[Congressional Record Volume 167, Number 35 (Wednesday, February 24, 2021)]
[Senate]
[Pages S858-S865]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
STATEMENTS ON INTRODUCED BILLS AND JOINT RESOLUTION
By Mr. THUNE (for himself, Ms. Stabenow, Mrs. Fischer, and Mr.
Warner):
S. 402. A bill to amend the Bipartisan Congressional Trade Priorities
and Accountability Act of 2015 to include a trade negotiating objecting
relating to addressing the security of the global communications
infrastructure; to the Committee on Finance.
Mr. THUNE. Mr. President, I ask unanimous consent that the text of
the bill be printed in the Record.
There being no objection, the text of the bill was ordered to be
printed in the Record, as follows:
S. 402
Be it enacted by the Senate and House of Representatives of
the United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Network Security Trade Act
of 2021''.
SEC. 2. TRADE NEGOTIATING OBJECTIVE RELATING TO SECURITY OF
COMMUNICATIONS NETWORKS.
Section 102(a) of the Bipartisan Congressional Trade
Priorities and Accountability Act of 2015 (19 U.S.C. 4201(a))
is amended--
(1) in paragraph (14), by striking ``; and'' and inserting
a semicolon;
(2) in paragraph (15), by striking the period at the end
and inserting ``; and''; and
(3) by adding at the end the following:
``(16) to ensure that the equipment and technology that
create the global communications infrastructure are not
compromised by addressing--
``(A) barriers to the security of communications networks
and supply chains; and
``(B) unfair trade practices of suppliers of communications
equipment that are owned, controlled, or supported by a
foreign government.''.
[[Page S859]]
______
By Mr. DURBIN (for himself, Ms. Duckworth, Mrs. Shaheen, Mr.
Brown, Ms. Stabenow, Mr. Blumenthal, Ms. Klobuchar, Ms. Smith,
Mr. Van Hollen, and Mr. Sanders):
S. 411. A bill to improve Federal efforts with respect to the
prevention of maternal mortality, and for other purposes; to the
Committee on Finance.
Mr. THUNE. Mr. President, I ask unanimous consent that the text of
the bill be printed in the Record.
There being no objection, the text of the bill was ordered to be
printed in the Record, as follows:
S. 411
Be it enacted by the Senate and House of Representatives of
the United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Mothers and Offspring
Mortality and Morbidity Awareness Act'' or the ``MOMMA's
Act''.
SEC. 2. FINDINGS.
Congress finds the following:
(1) Every year, across the United States, nearly 4,000,000
women give birth, about 700 women suffer fatal complications
during pregnancy, while giving birth or during the postpartum
period, and about 70,000 women suffer near-fatal, partum-
related complications.
(2) The maternal mortality rate is often used as a proxy to
measure the overall health of a population. While the infant
mortality rate in the United States has reached its lowest
point, the risk of death for women in the United States
during pregnancy, childbirth, or the postpartum period is
higher than such risk in many other high-income countries.
The estimated maternal mortality rate (deaths per 100,000
live births) for the 48 contiguous States and Washington,
D.C. increased from 14.5 percent in 2000 to 17.3 in 2017. The
United States is the only industrialized nation with a rising
maternal mortality rate.
(3) The National Vital Statistics System of the Centers for
Disease Control and Prevention has found that in 2018, there
were 17.4 maternal deaths for every 100,000 live births in
the United States. This ratio is more than double that of
most other high-income countries.
(4) It is estimated that more than 60 percent of maternal
deaths in the United States are preventable.
(5) According to the Centers for Disease Control and
Prevention, the maternal mortality rate varies drastically
for women by race and ethnicity. There are about 13 deaths
per 100,000 live births for White women, 40.8 deaths per
100,000 live births for non-Hispanic Black women, and 29.7
deaths per 100,000 live births for American Indian/Alaskan
Native women. While maternal mortality disparately impacts
Black women, this urgent public health crisis traverses race,
ethnicity, socioeconomic status, educational background, and
geography.
(6) In the United States, non-Hispanic Black women are
about 3 times more likely to die from causes related to
pregnancy and childbirth compared to non-Hispanic White
women, which is one of the most disconcerting racial
disparities in public health. This disparity widens in
certain cities and States across the country.
(7) According to the National Center for Health Statistics
of the Centers for Disease Control and Prevention, the
maternal mortality rate heightens with age, as women 40 and
older die at a rate of 81.9 per 100,000 births compared to
10.6 per 100,000 for women under 25. This translates to women
over 40 being 7.7 times more likely to die compared to their
counterparts under 25 years of age.
(8) The COVID-19 pandemic risks exacerbating the maternal
health crisis. A recent study of the Centers for Disease
Control and Prevention suggests that pregnant women are at a
significantly higher risk for severe outcomes, including
death, from COVID-19 as compared to non-pregnant women. The
COVID-19 pandemic has also decreased access to prenatal and
postpartum care.
(9) The findings described in paragraphs (1) through (8)
are of major concern to researchers, academics, members of
the business community, and providers across the obstetric
continuum represented by organizations such as--
(A) the American College of Nurse-Midwives;
(B) the American College of Obstetricians and
Gynecologists;
(C) the American Medical Association;
(D) the Association of Women's Health, Obstetric and
Neonatal Nurses;
(E) the Black Mamas Matter Alliance;
(F) the Black Women's Health Imperative;
(G) the California Maternal Quality Care Collaborative;
(H) EverThrive Illinois;
(I) the Illinois Perinatal Quality Collaborative;
(J) the March of Dimes;
(K) the National Association of Certified Professional
Midwives;
(L) the National Birth Equity Collaborative;
(M) the National Partnership for Women & Families;
(N) the National Polycystic Ovary Syndrome Association;
(O) the Preeclampsia Foundation;
(P) the Society for Maternal-Fetal Medicine; and
(Q) the What To Expect Project.
(10) Hemorrhage, cardiovascular and coronary conditions,
cardiomyopathy, infection or sepsis, embolism, mental health
conditions (including substance use disorder), hypertensive
disorders, stroke and cerebrovascular accidents, and
anesthesia complications are the predominant medical causes
of maternal-related deaths and complications. Most of these
conditions are largely preventable or manageable. Even when
these conditions are not preventable, mortality and morbidity
may be prevented when conditions are diagnosed and treated in
a timely manner.
(11) According to a study published by the Journal of
Perinatal Education, doula-assisted mothers are 4 times less
likely to have a low-birthweight baby, 2 times less likely to
experience a birth complication involving themselves or their
baby, and significantly more likely to initiate
breastfeeding. Doula care has also been shown to produce cost
savings resulting in part from reduced rates of cesarean and
pre-term births.
(12) Intimate partner violence is one of the leading causes
of maternal death, and women are more likely to experience
intimate partner violence during pregnancy than at any other
time in their lives. It is also more dangerous than
pregnancy. Intimate partner violence during pregnancy and
postpartum crosses every demographic and has been exacerbated
by the COVID-19 pandemic.
