[Congressional Record Volume 169, Number 130 (Thursday, July 27, 2023)]
[Senate]
[Pages S3731-S3733]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




  SECURING THE U.S. ORGAN PROCUREMENT AND TRANSPLANTATION NETWORK ACT

  Mr. WYDEN. Mr. President, before I make a unanimous request on this 
important bipartisan, bicameral bill, I wish to talk for a moment about 
why it is so critical that the Senate pass this urgently needed 
legislation.
  For hundreds of thousands of Americans and their families waiting for 
a transplant, this is not an abstract issue. We are talking about life 
and death. More than 100,000 people are on the waiting list to receive 
a transplant, and, on average, 17 people die each day waiting for an 
organ transplant. In the first half of this year alone, more than 2,200 
Americans have died while waiting for a transplant.

  The inadequacies of the current system are especially harmful to 
minority populations who are disproportionately represented on the 
organ transplant waitlist, yet, on average, wait longer for a 
transplant and are at a higher risk of death while waiting.
  I would just say to my colleagues that this is morally repugnant, and 
this legislation begins, finally, to root out this bias against our 
minority communities.
  For the last 40 years, the same contractor has had a stronghold on 
this contract. The lack of competition has not been in the best 
interest of patients, and this fall the contract will be up for 
renewal.
  In last year's bipartisan investigation, the Finance Committee found 
shocking failures with the current contractor who oversees the entire 
system: long wait times for patients on transplant lists, viable organs 
being lost or damaged in transit. We saw pictures of these organs lying 
around in airport hangars. There has just been a lack of accountability 
when the problems happen, technology failures, and even patient deaths.
  The last place anybody wants to hear about gross mismanagement and 
incompetence is in the business of saving lives. It is time for real 
accountability and real change.
  This bill would build on the administration's recently announced 
plans to modernize the program and clarify that there is the ability to 
award multiple contracts for these key functions. This would create 
real competition for these contracts and ensure the best-in-class 
organizations can be awarded contracts to support this critical system.
  The bill, which passed in the other body last week, would bring much 
needed change and modernization of the organ transplant system by 
supporting the administration's efforts and codifying, in the black 
letter law, modernization efforts where we aren't going to turn back 
the clock. We are not going to go back. We are going to go forward.
  I would like to thank a number of Members on both sides of the aisle 
who have been on the frontlines in this fight, particularly Senator 
Grassley, Senator Cardin, and Senator Young, who always worked in a 
bipartisan way. Senator Grassley, in particular, has been a longtime 
leader on this issue, an outspoken advocate for fixing a broken organ 
transplant system. I believe he had a challenging schedule, as many 
Senators did tonight, but I wanted to thank Senator Grassley. And I 
want to also thank my friend from Vermont, Senator Sanders, and his 
very talented staff for their commitment to help us get to this point, 
and we are going to continue to work in the future.
  Let's be clear about what is on offer. Every Member of Congress wants 
Americans to have the best-in-class organ transplant system. Our 
legislation is written from top to bottom to ensure competition for 
technical functions like those that will help this program perform to 
the highest possible level.
  I said we were going to pull out all the stops to get this passed 
because the patients deserve it. This is the final stop after all of 
these years of foot-dragging and excuses. And tonight, this is the 
final stop. Let's send the Securing the U.S. Organ Procurement 
Transplantation Network Act to the President's desk today.
  Mr. GRASSLEY. Mr. President, the Securing the U.S. Organ Procurement 
and Transplantation Network Act is an opportunity for Congress to make 
history, an opportunity to change the lives of the more than 100,000 
Americans waiting for an organ transplant.
  Organ donation has always been a bipartisan issue. In 1984, Congress 
passed the National Organ Transplant Act. That bill was cosponsored by 
Senator Al Gore and Senator Orrin Hatch. I would like to thank the 
bipartisan group of Senate colleagues who cosponsored our bill. I would 
like to give special thanks to Senator Cassidy, who championed the bill 
in the HELP Committee. I would also like to recognize Senators Wyden, 
Cardin, and Young, who have worked with me for years to shine a light 
on the deadly failures of the Nation's organ donation system.
  Thank you all for your leadership. Our bipartisan work will continue. 
The organ donation system has failed patients and generous donor 
families from all walks of life. After years of bipartisan work in the 
House and Senate, we have finally passed this bill. Success with this 
bill means patients are the winners.
  For almost two decades, Congress, government watchdogs, and the media 
have questioned the United Network for Organ Sharing's ability to carry 
out its responsibilities. I have written about these issues since 2005. 
Since then, 200,000 Americans have died on the organ waiting list.
  Those aren't numbers; those are lives. To put it in perspective, that 
is the population of Des Moines, IA. There is a reason I call the 
United Network for Organ Sharing the fox guarding the hen house.
  In August of 2022, the Senate Finance Committee issued a bipartisan 
report that detailed vast disparities in how Organ Procurement 
Organizations serve their communities. Based on the findings, the organ 
network has worse outcomes for people of color and rural residents. 
This bipartisan investigation, which started when I was chairman of the 
Senate Finance Committee, uncovered fraud, waste, abuse, criminality, 
deadly patient safety issues, failure to recover organs, and 
retaliation against whistleblowers. The Senate Finance Committee's 
bipartisan report was clear: ``From the top down, the U.S. transplant 
network is not working, putting Americans' lives at risk.''
  We must break up the monopoly that has held the U.S organ donation 
system hostage since 1986. Patients deserve the best possible care; it 
is the difference between life and death. Our bipartisan bill will help 
ensure they get the best care.
  Earlier this week, our colleagues in the House passed this same 
legislation to break up the organ monopoly and serve patients instead 
of special interests. Today, by passing this bill, we have accomplished 
a major milestone in saving lives and taking care of those who need it 
most.
  Mr. WYDEN. Mr. President, I ask unanimous consent that the Senate 
proceed to the immediate consideration of H.R. 2544, which was received 
at the House and is at the desk; further, that the bill be considered 
read a

