A bill to exempt Puerto Rico from the coastwise laws of the United States (commonly known as the "Jones Act").

Mr. President, I rise in support of the bipartisan Chronic Kidney Disease Improvement in Research and Treatment Act of 2017, which I am introducing with Senators Blunt and Nelson today. This legislation seeks to make a real difference in the lives of Americans suffering from kidney disease and end-stage renal disease.

Kidney disease is the 9th leading cause of death in the United States, and unfortunately, more than 1 in 10 Americans today suffer from some form of kidney disease. More than 661,000 Americans are living with kidney failure or end-stage renal disease, which is an irreversible condition that can be fatal without a kidney transplant or life-sustaining dialysis. Of these, 468,000 patients in our Country rely on life-sustaining dialysis care to survive and roughly 193,000 live with a functioning kidney transplant.

This legislation seeks to promote research, expand patient choice, and improve care coordination for these hundreds of thousands of patients. Specifically, it would identify payment disincentives that create barriers to kidney transplants. The bill would require the Government Accountability Office (GAO) to submit a comprehensive report on how and to what extent palliative care is utilized in treating individuals with advanced kidney disease and the effect of palliative care on the quality of life and treatment outcomes of individuals with ESRD. It would also direct the Department of Health and Human Services (HHS) to evaluate and report on the biological, social, and behavioral factors related to kidney disease and efforts to slow the progression of disease in minority populations disproportionately affected by this disease.

This legislation would improve access to pre-dialysis kidney education programs to better manage patients' kidney disease and even prevent kidney failure in some cases. Nephrologists and other health professionals would be incentivized to work in underserved rural and urban areas, and current payment policies would be modified to encourage home dialysis, which is not incentivized under the current Medicare payment structure. Patients with acute kidney injury would also be allowed to receive treatments through dialysis providers, therefore reducing costs associated with care provided in the more expensive hospital outpatient setting. Perhaps most importantly, our legislation would guarantee access to Medigap policies to all ESRD Medicare beneficiaries, regardless of age. Currently, Medicare patients under 65, whether disabled or ESRD beneficiaries do not have access to Medigap plans, even though Medicare is their primary insurance.

Lastly, the bill would expand the options for patients by allowing individuals diagnosed with kidney failure to enroll in the Medicare Advantage program starting in plan year 2020 and reauthorizing on a permanent basis the Medicare Advantage Special Needs Plan for patients with kidney failure.

I urge my colleagues to join me, Senator Blunt and Senator Nelson in supporting the Chronic Kidney Disease Improvement in Research and Treatment Act of 2017, which will improve the care of patients who suffer from kidney disease and end-stage renal disease.

Mr. President, I ask unanimous consent that the text of the bill be printed in the Record.

Mr. President, I understand that there is a bill at the desk, and I ask for its first reading.

Mr. President, I now ask for a second reading and, in order to place the bill on the calendar under the provisions of rule XIV, I object to my own request.

Mr. President, I understand that there is a bill at the desk due for a second reading.

In order to place the bill on the calendar under the provisions of rule XIV, I object to further proceedings.

Mr. President, I ask unanimous consent that the text of the bill be printed in the Record.