(13) Oral health is an important part of perinatal health.
Reducing bacteria in a woman's mouth during pregnancy can
significantly reduce her risk of developing oral diseases and
spreading decay-causing bacteria to her baby. Moreover, some
evidence suggests that women with periodontal disease during
pregnancy could be at greater risk for poor birth outcomes,
such as preeclampsia, pre-term birth, and low-birth weight.
Furthermore, a woman's oral health during pregnancy is a good
predictor of her newborn's oral health, and since mothers can
unintentionally spread oral bacteria to their babies, putting
their children at higher risk for tooth decay, prevention
efforts should happen even before children are born, as a
matter of pre-pregnancy health and prenatal care during
pregnancy.
(14) In the United States, death reporting and analysis is
a State function rather than a Federal process. States report
all deaths--including maternal deaths--on a semi-voluntary
basis, without standardization across States. While the
Centers for Disease Control and Prevention has the capacity
and system for collecting death-related data based on death
certificates, these data are not sufficiently reported by
States in an organized and standard format across States such
that the Centers for Disease Control and Prevention is able
to identify causes of maternal death and best practices for
the prevention of such death.
(15) Vital statistics systems often underestimate maternal
mortality and are insufficient data sources from which to
derive a full scope of medical and social determinant factors
contributing to maternal deaths, such as intimate partner
violence. While the addition of pregnancy checkboxes on death
certificates since 2003 have likely improved States'
abilities to identify pregnancy-related deaths, they are not
generally completed by obstetric providers or persons trained
to recognize pregnancy-related mortality. Thus, these vital
forms may be missing information or may capture inconsistent
data. Due to varying maternal mortality-related analyses,
lack of reliability, and granularity in data, current
maternal mortality informatics do not fully encapsulate the
myriad medical and socially determinant factors that
contribute to such high maternal mortality rates within the
United States compared to other developed nations. Lack of
standardization of data and data sharing across States and
between Federal entities, health networks, and research
institutions keep the Nation in the dark about ways to
prevent maternal deaths.
(16) Having reliable and valid State data aggregated at the
Federal level are critical to the Nation's ability to quell
surges in maternal death and imperative for researchers to
identify long-lasting interventions.
(17) Leaders in maternal wellness highly recommend that
maternal deaths and cases of maternal morbidity, including
complications that result in chronic illness and future
increased risk of death, be investigated at the State level
first, and that standardized, streamlined, de-identified data
regarding maternal deaths be sent annually to the Centers for
Disease Control and Prevention. Such data standardization and
collection would be similar in operation and effect to the
National Program of Cancer Registries of the Centers for
Disease Control and Prevention and akin to the Confidential
Enquiry in Maternal Deaths Programme in the United Kingdom.
Such a maternal mortalities and morbidities registry and
surveillance system would help providers, academicians,
lawmakers, and the public to address questions concerning the
types of, causes of, and best practices to thwart, maternal
mortality and morbidity.
(18) The United Nations' Millennium Development Goal 5a
aimed to reduce by 75 percent, between 1990 and 2015, the
maternal mortality rate, yet this metric has not been
achieved. In fact, the maternal mortality rate in the United
States has been estimated to have more than doubled between
2000 and 2014.
(19) Many States have struggled to establish or maintain
Maternal Mortality Review
[[Page S860]]
Committees (referred to in this section as ``MMRC''). On the
State level, MMRCs have lagged because States have not had
the resources to mount local reviews. State-level reviews are
necessary as only the State departments of health have the
authority to request medical records, autopsy reports, and
police reports critical to the function of the MMRC.
(20) The United States has no comparable, coordinated
Federal process by which to review cases of maternal
mortality, systems failures, or best practices. Many States
have active MMRCs and leverage their work to impact maternal
wellness. For example, the State of California has worked
extensively with their State health departments, health and
hospital systems, and research collaborative organizations,
including the California Maternal Quality Care Collaborative
and the Alliance for Innovation on Maternal Health, to
establish MMRCs, wherein such State has determined the most
prevalent causes of maternal mortality and recorded and
shared data with providers and researchers, who have
developed and implemented safety bundles and care protocols
related to preeclampsia, maternal hemorrhage, peripartum
cardiomyopathy, and the like. In this way, the State of
California has been able to leverage its maternal mortality
review board system, generate data, and apply those data to
effect changes in maternal care-related protocol. To date,
the State of California has reduced its maternal mortality
rate, which is now comparable to the low rates of the United
Kingdom.
(21) Hospitals and health systems across the United States
lack standardization of emergency obstetric protocols before,
during, and after delivery. Consequently, many providers are
delayed in recognizing critical signs indicating maternal
distress that quickly escalate into fatal or near-fatal
incidences. Moreover, any attempt to address an obstetric
emergency that does not consider both clinical and public
health approaches falls woefully under the mark of excellent
care delivery. State-based perinatal quality collaboratives,
or entities participating in the Alliance for Innovation on
Maternal Health (AIM), have formed obstetric protocols, tool
kits, and other resources to improve system care and response
as they relate to maternal complications and warning signs
for such conditions as maternal hemorrhage, hypertension, and
preeclampsia. These perinatal quality collaboratives serve an
important role in providing infrastructure that supports
quality improvement efforts addressing obstetric care and
outcomes. State-based perinatal quality collaboratives
partner with hospitals, physicians, nurses, patients, public
health, and other stakeholders to provide opportunities for
collaborative learning, rapid response data, and quality
improvement science support to achieve systems-level change.
(22) The Centers for Disease Control and Prevention reports
that nearly half of all maternal deaths occur in the
immediate postpartum period--the 42 days following a
pregnancy--whereas more than one-third of maternal deaths
occur while a person is still pregnant. Further, 21 percent
of maternal deaths occur between 1 and 6 weeks postpartum,
and 12 percent of maternal deaths occur during the remaining
portion of the postpartum year. Yet, for women eligible for
the Medicaid program on the basis of pregnancy, such Medicaid
coverage lapses at the end of the month on which the 60th
postpartum day lands.
(23) The experience of serious traumatic events, such as
being exposed to domestic violence, substance use disorder,
or pervasive and systematic racism, can over-activate the
body's stress-response system. Known as toxic stress, the
repetition of high-doses of cortisol to the brain, can harm
healthy neurological development and other body systems,
which can have cascading physical and mental health
consequences, as documented in the Adverse Childhood
Experiences study of the Centers for Disease Control and
Prevention.
(24) A growing body of evidence-based research has shown
the correlation between the stress associated with systematic
racism and one's birthing outcomes. The undue stress of sex
and race discrimination paired with institutional racism has
been demonstrated to contribute to a higher risk of maternal
mortality, irrespective of one's gestational age, maternal
age, socioeconomic status, educational level, or individual-
level health risk factors, including poverty, limited access
to prenatal care, and poor physical and mental health
(although these are not nominal factors). Black women remain
the most at risk for pregnancy-associated or pregnancy-
related causes of death. When it comes to preeclampsia, for
example, for which obesity is a risk factor, Black women of
normal weight remain at a higher at risk of dying during the
perinatal period compared to non-Black obese women.
