Health Care - U.S. Senator Amy Klobuchar

Quality and accessible health care is a very personal matter for me and my family, as it is for families across the country. When my daughter was born she was very sick. But due to an insurance company rule, I was forced to leave the hospital just 24 hours after she was born. I went to the state legislature and got one of the first laws passed in the country guaranteeing new moms and their babies a 48-hour hospital stay. That experience led me to run for office and fight for common-sense health care solutions like the Affordable Care Act and passing my bill to allow Medicare to negotiate lower prescription drug prices on behalf of our nation’s 50 million seniors with Medicare Part D drug coverage.

Comprehensive health care reform—the Affordable Care Act—was passed into law in 2010 with my strong advocacy and support and is a vital source of protection to every American. The legislation prohibits abusive practices like denying coverage and care to those with preexisting conditions, or setting annual or lifetime limits on coverage. The Affordable Care Act also ensures health care plans cover recommended preventative services such as cancer screenings, allows young people up to age 26 to stay on their parents’ plan, and closed the “donut hole” coverage gap in Medicare Part D prescription drug coverage.

I have always said that the Affordable Care Act is a beginning, not an end, and that improvements need to be made at both the state and federal levels. Over the past three years Congress increased premium tax credits, expanded eligibility for them to more middle class Americans, and capped the amount people pay for Affordable Care Act and MNsure health insurance premiums to no more than 8.5 percent of income. At least 85,000 Minnesotans are each saving hundreds of dollars on MNsure health premiums, and Minnesota is at its lowest uninsured rate ever.

To continue to rein in costs, we must put an end to the practice of pharmaceutical companies charging way too much for prescription drugs. Americans pay an average of 250 percent more for their prescription drugs than people in other industrialized countries. That’s why I am fighting to lower prescription drug prices. I was a lead advocate for significant legislation signed into law in 2022 to lower drug prices and lift the 20-year ban that kept Medicare from being allowed to negotiate directly with drug companies to lower prices on behalf of 50 million seniors. These provisions which empower Medicare to start negotiating lower drug prices on behalf of Medicare beneficiaries were based on a bill I have long led, the Empowering Medicare Seniors to Negotiate Drug Prices Act. Negotiations for lower prices have already begun on 10 of the most costly drugs to Medicare. Seniors taking Eliquis, Xarelto, Jardiance, Januvia, Farxiga, Entresto, Enbrel, Imbruvica, Stelara, as well as any Fiasp and NovoLog insulin products could see negotiated consumer prices for these life-saving drugs by 2026.

In addition to Americans seeing savings at the pharmacy counter, taxpayers are projected to save billions over the next ten years as a result of negotiation. Now of course the bill I led for years would have gone further and included price negotiation for all prescription drugs, and I continue to push for more medications to have negotiated lower prices.

Importantly, the 2022 law also prevents drug companies from raising prices faster than the rate of inflation. Additionally, the law will cap the total amount seniors with Medicare Part D pay out-of-pocket for all their prescription drugs to no more than $2,000 a year. In 2025 when this $2,000 cap on seniors’ total out-of-pocket costs takes effect, the reforms to Part D are projected to save 235,000 Minnesota seniors an average of $480 per year. In addition, the out-of-pocket cost of insulin for Medicare patients living with diabetes is now capped at $35 per month, helping at least 47,000 Minnesotans. Finally, vaccines like shingles and pneumonia are now available for free, with no out-of-pocket costs.

I will also keep fighting to expand Medicare coverage of hearing, vision, and dental care.
Helping Minnesotans access preventive care is an important part of staying healthy and keeping costs down.

Information about the Affordable Care Act is available here.
Information about the Minnesota Insurance Marketplace MNsure is available here.

As Minnesota's U.S. senator, I will continue to focus on these health care priorities:

Achieving universal, affordable quality health coverage. We need universal health care, and I support the many ways that would help us reach that goal, including creating a public insurance option, expanding the Affordable Care Act health insurance exchanges, and the expansion of Medicare and Medicaid. I support proposals that would help reach that goal, including the State Public Option Act, which would give states the option of allowing all of their residents —regardless of their income — to get Medicaid coverage; the Medicare-X Choice Act, which would enable Americans to buy a public health insurance plan based on Medicare; and legislation extending Medicare to age 50 and over. Our goal should be simple: Every American has accessible, affordable, high-quality health care.
Reining in the high cost of health care. Whether it’s sky-high drug prices, unexpected fees, or unaffordable treatment, we must address factors that lead to increased health care costs for both consumers and taxpayers. Minnesota has always been an early leader in health care delivery system reform, and we must continue to build on our successes and expand high-value care.

Lowering prescription drug prices. When a family member gets sick, the family’s focus should be on getting their loved one well, not on being able to pay for treatment or medicine. Yet prescription drug prices have been an increasing burden to families across Minnesota and our country. Americans pay the highest prices in the world for the same brand-name prescription drugs. In August 2022, provisions based on legislation I led for years were signed into law, lifting the 20-year ban that stopped Medicare from negotiating prices with drug companies on behalf of 50 million seniors. As a result of this new law, Medicare has started the negotiation process for ten of the most costly drugs to Medicare, and people could see negotiated consumer prices for these life-saving drugs by 2026. Medicare will continue to lower prescription drug costs for seniors by negotiating the price of additional prescription drugs every year.

