[Congressional Record Volume 166, Number 159 (Tuesday, September 15, 2020)]
[House]
[Pages H4417-H4420]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                              {time}  1745
         PROTECTING ACCESS TO COVID-19 HEALTHCARE TELEMEDICINE

  The SPEAKER pro tempore (Mr. Case). Under the Speaker's announced 
policy of January 3, 2019, the gentleman from Arizona (Mr. Schweikert) 
is recognized for 60 minutes as the designee of the minority leader.
  Mr. SCHWEIKERT. Mr. Speaker, I wanted to do something this evening in 
light of the angst which is election time. You hear somewhat sort of 
the hyperbolic language. I am actually hearing many of our friends on 
the left almost sound like it was 5 years ago, talking about 
preexisting conditions, ObamaCare. We have all come to a consensus, I 
believe, as a political body and as a Nation, we are covering 
preexisting conditions.
  So one of the things I want to share and I am going to tie this in to 
what we are going through in the pandemic and an opportunity to go 
beyond what is the debate of the Republican alternative from a couple 
years ago on healthcare or the ACA and how I believe we have changed 
it.
  Remember, the ACA was a financing mechanism. It functionally said who 
got subsidized, who had to pay. Our Republican alternative, 
functionally, was a financing mechanism. It was who had to pay and who 
got subsidized.
  What I am begging us all around here to think about is what we pay. 
Why isn't this body coming together and moving creative, technology-
driven ideas to change the price of healthcare? Because when we are 
doing the financing mechanisms, we are not saving our country.
  Remember, the single greatest driver of U.S. debt over the next 30 
years--and it is really difficult politically to talk about--is 
Medicare.
  Well, if you are like I am, where you believe we have a moral 
obligation to

[[Page H4418]]

protect Medicare and Social Security, we have a moral, ethical 
obligation, we also need to be honest about the debt. And I have spent 
the previous couple of years coming here and showing the charts of what 
was going on. And it was like silence from my brothers and sisters here 
because it is so uncomfortable to talk about.
  So what I am coming to the floor tonight to do is, I just want to 
start the inkling of there are solutions. They are not perfect. They 
are going to have glitches, but they start to head us in a direction 
where we can change the price of healthcare and by doing that, you save 
Medicare. But you also save the country from the crushing debt that is 
coming. So this is a moment of optimism.
  I am going to grab this board, and this is just part of the thought 
experiment I want to engage with. This one we picked up today. This is 
brand new.
  We understand the next generation of Apple Watch is coming with an 
oxygen sensor.
  Why is that part of the disruption that helps save the country? I 
need you to think creatively with me.
  It turns out that there is a study going on that basically looks at 
the concept of if we can know your oxygen, your blood oxygen 
calculations, we can see your heart rhythm, and those things. But also, 
your body temperature, we can calculate if you have a virus, if you are 
getting sick.
  Now, obviously, the statisticians--the experts--need to build the 
model and prove it, but what would happen if the thing you have on your 
wrist is functionally a traveling medical lab with you, monitoring your 
health all the time, producing the data, using the algorithm and 
telling you, Hey, guess what? We believe you have this because we are 
monitoring these things.
  Is that hopeful?
  Is that futuristic?
  Is it here?
  Because this watch, I guess, is out in the next few months.
  But it turns out that type of data coming off the technology we are 
able to have on our bodies, this body has not stepped up and gotten 
laws, the rules, the regulations, the reimbursements to the point where 
technology can help us change the price of healthcare.
  So can we stop having just the darn stupid debates around here where 
we debate for hours on who is going to get subsidized and who has to 
pay? Can we start having honest conversations of what to pay? What can 
we as a body do to promote the technology, to promote optionality, to 
promote convenience?
  So part of my argument here is, we are actually living part of the 
disruption right now. A handful of Democrats, and a number of us on the 
Republican side, I have had--we have had--some telemedicine bills 
around here for years. And no one would hear them. We would do lip 
service. We would talk about, well, we are going to allow some 
telemedicine, maybe with the VA, but the concept that we were going to 
have CMS for Medicare/Medicaid patients--particularly Medicare--allowed 
the use of telemedicine. We know we have an army of lobbyists around 
here that were very uncomfortable.
  If I had one more staffer, lobbyist, even brothers and sisters who 
are Members of Congress look at me and say, ``David, we need to do this 
slowly. We need to do it incrementally.'' Well, what happened a few 
months ago? The pandemic.
  And we grabbed some of the language that we have had now for years 
and put it into one of the first coronavirus packages. And now 
telemedicine is reimbursable to our seniors.
  And what's happened?
  We have had--and this one goes back to April--it's my understanding 
the numbers have gotten dramatically more, but we haven't been able to 
vet it--the use of telemedicine with seniors has skyrocketed. 
Satisfaction is off the charts. They are happy. The doctors we have 
been meeting with and talking to are actually happy and actually will 
tell you they are spending more time with their patients, being able to 
have a conversation, that patients are willing to share more. We have 
the living example of the disruption happening right now. And all those 
who kept saying, ``David, let's go slow, let's do it incrementally,'' 
it didn't happen that way.
  We dove in, and it is working. We need to make it better. We need to 
make it permanent. Because a lot of folks don't understand, when the 
pandemic is declared over, so does this telemedicine. It's over. The 
reimbursements, the access, the availability we have given to our 
seniors--who we are telling to stay home, to stay healthy--to rural 
America, so you don't have to drive, it goes away. We need to make it 
permanent.

