Quality and accessible health care is a very personal matter for me and my family. 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.
Comprehensive health care reform legislation – the Affordable Care Act – was passed in 2010. The law prohibits abusive practices that previously kept health care out of reach for millions of Americans, like denying coverage to individuals with pre-existing conditions. The law also provides coverage for preventive services, helps seniors pay for prescription drugs by closing the gap in prescription drug coverage known as the "donut hole," and allows young people to stay on their parents' plans until they are 26 years old.
I have always said that the health reform law is a beginning, not an end, and that changes will need to be made on both the state and federal level. Changes to bring down costs to consumers include reinsurance and providing cost-sharing reductions, continuing to implement delivery system reform, and addressing the skyrocketing costs of prescription drugs. To bring down prescription drug costs, I have introduced multiple pieces of legislation that would expand access to cost-saving generic drugs, deter pharmaceutical companies from blocking cheaper generic alternatives, allow personal importation of more affordable drugs from Canada, and lift the ban that prohibits Medicare from negotiating for the best possible price of prescription drugs on behalf of the 41 million seniors in Medicare Part D.
At the same time as we advocate for more comprehensive and affordable health care, we must not repeal the Affordable Care Act’s protections and make sure critical federal programs like Medicare and Medicaid remain strong. I will continue to fight for affordable, high-quality health care that the families across our state and country deserve, including in rural communities that face unique health care challenges. Ensuring rural communities have access to health care not only keeps people healthy, but also boosts worker productivity, improves quality of life, and drives economic growth.
As Minnesota's U.S. Senator, I will continue to focus on these health care priorities:
- Lowering prescription drug prices. When families get sick, their focus should be on getting well, not on affording their prescriptions. Yet drug prices are an increasing burden across Minnesota and our country. According to a 2018 report from the Health Care Cost Institute, the price of brand-name prescription drugs increased 110 percent between 2012 and 2016, even though usage of these drugs went down. I will fight to make prescription drugs more affordable for all Americans by lifting the ban on Medicare negotiating prices directly with drug companies on behalf of the 41 million seniors in the Part D program, allowing for the importation of safe, less-expensive drugs from countries like Canada, ending the “pay-for-delay” practice of brand-name drug manufacturers paying off their less-expensive generic competitors to stay out of the market, stopping anticompetitive tactics—like brand-name companies denying generic companies access to samples—that prevent consumers from having access to less expensive generic alternatives in the pharmaceutical market, and reducing drug waste that costs taxpayers millions of dollars.
- Making healthcare more affordable and accessible. In addition to addressing skyrocketing prescription drug prices, we must address other factors that lead to increased healthcare costs, including by reducing costs for consumers in the individual marketplace and continuing to implement delivery system reforms. We must provide cost sharing reductions to lower out-of-pocket healthcare costs like copays and deductibles and 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 healthcare costs—especially in rural markets. We should also advocate for expanding existing programs to cover more people. Our goal should be simple: Every American deserves affordable, high-quality health care.
- Preserving access to health care in rural areas. Our rural communities face unique healthcare challenges. Rural health care facilities often operate on extremely small margins and have a much harder time recruiting and retaining highly skilled medical practitioners. Preserving and strengthening access to quality health care in rural areas is crucial to the success and prosperity of our state.
- Rewarding high-quality, efficient care. Minnesota is known for its high-quality health care delivery systems and innovative quality measures that provide Medicare beneficiaries with better value, but Medicare does not always reward this high quality. For example, according to a study by the Dartmouth Institute for Health Policy and Clinical Practice, if spending for chronically ill patients everywhere in the country mirrored the efficient level of spending in the Mayo Clinic's home region of Rochester, Minnesota, Medicare could save $50 billion in taxpayer money over five years. To rein in costs, we need to continue implementing delivery system reform so that Medicare rewards the quality of care instead of the volume of services and all states aim for the high-quality, cost-effective results we have achieved in Minnesota.
- Investing in science. 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, and other diseases and not on finding the money 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 to individual patients’ needs and treat them more effectively.
- Reducing costs for small businesses. There are more than 500,000 small businesses in our state. These businesses make up about half of the state’s private-sector employment. We must make it easier for our small businesses to continue to provide coverage to their employees, including by providing and expanding tax credits for their contributions to employees’ health insurance plans.
- Taking care of 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 - more than half of whom are adult children taking care of their parents. Millions of families already find themselves coping with the challenges and costs of caring for elderly parents—and the numbers will continue to grow as our senior population is set to double over the next 30 years. We must address the needs of these family caregivers, especially caregivers of patients living with Alzheimer’s disease or related dementias. In 2016, nearly 16 million caregivers provided more than 18 billion hours of unpaid care to patients with Alzheimer’s disease and related dementias at an estimated cost of $230 billion. We also must make sure we’re doing everything we can to support people who are taking care of their loved ones with disabilities, including by providing tax credits and training.