This new law is just the beginning, and I will continue fighting to drive down prices and increase innovation. We must stop pharmaceutical companies from blocking competition in the market that would drive down prices and increase innovation. My bipartisan bills would limit anticompetitive tactics used by powerful drug companies to block consumer access to cost-saving generics and other alternatives and allow personal importation of safe and more affordable drugs from Canada. In 2019, with a bipartisan group of senators, I introduced and passed into law the CREATES Act, to end tactics some brand-name drug companies were using to prevent generic manufacturers from being able to receive approval for their products, like denying access to samples. This year I introduced bipartisan legislation with Senators Peter Welch of Vermont and Mike Braun of Indiana to limit the number of patents related to the same invention that a drug company can assert in litigation, targeting a tactic that drug companies have used to stave off generic competition for decades.
Preserving access to health care in rural areas. Our rural communities face unique health care challenges. Rural health care facilities often operate on extremely small margins and have a much harder time recruiting highly skilled medical staff. Senator Chuck Grassley of Iowa and I introduced and passed into law in 2018 the Rural Emergency Acute Care Hospital (REACH) Act to help rural hospitals stay open while meeting the needs of rural residents for emergency room care and outpatient services. I have also co-sponsored several bills to preserve and strengthen access to care in rural areas, like the Critical Access Hospital Relief Act, the Protecting Access to Rural Therapy Services Act, the Rural MOMS Act, and the Rural Health Connectivity Act. My bipartisan bill with Senator Shelley Moore Capito of West Virginia, the Improving Access to Cardiac and Pulmonary Rehabilitation Act, was signed into law in 2018 and is expanding access to care by allowing physician assistants, nurse practitioners, and clinical nurse specialists to supervise cardiac, intensive cardiac, and pulmonary rehabilitation programs. I also support the CONNECT for Health Act to expand coverage of telehealth services under Medicare.
Promoting health equity and tackling racial disparities in health care. I support several bills to address the specific health needs of our minority communities, including increasing access to preventative care and mental health resources. While we work to address the specific needs of communities, I recognize the importance of addressing the underlying causes of these disparities including pervasive inequalities in access to health care, discrimination and unequal opportunities in housing, underinvestment in public transportation in minority communities, and the existence of food deserts where people do not have sufficient access to healthy foods and produce. In the interim relief bill that Congress passed in April 2020, I supported including funding specifically for small lenders and community-based financial institutions that serve the needs of unbanked and underserved small businesses—including minority- and women-owned businesses. These programs were also given priority in the comprehensive relief package passed by Congress in December 2020. I support legislation introduced by my colleague Senator Tina Smith which would require the Centers for Disease Control to improve health outcomes and reduce health inequities. As Congress considers future legislation, we must do more to overcome historic disenfranchisement by considering the particular needs of minority communities, including minority entrepreneurs who have had difficulty accessing traditional sources of lending.
Supporting and protecting our seniors and people with disabilities. More than half of Americans turning 65 today are projected to need some type of long-term care in their lives. While nursing homes, assisted-living facilities, and home care providers serve our elderly in some situations, the vast majority of elder care comes from informal caregivers—such as spouses, or adult children taking care of their parents. Additionally, informal caregiving does not end when a person transitions from the community to residential care. Millions of families already find themselves members of the “sandwich generation,” coping with the challenges and costs of caring for elderly parents at the same time they are caring for their own children. As the Baby Boomer generation ages, both their needs for and roles as spousal caregivers grow. My bill, the Americans Giving Care to Elders (AGE) Act, would provide caregivers with a tax credit for up to $6,000 for the eldercare expenses incurred for their aging relative. I also introduced the bipartisan Alzheimer’s Caregiver Support Act with Senator Susan Collins of Maine, which would expand training and support services for families and caregivers of patients with Alzheimer’s and related dementias. [See Seniors]
Strengthening mental health, addiction, and substance use disorder services and treatment. Expanding access to mental health care and evidence-based substance use disorder treatment, including support for clinics, community-based services, and telehealth options, remains one of my top priorities. In 2022 we lost 1,343 Minnesotans to overdoses and opioid-involved deaths increased 3 percent. Fentanyl was involved in 92 percent of these opioid-involved deaths. Alcohol-related deaths in Minnesota have also increased significantly over the past 20 years, averaging over 2,000 a year. In addition to ensuring that communities have the resources they need for prevention and treatment, we must focus on recruiting, retaining, and training mental health and behavioral health workers and specialists in both rural and urban communities. I also strongly support legislation aimed at significantly increasing resources to stop the flow of fentanyl at the border and cracking down on online drug dealing.
Cracking down on health care fraud and protecting personal health data. Law enforcement authorities estimate that health care fraud costs taxpayers tens of billions of dollars every year. These criminals scheme the system to rob American taxpayers of money that should be used to provide health care to those who need it most. One way we can crack down on fraud is by continually modernizing our health care system and investing in health information technology that keeps personal health data private and secure.
Increasing research funding to seek new cures. In Minnesota, we value science and the progress it represents. We must continue to invest in ground-breaking research at the National Institutes of Health (NIH), our nation’s primary entity for biomedical research so that our scientists can concentrate on finding life-saving cures for Alzheimer’s, cancer, muscular dystrophy, ALS, and other diseases and not on finding grants to do their work. We must also invest in the cutting-edge research underway on individualized, or precision, medicine. By understanding the link between genes and diseases, doctors will be able to tailor care more effectively to individual patients’ needs.