  But I am asking us to now think even broader. Instead of just doing 
what I am hoping--we have legislation to do this--to extend 
telemedicine, as we have made it available during this time of the 
pandemic. Why don't we do that? Let's extend it but let's actually 
think broader. What can we do to make healthcare more accessible?
  I mean, how many speeches have happened on this floor talking about 
accessibility for healthcare, for our poor, for those trapped in 
certain urban islands, those trapped in rural America, those trapped at 
home.
  I want us to get comfortable with the fact that the disruption is 
here, the technology is here. There are items like this where it is 
functionally a doctor's visit in your medicine cabinet. And it has the 
potential for changing the cost of healthcare.
  Mr. Speaker, let's go through some of these. We want to protect the 
access to telemedicine, so our first piece of legislation is--I am 
asking every Member of Congress to think this through. Talk to your 
constituents, talk to your medical experts. What has their experience 
been like? And are you prepared to take this away from every senior and 
American who has had this optionality? Are you ready to take this away 
the day the pandemic is declared over?
  And then when you have the discussion, the debate with people like me 
that actually believe in that technology, we can actually expand the 
definition of telemedicine. So it is more than just talking to a doctor 
on your phone or doing FaceTime with that medical professional, but it 
is also the sensors and the data.
  You saw the very first board where we talked about a future watch 
that is actually coming in a few months that will be an oxygen sensor, 
a pulse rate sensor, a temperature sensor that you will have on your 
wrist that can actually do linear conversions because it will have 
multiple samples from you. And the algorithm can help tell you if 
something is happening to your body.
  But also, we need to move pieces of legislation so we can keep this, 
keep the reimbursement, keep it legal, keep it with us.
  Let's actually take this to what we are experiencing right now.
  How many Americans are seniors? We have asked them to stay home. We 
have asked them to limit their contacts. We have asked them to be 
careful. We have given them telemedicine, but we need to take it to the 
next level.
  There are now products that are on the market, that are out there 
today--we need to start reimbursing them and taking care of them--where 
you can actually do your COVID test at home. You can get on that 
telemedicine, that phone call, talk to the medical professional, do the 
COVID test right there with him on the phone--there are multiple 
providers of this--and get your results in a couple of days. This is 
instead of asking my father, who is in his mid-eighties, to get in the 
car and go wait in line at one of the drive-through testing sites, or 
someone else to go wait at a doctor's office or an urgent care office, 
or wherever they're doing this; this exists today.
  Why aren't we reimbursing them?
  Why aren't we making this available today?
  If we say we love and care for our most vulnerable populations, why 
aren't we thinking of the future?
  Why aren't we thinking of the convenience?
  Why aren't we thinking of the technology?
  We need to do things like this and not be afraid of it.
  Yes, it is a disruption for a lot of business models out there that 
wants the person coming in to test, to come into their center. But this 
is the future. And if we do this right, we can expand access. We can 
expand availability, and we can actually change the price curve.

