A bill to amend title XVIII of the Social Security Act to improve access to, and utilization of, bone mass measurement benefits under part B of the Medicare program by establishing a minimum payment amount under such part for bone mass measurement.

Mr. President, today, I am joining with Senator Murray in introducing the Border Zone Reasonableness Restoration Act of 2018. This legislation, if enacted, will establish critical privacy protections for Americans by limiting the unjustifiably wide ``border zone'' within which Department of Homeland Security officers may-- without a warrant--stop vehicles and search private land for the purpose of patrolling the border.

The current 100 mile ``border zone'' was established through regulatory fiat. While the Fourth Amendment allows limited exceptions to the warrant requirement at or close to the border, this 100 mile zone is neither limited nor reasonable. It includes marine borders. At present, it encompasses almost two-thirds of the population of the United States. This includes major cities such as New York, Seattle, Chicago, New Orleans, and Los Angeles, even the ``border town'' of Richmond, Virginia, as well as entire states such as Maine, Delaware, and Florida.

The need for this legislation has never been clearer. The Trump administration's aggressive yet wasteful use of immigration enforcement resources has subjected law-abiding citizens to needless and intrusive searches at Customs and Border Protection (CBP) checkpoints far from the border. Not only do these searches produce minimal value to border enforcement, they violate the constitutionally protected privacy of citizens and residents of border regions, including in my home State of Vermont. Recently, CBP agents in Vermont have boarded Greyhound buses in Burlington without a warrant and inquired about the citizenship of passengers. They have targeted international college students for questioning about their legal status. In the nearby States of Maine and New Hampshire, they have shut down interstate highways with immigration checkpoints. In Montana, a CBP agent even stopped an American citizen simply for speaking Spanish.

This should not be a partisan issue. This is about ensuring that every person in this Nation receives the constitutional protections to which they are entitled. Both the American Civil Liberties Union and the Cato Institute have sharply criticized these practices as problematic under the Fourth Amendment. Vermonters have rightly been concerned about these expanded border zone searches. They believe, as I do, that once inside our country the phrase `show me your papers' does not belong inside the United States of America.

The Border Zone Reasonableness Restoration Act is based on an amendment that Senator Murray and I successfully attached to immigration reform legislation in 2013 during the Obama Administration. The 100 mile ``border zone''--and the similar 25 mile zone where many types of warrantless property searches are permitted--predates this current administration, but the actions of this administration have shown just how much we need legislation like this today.

The Fourth Amendment does not stop 100 miles from our land and sea borders. Its protections extend whether in the heart of Kansas or in the middle of Vermont. Ensuring that the protections of the Fourth Amendment are available to everyone within the United States should be important to all of us, regardless of party or ideology. I hope all Senators will support this commonsense measure to ensure the Fourth Amendment is upheld.

Mr. President, I rise today to introduce legislation with my colleague from Maryland, Senator Ben Cardin, which would increase access to preventive bone density screenings and improve osteoporosis diagnosis and treatment in the process. We are pleased to have Senators Wicker, King, and Stabenow as cosponsors.

The public health risk of osteoporosis cannot be understated. Today, approximately 54 million Americans either have osteoporosis or low bone mass, which places them at increased risk for osteoporosis. Women are disproportionally affected, accounting for 71 percent of osteoporotic fractures and 75 percent of costs. Osteoporosis is often called ``the silent disease'' because bone loss usually occurs gradually over the years without symptoms.

As the NIH Osteoporosis and Related Bone Disease National Resource Center observes, falls are especially dangerous for people who are unaware that they have low bone density. If the patient and the doctor fail to connect the broken bone to osteoporosis, the chance to make a diagnosis with a bone density test and begin a prevention or treatment program is lost.

Early diagnosis and treatment of osteoporosis are proven to dramatically reduce fracture rates, and appropriate reimbursement for tests that measure bone mass and predict fracture risk are necessary to maintain patient access to care, particularly in rural or underserved areas. Our legislation, the Increasing Access to Osteoporosis Testing for Medicare Beneficiaries Act of 2018, tackles a proven barrier to proper screening by creating a floor reimbursement rate under Medicare for the dual energy X-ray absorptiometry (DXA) test, the ``gold standard'' for osteoporosis diagnosis.

Congress has twice recognized the importance of reversing Medicare cuts to DXA reimbursement in order to maintain patient access, yet the Medicare reimbursement rate for DXA tests administered in a doctor's office has declined from $140 in 2006 to only $42 in 2018--a dramatic 70 percent decline. The National Osteoporosis Foundation has found that declining reimbursement rates have created a 26 percent decline in physicians performing DXA tests since 2008, resulting in a corresponding 22 percent decline in diagnoses since 2009.