(25) The rising maternal mortality rate in the United
States is driven predominantly by the disproportionately high
rates of Black maternal mortality.
(26) Compared to women from other racial and ethnic
demographics, Black women across the socioeconomic spectrum
experience prolonged, unrelenting stress related to
systematic racial and gender discrimination, contributing to
higher rates of maternal mortality, giving birth to low-
weight babies, and experiencing pre-term birth. Racism is a
risk-factor for these aforementioned experiences. This
cumulative stress, called weathering, often extends across
the life course and is situated in everyday spaces where
Black women establish livelihood. Systematic racism,
structural barriers, lack of access to care, lack of access
to nutritious food, and social determinants of health
exacerbate Black women's likelihood to experience poor or
fatal birthing outcomes, but do not fully account for the
great disparity.
(27) Black women are twice as likely to experience
postpartum depression, and disproportionately higher rates of
preeclampsia compared to White women.
(28) Racism is deeply ingrained in United States systems,
including in health care delivery systems between patients
and providers, often resulting in disparate treatment for
pain, irreverence for cultural norms with respect to health,
and dismissiveness. However, the provider pool is not primed
with many people of color, nor are providers (whether
maternity care clinicians or maternity care support
personnel) consistently required to undergo implicit bias,
cultural competency, respectful care practices, or empathy
training on a consistent, on-going basis.
(29) Not all people who have been pregnant or given birth
identify as being a ``woman''. The terms ``birthing people''
or ``birthing persons'' are also used to describe pregnant
and postpartum people.
SEC. 3. IMPROVING FEDERAL EFFORTS WITH RESPECT TO PREVENTION
OF MATERNAL MORTALITY.
(a) Technical Assistance for States With Respect to
Reporting Maternal Mortality.--Not later than one year after
the date of enactment of this Act, the Director of the
Centers for Disease Control and Prevention (referred to in
this section as the ``Director''), in consultation with the
Administrator of the Health Resources and Services
Administration, shall provide technical assistance to States
that elect to report comprehensive data on maternal mortality
and factors relating to such mortality (including oral and
mental health), intimate partner violence, and breastfeeding
health information, for the purpose of encouraging uniformity
in the reporting of such data and to encourage the sharing of
such data among the respective States.
(b) Best Practices Relating to Prevention of Maternal
Mortality.--
(1) In general.--Not later than one year after the date of
enactment of this Act--
(A) the Director, in consultation with relevant patient and
provider groups, shall issue best practices to State maternal
mortality review committees on how best to identify and
review maternal mortality cases, taking into account any data
made available by States relating to maternal mortality,
including data on oral, mental, and breastfeeding health, and
utilization of any emergency services; and
(B) the Director, working in collaboration with the Health
Resources and Services Administration, shall issue best
practices to hospitals, State professional society groups,
and perinatal quality collaboratives on how best to prevent
maternal mortality.
(2) Authorization of appropriations.--For purposes of
carrying out this subsection, there is authorized to be
appropriated $5,000,000 for each of fiscal years 2021 through
2025.
(c) Alliance for Innovation on Maternal Health Grant
Program.--
(1) In general.--Not later than one year after the date of
enactment of this Act, the Secretary of Health and Human
Services (referred to in this subsection as the
``Secretary''), acting through the Associate Administrator of
the Maternal and Child Health Bureau of the Health Resources
and Services Administration, shall establish a grant program
to be known as the Alliance for Innovation on Maternal Health
Grant Program (referred to in this subsection as ``AIM'')
under which the Secretary shall award grants to eligible
entities for the purpose of--
(A) directing widespread adoption and implementation of
maternal safety bundles through collaborative State-based
teams; and
(B) collecting and analyzing process, structure, and
outcome data to drive continuous improvement in the
implementation of such safety bundles by such State-based
teams with the ultimate goal of eliminating preventable
maternal mortality and severe maternal morbidity in the
United States.
(2) Eligible entities.--In order to be eligible for a grant
under paragraph (1), an entity shall--
(A) submit to the Secretary an application at such time, in
such manner, and containing such information as the Secretary
may require; and
(B) demonstrate in such application that the entity is an
interdisciplinary, multi-stakeholder, national organization
with a national data-driven maternal safety and quality
improvement initiative based on implementation approaches
that have been proven to improve maternal safety and outcomes
in the United States.
(3) Use of funds.--An eligible entity that receives a grant
under paragraph (1) shall use such grant funds--
(A) to develop and implement, through a robust, multi-
stakeholder process, maternal safety bundles to assist
States, perinatal quality collaboratives, and health care
systems in aligning national, State, and hospital-level
quality improvement efforts to improve maternal health
outcomes, specifically the reduction of maternal mortality
and severe maternal morbidity;
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(B) to ensure, in developing and implementing maternal
safety bundles under subparagraph (A), that such maternal
safety bundles--
(i) satisfy the quality improvement needs of a State,
perinatal quality collaborative, or health care system by
factoring in the results and findings of relevant data
reviews, such as reviews conducted by a State maternal
mortality review committee; and
(ii) address topics which may include--
(I) information on evidence-based practices to improve the
quality and safety of maternal health care in hospitals and
other health care settings of a State or health care system,
including by addressing topics commonly associated with
health complications or risks related to prenatal care, labor
care, birthing, and postpartum care;
(II) best practices for improving maternal health care
based on data findings and reviews conducted by a State
maternal mortality review committee that address topics of
relevance to common complications or health risks related to
prenatal care, labor care, birthing, and postpartum care;
(III) information on addressing determinants of health that
impact maternal health outcomes for women before, during, and
after pregnancy;
(IV) obstetric hemorrhage;
(V) obstetric and postpartum care for women with substance
use disorders, including opioid use disorder;
(VI) maternal cardiovascular system;
(VII) maternal mental health;
(VIII) postpartum care basics for maternal safety;
(IX) reduction of peripartum racial and ethnic disparities;
(X) reduction of primary caesarean birth;
(XI) severe hypertension in pregnancy;
(XII) severe maternal morbidity reviews;
(XIII) support after a severe maternal morbidity event;
(XIV) thromboembolism;
(XV) optimization of support for breastfeeding;
(XVI) maternal oral health; and
(XVII) Intimate partner violence; and
(C) to provide ongoing technical assistance at the national
and State levels to support implementation of maternal safety
bundles under subparagraph (A).
(4) Maternal safety bundle defined.--For purposes of this
subsection, the term ``maternal safety bundle'' means
standardized, evidence-informed processes for maternal health
care.
(5) Authorization of appropriations.--For purposes of
carrying out this subsection, there is authorized to be
appropriated $10,000,000 for each of fiscal years 2021
through 2025.