[[Page H4419]]

  We can make access to healthcare less expensive. And is this a 
Republican goal or Democrat goal? I think it just needs to be an 
American goal.
  So as we move forward, the impact--and there is a lot of--it is hard 
to read this slide, but I guess what I am trying to say here is: As you 
look at this, we went from basically only about--oh, excuse me. I had 
it wrong.
  In 2019, only about 11 percent used any type of telemedicine option. 
You called the medical professional, you told them your symptoms, you 
got some sort of diagnosis. We have had an explosion since then.
  In 2020, now, our numbers, we think, are already old because we wrote 
this slide about a month-and-a-half ago on the data we had then. It 
went from 11 percent to 46 percent. We are hearing stories that it is 
substantially higher than that today.

  For those that were arguing for the incremental adoption of the 
technology, we hit a pandemic, we got to bathe in the fire, and it 
worked. Yeah, there are glitches, but it has worked. Asking people not 
to get in their car, not to actually go wait in the waiting room, not 
sit--it is here.
  How do we expand it?
  How do we make it even more accessible?
  And how do we broaden the definition of what is telemedicine?
  And my argument in many ways here is more than just the simple 
adoption of technology. Moving away from the skepticism that, Oh, 
seniors aren't going to know how to use it or like to use it. We have 
already removed that. We have demonstrated seniors figured it out very 
quickly. That sort of cynicism that was out there.
  But can we, as a Congress--when we get beyond this election cycle, 
where we are busy knifing each other for things that we know are just 
rhetorically stale--start giving a damn about the future of this 
country, about the availability of healthcare and what we are going to 
do to actually do something elegant, where we change the cost curve and 
we raise the accessibility? I would think this would make both sides 
giddy. We just have to make it legal.
  And why I explained that is, a few months ago I was on the floor--and 
I have done this multiple times--we were showing some of the technology 
that is coming. And one was something that looked like a big kazoo. You 
blow into it and it would almost instantly tell you you had the flu. 
And the professor who had been working on this, in some of her 
writings, she talked about it saying, Then the algorithm could bang off 
your medical records, right off your phone, encrypted so it is nice and 
safe, and order your antivirals.
  Would that make society healthier?
  Would it increase accessibility?
  Would it lower the price of healthcare?
  Of course, it would.