- Incentivizing preventive care and wellness. Our health care system needs to reward prevention. Preventing or managing chronic medical problems early can help avoid complications and the need for costly care. A healthier lifestyle benefits not only individuals and their families, but also the businesses that employ them. Wellness initiatives for the workforce help lower health care costs, lifting a heavy burden off the shoulders of our businesses and sharpening America's competitive edge. As co-chair of the Bipartisan Congressional Wellness Caucus, I am working to educate my colleagues in Washington and the American public about the value of workplace wellness programs and ensure new technologies like wearable fitness trackers have appropriate privacy and security protections.
- Cracking down on health care fraud. Law enforcement authorities estimate that health care fraud costs taxpayers an estimated tens of billions of dollars every year. These criminals scheme the system to rob the American taxpayers of money that should be used to provide health care to those who need it most. We must put a stop to this.
- Utilizing technology. We must continue to modernize our health care system and invest in health information technology that improves patient care and helps lower costs instead of creating additional paperwork.
As Minnesota's U.S. Senator I am fighting for better, more affordable health care for Minnesotans by:
- Lowering prescription drug costs. I have introduced multiple pieces of legislation to address the skyrocketing costs of prescription drugs by:
- Requiring Medicare to negotiate lower drug prices for our seniors. There are 41 million seniors in the Medicare Part D prescription drug program. I am leading legislation with 33 cosponsors – the Empowering Medicare Seniors to Negotiate Drug Prices Act of 2017 – to eliminate the current ban that prevents Medicare from negotiating directly with drug companies for lower prices on behalf of these seniors, who are paying excessive prices for prescription drugs.
- Allowing the importation of safe, less expensive prescription medicines from Canada and other approved countries. Americans pay double what Canadians do for retail prescription drugs. That is why I introduced the Safe and Affordable Drugs from Canada Act with Senator John McCain to allow people to import prescription drugs for personal use from safe, proven Canadian pharmacies. I also introduced a bill with Senator Mike Lee 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 Grassley, I have introduced legislation to help end the “pay-for-delay” practice of brand-name drug manufacturers paying off their less-expensive generic competitors to stay out of the market. I have also introduced the CREATES Act with a bipartisan group of Senators to end tactics some brand name companies use to prevent generic manufacturers from being able to receive approval for their products—like denying access to samples. These bills would save taxpayers billions of dollars.
- Calling out drug companies for high prices. After I raised concerns, the Centers for Medicare and Medicaid Services found that Mylan had incorrectly classified its brand-name product, EpiPen, as a generic drug under Medicaid and therefore was paying smaller rebates to states. I called for a nationwide investigation to determine how many other drugs are misclassified and how much these misclassifications have cost taxpayers, and the 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 now sells a generic EpiPen for half the price of their brand-name version, but questions remain about skyrocketing prices across the board. 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 last decade. I joined Senators Susan Collins from Maine and Tammy Baldwin from 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.
- Reducing drug waste that costs taxpayers millions of dollars. When I asked the Department of Health and Human Services Office of Inspector General about 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. I introduced the bipartisan Reducing Drug Waste Act with Senator Grassley to require the Food and Drug Administration (FDA) and Centers for Medicare and Medicaid Services (CMS) to address the costs of this drug waste that results from the size of single use drug vials and other drug delivery systems like eye-drops.
- Fighting price gouging by pharmaceutical companies. There is evidence that pharmaceutical companies target outrageous price increases for selected drugs used by vulnerable populations or for rare diseases. During my time in the Senate, I've called on the Federal Trade Commission (FTC) to investigate pharmaceutical companies for anticompetitive practices and price manipulation.
- Making health care more affordable and accessible. I am working on reforms so that every Minnesotan can get the affordable, high-quality health care they deserve by:
- Bringing down rates and out-of-pocket costs and reforming the delivery system. I am a cosponsor of the Bipartisan Health Care Stabilization Act to provide cost sharing reductions to lower out-of-pocket healthcare costs 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 healthcare costs, especially in rural markets. I also authored legislation—passed 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 pre-existing condition and children can stay on their parent’s plans through the age of 26. I have worked to close the Medicare Part D Prescription Drug Program "donut hole" to lower prescription drug costs for seniors, including by 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 February of 2018. More than 10 million seniors have saved over $20 billion in discounts on prescription drugs, an average savings of $1,945 per person, and nearly all of the 941,000 Medicare beneficiaries in Minnesota can now receive certain preventive services for free.
- Making health care more affordable by expanding existing programs. As we work to improve the Affordable Care Act and bring down the cost of prescription drugs, we should also advocate for more comprehensive and affordable healthcare by building on existing programs. I am a cosponsor of the State Public Option Act, which would give states the option of allowing all of their residents to buy Medicaid coverage, and the Medicare-X Choice Act, which would allow Americans across the country to buy a public insurance plan based on Medicare on the exchanges.
- Ensuring access to vital drugs, treatments, and medical equipment. I authored and passed the bipartisan Preserving Access to Life-Saving Medications Act to require prescription drug manufacturers to get at the dangerous issue of drug shortages by giving early notification to the Food and Drug Administration (FDA) of any incident that would likely result in a shortage. Early notification helped the FDA prevent 170 drug shortages in 2013, 101 in 2014, and 142 in 2015. I also introduced the bipartisan Steve Gleason Act of 2017—which was signed into law as part of the Bipartisan Budget Act in February of 2018—to ensure Medicare pays for speech generating devices for people with ALS (Lou Gehrig’s disease), 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.