As Minnesota's U.S. senator, I am fighting for better, more affordable health care by:

Addressing prescription drug prices and access. I have introduced and passed multiple pieces of legislation to reduce the prices of prescription drugs and ensure appropriate access, including:

Requiring Medicare to negotiate lower drug prices for our seniors. I was a strong advocate for legislation signed into law in August 2022, which lifted the 20-year ban that stops Medicare from being able to negotiate prices directly with drug companies on behalf of 50 million seniors. These provisions were based on legislation I have long led, the Empowering Medicare Seniors to Negotiate Drug Prices Act. As a result of this new law, Medicare has started negotiating a lower price for ten among the most costly drugs to Medicare, and people will start seeing savings in January 2026. Medicare will continue to lower prescription drug costs for seniors by negotiating the price of additional prescription drugs every year. The first drugs that will have lower prices negotiated on behalf of consumers are: Eliquis, Xarelto, Jardiance, Januvia, Farxiga, Entresto, Enbrel, Imbruvica, Stelara, and Fiasp and NovoLog insulin products. The negotiated cost savings from these initial ten blockbuster drugs alone will be significant–up to 9 million seniors paid $3.4 billion in 2022 just in out-of-pocket costs for these drugs. In addition to Americans seeing savings at the pharmacy counter, taxpayers are projected to save billions over the next ten years as a result of negotiation. Now of course my bill would have gone further and included price negotiation for all prescription drugs, and I will continue to push for this. To continue to build on this historic progress to allow Medicare to better control the prices of medication, I introduced the Strengthening Medicare and Reducing Taxpayer (SMART) Prices Act which would increase the savings to American families and taxpayers by doubling the number of drugs Medicare must negotiate prices of on behalf of seniors and increasing the number of drugs and biologics that the federal government must negotiate.
Allowing the importation of safe, less expensive prescription medicines from Canada and other approved countries. For years I have led the Safe and Affordable Drugs from Canada Act with Senator Chuck Grassley of Iowa to allow people to import certain prescription drugs for personal use from certified Canadian pharmacies. I also introduced a bill with Senator Mike Lee of Utah that would allow temporary importation of drugs from countries with strong safety standards—like Australia and those in the European Union—when there is limited competition or a drug shortage in the United States.
Boosting competition to improve access to less expensive generic drugs. I have fought to make sure competition, not unfair conduct, determines the price of prescription drugs. With Senator Chuck Grassley of Iowa, I have introduced bipartisan legislation to help end the so-called “pay-for-delay” practice of brand-name drug manufacturers paying off their less-expensive generic competitors to stay out of the market. Additionally, my and Senator Grassley’s bill, the Stop STALLING Act, would reduce incentives for branded pharmaceutical companies to file sham petitions with the Food and Drug Administration to delay or prevent the approval of generics and biosimilars. Our legislation passed in the Judiciary Committee in 2019 and 2021. Additionally, bipartisan legislation that I introduced with a group of senators, the CREATES Act, to end tactics that some brand-name drug companies use to prevent generic manufacturers from being able to receive approval for their products, like denying access to samples, became law in 2019. This year, I introduced bipartisan legislation with Senators Peter Welch of Vermont and Mike Braun of Indiana to limit the number of patents related to the same invention that a drug company can assert in litigation, targeting a tactic that drug companies have used to stave off generic competition for decades.
Calling out drug companies for high prices. After I raised concerns, the Centers for Medicare and Medicaid Services found that a drug company formerly known as Mylan had incorrectly classified its brand-name product, EpiPen, as a generic drug under Medicaid and therefore was paying less money than was due to states. When I called for a nationwide investigation to determine how many other drugs are misclassified and how much these misclassifications have cost taxpayers, the U.S. Department of Health and Human Services Office of Inspector General found that drug misclassification may have cost Medicaid $1.3 billion from 2012 to 2016. Mylan has since lowered the price of generic EpiPen to half the price of their brand-name version. Additionally, I have called on Eli Lilly, Sanofi, and Novo Nordisk to take action to help people with diabetes afford insulin and explain why prices have tripled over the past decade. I joined Senators Susan Collins of Maine and Tammy Baldwin of Wisconsin to demand answers from Strongbridge Biopharma after the price of a drug that treats glaucoma and a type of rare genetic disease that causes muscle weakness or loss was hiked from $50 to $15,000. Relatedly, I called on six pharmaceutical companies that are the biggest producers of asthma inhalers to remove patents that the Federal Trade Commission identified as improperly protecting high prices for inhalers and EpiPens. So far, three of those companies have capped out-of-pocket costs for certain inhaler products to $35 in response.
Reducing drug waste that costs taxpayers millions of dollars. When I asked the U.S. Department of Health and Human Services Office of Inspector General about the waste generated by the size of single-use drug vials, the investigation found that Medicare was spending hundreds of millions of dollars on drugs that get thrown out because the single-use vial sizes were often bigger than the dose a patient needed. To stop this wasteful spending, I introduced and passed into law in 2018 the bipartisan Reducing Drug Waste Act with Senator Chuck Grassley to prevent paying for left-over medicine amounts that could not be used. The law also required a Joint Action Plan to reduce drug waste and better manage costs with respect to single-use drug vials and other drug-delivery systems like eye drops.
Fighting price gouging by pharmaceutical companies. In 2022 Congress passed legislation that penalizes drug companies from raising prices faster than the rate of inflation. I also lead the Lower Drug Costs for Families Act with Senator Cortez Masto of Nevada, which would double down on fighting price-gouging in the private insurance market. Separately, I’ve called on the Federal Trade Commission (FTC) to investigate pharmaceutical companies for anticompetitive practices and price manipulation. I also called on the Government Accountability Office (GAO) to study the effects of “rebate traps” on pharmaceutical prices and competition. Rebate traps have been used by drug manufacturers to block competition and limit patients’ access to lower-cost generic drugs as well as new innovative medicines. The report found that Medicare Part D beneficiaries pay more than their insurers for 79 of the 100 most highly rebated drugs in Medicare. This finding led to the Senate Finance Committee passing a bipartisan bill that caps cost-sharing for all Medicare Part D enrollees at the net price of any drug, inclusive of rebates.
Allowing for the safe disposal of prescription drugs. I authored the bipartisan Secure and Responsible Drug Disposal Act, which was signed into law by President Obama in 2010, to provide consumers with safe and responsible ways to dispose of unused controlled substances. This law allows individuals and long-term-care facilities to deliver potentially dangerous prescription drugs to law enforcement officials for safe disposal and also promotes the development and expansion of drug take-back programs.

