Ensuring Children’s Access to Specialty Care Act of 2019

Mr. President, today Senator Crapo of Idaho, Senator Merkley of Oregon, Senator Risch of Idaho, and I are introducing the Forest Management for Rural Stability Act. This legislation replaces the Secure Rural Schools and Community Self-Determination Act (SRS) to provide revenue sharing with and compensation to over 700 rural forested counties in the over 40 States that host America's treasured, public forested lands and wildlife refuges.

In 2000, then-Senator Larry Craig, also of Idaho, and I, had signed into law SRS: a 6-year long safety-net program to stabilize county budgets following years of depleted revenue sharing payments from the U.S. Forest Service (USFS) and the Oregon and California Grant Lands managed by the U.S. Bureau of Land Management (BLM). Over its lifetime, SRS has been a success, providing more than $6.8 billion nationwide for rural roads, schools, and healthy forest projects. SRS also provided the basis for the beginning of, and the now growing propensity for, the USFS and the BLM to collaborate with local people and interests on the management of these public lands, and for local folks and counties to collaborate together and with the USFS and BLM, in return.

Despite its many successes, the continuation of SRS is in jeopardy. The program expired in fiscal year 2016. Congress passed a two-year extension of the program, but after its expiration. And this was not the first time nor the last time Congress allowed it to expire--SRS is expired right now, though Senator Crapo and I are attempting, in these last moments of the 115th Congress, to reauthorize it again for at least a year, perhaps two.

This stop and start existence of this program hits at the heart of any attempts at collaboration. And it certainly undermines any attempts for a county to budget. Our rural counties should not continue to suffer neither this uncertainty, nor the market based uncertainty that comes with simply relying on revenue sharing and forest management for support.

That is why Senator Crapo and I propose an SRS modernization, funding certainty while supporting active forest management. The Forest Management for Rural Stability Act establishes a permanent endowment fund,

the Natural Resources Permanent Fund, to provide stable, reliable, increasing payments to counties, in perpetuity, removing them from the vagaries of Congress or the market.

Under this legislation, Congress charters a fiduciary corporation, the Forest and Refuge County Foundation, to manage the endowed fund. The corporation will be independent from any instrumentality of the U.S. government, including Congress, to ensure the principle balance is held in perpetuity and is separate from annual appropriations. The corporation will be overseen by a board of directors responsible for a transparent governance structure. The principle of the fund will be invested to earn interest. To grow the fund, in addition to the investment income, the USFS, BLM, and the Fish and Wildlife Service will deposit their annual revenue sharing receipts into the fund. The interest the fund generates will constitute the payments to the counties, distributed annually using the existing SRS formula. Initial payments to counties will be equal what counties received for Fiscal Year 2017 SRS payments.

The Forest Management for Rural Stability Act continues Congress's commitment to fostering economic growth in rural counties by continuing Forest Service Resource Advisory Committees. In addition, the bill gives county governments greater flexibility in how these funds are spent for economic development and rural jobs.

Passing the Forest Management for Rural Stability Act will update SRS for 2018 and beyond--looking forward for our forested counties, rather than backward to last century efforts.

This bill updates an already successful program that deserves action. I urge my colleagues to support this important bill.

Mr. President, Social Security provides vital benefits to millions of Americans who work and pay into the system with each paycheck. Because Social Security is fundamental to workers' retirement security, the law protected benefits from creditors. The only exceptions were unpaid Federal taxes, child support or alimony payments, and court-ordered victim restitution. These protections ensured that the social safety net programs would be there for basic needs. That protection was weakened over 20 years ago when the law was changed. Now, more and more seniors face cuts in their Social Security benefits because of student loan debts. The Wall Street Journal recently highlighted the issue with an article titled, ``Over 60, and Crushed by Student Loan Debt.'' We need to take action to restore the strong protections to Social Security and other benefit programs.

We now realize what a profound effect the loss of these protections has had on retirees and individuals with disabilities, who often live on fixed incomes. More and more seniors and people with disabilities are having their Social Security and other lifeline benefits taken away to pay Federal debts. For example, according to recent data from the U.S. Bureau of Fiscal Service, over 167,000 Americans had their benefits garnished for student loan debt. Those 167,000 had nearly $200 million garnished from their earned benefits. This is just the tip of the iceberg as more Americans start receiving benefits. Between 2008 and 2018, the number of individuals whose Social Security benefits were offset to pay student loans debt increased by 133 percent, from about 72,000 to 169,000. Over that same period, the amount collected from Social Security benefits ballooned from almost $63 million to nearly $200 million, a 217 percent increase.

Social Security plays a critical role in keeping seniors and people with disabilities out of poverty. In Oregon alone, Social Security cuts the poverty rate of the elderly from about 35 percent to 5 percent. However, despite Social Security's critical role in the safety net, close to 1 out of every 10 seniors over age 65 and 1 in 5 disabled workers still live in poverty and that is simply unacceptable.

