[Congressional Record Volume 170, Number 190 (Friday, December 20, 2024)]
[Senate]
[Pages S7251-S7252]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]



                  Unanimous Consent Request--H.R. 766

  Mr. CARDIN. Mr. President, in a moment, I am going to be making a 
unanimous consent request. I am going to wait for Senator Grassley to 
be on the floor.
  Let me just, if I might, explain what the unanimous consent will be. 
It deals with H.R. 766. I am a proud sponsor of the Preventive Health 
Savings Act since the 113th Congress as it stands. The Congressional 
Budget Office scores budgetary implications of preventive health 
legislation in a 10-year timeframe, limiting Congress's ability to 
understand the long-term impacts of meaningful prevention policies.
  This bicameral, bipartisan legislation would direct CBO to more 
accurately reflect the long-term cost saving potential of preventive 
healthcare initiatives and encourage the use of data-informed 
preventive health measures.
  On March 19 of this year, the House of Representatives passed this 
legislation by voice vote.
  Now, here is the challenge we have. This legislation will allow us to 
implement preventive healthcare sooner. That will save lives and will 
save dollars. To just give you one example, we now have a multicancer 
blood screening test that could be implemented for certain targeted 
populations.
  The longer that is delayed--and being reimbursable under our 
healthcare system--the more people are not going to have the advantage 
of that, and more lives are going to be lost. And later detection of 
cancer, we know, is a more costly type of care that is needed, and it 
costs more money.
  So we have a chance today, because this is a House-passed bill, to 
send this bill to the President, and that is why I will be making a 
unanimous consent request in regards to the bill.
  I know that Senator Grassley has other legislation that he has been 
trying to get attached. I will urge him not to do that because it will, 
obviously, mean this bill will not pass. His issue is not related to 
the issue that this bill is about.
  I want to thank Senator Whitehouse and Senator Grassley for their 
help on the Budget Committee itself. But this is our last opportunity 
to do something meaningful to implement preventive healthcare that will 
save lives and actually save dollars for the taxpayers of this country. 
There is no question about it. This bill saves money, and we can get it 
done now.
  Any amendment on it, obviously, would have to go back to the House, 
and there is no possibility that the House would agree to it.
  Mr. President, as if in legislative session, I ask unanimous consent 
that the Senate proceed to the immediate consideration of H.R. 766, 
which was received from the House and is at the desk; further, that the 
bill be considered read a third time and passed; and that the motion to 
reconsider be considered made and laid upon the table.
  The PRESIDING OFFICER. Is there objection?
  The Senator from Iowa is recognized.
  Mr. GRASSLEY. Mr. President, reserving the right to object, I have a 
counteroffer. But before I get to that, I want to say, first of all, it 
is not easy for me to stand here and object to something the Senator 
from Maryland wants to bring up, because he is a gentleman in the 100 
percent way in the U.S. Senate. So it is not easy to go against his 
ideas.
  But I want you to know, I have been working on the this with 
Representative Burgess, the leader in the House of Representatives, and 
we offered four amendments to him. In the negotiations, he agreed to 
two of them, and two of them he didn't agree to. And we agreed not to 
push for that amendment.
  So we felt that we had good discussions with Representative Burgess. 
But now we are working on the House bill here, and none of those things 
that Burgess agreed to could be. So where we are is that, even though 
Burgess agreed to some compromise, Senators over here have issues with 
preventing Congress from depositing savings into the Medicare 
Improvement Fund in budget years 11 through 30, based upon CBO 
estimates of preventing health savings legislation.
  Now, I have no doubt that preventive medicine saves money, but 
putting money in a fund for 11 to 30 years out can only lead to what we 
know happens too often here in the U.S. Senate of budget gimmicks, 
saying that we are going to use funds in a certain fund. Well, that is 
a perfectly legitimate thing to do, but you have to have confidence 
that what CBO says about that is going to be legitimate and have 
credibility.
  And so what I have been trying to work out with Representative 
Burgess

[[Page S7252]]

is just exactly to do that: Put this fund out there. As you say, it is 
going to save money. But I want to make sure that CBO, when they say 
something, we have a way of verifying that.
  So I want to say that I appreciate the intentions of this bill. 
Increasing preventive healthcare to improve health outcomes and help 
patients and taxpayers avoid costly treatment and services down 
the road is a laudable goal. However, I am concerned that, as currently 
constructed, this bill will lead to budget gimmicks that will 
ultimately increase rather than decrease health spending.