Making health care coverage universal and affordable. I support reforms to help all Minnesotans access affordable, high-quality health care they deserve, such as:

Providing a public option and expanding Medicare and Medicaid. We must make health care universal and affordable, and that includes providing a public option and expanding Medicare and Medicaid. I have cosponsored the State Public Option Act, which would give states the option of allowing all of their residents - regardless of income - to buy Medicaid coverage, and the Medicare-X Choice Act, which would enable Americans to buy a public health insurance plan based on Medicare.

Bringing down health insurance monthly premium rates and out-of-pocket costs and reforming the delivery system. Congress has built on the promise of the Affordable Care Act by improving premium tax credits and capping the amount people pay for Affordable Care Act and MNsure health insurance premiums to no more than 8.5 percent of income. Roughly 85,000 Minnesotans are each saving hundreds of dollars on MNsure health premiums, and Minnesota is at its lowest uninsured rate ever. In 2018 I cosponsored the Bipartisan Health Care Stabilization Act to provide cost-sharing reductions to lower out-of-pocket expenses like copays and deductibles and to make it easier for states to enact reinsurance programs like Minnesota’s. Reinsurance protects against premiums going up for everyone due to a small number of patients with extremely high health care costs, especially in rural markets. I also authored legislation—enacted as part of the Affordable Care Act —that created a “value index” for Medicare reimbursement rates so that we reward the type of high-quality, efficient care that Minnesota and other states deliver instead of the volume of services. I have fought to protect safeguards put in place by the Affordable Care Act so people can no longer be denied coverage due to a preexisting condition and children can stay on their parent’s plans through the age of 26. I worked to close the Medicare Part D Prescription Drug Program “donut hole” to lower prescription drug costs for seniors. This includes increasing the share of costs that brand-name drug companies must cover for beneficiaries as part of the Bipartisan Budget Act signed into law in 2018. As of 2022, 50 million seniors enrolled in the Medicare Part D Prescription Drug Program no longer face a coverage gap when it comes to accessing their prescription drugs at an affordable rate, and nearly all of the more than 1 million Medicare beneficiaries in Minnesota can now receive certain preventive services at no cost.

Improving access to vital drugs, treatments, and medical equipment. In 2012 I authored and Congress passed into law the first bill to prevent and mitigate drug shortages. My legislation with Senator Susan Collins of Maine, the Preserving Access to Life-Saving Medications Act, requires prescription drug manufacturers to give early notification to the Food and Drug Administration (FDA) of any supply situation or manufacturing incident that would likely result in a shortage. Early notification helped the FDA prevent 222 drug shortages in 2022. Unfortunately, shortages continue to pose a serious challenge to health providers and patients.

That’s why I worked across the aisle again to introduce bipartisan legislation with Senator Susan Collins of Maine, which would require drugmakers to report to the FDA any circumstances, including projected increases in demand, that may lead to a shortage of prescription or over-the-counter medications. My bill also requires drugmakers to report to the FDA the suppliers of their active ingredients in order to build more resilience into the supply chain for our medications.

Increasing research funding to seek new cures for diseases and tackle Alzheimer’s and ALS. I have consistently fought for strong funding for research at our federal research agencies, including the National Institutes of Health (NIH). With my support, the NIH received a $100 million increase in funding for fiscal year 2024, which was the eleventh straight annual funding increase. I supported the 21st Century CURES Act—and was there when President Obama signed it into law in 2016—which funded nearly $5 billion for NIH research into cures for Alzheimer’s, cancer, and other diseases. Over the past eleven years, Congress has increased funding for the NIH by 55 percent. During that time we have also quintupled funding for Alzheimer’s and related dementia research from $562 million to $3.8 billion. I’m also proud that I supported the 2022 launch of the Advanced Research Projects for Health (ARPA-H) to provide a pathway for creating transformative health breakthroughs for diseases like ALS (Lou Gehrig’s Disease) that cannot readily be accomplished through traditional research or commercial activity.