Regrettably, as a result of reduced screenings due to declining reimbursements, it is estimated that more than 40,000 additional hip fractures occur each year, resulting in nearly 10,000 additional hip fracture-related deaths. As osteoporosis is already under-diagnosed in the Medicare population, it is clear that we must change this trajectory.

This legislation is endorsed by the American Association of Clinical Endocrinologists, the National Osteoporosis Foundation, and more than forty additional national medical societies and patient advocate organizations. I thank Senator Cardin for joining me in this effort to increase patient access to osteoporosis screening and diagnosis, while lowering costs and consequences resulting from a lack of diagnosis. I encourage my colleagues to support its adoption.

Mr. President, I rise today to introduce legislation with my colleague from Maryland, Senator Ben Cardin, which would increase access to preventive bone density screenings and improve osteoporosis diagnosis and treatment in the process. We are pleased to have Senators Wicker, King, and Stabenow as cosponsors.

The public health risk of osteoporosis cannot be understated. Today, approximately 54 million Americans either have osteoporosis or low bone mass, which places them at increased risk for osteoporosis. Women are disproportionally affected, accounting for 71 percent of osteoporotic fractures and 75 percent of costs. Osteoporosis is often called ``the silent disease'' because bone loss usually occurs gradually over the years without symptoms.

As the NIH Osteoporosis and Related Bone Disease National Resource Center observes, falls are especially dangerous for people who are unaware that they have low bone density. If the patient and the doctor fail to connect the broken bone to osteoporosis, the chance to make a diagnosis with a bone density test and begin a prevention or treatment program is lost.

Early diagnosis and treatment of osteoporosis are proven to dramatically reduce fracture rates, and appropriate reimbursement for tests that measure bone mass and predict fracture risk are necessary to maintain patient access to care, particularly in rural or underserved areas. Our legislation, the Increasing Access to Osteoporosis Testing for Medicare Beneficiaries Act of 2018, tackles a proven barrier to proper screening by creating a floor reimbursement rate under Medicare for the dual energy X-ray absorptiometry (DXA) test, the ``gold standard'' for osteoporosis diagnosis.

Congress has twice recognized the importance of reversing Medicare cuts to DXA reimbursement in order to maintain patient access, yet the Medicare reimbursement rate for DXA tests administered in a doctor's office has declined from $140 in 2006 to only $42 in 2018--a dramatic 70 percent decline. The National Osteoporosis Foundation has found that declining reimbursement rates have created a 26 percent decline in physicians performing DXA tests since 2008, resulting in a corresponding 22 percent decline in diagnoses since 2009.

Regrettably, as a result of reduced screenings due to declining reimbursements, it is estimated that more than 40,000 additional hip fractures occur each year, resulting in nearly 10,000 additional hip fracture-related deaths. As osteoporosis is already under-diagnosed in the Medicare population, it is clear that we must change this trajectory.

This legislation is endorsed by the American Association of Clinical Endocrinologists, the National Osteoporosis Foundation, and more than forty additional national medical societies and patient advocate organizations. I thank Senator Cardin for joining me in this effort to increase patient access to osteoporosis screening and diagnosis, while lowering costs and consequences resulting from a lack of diagnosis. I encourage my colleagues to support its adoption.

Mr. President, I rise today to introduce the Protect Our Food From Phthalate Contamination Act. This bill would ban chemicals called ortho-phthalates from materials that come in contact with our food, because these phthalates have been found to actually leach into what we eat.

Phthalates have been known to interfere with the body's hormones, leading to a range of health concerns including reproductive harm. These chemicals have also been linked to learning and behavior problems in children and insulin resistance in adolescents and adults.

According to a recent study, individuals who regularly eat out had 30 percent higher phthalate levels. The findings for teenagers are particularly troubling, where testing showed phthalate levels 55 percent higher than people who ate at home. Enjoying a meal out or using packaged food to prepare meals on a busy schedule shouldn't come with the cost of chemical exposure that can cause harm.

We've already banned certain phthalates from children's toys due to serious health concerns, and now we need to remove the exposure through the food we eat. Phthalates can be found throughout the food supply chain, from the plastic gloves worn to handle food to the containers and wrappings used for packaging.

This legislation would specifically ban the type of phthalates, ortho-phthalates, currently being used in some food production and packaging, and require that any substance used as a replacement is also safe. The bill would implement the ban over the course of two years, so that companies have time to phase out these harmful chemicals.

This bill is supported by several health and consumer organizations, including the American Academy of Pediatrics, Breast Cancer Prevention Partners, Earthjustice, Environmental Defense Fund, Environmental Health Strategy Center, Environmental Working Group, and Safer Chemicals, Healthy Families.

I appreciate the support of my colleague, Senator Blumenthal, who is an original cosponsor of the bill. I look forward to working with my colleagues on this important issue. Thank you Mr. President and I yield the floor.

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