[[Page S3732]]

third time and passed and the motion to reconsider be considered made 
and laid upon the table with no intervening action or debate.
  The PRESIDING OFFICER. Is there objection?
  Mr. SANDERS. Reserving the right to object
  The PRESIDING OFFICER. The Senator from Vermont.
  Mr. SANDERS. Let me begin by thanking Chairman Wyden for his 
leadership on the need to fundamentally reform our Nation's organ 
transplant program. I share his concerns. A 2020 bipartisan Finance 
Committee investigation that Chairman Wyden co-led with respect to the 
current system found ``lapses in patient safety, misuse of taxpayer 
dollars, and tens of thousands of organs going unrecovered or not 
transplanted . . . resulting in fraud, waste, and abuse of our Nation's 
Medicare program and American taxpayer dollars.''
  That is unacceptable and that has got to change. The legislation 
Senator Wyden would like to pass in the Senate today by unanimous 
consent, while not perfect, includes important reforms to the current 
system that I support. Once it is signed into law, there may need to be 
some technical changes to it that I look forward to working with 
Chairman Wyden and my other colleagues on.
  All of us believe that the administration should have the flexibility 
it needs to fix the current system. We also believe that corporations 
should not be able to make an outrageous profit from the organ network.
  As my good friend from Oregon knows, this bill is within the 
jurisdiction of the HELP Committee, a committee that I chair.
  Before I withdraw my objections to the organ transplant bill, I want 
to raise an issue of enormous importance to the American people, and 
that is the need to address the very serious primary care crisis in 
America and the massive shortage of doctors, nurses, mental health 
professionals, and dentists in America.
  As my colleague from Oregon knows very well, tens of millions of 
Americans are unable to access the primary medical care, dental care, 
and mental health care that they desperately need.
  As everyone in America understands, we don't have enough doctors, 
nurses, psychologists, psychiatrists, dentists, and home healthcare 
workers in our country.
  As the Senator from Oregon knows very well, on September 30, 
mandatory funding for Community Health Centers, the National Health 
Service Corps, and Teaching Health Centers will expire unless Congress 
acts, and Congress must act.
  The HELP Committee is working on bipartisan legislation, not only to 
reauthorize these critical programs, but to significantly expand them. 
We need a major expansion of Community Health Centers in America to 
make sure that tens of millions of underserved Americans not only 
receive the primary care they need, but are also able to receive the 
high-quality mental health care and dental care they need as well.
  We need a major expansion of the National Health Service Corps 
Program, the program that provides scholarships and debt forgiveness 
for doctors, nurses, dentists, and mental health providers who are 
prepared to work in our Nation's most underserved areas.
  We need a major expansion of the Teaching Health Center Program, the 
Nurse Corps, and the Nurse Faculty Loan Program, among many other 
things.
  Of particular concern is an issue I heard about from every single 
major medical organization in our country, and that is that over the 
next decade, our Nation faces a shortage of more than 120,000 doctors, 
including a major shortage of primary care doctors. I don't know how we 
can grow the number of doctors in America without expanding the 
Medicare Graduate Medical Education--GME--Program, a program that is 
within the jurisdiction of the Finance Committee.
  Let's be clear. The problem is not so much about the number of 
doctors graduating from medical school. No, the problem--the 
bottleneck--is that some 6,800 applicants for a residency position 
don't match into a program due to a shortage of spots. As my colleague 
from Oregon knows, if a doctor graduates from medical school but cannot 
get a residency slot, that person cannot practice medicine in the 
United States.
  In my view, it is critically important that we expand the GME 
Program. There is bipartisan legislation that does this: S. 1302. The 
Resident Physician Shortage Reduction Act of 2023, led by Senators 
Menendez, Boozman, Schumer, and Collins, would raise the number of GME 
positions by 14,000 over the next 7 years. Consistent with legislation 
that passed the House last Congress, I believe that a significant 
percentage of these additional slots should be dedicated to primary 
care and mental health care.
  As you know, the Medicare GME Program is within the jurisdiction of 
the Finance Committee, and the other programs I mentioned are within 
the jurisdiction of the HELP Committee.
  I ask my good friend and colleague from Oregon, will you commit today 
that as chairman of the Finance Committee, you will do everything 
within your ability to pass bipartisan legislation in the Senate that 
includes a major expansion of the Medicare Graduate Medical Education 
Program?
  Mr. WYDEN. I thank my colleague for all his leadership, and I am 
certainly planning to speak on the very strong merits of what you 
described. And if you would like to continue, we will go through that 
shortly.
  Would the gentleman like to yield to me?
  Mr. SANDERS. Sure.
  Mr. WYDEN. I thank my colleague for being our leader here in the 
Congress and, frankly, for this Nation because he has consistently made 
the point that given the demographics of where we are going to have so 
many more older people, where we have so many young people at risk, we 
desperately need Chairman Sanders to do what he is talking about, which 
is to address this massive shortage of healthcare workers in America.
  Addressing healthcare workforce shortages means we are going to have 
to have fresh, big league ideas to get these workers all across our 
country, and it is vitally important that we address several of the 
biggest ideas Chairman Sanders and I are talking about.