Additionally, in 2021 I was proud to support the Accelerating Access to Critical Therapies (ACT) for ALS Act that was signed into law. This bill creates grant programs to expand investigational treatment options for ALS (Lou Gehrig’s disease) patients. This followed the successful enactment in 2020 of a bill I supported, the ALS Disability Insurance Access Act that eliminated the five-month waiting period before ALS patients could access Social Security Disability Insurance (SSDI) benefits.

I also introduced the bipartisan Steve Gleason Act of 2017—which was signed into law as part of the Bipartisan Budget Act in 2018—to ensure Medicare pays for speech-generating devices for people with ALS, Parkinson’s, and other degenerative diseases. Speech-generating devices are a lifeline for these patients, but a Medicare policy change had put coverage at risk.

Expanding health care coverage for children. I supported the Medicare Access and Children's Health Insurance Program Reauthorization Act, signed into law in 2015, to support health coverage for approximately 8.9 million children who do not qualify for Medicaid and whose families cannot afford private insurance. In 2018, we successfully extended funding of CHIP, the Children's Health Insurance Program, through 2027.

Empowering patients. As co-chair of the bipartisan Rare Disease Congressional Caucus, I am working to increase the number of safe, effective, and affordable treatments that are available for people with rare diseases and to give patients a stronger voice during the drug development process. I led the bipartisan Paul D. Wellstone Muscular Dystrophy Community Assistance, Research, and Education (MD-CARE) Amendments Act that was signed into law in 2014. Provisions from the Patient-Focused Impact Assessment Act—which I introduced with Senator Roger Wicker of Mississippi —also became law as part of the 21st Century CURES Act, increasing transparency in the drug approval process by ensuring the Food and Drug Administration (FDA) takes patients’ perspective into account when considering a drug for approval. Senator Wicker and I also introduced the Better Empowerment Now to Enhance Framework and Improve Treatments (BENEFIT) Act—that passed the Senate in 2017—to require a larger role for patients and patient data when the FDA weighs the risks and benefits of new treatments. I also introduced the Speeding Therapy Access Today (STAT) Act with Senator Wicker to improve access to therapies for the rare disease community by promoting coordination within the government to advance science-based policies and ensure patients ultimately receive access to approved therapies. A provision from my bill was enacted into law in December 2022. Finally, I have cosponsored legislation to make it easier for researchers to study the medical effectiveness and safety of marijuana and cannabidiol, which is used to treat conditions such as epilepsy.

Promoting innovation. I have worked to reduce delays in delivering life-saving medical devices to the patients who need them after approvals for many life-saving devices had languished for years. That’s why I worked with other senators on the bipartisan Medical Device Regulatory Improvement Act, key provisions of which were included in legislation that passed the Senate by a vote of 92-4 and was signed into law by President Obama in 2012. The 21st Century CURES Act and the FDA Reauthorization Act which were enacted in 2016 and 2017 have also helped to foster innovation for drugs and medical devices that can provide breakthrough treatments. I also led successful efforts to permanently repeal the 2.3 percent excise tax on medical devices, which inordinately impacted our state, so that medical technology manufacturers can continue to provide consumers cutting-edge, life-saving products.

Helping small businesses improve health plans. Since 2011, small businesses have been eligible for tax credits worth up to 50 percent of their contribution to their employees' health insurance plans. I have sponsored the Health Care for Small Business Act to expand these tax credits and make it easier for small businesses to use them. I fought to include the Small Business Health Options Program (SHOP) Act in the Affordable Care Act so that small businesses can increase the choices of health care plans for their employees. I also successfully fought to repeal a burdensome tax-reporting requirement for small businesses that was originally in the Affordable Care Act.

Ensuring that our hospitals and health workers have the resources they need.

Strengthening our health care workforce. In many places we need more workers to care for patients. That is why I encouraged the previous administration to streamline the process for doctors seeking employment-based visas to help increase access to health care in underserved areas, especially rural areas, which are served by doctors in the Conrad 30 program. I also urged the previous administration to waive restrictions preventing medical professionals on employment-based visas from practicing in areas where they are needed most during the pandemic. For years, I have led bipartisan legislation to increase the number of doctors able to work in rural and medically underserved communities.

Prioritizing mental health. Mental health issues can also take such a toll on families. I have and will continue to fight to increase access to mental health care. In 2020, with my strong support, Congress created and has since provided over $1 billion in critical funding for the 988 Suicide and Crisis Lifeline, a national network of local crisis centers that provides free and confidential support 24 hours a day, 7 days a week, to people in suicidal crisis or emotional distress. In 2022, I led the bipartisan Justice and Mental Health Collaboration Reauthorization Act with Senator John Cornyn of Texas to further support the 988 Lifeline. Since its launch in July 2022, 988 Lifeline has already allowed thousands of individuals, of all ages, to get help for themselves or a loved one by connecting them with a trained crisis counselor. In just one month - March 2023 - over 370,000 calls, texts, and chats were routed through the Lifeline nationally, and nearly 4,000 in Minnesota alone. There are far too many families devastated by the physical, emotional, and financial consequences of mental illness. We must do everything we can to help people in crisis get the help they need. If you or someone you love needs free help with a mental health crisis or are having thoughts of suicide or a mental health crisis, please visit www.samhsa.gov/find-help/988 or call or text 988.