(d) Funding for State-Based Perinatal Quality
Collaboratives Development and Sustainability.--
(1) In general.--Not later than one year after the date of
enactment of this Act, the Secretary of Health and Human
Services (referred to in this subsection as the
``Secretary''), acting through the Division of Reproductive
Health of the Centers for Disease Control and Prevention,
shall establish a grant program to be known as the State-
Based Perinatal Quality Collaborative grant program under
which the Secretary awards grants to eligible entities for
the purpose of development and sustainability of perinatal
quality collaboratives in every State, the District of
Columbia, and eligible territories, in order to measurably
improve perinatal care and perinatal health outcomes for
pregnant and postpartum women and their infants.
(2) Grant amounts.--Grants awarded under this subsection
shall be in amounts not to exceed $250,000 per year, for the
duration of the grant period.
(3) State-based perinatal quality collaborative defined.--
For purposes of this subsection, the term ``State-based
perinatal quality collaborative'' means a network of teams
that--
(A) is multidisciplinary in nature and includes the full
range of perinatal and maternity care providers;
(B) works to improve measurable outcomes for maternal and
infant health by advancing evidence-informed clinical
practices using quality improvement principles;
(C) works with hospital-based or outpatient facility-based
clinical teams, experts, and stakeholders, including patients
and families, to spread best practices and optimize resources
to improve perinatal care and outcomes;
(D) employs strategies that include the use of the
collaborative learning model to provide opportunities for
hospitals and clinical teams to collaborate on improvement
strategies, rapid-response data to provide timely feedback to
hospital and other clinical teams to track progress, and
quality improvement science to provide support and coaching
to hospital and clinical teams;
(E) has the goal of improving population-level outcomes in
maternal and infant health; and
(F) has the goal of improving outcomes of all birthing
people, through the coordination, integration, and
collaboration across birth settings.
(4) Authorization of appropriations.--For purposes of
carrying out this subsection, there is authorized to be
appropriated $14,000,000 per year for each of fiscal years
2021 through 2025.
(e) Expansion of Medicaid and CHIP Coverage for Pregnant
and Postpartum Women.--
(1) Requiring coverage of oral health services for pregnant
and postpartum women.--
(A) Medicaid.--Section 1905 of the Social Security Act (42
U.S.C. 1396d) is amended--
(i) in subsection (a)(4)--
(I) by striking ``; and (D)'' and inserting ``; (D)''; and
(II) by inserting ``; and (E) oral health services for
pregnant and postpartum women (as defined in subsection
(hh))'' after ``subsection (bb))''; and
(ii) by adding at the end the following new subsection:
``(hh) Oral Health Services for Pregnant and Postpartum
Women.--
``(1) In general.--For purposes of this title, the term
`oral health services for pregnant and postpartum women'
means dental services necessary to prevent disease and
promote oral health, restore oral structures to health and
function, and treat emergency conditions that are furnished
to a woman during pregnancy (or during the 1-year period
beginning on the last day of the pregnancy).
``(2) Coverage requirements.--To satisfy the requirement to
provide oral health services for pregnant and postpartum
women, a State shall, at a minimum, provide coverage for
preventive, diagnostic, periodontal, and restorative care
consistent with recommendations for perinatal oral health
care and dental care during pregnancy from the American
Academy of Pediatric Dentistry and the American College of
Obstetricians and Gynecologists.''.
(B) CHIP.--Section 2103(c)(5)(A) of the Social Security Act
(42 U.S.C. 1397cc(c)(5)(A)) is amended by inserting ``or a
targeted low-income pregnant woman'' after ``targeted low-
income child''.
(2) Extending medicaid coverage for pregnant and postpartum
women.--Section 1902 of the Social Security Act (42 U.S.C.
1396a) is amended--
(A) in subsection (e)--
(i) in paragraph (5)--
(I) by inserting ``(including oral health services for
pregnant and postpartum women (as defined in section
1905(hh)))'' after ``postpartum medical assistance under the
plan''; and
(II) by striking ``60-day'' and inserting ``1-year''; and
(ii) in paragraph (6), by striking ``60-day'' and inserting
``1-year''; and
(B) in subsection (l)(1)(A), by striking ``60-day'' and
inserting ``1-year''.
(3) Extending medicaid coverage for lawful residents.--
Section 1903(v)(4)(A)(i) of the Social Security Act (42
U.S.C. 1396b(v)(4)(A)(i)) is amended by striking ``60-day''
and inserting ``1-year''.
(4) Extending chip coverage for pregnant and postpartum
women.--Section 2112(d)(2)(A) of the Social Security Act (42
U.S.C. 1397ll(d)(2)(A)) is amended by striking ``60-day'' and
inserting ``1-year''.
(5) Maintenance of effort.--
(A) Medicaid.--Section 1902(l) of the Social Security Act
(42 U.S.C. 1396a(l)) is amended by adding at the end the
following new paragraph:
``(5) During the period that begins on the date of
enactment of this paragraph and ends on the date that is five
years after such date of enactment, as a condition for
receiving any Federal payments under section 1903(a) for
calendar quarters occurring during such period, a State shall
not have in effect, with respect to women who are eligible
for medical assistance under the State plan or under a waiver
of such plan on the basis of being pregnant or having been
pregnant, eligibility standards, methodologies, or procedures
under the State plan or waiver that are more restrictive than
the eligibility standards, methodologies, or procedures,
respectively, under such plan or waiver that are in effect on
the date of enactment of this paragraph.''.
(B) CHIP.--Section 2105(d) of the Social Security Act (42
U.S.C. 1397ee(d)) is amended by adding at the end the
following new paragraph:
``(4) In eligibility standards for targeted low-income
pregnant women.--During the period that begins on the date of
enactment of this paragraph and ends on the date that is five
years after such date of enactment, as a condition of
receiving payments under subsection (a) and section 1903(a),
a State that elects to provide assistance to women on the
basis of being pregnant (including pregnancy-related
assistance provided to targeted low-income pregnant women (as
defined in section 2112(d)), pregnancy-related assistance
provided to women who are eligible for such assistance
through application of section 1902(v)(4)(A)(i) under section
2107(e)(1), or any other assistance under the State child
health plan (or a waiver of such plan) which is provided to
women on the basis of being pregnant) shall not have in
effect, with respect to such women, eligibility standards,
methodologies, or procedures under such plan (or waiver) that
are more restrictive than the eligibility standards,
methodologies, or procedures, respectively, under such plan
(or waiver) that are in effect on the date of enactment of
this paragraph.''.
(6) Information on benefits.--The Secretary of Health and
Human Services shall make publicly available on the Internet
website of the Department of Health and Human Services,
information regarding benefits available to pregnant and
postpartum women and under the Medicaid program and the
Children's Health Insurance Program, including information
on--
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(A) benefits that States are required to provide to
pregnant and postpartum women under such programs;
(B) optional benefits that States may provide to pregnant
and postpartum women under such programs; and
(C) the availability of different kinds of benefits for
pregnant and postpartum women, including oral health and
mental health benefits, under such programs.