                              {time}  1800

  Anyone else know the problem with this technology? It is functionally 
illegal today.
  The way we reimburse, the way we allow prescriptions to be written, 
it is a tough discussion because there are lots of special interest 
groups that we need to work with and respect their talents.
  But if we know the greatest fragility of future debt in our society 
is actually healthcare costs, why wouldn't we embrace something that at 
least we haven't completely made partisan yet? That is healthcare 
technology and the access and availability it brings to us.
  So, my discussion tonight is a very simple one. We have just lived 
the experience of COVID, of having so much of our population trapped at 
home, fearful to go out. As part of our legislation, we allowed access 
and reimbursement to telemedicine. It has been adopted broadly.
  Is this one of those moments we are going to take the success we have 
had and keep it permanent by not forcing it to expire when the pandemic 
is declared over? Are we going to actually be a little bit of futurists 
in saying we saw this experiment work for our society--for our country, 
for our communities, for our seniors? Could we take the positive part 
of this experience and go further?
  That going further, what would happen if we do it the right way where 
it actually starts to help lower the cost of healthcare and increase 
accessibility? It is before us.
  So many of us have been heartbroken with what we have gone through 
the last few months. We have ached when we have seen people lose their 
jobs, hearing of family members who have lost their lives. Are we going 
to find some things positive that we have learned over these last few 
very difficult months and carry those things forward?
  I am going to beg of the body to think this through, that is, the 
adoption of technology as part of individual access to healthcare. 
Maybe we have to change the name because when we say telemedicine, we 
instantly think of looking at my phone and doing FaceTime and not 
realizing it also can be the data coming off your watch, the oxygen 
patch. Well, now we are about to have an oxygen sensor in the phone.
  But how do we make it that telemedicine is the use of technology to 
keep us healthy and also to find a financial benefit of lowering the 
cost and increasing the accessibility?
  This is going to be one of my passions over the next few months and, 
if I am blessed to be reelected, over the coming couple of years. We 
need to make it permanent. We need to open up the definition.
  Things like the home testing, I really am begging the body to think 
about that if we do move another COVID bill, that we turn this into 
being reimbursable because this is a combination of home COVID tests 
that you tie into your telemedicine appointment, and you can get a 
result in, I think, one of them, within 48 hours.
  This is good stuff. They are out there today. There is a debate about 
whether they can be reimbursed. We need to fix this because we all get 
behind these microphones, and we wax eloquently of what we think, but 
it turns out there are actual solutions around us.
  So, that is my pitch. It is not a particularly complicated one. But 
with a couple of pieces of legislation that I am blessed to be 
sponsoring, and with some of our friends here--and I have some 
Democrats who are sponsoring with us, too--I think we are seeing a 
vision. We can actually deliver solutions instead of just political 
rhetoric.
  Mr. Speaker, I think I was supposed to have a friend from Louisiana 
coming in. We were going to talk a little bit about the environment of 
what was about to just happen in Louisiana. Until he gets here, I did 
want to do one story, and let's see if I can tell this without setting 
too many people on fire.
  I am blessed to be the dad of a little girl that is not even 5 years 
old yet. She will be in a couple of weeks. She started kindergarten, 
but the starting of her kindergarten was sitting behind a Chromebook 
laptop completely isolated, whether it be at home for the first week or 
two, and then the second week or two sitting in an empty gym separated 
from anyone.
  I mean, the picture will rip your heart out. She is sitting behind a 
laptop with cardboard walls on the side of her. She would come home and 
say: Daddy, please don't make me go. Daddy, I don't like this. Daddy, 
please let me go with you.
  It was ripping my little girl apart.
  Then, this last week, my school district allowed children to be in 
the classroom with their teacher. They have taken lots of safety 
precautions. I am blessed that, in my area, the statistics have all 
fallen within the protocols, the numbers, that it was safe. We only 
want schools to open if it is safe.
  Overnight, it was as if I have a different little girl. She was 
happy. She was joyful. ``Daddy, I have friends.'' The second day, I am 
a little disturbed. ``Daddy, I have a boyfriend.'' As the father of a 
soon-to-be 5-year-old, that was stressing.
  I am wondering how many other Americans have seen this with their 
kids, their grandkids? How many young people have we done such violence 
to not only their education but their emotional well-being, their 
ability to get services?
  I desperately ask everyone--because I know in so many school 
districts and the country, and even in my community, the issue of 
opening schools has become political. It is not science. It is 
political.
  We see some of the protests from our teachers unions in some spots. 
Now, we have protests from our parents.

[[Page H4420]]

  We all said we were going to try to address this using math, using 
science. But beyond that math and science--that is your benchmark--
please, we need part of the consideration to be the emotional well-
being of our kids. It also needs to be the well-being of their 
scholastics.
  Another project we are doing in the Joint Economic Committee--and I 
am going to geek out for a second-- we are starting to do some math 
that says we may be damaging millions of Americans in their future 
earning power. We are setting them back. We may be damaging millions of 
Americans in their retirement.