Strengthening mental health and substance use disorder services. I understand the toll that mental health, addiction, and substance use disorders can take on families and communities. I’ve continued to fight for legislation that expands access to services and ensures communities have the resources they need for prevention and treatment.

Providing access to mental health services. Substance use and mental health disorders do not discriminate, and if we are going to combat addiction we must prioritize prevention, early intervention, expanding access to evidence-based treatment, and allowing people a path to recovery.

Preventing and successfully treating eating disorders. I introduced the bipartisan Anna Westin Act—which was included in the 21st Century CURES Act signed into law in 2016—to help the millions of Americans suffering from eating disorders get the help they need. The law increases awareness and early detection of eating disorders, requires insurers to cover residential treatment, and clarifies the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act to ensure health insurance companies cover all mental health and substance use disorder benefits in the same way they do physical illnesses. The Anna Westin Legacy Act, my bill with Senator Shelley Moore Capito of West Virginia, expands on the original Anna Westin Act by authorizing a Center of Excellence for Eating Disorders to provide training to health care workers, teachers, and parents on how to identify eating disorders and support patients in recovery. That bill was signed into law in 2022. I also support the Excellence in Mental Health and Addiction Treatment Expansion Act to allow more states to conduct demonstration programs—like Minnesota has—to improve access to community mental health services. We successfully increased funding for these community mental health programs in 2018.

Combating the addiction and overdose crises. No matter where I go in our state, I hear heartbreaking stories about families and entire communities torn apart by substance use disorders. In 2022, on average three Minnesotans died each day from a drug overdose, and for every one drug overdose death there were nearly 13 nonfatal drug overdoses. We lose more people from drug overdoses or alcohol-related deaths in Minnesota than from car crashes and homicides combined. I’m committed to working together with federal, state, and local leaders, public health practitioners, law enforcement officers, and advocates to ensure we have the tools in place to prevent overdose and addiction. I worked with a bipartisan group of colleagues in 2022 to push seven major drug manufacturers of Naloxone or Narcan to make the opioid overdose reversal medication available over-the-counter. Now two drug manufacturers have made their products Narcan and RiVive, available over-the-counter. By making treatments for opioid use disorder and overdose more readily available, more lives will be saved.

I also led a bipartisan bill called the Comprehensive Addiction and Recovery Act (CARA), which became law in 2016. This legislation encourages states and local communities to pursue a full array of proven strategies in the fight against addiction. In 2020, I introduced the CARA 3.0 Act with a bipartisan group of senators to build on the momentum of CARA by increasing funding and putting in place additional policy reforms to combat the opioid epidemic. One important provision in the CARA 3.0 Act is based on my bipartisan bill, the Prescription Drug Monitoring Act, to require states that receive certain federal funding to have prescription drug monitoring programs that use best practices to stop the kind of “doctor shopping” that facilitates addiction. Additionally, in 2018, I voted for the SUPPORT Act that provided $20 billion in funding for addiction treatment, prevention, and recovery. More recently I supported increases in grant funding used to improve health outcomes for people with drug and alcohol addiction, and also to expand access to Certified Community Behavioral Health Clinics (CCBHCs) which provide a team-based collaborative approach to addiction recovery services.

Before I was elected to the Senate, I spent eight years serving as the Hennepin County Attorney. Drug cases made up about one-third of our caseload and I saw firsthand how difficult it is to break this cycle of destructive behavior. Drug treatment courts, for example, are an important, cost-effective way to help low-level, non-violent drug offenders stay on the right side of the law by addressing underlying unresolved trauma or behavioral health issues. That is why I lead efforts in the U.S. Senate to ensure drug courts receive strong federal funding every year. I have also introduced bipartisan legislation with Senator Wicker of Mississippi to update and modernize drug and alcohol treatment courts.

In addition, I’ve been focused on working to crack down on drug trafficking to stop illicit drugs and fake pills from entering our borders. I am working to get funding for cutting-edge technology to detect and intercept fentanyl at our borders and bolster federal law enforcement’s ability to investigate online fentanyl trafficking.

I have also led efforts to combat drug trafficking through the mail. In 2018, my bipartisan STOP Act, which was signed into law, requires the U.S. Postal Service to collect data on packages sent from overseas to better identify illegal fentanyl shipments. To build on the success of the original STOP Act, I have worked with Senator Shelley Moore Capito of West Virginia to introduce bipartisan legislation to establish a new criminal penalty for people who try to get around those requirements. The bill also allows the federal government to partner with private companies and foreign allies who are taking innovative steps to stop fentanyl trafficking. Finally, this year I worked to pass the bipartisan FEND Off Fentanyl Act in the Senate, which would officially declare international fentanyl trafficking a national emergency and provide new authorities to impose tough sanctions on transnational criminal organizations in China, Mexico, or any other fentanyl supply chain hub. I’ll continue to fight for additional funds and resources for communities across our state that have been impacted by addiction.

I am also focused on addressing the growing use of social media platforms as digital marketplaces for illegal drugs. In our increasingly digital world, drug trafficking doesn’t only happen in alleys or on street corners. We know that drug cartels have harnessed the power of social media to sell their deadly drugs, leaving our kids in danger. Last year, the Drug Enforcement Administration investigated 390 drug overdose cases and found that a third of them had direct ties to social media. That is why I am leading and cosponsoring several bipartisan bills to crack down on online drug dealing, including legislation to hold social media companies accountable by requiring them to report drug trafficking on their platforms to law enforcement. This will help law enforcement crack down on illegal drug sales and protect kids.