(7) Federal funding for cost of extended medicaid and chip
coverage for postpartum women.--
(A) Medicaid.--Section 1905 of the Social Security Act (42
U.S.C. 1396d), as amended by paragraph (1), is further
amended--
(i) in subsection (b), by striking ``and (ff)'' and
inserting ``(aa), and (ii)''; and
(ii) by adding at the end the following:
``(b) Increased FMAP for Extended Medical Assistance for
Postpartum Women.--Notwithstanding subsection (b), the
Federal medical assistance percentage for a State, with
respect to amounts expended by such State for medical
assistance for a woman who is eligible for such assistance on
the basis of being pregnant or having been pregnant that is
provided during the 305-day period that begins on the 60th
day after the last day of her pregnancy (including any such
assistance provided during the month in which such period
ends), shall be equal to--
``(1) 100 percent for the first 20 calendar quarters during
which this subsection is in effect; and
``(2) 90 percent for calendar quarters thereafter.''.
(B) CHIP.--Section 2105(c) of the Social Security Act (42
U.S.C. 1397ee(c)) is amended by adding at the end the
following new paragraph:
``(12) Enhanced payment for extended assistance provided to
pregnant women.--Notwithstanding subsection (b), the enhanced
FMAP, with respect to payments under subsection (a) for
expenditures under the State child health plan (or a waiver
of such plan) for assistance provided under the plan (or
waiver) to a woman who is eligible for such assistance on the
basis of being pregnant (including pregnancy-related
assistance provided to a targeted low-income pregnant woman
(as defined in section 2112(d)), pregnancy-related assistance
provided to a woman who is eligible for such assistance
through application of section 1902(v)(4)(A)(i) under section
2107(e)(1), or any other assistance under the plan (or
waiver) provided to a woman who is eligible for such
assistance on the basis of being pregnant) during the 305-day
period that begins on the 60th day after the last day of her
pregnancy (including any such assistance provided during the
month in which such period ends), shall be equal to--
``(A) 100 percent for the first 20 calendar quarters during
which this paragraph is in effect; and
``(B) 90 percent for calendar quarters thereafter.''.
(8) Guidance on state options for medicaid coverage of
doula services.--Not later than 1 year after the date of the
enactment of this Act, the Secretary of Health and Human
Services, acting through the Administrator of the Centers for
Medicare & Medicaid Services, shall issue guidance for the
States concerning options for Medicaid coverage and payment
for support services provided by doulas.
(9) Effective date.--
(A) In general.--Subject to subparagraph (B), the
amendments made by this subsection shall take effect on the
first day of the first calendar quarter that begins on or
after the date that is one year after the date of enactment
of this Act.
(B) Exception for state legislation.--In the case of a
State plan under title XIX of the Social Security Act or a
State child health plan under title XXI of such Act that the
Secretary of Health and Human Services determines requires
State legislation in order for the respective plan to meet
any requirement imposed by amendments made by this
subsection, the respective plan shall not be regarded as
failing to comply with the requirements of such title solely
on the basis of its failure to meet such an additional
requirement before the first day of the first calendar
quarter beginning after the close of the first regular
session of the State legislature that begins after the date
of enactment of this Act. For purposes of the previous
sentence, in the case of a State that has a 2-year
legislative session, each year of the session shall be
considered to be a separate regular session of the State
legislature.
(f) Regional Centers of Excellence.--Part P of title III of
the Public Health Service Act (42 U.S.C. 280g et seq.) is
amended by adding at the end the following new section:
``SEC. 399V-7. REGIONAL CENTERS OF EXCELLENCE ADDRESSING
IMPLICIT BIAS AND CULTURAL COMPETENCY IN
PATIENT-PROVIDER INTERACTIONS EDUCATION.
``(a) In General.--Not later than one year after the date
of enactment of this section, the Secretary, in consultation
with such other agency heads as the Secretary determines
appropriate, shall award cooperative agreements for the
establishment or support of regional centers of excellence
addressing implicit bias, cultural competency, and respectful
care practices in patient-provider interactions education for
the purpose of enhancing and improving how health care
professionals are educated in implicit bias and delivering
culturally competent health care.
``(b) Eligibility.--To be eligible to receive a cooperative
agreement under subsection (a), an entity shall--
``(1) be a public or other nonprofit entity specified by
the Secretary that provides educational and training
opportunities for students and health care professionals,
which may be a health system, teaching hospital, community
health center, medical school, school of public health,
school of nursing, dental school, social work school, school
of professional psychology, or any other health professional
school or program at an institution of higher education (as
defined in section 101 of the Higher Education Act of 1965)
focused on the prevention, treatment, or recovery of health
conditions that contribute to maternal mortality and the
prevention of maternal mortality and severe maternal
morbidity;
``(2) demonstrate community engagement and participation,
such as through partnerships with home visiting and case
management programs;
``(3) demonstrate engagement with groups engaged in the
implementation of health care professional training in
implicit bias and delivering culturally competent care, such
as departments of public health, perinatal quality
collaboratives, hospital systems, and health care
professional groups, in order to obtain input on resources
needed for effective implementation strategies; and
``(4) provide to the Secretary such information, at such
time and in such manner, as the Secretary may require.
``(c) Diversity.--In awarding a cooperative agreement under
subsection (a), the Secretary shall take into account any
regional differences among eligible entities and make an
effort to ensure geographic diversity among award recipients.
``(d) Dissemination of Information.--
``(1) Public availability.--The Secretary shall make
publicly available on the internet website of the Department
of Health and Human Services information submitted to the
Secretary under subsection (b)(3).
``(2) Evaluation.--The Secretary shall evaluate each
regional center of excellence established or supported
pursuant to subsection (a) and disseminate the findings
resulting from each such evaluation to the appropriate public
and private entities.
``(3) Distribution.--The Secretary shall share evaluations
and overall findings with State departments of health and
other relevant State level offices to inform State and local
best practices.
``(e) Maternal Mortality Defined.--In this section, the
term `maternal mortality' means death of a woman that occurs
during pregnancy or within the one-year period following the
end of such pregnancy.
``(f) Authorization of Appropriations.--For purposes of
carrying out this section, there is authorized to be
appropriated $5,000,000 for each of fiscal years 2021 through
2025.''.
(g) Special Supplemental Nutrition Program for Women,
Infants, and Children.--Section 17(d)(3)(A)(ii) of the Child
Nutrition Act of 1966 (42 U.S.C. 1786(d)(3)(A)(ii)) is
amended--
(1) by striking the clause designation and heading and all
that follows through ``A State'' and inserting the following:
``(ii) Women.--
``(I) Breastfeeding women.--A State'';
(2) in subclause (I) (as so designated), by striking ``1
year'' and all that follows through ``earlier'' and inserting
``2 years postpartum''; and
(3) by adding at the end the following:
``(II) Postpartum women.--A State may elect to certify a
postpartum woman for a period of 2 years.''.