  The sponsors are well aware of my concerns. I worked in good faith to 
offer up ideas to address my budget gimmick concerns. I made it clear I 
am willing to compromise. I have already done so with my most recent 
offer and dropped commonsense budget process reform provisions that I 
thought were important. And these budget process reforms were what was 
in the famous Enzi-Whitehouse bill that Senator Enzi--former-Senator 
Enzi--and, now, Senator Whitehouse worked out in Budget Committee 
reform. And I have said that Burgess was willing to go along with my 
changes to establish commonsense guardrails and to prevent budget 
gimmicks. But these changes have been rejected in the Senate, and my 
concerns haven't been addressed.
  The bill before us contains no commonsense guardrails, such as 
requiring a disclaimer that a supplementary estimate doesn't replace a 
CBO 10-year cost estimate, ensuring supplementary estimates are 
separate and distinct from the 10-year cost estimates, and requiring 
the Congressional Budget Office to be transparent in their modeling.
  That latter point is based on the proposition that we expect CBO to 
show us how they arrived at figures dealing with cost savings of some 
particular preventive medicine program.
  The bill also doesn't address concerns about how supplementary 
analysis could be used for budget gimmicks in the future, such as 
depositing uncertain out-year savings into the Medicare and Medicaid 
Improvement Funds.
  The bill needs commonsense guardrails to prevent budget gimmicks. So 
I would like to suggest this alternative.
  So I ask the Senator from Maryland to modify his request to include 
my amendment, which is at the desk; that the amendment be considered 
and agreed to; that the bill, as amended, be considered read a third 
time and passed; and that the motion to reconsider be considered made 
and laid upon the table.
  The PRESIDING OFFICER. Is there objection to the modification?
  Mr. CARDIN. Mr. President, reserving the right to object, if I 
might--and, again, I appreciate Senator Grassley's comments about this 
Senator. I feel the same about Senator Grassley. He has been an 
incredible voice in the U.S. Senate, particularly on transparency, 
particularly against waste, and has taken on some of the most 
challenging battles here on the floor of the U.S. Senate.
  I have worked on this legislation now for several Congresses. My 
partners are Senator Crapo, Senator Cramer, Senator King. We have all 
worked on this bill together.
  And the bill is very simple. It just allows a more realistic budget 
window for preventive healthcare. And it is something that we have been 
talking about for a long time so that we don't get trapped with high 
upfront costs that have large savings, and we never get to the savings 
because CBO cannot score it under the current budget rules.
  The challenges that Senator Grassley is raising are not in this bill. 
We have worked very closely with the budget people to make sure that 
this bill does not contain the concerns that Senator Grassley is 
raising.
  The Senator might be raising a very legitimate concerns, but it is 
not this legislation that is causing it. This legislation only allows 
us to be able to implement in a more realistic way preventive 
healthcare services with legitimate cost estimates and offsets so that 
we can get the savings from preventive healthcare and implement 
preventive healthcare sooner, saving lives and dollars.
  We can make progress on this issue now. The problem is twofold with 
the request that is being made. First, the potential abuse is not in 
this legislation. It deals with a broader issue. And then, secondly, if 
this bill is amended, I think Senator Grassley also understands the 
chances of passage are zero. There is no possibility that this bill can 
be taken up in the House at this late stage.
  So this is our last opportunity. I came to the floor today and not 
before because I respect greatly Senator Grassley and his concerns, and 
I was hoping we could find a path forward for that to happen. But there 
is no path forward for that to happen now, and by including the 
request, I would be sacrificing both bills. And I would hope the 
Senator would recognize that and allow this modest improvement for 
preventive healthcare to go forward.
  With that, I regretfully object.
  The PRESIDING OFFICER. Objection on the modification is heard.
  Is there objection to the original request?
  Mr. GRASSLEY. Mr. President, yes, I object. I would like to--
  The PRESIDING OFFICER. Objection is heard.
  Mr. GRASSLEY. Around here, we use the words ``budget gimmickry'' 
pretty freely. And I want to say, as an example, that every Senator in 
this Senate knows the term ``Medicare sequester'' as a budget gimmick, 
so something at the end of the 10-year window we are going to draw in 
to spend money today. That is one example of a budget gimmick. I just 
want to make sure that we don't widen that down the road.
  I yield the floor.
  Mr. CARDIN. Mr. President, I suggest the absence of a quorum.
  The PRESIDING OFFICER. The clerk will call the roll.
  The legislative clerk proceeded to call the roll.
  Mr. PETERS. Mr. President, I ask unanimous consent that the order for 
the quorum call be rescinded.
  The PRESIDING OFFICER. Without objection, it is so ordered.

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