Lastly, while we must ensure that people suffering from chronic pain receive the treatment they need, we must address our country’s opioid epidemic from every angle. In December 2022 Congress passed the Non-Opioids Prevent Addiction in the Nation (NOPAIN) Act, that I supported, which now allows Medicare to reimburse providers for dispensing non-opioid options. This will ensure that Medicare beneficiaries have access to non-opioid options to manage their post-surgical pain, helping patients avoid addiction as well as potential opioid misuse by others in their household. Additionally, the Food & Drug Administration now requires opioid medication to be dispensed with prepaid mail-back envelopes or in-home disposal to encourage patients to safely and securely dispose of any unused opioids.

Preserving access to health care in rural areas. I understand that health care is not a one-size-fits-all proposition, especially for rural communities that face unique challenges in making high-quality health care accessible to all residents. I have led the successful effort to extend the Conrad State 30 program that allows international doctors trained in the United States to extend their stay in the country if they agree to practice in underserved communities, and I have introduced bipartisan legislation to expand the program. I successfully fought to renew funding for community health centers—which are critical sources of care in rural areas—as part of the Bipartisan Budget Act. I have also cosponsored multiple pieces of legislation—the Rural Emergency Acute Care Hospital (REACH) Act, the Improving Access to Cardiac and Pulmonary Rehabilitation Act, the Critical Access Hospital Relief Act that became law in 2018, the Protecting Access to Rural Therapy Services Act, and the Rural Health Connectivity Act—to strengthen and expand access to care in rural areas. The Improving Access to Cardiac and Pulmonary Rehabilitation Act—which expands access to care by allowing physician assistants, nurse practitioners, and clinical nurse specialists to supervise cardiac, intensive cardiac, and pulmonary rehabilitation programs—and the CHRONIC Care Act—which expands the use of telehealth and makes additional reforms to the health care delivery system—were signed into law in 2018. I also support the CONNECT for Health Act to expand coverage of telehealth services under Medicare.

Tackling health equity and racial disparities in health care. I am working to ensure our health care policies and programs better address racial disparities throughout our health care system. We must make sure that every Minnesotan has access to reliable, quality, and just care by:

Promoting preventive care. For many Minnesotans, the pandemic meant the delay or cancellation of preventive care services, such as cancer screenings and vaccinations. This has particularly impacted people in underserved and rural communities who are more likely to get diagnosed in later stages of the disease, lowering their chances of less invasive, successful treatment. That’s why I introduced the bipartisan Preventative Care Awareness Act to require the Department of Health and Human Services to focus on decreasing disparities in accessing preventive services.

Addressing Sickle Cell Disease. Sickle cell is a deadly inherited blood disorder that disproportionately impacts African Americans. The Centers for Disease Control and Prevention (CDC) estimates that sickle cell disease occurs in 1 out of every 365 African American births. I cosponsor the bipartisan Sickle Cell Disease Comprehensive Care Act, which would establish and fund a demonstration project for state Medicaid programs to improve outpatient care for people with sickle cell disease. I also am a cosponsor of the Sickle Cell Disease Treatment Centers Act that would establish an integrated hub and spoke model of treatment centers for people with sickle cell trait. Additionally, I was proud to support Senator Cory Booker of New Jersey’s bipartisan Sickle Cell Disease and Other Heritable Blood Disorders Research, Surveillance, Prevention, and Treatment Act, signed into law in 2018 to improve the screening, treatment, and data on sickle cell disease.

Tackling maternal mortality. We must address our nation’s unacceptably high and rising maternal mortality rate. The problem is particularly acute in communities of color, with Black and Native women more than two and a half times more likely to die from pregnancy-related complications. In 2021, I pushed for Congress to give states a new option to extend postpartum coverage to 12 months under Medicaid in order to help address our country’s high rate of maternal mortality, 52 percent of which occurs after delivery. As a result, Minnesota has ensured access to Minnesota Care for moms for at least 12 months after giving birth. I was also proud to support the passage into law in 2022 of the Rural Maternal Health Quality Improvement Act and my friend and fellow Minnesota Senator, Tina Smith’s bill, the Rural Maternal and Obstetric Modernization of Services (MOMS) Act.

Preventing Disruptions in Health Care. I also support the Equity in Pretrial Health Coverage Act, that would prevent someone awaiting trial who has not been convicted from losing their federal healthcare coverage, such as Medicare, Veterans Affairs care, Medicaid, and Children’s Health Insurance Program. People who have not been proven guilty should not experience disruptions to care that may prevent them from accessing needed medications or treatment.

Supporting and protecting our seniors and people living with disabilities. We must ensure that the most vulnerable people in our society have the care and support they need, which includes protecting them from abuse and exploitation, promoting their financial stability and security, and supporting their families and caregivers.