(h) Definitions.--In this section:
(1) Maternal mortality.--The term ``maternal mortality''
means death of a woman that occurs during pregnancy or within
the one-year period following the end of such pregnancy.
(2) Pregnancy related death.--The term ``pregnancy related
death'' includes the death of a woman during pregnancy or
within one year of the end of pregnancy from a pregnancy
complication, a chain of events initiated by pregnancy, or
the aggravation of an unrelated condition by the physiologic
effects of pregnancy.
(3) Severe maternal morbidity.--The term ``severe maternal
morbidity'' includes unexpected outcomes of labor and
delivery that result in significant short-term or long-term
consequences to a woman's health.
SEC. 4. INCREASING EXCISE TAXES ON CIGARETTES AND
ESTABLISHING EXCISE TAX EQUITY AMONG ALL
TOBACCO PRODUCT TAX RATES.
(a) Tax Parity for Roll-Your-Own Tobacco.--Section 5701(g)
of the Internal Revenue Code of 1986 is amended by striking
``$24.78'' and inserting ``$49.56''.
(b) Tax Parity for Pipe Tobacco.--Section 5701(f) of the
Internal Revenue Code of 1986 is amended by striking
``$2.8311 cents'' and inserting ``$49.56''.
(c) Tax Parity for Smokeless Tobacco.--
(1) Section 5701(e) of the Internal Revenue Code of 1986 is
amended--
(A) in paragraph (1), by striking ``$1.51'' and inserting
``$26.84'';
(B) in paragraph (2), by striking ``50.33 cents'' and
inserting ``$10.74''; and
(C) by adding at the end the following:
``(3) Smokeless tobacco sold in discrete single-use
units.--On discrete single-use units, $100.66 per
thousand.''.
(2) Section 5702(m) of such Code is amended--
(A) in paragraph (1), by striking ``or chewing tobacco''
and inserting ``, chewing tobacco, or discrete single-use
unit'';
[[Page S863]]
(B) in paragraphs (2) and (3), by inserting ``that is not a
discrete single-use unit'' before the period in each such
paragraph; and
(C) by adding at the end the following:
``(4) Discrete single-use unit.--The term `discrete single-
use unit' means any product containing, made from, or derived
from tobacco or nicotine that--
``(A) is not intended to be smoked; and
``(B) is in the form of a lozenge, tablet, pill, pouch,
dissolvable strip, or other discrete single-use or single-
dose unit.''.
(d) Tax Parity for Small Cigars.--Paragraph (1) of section
5701(a) of the Internal Revenue Code of 1986 is amended by
striking ``$50.33'' and inserting ``$100.66''.
(e) Tax Parity for Large Cigars.--
(1) In general.--Paragraph (2) of section 5701(a) of the
Internal Revenue Code of 1986 is amended by striking ``52.75
percent'' and all that follows through the period and
inserting the following: ``$49.56 per pound and a
proportionate tax at the like rate on all fractional parts of
a pound but not less than 10.066 cents per cigar.''.
(2) Guidance.--The Secretary of the Treasury, or the
Secretary's delegate, may issue guidance regarding the
appropriate method for determining the weight of large cigars
for purposes of calculating the applicable tax under section
5701(a)(2) of the Internal Revenue Code of 1986.
(f) Tax Parity for Roll-Your-Own Tobacco and Certain
Processed Tobacco.--Subsection (o) of section 5702 of the
Internal Revenue Code of 1986 is amended by inserting ``, and
includes processed tobacco that is removed for delivery or
delivered to a person other than a person with a permit
provided under section 5713, but does not include removals of
processed tobacco for exportation'' after ``wrappers
thereof''.
(g) Clarifying Tax Rate for Other Tobacco Products.--
(1) In general.--Section 5701 of the Internal Revenue Code
of 1986 is amended by adding at the end the following new
subsection:
``(i) Other Tobacco Products.--Any product not otherwise
described under this section that has been determined to be a
tobacco product by the Food and Drug Administration through
its authorities under the Family Smoking Prevention and
Tobacco Control Act shall be taxed at a level of tax
equivalent to the tax rate for cigarettes on an estimated per
use basis as determined by the Secretary.''.
(2) Establishing per use basis.--For purposes of section
5701(i) of the Internal Revenue Code of 1986, not later than
12 months after the later of the date of the enactment of
this Act or the date that a product has been determined to be
a tobacco product by the Food and Drug Administration, the
Secretary of the Treasury (or the Secretary of the Treasury's
delegate) shall issue final regulations establishing the
level of tax for such product that is equivalent to the tax
rate for cigarettes on an estimated per use basis.
(h) Clarifying Definition of Tobacco Products.--
(1) In general.--Subsection (c) of section 5702 of the
Internal Revenue Code of 1986 is amended to read as follows:
``(c) Tobacco Products.--The term `tobacco products'
means--
``(1) cigars, cigarettes, smokeless tobacco, pipe tobacco,
and roll-your-own tobacco, and
``(2) any other product subject to tax pursuant to section
5701(i).''.
(2) Conforming amendments.--Subsection (d) of section 5702
of such Code is amended by striking ``cigars, cigarettes,
smokeless tobacco, pipe tobacco, or roll-your-own tobacco''
each place it appears and inserting ``tobacco products''.
(i) Increasing Tax on Cigarettes.--
(1) Small cigarettes.--Section 5701(b)(1) of such Code is
amended by striking ``$50.33'' and inserting ``$100.66''.
(2) Large cigarettes.--Section 5701(b)(2) of such Code is
amended by striking ``$105.69'' and inserting ``$211.38''.
(j) Tax Rates Adjusted for Inflation.--Section 5701 of such
Code, as amended by subsection (g), is amended by adding at
the end the following new subsection:
``(j) Inflation Adjustment.--
``(1) In general.--In the case of any calendar year
beginning after 2021, the dollar amounts provided under this
chapter shall each be increased by an amount equal to--
``(A) such dollar amount, multiplied by
``(B) the cost-of-living adjustment determined under
section 1(f)(3) for the calendar year, determined by
substituting `calendar year 2020' for `calendar year 2016' in
subparagraph (A)(ii) thereof.
``(2) Rounding.--If any amount as adjusted under paragraph
(1) is not a multiple of $0.01, such amount shall be rounded
to the next highest multiple of $0.01.''.
(k) Floor Stocks Taxes.--
(1) Imposition of tax.--On tobacco products manufactured in
or imported into the United States which are removed before
any tax increase date and held on such date for sale by any
person, there is hereby imposed a tax in an amount equal to
the excess of--
(A) the tax which would be imposed under section 5701 of
the Internal Revenue Code of 1986 on the article if the
article had been removed on such date, over
(B) the prior tax (if any) imposed under section 5701 of
such Code on such article.
(2) Credit against tax.--Each person shall be allowed as a
credit against the taxes imposed by paragraph (1) an amount
equal to $500. Such credit shall not exceed the amount of
taxes imposed by paragraph (1) on such date for which such
person is liable.