  For example, expanding funding for the Medicare Graduate Medical 
Education Program--what is called GME--would grow the number of 
doctors, especially primary care physicians and psychiatrists.
  This evening, Chairman Sanders, I want to make it clear that our two 
committees--yours doing important work, what is known as HELP, and ours 
on the Finance Committee--we are committed to bipartisan legislation 
that is going to increase investments in the Medicare Graduate Medical 
Education Program. We are also going to focus on incentivizing 
healthcare providers to partner with schools to train and develop 
healthcare professionals from medical assistants to advanced practice 
nurses.
  We are also going to have to address expanding the number of 
behavioral health providers because we know we have an enormous mental 
health program challenge in America. We have to increase access to 
maternal health programs in rural areas and invest in the direct care 
workforce to ensure the health and safety of older Americans and those 
with disabilities.
  What Senator Sanders is talking about is an all-hands-on-deck 
approach with our two committees, the two lead committees in the 
healthcare area working together to increase the number of workers.
  Tonight, Chairman Sanders, as chair of the Finance Committee, I want 
to make clear that I intend to work very closely with you on these 
issues. We are going to be partners in the effort in the Finance and 
HELP Committees to bring forward legislation in the fall to address the 
healthcare workforce crisis in America. And I want to hear the rest of 
your remarks and hope then we can have a lifting of the objection and 
pass the bill.
  Mr. SANDERS. My remarks will be brief.
  I just want to thank the chairman, Senator Wyden, of the Finance 
Committee, for his commitment and for his leadership on these issues. I 
look forward to working with him to expand access to primary care in 
America and address the major shortage of healthcare workers in 
America.

[[Page S3733]]

  Mr. President, with that commitment, I will not object.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  The bill (H.R. 2544) was ordered to a third reading, was read the 
third time, and passed.
  The PRESIDING OFFICER. The Senator from Delaware.

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