Assisting seniors and their families. I introduced the Americans Giving Care to Elders Act, which would establish a federal tax credit to assist with the costs of caring for an aging family member. I also introduced with Senator Susan Collins of Maine the Alzheimer’s Caregiver Support Act, which would expand training and support services for families and caregivers of patients with Alzheimer’s and related dementia. In addition, I introduced a bipartisan bill with Senator Chuck Grassley of Iowa that was signed into law in 2018 called Kevin and Avonte’s Law, to help families locate missing loved ones with developmental disabilities, Alzheimer’s, or other forms of dementia and to provide training and technology to first responders and law enforcement to help them find these vulnerable family members. Our bill reauthorizing Kevin and Avonte’s Law was passed in 2022.

I have also introduced and cosponsored multiple bipartisan bills to improve the quality of life for seniors and encourage the use of remote monitoring technology and telehealth services in Medicare and other programs, including the CHRONIC Care Act, the Fostering Independence Through Technology (FITT) Act, the Independence at Home Act, and the CONNECT for Health Act.

Protecting our seniors from abuse in care facilities. Our seniors are among the most vulnerable populations, and we must work to protect them from abuse. I was appalled by the reports in 2017 revealing that thousands of allegations of neglect, abuse, and theft in facilities for seniors in Minnesota were not being investigated on-site. Our state took action to better protect seniors, but elder abuse is a national issue we face across the country as our senior population is set to double over the next 40 years. The U.S. Department of Health and Human Services Inspector General has found that Medicare does not have adequate procedures for identifying and reporting potential incidents of abuse or neglect in nursing home facilities, and the Government Accountability Office has found that we need better oversight of critical incidents in facilities that get Medicaid funding as well. I called on the previous administration to reverse its decision to roll back enforcement of protections for our seniors across the country and I am working with Senator Susan Collins of Maine and the Government Accountability Office to identify additional safeguards we can implement to better protect seniors from abuse or mistreatment.

Protecting seniors from financial exploitation. While most court-appointed guardians are professional, caring, and law-abiding, there are some bad actors who use their position of power for their own gain. I introduced the bipartisan Court-Appointed Guardian Accountability and Senior Protection Act—signed into law in 2017—that protects seniors from financial exploitation by court-appointed guardians who abuse their position. More recently, with Republican Senator Susan Collins, I introduced the Seniors Fraud Prevention Act that was signed into law in 2022. The new law provides protection to seniors from fraud schemes by establishing an effective complaint system that ensures complaints of fraud are quickly forwarded to the appropriate law enforcement agencies. It also will help the Federal Trade Commission monitor the market for mail, television, internet, and robocall fraud targeting seniors.

Supporting people living with disabilities. I worked to get the Achieving a Better Life Experience—or ABLE—Act signed into law, which allows people with disabilities to use tax-advantaged savings accounts to cover expenses like education, transportation, and housing without putting other support they count on at risk. I am also a cosponsor of bipartisan legislation to expand these ABLE accounts to people who develop a disability before they turn age 46 rather than age 26 under current law. This allows families to transfer funds saved in a 529 education savings account into an ABLE account without incurring a tax penalty and increases the amount that people with disabilities can save in an ABLE account if they are working and earning an income. I have also fought to protect against cuts to the Medicaid program, which covers 40 percent of people with disabilities in our country, and to prevent people with preexisting conditions from losing access to their health insurance coverage.

Increasing research funding to seek new cures. I have consistently fought for strong funding for research at our federal research agencies, including the National Institutes of Health (NIH), so that researchers don’t have their hands tied by the whims of Washington. I supported the 21st Century CURES Act—and was there when President Obama signed it into law in 2016–which funded nearly $5 billion for NIH research into cures for Alzheimer’s, cancer, and other diseases. Over the past ten years, Congress has increased funding for the NIH by 55 percent. During that time we have also quintupled funding for Alzheimer’s and related dementias research from $631 million to $3.5 billion. I’m also proud that I supported the 2022 launch of the Advanced Research Projects for Health (ARPA-H) to provide a pathway for creating transformative health breakthroughs for diseases like ALS (Lou Gehrig’s Disease) that cannot readily be accomplished through traditional research or commercial activity. Additionally, I led the bipartisan Paul D. Wellstone Muscular Dystrophy Community Assistance, Research, and Education (MD-CARE) Amendments Act that was signed into law in 2014. Finally, as co-chair of the bipartisan Rare Disease Congressional Caucus, I am working to increase the number of safe, effective, and affordable treatments that are available for people with rare diseases. Lastly, during the government shutdown in October 2013, I donated my pay to the NIH because lifesaving medical research was halted during the shutdown.

Combating health care fraud and increasing transparency. To help deter health care fraud, I cosponsored bipartisan legislation signed into law to help save billions of dollars each year by requiring direct depositing of all Medicare and Medicaid payments made to providers to prevent fraudulent billing practices. The legislation offers law enforcement officials one more tool to combat health care fraud. I also led the Physician Payments Sunshine Act with Senator Chuck Grassley of Iowa to make both medical device and pharmaceutical financial arrangements public. The legislation became law in 2010, and I have continued to fight against any attempt to weaken it. I have introduced legislation with Senator Lisa Murkowski of Alaska to protect consumers’ private health data by requiring that regulations be issued for new health technologies—like wearable fitness trackers, direct-to-consumer genetic testing services, and mobile applications not regulated by existing laws. In 2020, I also wrote to the U.S. Department of Health and Human Services about the need for additional regulations that protect personal health data after a new wearable with concerning data-collection practices entered the market.