(3) Liability for tax and method of payment.--
(A) Liability for tax.--A person holding tobacco products
on any tax increase date to which any tax imposed by
paragraph (1) applies shall be liable for such tax.
(B) Method of payment.--The tax imposed by paragraph (1)
shall be paid in such manner as the Secretary shall prescribe
by regulations.
(C) Time for payment.--The tax imposed by paragraph (1)
shall be paid on or before the date that is 120 days after
the effective date of the tax rate increase.
(4) Articles in foreign trade zones.--Notwithstanding the
Act of June 18, 1934 (commonly known as the Foreign Trade
Zone Act, 48 Stat. 998, 19 U.S.C. 81a et seq.), or any other
provision of law, any article which is located in a foreign
trade zone on any tax increase date shall be subject to the
tax imposed by paragraph (1) if--
(A) internal revenue taxes have been determined, or customs
duties liquidated, with respect to such article before such
date pursuant to a request made under the 1st proviso of
section 3(a) of such Act, or
(B) such article is held on such date under the supervision
of an officer of the United States Customs and Border
Protection of the Department of Homeland Security pursuant to
the 2d proviso of such section 3(a).
(5) Definitions.--For purposes of this subsection--
(A) In general.--Any term used in this subsection which is
also used in section 5702 of such Code shall have the same
meaning as such term has in such section.
(B) Tax increase date.--The term ``tax increase date''
means the effective date of any increase in any tobacco
product excise tax rate pursuant to the amendments made by
this section (other than subsection (j) thereof).
(C) Secretary.--The term ``Secretary'' means the Secretary
of the Treasury or the Secretary's delegate.
(6) Controlled groups.--Rules similar to the rules of
section 5061(e)(3) of such Code shall apply for purposes of
this subsection.
(7) Other laws applicable.--All provisions of law,
including penalties, applicable with respect to the taxes
imposed by section 5701 of such Code shall, insofar as
applicable and not inconsistent with the provisions of this
subsection, apply to the floor stocks taxes imposed by
paragraph (1), to the same extent as if such taxes were
imposed by such section 5701. The Secretary may treat any
person who bore the ultimate burden of the tax imposed by
paragraph (1) as the person to whom a credit or refund under
such provisions may be allowed or made.
(l) Effective Dates.--
(1) In general.--Except as provided in paragraphs (2)
through (4), the amendments made by this section shall apply
to articles removed (as defined in section 5702(j) of the
Internal Revenue Code of 1986) after the last day of the
month which includes the date of the enactment of this Act.
(2) Discrete single-use units and processed tobacco.--The
amendments made by subsections (c)(1)(C), (c)(2), and (f)
shall apply to articles removed (as defined in section
5702(j) of the Internal Revenue Code of 1986) after the date
that is 6 months after the date of the enactment of this Act.
(3) Large cigars.--The amendments made by subsection (e)
shall apply to articles removed after December 31, 2021.
(4) Other tobacco products.--The amendments made by
subsection (g)(1) shall apply to products removed after the
last day of the month which includes the date that the
Secretary of the Treasury (or the Secretary of the Treasury's
delegate) issues final regulations establishing the level of
tax for such product.
______
By Ms. KLOBUCHAR:
S. 422. A bill to allow Senators, Senators-elect, committees of the
Senate, leadership offices, and other offices of the Senate to share
employees, and for other purposes; considered and passed.
S. 422
Be it enacted by the Senate and House of Representatives of
the United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Senate Shared Employee
Act''.
SEC. 2. ALLOWING SENATORS, COMMITTEES, LEADERSHIP OFFICES,
AND OTHER OFFICES OF THE SENATE TO SHARE
EMPLOYEES.
(a) In General.--Section 114 of the Legislative Branch
Appropriation Act, 1978 (2 U.S.C. 4576) is amended--
(1) by inserting ``(a)'' before ``Notwithstanding'';
(2) by striking ``position, each of'' and all that follows
through the period at the end and inserting the following:
``qualifying position if the aggregate gross pay from those
positions does not exceed--
``(1) the maximum rate specified in section 105(d)(2) of
the Legislative Branch Appropriation Act, 1968 (2 U.S.C.
4575(d)(2)), as amended and modified; or
``(2) in a case where 1 or more of the individual's
qualifying positions are positions described in subsection
(d)(2)(B), the maximum rate specified in section 105(e)(3) of
the Legislative Branch Appropriation Act, 1968 (2 U.S.C.
4575(e)(3)), as amended and modified.''; and
(3) by adding at the end the following:
``(b)(1) For an individual serving in more than 1
qualifying position under subsection
[[Page S864]]
(a), the cost of any travel for official business shall be
paid by the office authorizing the travel.
``(2) Messages for each electronic mail account used in
connection with carrying out the official duties of an
individual serving in more than 1 qualifying position under
subsection (a) may be delivered to and sent from a single
handheld communications device provided to the individual for
purposes of official business.
``(3)(A) For purposes of the Ethics in Government Act of
1978 (5 U.S.C. App.), the rate of basic pay for an individual
serving in more than 1 qualifying position under subsection
(a) shall be the total basic pay received by the individual
from all such positions.
``(B) For an individual serving in more than one qualifying
position under subsection (a), for purposes of the rights and
obligations described in, or described in the provisions
applied under, title II of the Congressional Accountability
Act of 1995 (2 U.S.C. 1311 et seq.) related to practices used
at a time when the individual is serving in such a qualifying
position with an employing office, the rate of pay for the
individual shall be the individual rate of pay received from
the employing office.
``(c)(1) If the duties of a qualifying position under
subsection (a) include information technology services and
support, an individual may only serve in the qualifying
position and 1 or more additional qualifying positions under
such subsection if the individual is in compliance with each
information technology standard and policy established for
Senate offices by the Office of the Sergeant at Arms and
Doorkeeper of the Senate.
``(2) Notwithstanding subsection (a), an employee serving
in a qualifying position in the Office of the Secretary of
the Senate or the Office of the Sergeant at Arms and
Doorkeeper of the Senate may serve in an additional
qualifying position only if--
``(A) the other qualifying position is with the other
Office; or
``(B) the Committee on Rules and Administration of the
Senate has approved the arrangement.
``(d) In this section, the term `qualifying position' means
a position that--
``(1) is designated as a shared position for purposes of
this section by the Senator or other head of the office in
which the position is located; and
``(2) is one of the following:
``(A) A position--
``(i) that is in the office of a Senator; and
``(ii) the pay of which is disbursed by the Secretary of
the Senate.
``(B) A position--
``(i) that is in any committee of the Senate (including a
select or special committee) or a joint committee of
Congress; and
``(ii) the pay of which is disbursed by the Secretary of
the Senate out of an appropriation under the heading
`inquiries and investigations' or `Joint Economic Committee',
or a heading relating to a Joint Congressional Committee on
Inaugural Ceremonies.