  Because if you come to the tables, these actuarial tables that we 
have, and say: What happens if I lost earning power or I lost growth in 
my Social Security, in my pension, and even my career path for several 
months, for a year? Have we taken a step backward and understood what 
other things are happening in our communities?
  It turns out one of the linchpins for the next part of the spiking of 
employment coming back, people getting back into society and our 
communities, is a barrier called daycare and schools. How many parents 
are doing their darndest to work from home, but the difficulty is doing 
it when your child is in the next room sitting behind a laptop 
completely depressed, trying to do teleschool.
  We really need to have a tough conversation and be honest with the 
numbers and strip the crazy partisan debate over: Is opening schools 
partisan?
  It is insanity. We have loved and cared for our kids. Let's love on 
them. Let's do the right thing.
  I am sorry to personalize the story, but I saw it through the lens of 
a 5-year-old. I can only imagine what so many others have gone through 
with their children.
  I mean, I am hearing stories of adolescents--we had another one in my 
community just last week--who have taken their lives. Now, I don't know 
if that is tied to not being able to socialize or not being able to get 
counseling services or just the human relations of being at school. I 
don't know. But you do have to take a step backward and think about it.
  Are we willing to engage in this type of cruelty to our children, to 
those who are trying to build their careers so they can have a healthy 
retirement, take care of their family for future investments, for just 
the ability to be part of the American Dream? Because we have some 
well-organized groups out there that see a political advantage. That is 
the definition of cruelty.
  Let's take a step backward, go back to our earlier promises that we 
were going to do this through science. It is as much as the COVID 
statistics in your community and your school district as the human 
element of let's take care of our kids, let's actually also take care 
of those parents. Let's do the right thing here.
  I am so disappointed in so many of my brothers and sisters who are in 
the world of politics who are just blinded with a level of rage, that 
the need to win the election--well, I have sort of said it.
  Let's move away from this sort of cruelty and move back to solutions. 
Whether it be my hope that we found a way to make healthcare more 
accessible and more affordable to what we are going to do for our 
families to allow them to safely go back to school.
  My friend from Louisiana is here. I want to share my time with him, 
but I also want to understand what is about to happen with the 
hurricane.
  Didn't you get blasted just a couple of weeks ago with very, very 
heavy rains?
  Mr. HIGGINS of Louisiana. Incredibly powerful winds, good sir. Yes, 
sir.
  Mr. SCHWEIKERT. Look, I have a soft spot. My mother was from Baton 
Rouge. It is one of the reasons I love the food. And every time I hear 
your accent, I think of my extended family.
  But I wanted to give you some time. Tell us what is happening in your 
community, and let us know, beyond thoughts and prayers, what is 
needed.
  I yield to the gentleman from Louisiana (Mr. Higgins).
  Mr. HIGGINS of Louisiana. I thank my friend, the gentleman, for 
yielding.
  Mr. Speaker, I rise today simply to remind America of southwest 
Louisiana's plight in the wake of Hurricane Laura. While the national 
media and much of America has moved on, I will not allow the people of 
Louisiana to be forgotten here in Congress.
  Just 2 weeks ago, my district witnessed the most powerful hurricane 
in our State's modern history, sustained winds above 150-miles-per-
hour, a storm surge over 10 feet, a catastrophic loss across much of 
the State.
  Thousands of families have been displaced. Many are still without 
power, without water, without access to the internet, without 
sanitation. Virtually all infrastructure, public and private, was 
heavily damaged.
  Behind me are images from my district. These are not isolated 
examples. This is every street, every neighborhood, and every business 
across two entire parishes of southwest Louisiana and beyond.
  I am grateful to President Trump for his quick response. He was on 
the ground just as soon as we could safely land Air Force One. I am 
grateful for his response and his strong commitment.
  I am so thankful for the outpouring of support from faith-based and 
charitable organizations and from the countless first responders and 
volunteers who are working tirelessly to help Louisiana recover.
  Mr. SCHWEIKERT. Mr. Speaker, I yield back the balance of my time.

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