in Oklahoma 
can't get the critical access designation and can't survive because 34 
miles away there is a hospital in another State that has the critical 
access.

  We need the flexibility in our States to be able to do this kind of 
designation. Senator Durbin and I have run this through a lot of places 
and a lot of people, and we have gotten a lot of technical input in it 
to make sure this actually works for our rural hospitals and provides 
not just a short-term survival through COVID-19 but also provides long-
term stability for them. This is the kind of work we should do together 
to make sure we stabilize those rural hospitals. They are a lifeline to 
people in rural America. They are a lifeline of employment, and they 
are a stable feature in every community. Without them, those 
communities dry up because people need access to healthcare, and this 
is the way that they can get it.
  I am glad to partner with Senator Durbin on this issue, and it is our 
hope to get this into the next bill dealing with COVID-19 in the days 
ahead. Quite frankly, it was our hope to get it into the last one--we 
didn't get it--and into the one before that. Surprisingly enough, 
everyone seems to be nodding their heads on both sides of the aisle 
saying: That is a good idea. That will be effective. We want to move it 
from ``that is a good idea'' to ``done'' for the sake of rural 
hospitals across the Nation.
  With that, I yield the floor.
  The PRESIDING OFFICER. The Senator from Illinois.
  Mr. DURBIN. I thank my colleague from Oklahoma. I could not have said 
it any better or more effectively than he just did.
  Like Oklahoma, downstate Illinois has an area of smaller cities and 
rural towns and smalltown communities. Many of them are lucky enough to 
have great hospitals, and they love their hospitals. They are not only 
important sources of medical care; they are a major part of the local 
economy and really are a rallying point for communities. Auxiliaries, 
volunteers, and so many people make these hospitals the focal point 
when you visit these communities. They are so proud of them.
  Of course, we are worried about what this current pandemic is going 
to do. I have had conference calls with leaders from almost 120 
hospitals across Illinois. I invited Members of Congress in, so we had 
bipartisan exchanges about the current state of affairs. One hospital 
CEO from Crawford County, downstate along the Indiana border, told me 
that he used to pay 22 cents for a surgical gown, and now he pays 
between $11 and $20 for each one. Hospitals are facing limited access 
to reagents, swabs, and supplies that they need. The Heroes Act would 
direct the administration to utilize the Defense Production Act to help 
solve that problem, and I commend Senators Murphy and Baldwin for their 
legislation, which I am joining, to do the same.
  One of the most profound consequences of the pandemic is the impact 
on the solvency of these hospitals. Across Illinois, rural hospitals 
are the heart and soul of the community; otherwise, people drive 
literally for hours to get medical care, sometimes in emergency 
situations. They are important parts of the local economy. We think 
downstate hospitals generate $5 billion into our State economy each 
year, and I don't doubt that.
  This pandemic has pushed them to the brink. Even prior to this 
crisis, they were facing financial uncertainty. Half of rural hospitals 
were operating in the red. One in four were at risk of closure. As the 
Senator from Oklahoma mentioned, 120 have closed across the Nation in 
the past decade.
  We have fared a little better in Illinois, but we are worried about 
the future. When a rural hospital closes, not only do doctors 
disappear, but jobs disappear, and businesses struggle to stay.
  The coronavirus pandemic has accelerated and compounded the strains 
we face. We believe our Illinois hospitals are losing $1.4 billion each 
month. Many, like those near nursing homes and meat processing plants, 
have had to expand surge staffing to deal with COVID patients. All have 
been forced to cancel outpatient and elective services. In Illinois, 70 
percent of rural hospital revenues are from outpatient services. The 
same is true in neighboring States like Kentucky.
  Nationwide, rural hospitals have on average only 33 days of cash on 
hand. There is an immediate need to stabilize, and that is why we have 
come up with this bipartisan plan. Senator James Lankford and I have 
introduced a bill called the Rural Hospital Closure Relief Act. It is 
supported by the American Hospital Association and the National Rural 
Health Association. It would update Medicare's ``critical access 
hospital'' designation to provide flexibility around the 35-mile 
distance requirement, so more rural hospitals would qualify for 
additional payments from the Federal Government.
  We project that six hospitals in Iowa and scores more in Illinois, 
New York, and Kentucky would qualify for this financial lifeline, 
securing their stability. We do it in a restrained, cost-effective 
manner by focusing on the hospitals that have faced financial losses 
and are located in areas with a shortage of healthcare providers. It is 
common sense.
  This bipartisan bill is a priority for us. We want to make it a 
priority for the Senate, and we hope to do so. We know that we have 
come to this discussion with a good, encouraging conversation with 
Senator Grassley today in support of the Iowa Rural Health Association. 
The CEO and leader of the Kentucky Rural Health Association projects 
that more than 18 rural hospitals in that State are at high risk of 
closure. We hope to make that point very clear to the majority leader. 
Several of them would be helped by our legislation.
  With a spike in COVID-19 cases across rural America, we have seen 
hospitals reaching capacity, and we need to make sure that our 
hospitals--the ones we are talking about in rural areas--survive. The 
health and economic toll of this crises demands it. I hope that 
Democrats and Republicans in the Senate include this in any bipartisan 
package. The cost of inaction will be disastrous.
  Senator Lankford and I were prepared to seek passage of this bill by 
unanimous consent today, but we have been encouraged to continue 
negotiating with our colleagues to see if we can make it part of the 
package--a timely part of the package--in the near future. I hope that 
is the case, and we will hold off from any unanimous consent request 
because of that hope

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