``(C) A position--
``(i) that is in another office (excluding the Office of
the Vice President and the Office of the Chaplain of the
Senate); and
``(ii) the pay of which is disbursed by the Secretary of
the Senate out of an appropriation under the heading
`Salaries, Officers and Employees'.
``(D) A position--
``(i) that is filled pursuant to section 105 of the Second
Supplemental Appropriations Act, 1978 (2 U.S.C. 6311); and
``(ii) the pay of which is disbursed by the Secretary of
the Senate out of an appropriation under the heading
`miscellaneous items'.''.
(b) Effective Date.--The amendments made by subsection (a)
shall take effect beginning on the day that is 6 months after
the date of enactment of this Act.
______
By Mr. DURBIN (for himself, Mr. Lee, Mr. Leahy, Mr. Grassley,
Mrs. Feinstein, Mr. Rubio, Ms. Klobuchar, Mr. Cruz, Mr. Coons,
Mrs. Blackburn, Mr. Blumenthal, and Ms. Hirono):
S. 426. A bill to amend the Inspector General Act of 1978 relative to
the powers of the Department of Justice Inspector General; to the
Committee on the Judiciary.
Mr. DURBIN. Mr. President, I ask unanimous consent that the text of
the bill be printed in the Record.
There being no objection, the text of the bill was ordered to be
printed in the Record, as follows:
S. 426
Be it enacted by the Senate and House of Representatives of
the United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Inspector General Access Act
of 2021''.
SEC. 2. INVESTIGATIONS OF DEPARTMENT OF JUSTICE PERSONNEL.
Section 8E of the Inspector General Act of 1978 (5 U.S.C.
App.) is amended--
(1) in subsection (b)--
(A) in paragraph (2), by striking ``and paragraph (3)'';
(B) by striking paragraph (3);
(C) by redesignating paragraphs (4) and (5) as paragraphs
(3) and (4), respectively; and
(D) in paragraph (4), as redesignated, by striking
``paragraph (4)'' and inserting ``paragraph (3)''; and
(2) in subsection (d), by striking ``, except with respect
to allegations described in subsection (b)(3),''.
______
By Ms. COLLINS (for herself and Ms. Rosen):
S. 436. A bill to provide Federal matching funding for State-level
broadband programs; to the Committee on Commerce, Science, and
Transportation.
Ms. COLLINS. Mr. President, I rise today to introduce the American
Broadband Buildout Act. This legislation would help ensure that rural
Americans have access to broadband services at the speeds they need to
participate fully in the benefits of our modern society and economy. I
want to thank my colleague Senator Rosen for joining me in introducing
this bill today.
Twenty-five years ago, Americans typically accessed the internet
using their home phone lines via modems, capable of downloading data at
just 56 kilobits per second, too slow even to support MP3-quality
streaming music. Today, the Federal Communications Commission defines
broadband service as having a threshold download speed nearly 500 times
faster.
Many areas of our country, particularly our rural communities, simply
do not have the infrastructure to achieve these speeds and fully tap
into the opportunities that digital connectivity can deliver. According
to a 2019 Pew Research Center survey, nearly 37 percent of rural
Americans lack a broadband connection compared to 25 percent of urban
Americans.
Similar disparities occur in terms of broadband adoption. That is the
rate at which Americans subscribe to broadband service once they have
access to it.
The survey also found that 15 percent of rural Americans don't use
the internet at home compared to just 9 percent of urban Americans.
The current pandemic has brought these connectivity challenges into
stark focus as many families have had to move their education, their
workplaces, and their healthcare services online.
Andrea Powers, the town manager of Fort Fairfield in northern Maine,
recently described a number of challenges in her community: students
who have to sit on the town's library steps in order to finish research
projects and submit their papers; a business owner who was forced to
relocate his company to another community in order to have a chance to
succeed; a senior citizen who requires the care of distant doctors but
does not have the capacity to travel nor access the telehealth options.
Andrea told me the story of one family whose jobs rely heavily on
access to high-speed broadband. They were told that it would cost them
$15,000 to bring that connection to their doorstep. Andrea summed up
the reality facing so many rural communities that lack access in this
way. She said: ``We will continue to see a loss of business retention
and expansion along with job creation. We simply cannot afford to allow
this to happen. Online schooling, business growth and development,
telehealth care, and economic agriculture success are all dependent on
. . . affordable fiber optic broadband.''
Telehealth services are an essential piece of the national broadband
conversation. Often, rural communities struggle to attract and retain
healthcare providers that they need to ensure access to quality care.
Broadband is vital to bridging that gap to enable innovative healthcare
delivery.
Let me give you an example. Hospice workers at Northern Light
Homecare were able to use the internet and video technology to help
support a patient living on an island off the coast of Maine--not far
as the seagull flies, but hours away in travel time. Although the
connection was poor, the video enabled nurses to monitor the patient's
condition and symptoms and, equally important, to provide emotional
support to her and to her family. As one hospice worker put it, ``our
hospice team could be doing so much more with video and telemonitoring
technologies if only Maine had better connectivity.''
The American Broadband Buildout Act would help close this ``digital
divide'' between urban and rural America by providing up to $15 billion
in matching grants to assist States and State-
[[Page S865]]
approved entities in building that ``last-mile'' infrastructure to
bring high-speed broadband directly to homes and businesses in areas
that lack it.
Projects would have to be located in unserved areas--that is, areas
where broadband is unavailable at speeds that meet the FCC standards.
Focusing on those areas will direct support where it is most needed and
will protect against overbuilding where infrastructure is already in
place.
The Federal funding authorized in our bill would be matched through
public-private partnerships between the broadband service provider and
the State where they provide service. This means that States and their
private sector partners will have ``skin in the game'' so that the
projects will be well thought out and sustainable. This model will also
incentivize existing service providers to extend their networks to
rural areas and swiftly connect new households.
Third, the bill would require that projects be designed to be
``future proof,'' meaning that the infrastructure installed must be
capable of delivering higher speeds as broadband accelerates in the
future. We want these investments to serve rural Americans now and in
the future without having to rebuild every time technology advances.
Our bill would also prioritize projects in States that have
traditionally lagged behind the national average in terms of broadband
subscribers and those that are at risk of falling further behind as
broadband speeds increase.
Finally, the bill would provide grants for digital literacy and
public awareness campaigns to encourage wider broadband adoption once
access is available. Increasing broadband adoption will help drive down
the cost of the service and make it more affordable for everyone.
Rural Americans need access to high-speed internet just as urban
Americans do. In fact, one could argue they need it even more,
especially during these times that can require remote work, education,
and healthcare. The bill that Senator Rosen and I are introducing today
would help bridge this digital divide by funding ``future proof''
broadband where it is needed most and give a boost to job creation in
rural America.
As the Presiding Officer well knows, businesses will not locate in
areas that do not have this essential service, in many cases. I urge
all of our colleagues to join in supporting this bill.
Thank you
____________________