- Preserving access to health care in rural areas. 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, like the Rural Emergency Acute Care Hospital (REACH) Act, Improving Access to Cardiac and Pulmonary Rehabilitation Act, Critical Access Hospital Relief Act, 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 February of 2018.
- Providing support for 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 the Alzheimer’s Caregiver Support Act with Senator Collins from Maine, which would expand training and support services for families and caregivers of patients with Alzheimer’s and related dementias. In addition, I introduced a bill with Republican Senator Chuck Grassley—signed into law in March of 2018—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 individuals. 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—which was signed into law in February of 2018—the Fostering Independence Through Technology Act, the Independence at Home Act, and the CONNECT for Health Act.
- Expanding health care coverage for children. I supported the Medicare Access and Children's Health Insurance Program Reauthorization Act, which was signed into law in April 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 February of 2018, we successfully extended funding of the Children's Health Insurance Program through 2027.
- Providing access to mental health services. I introduced the bipartisan Anna Westin Act—which was included in the 21st Century CURES Act signed into law in December 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. 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 March of 2018.
- Combatting the opioid crisis. I’m also working to combat the opioid crisis and ensure that communities have the resources they need for prevention and treatment. Along with three other senators, I introduced the Comprehensive Addiction and Recovery Act (CARA), which became law in July 2016. This bipartisan legislation encourages states and local communities to pursue a full array of proven strategies in the fight against addiction. Earlier this year, I introduced the CARA 2.0 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 2.0 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 and to share their data with other states. We know that opioid addiction too often begins with the abuse of legal prescription painkillers, and with this bill, we can do something about that.
- Increasing research funding to seek new cures. I have consistently fought for strong funding for research at our federal research agencies, including the NIH, so 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 December 2016—which contains nearly $5 billion in funding for NIH research into cures for Alzheimer’s, cancer, and other diseases. The 2016, 2017, and 2018 spending bills that were signed into law also included significant increases in NIH funding, which were the largest increase in over a decade. During the 2013 government shutdown, I donated my salary to the NIH. I also introduced a bipartisan resolution with Senator Collins from Maine declaring that the goal of preventing and effectively treating Alzheimer's by 2025 is an "urgent national priority." 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.
- Protecting our seniors from abuse. Our seniors are among the most vulnerable populations, and we must work to protect them from abuse. I was appalled by the recent reports revealing that thousands of allegations of neglect, abuse, and theft in facilities for seniors in Minnesota were not being investigated on site. Our state is taking action to better protect these seniors, but elder abuse is a national issue we’re facing across the country as our senior population is set to double over the next 30 years. The 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 have called on the 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, Chair of the Senate Special Committee on Aging, 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 a bipartisan bill – signed into law in 2017 – that protects seniors from financial exploitation by court-appointed guardians who abuse their position. I am also leading a bill to help fight scams designed to strip seniors of their assets by improving monitoring and response to fraud complaints and helping educate seniors about fraud schemes.
- Supporting people 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 individuals who develop a disability before they turn 46 rather than 26 under current law, allowing families to transfer funds saved in a 529 education savings account into an ABLE account without incurring a tax penalty, and increasing the amount that individuals 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 pre-existing conditions from losing access to their health insurance coverage.
- Supporting our small businesses. Since the start of 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 small businesses can increase the choices of health care plans for their employees.
- Reducing burdensome regulations and promoting innovation. I fought to get a change to the burdensome 1099 reporting requirement for small businesses that was originally in the Affordable Care Act signed into law. Key provisions of my bipartisan Medical Device Regulatory Improvement Act – which helps streamline the Food and Drug Administration’s (FDA) regulation of medical devices to avoid delaying new and innovative devices from reaching the market – were also signed into law in July 2012. The 21st Century CURES Act and the FDA Reauthorization Act that were enacted in 2016 and 2017 will also help to foster medical innovation and streamline review for drugs and medical devices that can provide breakthrough treatments. I have also introduced legislation to repeal the medical device tax so manufacturers can continue to provide cutting-edge, life-saving products for consumers. We have been successful in securing suspensions of this additional tax on manufacturing, innovation, and research for 2016 through 2019.
- Combating health care fraud. 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 the tens of billions of dollars lost each year to health care fraud.
- Allowing for safe disposal of prescription drugs. I authored the bipartisan Secure and Responsible Drug Disposal Act, which was signed into law by President Obama in October 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 the most dangerous prescription drugs to law enforcement officials for safe disposal and also promotes the development and expansion of drug take-back programs.
- 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 that were signed into law in 2014. I support Minnesota’s medical marijuana law for people with cancer, multiple sclerosis, and other approved conditions and I have opposed efforts by the Attorney General to roll back the Obama Administration policy that the federal government would not interfere with state laws decriminalizing or legalizing marijuana. Provisions from the Patient-Focused Impact Assessment Act—which I introduced with Senator Wicker from 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—which 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.
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