I, along with Senators Brown, Whitehouse, Leahy, Warren, Hirano, Sanders, Gillibrand, Merkley, and Schatz are reintroducing the Protection of Social Security Benefits Restoration Act. The bill would restore the strong protections in the law that prevented the government from taking earned benefits to pay Federal non-tax debts, and help ensure beneficiaries will be able to maintain a basic standard of living. The bill is supported by AARP, the National Committee to Preserve Social Security and Medicare, National Association of Disability Representatives, AFL-CIO, National Organization of Social Security Claimants' Representatives, Social Security Works, National Organization for Women, Justice in Aging, American Federation of Teachers, Alliance for Retired Americans, Economic Policy Institute.

I ask Unanimous Consent that a letter from the National Committee to Preserve Social Security and Medicare endorsing our bill be printed in the Record.

May 15, 2019.

Hon. Ron Wyden,

Dirksen Senate Office Building, Washington, DC.

Dear Senator Wyden: On behalf of the millions of members

and supporters of the National Committee to Preserve Social

Security and Medicare, I write to endorse your bill the

``Protection of Social Security Benefits Restoration Act.''

Since the inception of the Social Security program in 1935,

the Social Security Act provided strong protections against

loss of retirement income through the garnishment or

attachment of Social Security benefits for the purpose of

recovering debts owed by retirees. For decades the law

provided near iron-clad protection against impoverishment in

old age due to debt collection.

Unfortunately, in 1996 the Congress reversed course by

authorizing the garnishment of Social Security and other

earned benefits for the purpose of collecting debts owed by

seniors to the federal government. Figuring prominently in

this matter is the recovery of student loan debts from

seniors who are living on their all-too-modest monthly Social

Security benefits.

With student loan debt becoming an increasingly serious

problem in this country, we agree with you that now is the

time to act. The Congress must restore the historic

protections that once were provided by Social Security

against the spectacle of impoverishment in old age so that

the federal government can collect debts that all too often

were incurred years, even decades ago.

For these reasons, the National Committee endorses your

bill, the ``Protection of Social Security Benefits

Restoration Act,'' and urges other members of the United

States Senate to cosponsor this vitally important measure. We

thank you for your leadership on this matter and look forward

to working with you to enact this bill.

Sincerely,

Max Richtman,

President and CEO, National Committee to Preserve Social

Security and Medicare.

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

Mr. President, I rise today with my colleague from Minnesota, Senator Tina Smith, to introduce the TICK Act. This stands for Ticks: Identify, Control, and Knockout Act. I would also like to recognize my colleague from Maine, Senator King, who is joining us as an original cosponsor.

Our bipartisan legislation would provide local communities and States with the resources needed to help prevent, detect early, and treat Lyme and other tick-borne diseases.

Tick-borne diseases like Lyme have become a major public health concern, with the incidence exploding over the past 15 years. The number of Americans with tick-borne diseases has been rising at an alarming rate. In 2003, Lyme disease infected approximately 30,000 Americans. Last year there were an estimated 450,000 cases--a staggering 1,400-percent increase.

In Maine, last year alone, there were 2,000 new cases of Lyme disease. That is a sharp increase from the 752 cases in 2010.

Other tick-borne diseases are also on the rise. Anaplasmosis, for example, has more than tripled.

Far too many Americans with Lyme disease experience a complex diagnostic odyssey that takes months or even years. One of my constituents, Paula Jackson Jones, from Damariscotta, ME, shared with me her harrowing tale that took 2 years, scores of tests, and 23 different physicians before she finally received the correct diagnosis that she had Lyme disease. Her journey started one afternoon 10 years ago after raking leaves in her backyard. A week later, unusual symptoms began to appear: anxiety attacks, pain, muscle spasms, and fatigue. These symptoms became debilitating.

Before receiving the correct diagnosis, Paula was diagnosed incorrectly with multiple sclerosis, Parkinson's, and other diseases. Once she finally received the proper diagnosis and treatment, Paula founded Midcoast Lyme Disease Support & Education, a nonprofit that raises public awareness about Lyme disease.

She told me:

This has been a 10-year crusade for me with the first 5

years fighting for my life and the latter, fighting on behalf

of others.

In addition to the physical and emotional toll that Lyme disease takes, it is also expensive. Paula is still paying off more than $250,000 worth of medical bills that she has incurred. Medical costs of Lyme disease are estimated at $1.3 billion per year. When accounting for indirect medical costs, including the loss of work, the annual cost balloons to $75 billion per year.

A correct and early diagnosis can reduce costs, as well as improve the prognosis, but we have a long way to go. When HIV became a public health crisis, fortunately, a gold standard for identification and treatment was developed within 10 years. Lyme disease, by contrast, was identified more than 40 years ago; yet there still is no gold standard treatment, and existing prevention, education, and diagnostic efforts have proven to be inadequate.

The TICK Act would apply a three-pronged approach to addressing Lyme and other tick and vector-borne diseases. First, it would establish an office of oversight and coordination of vector-borne diseases at the Department of Health and Human Services. This office would develop a national strategy to prevent and treat Lyme and other tick-borne diseases. It would expand research and improve testing, treatment affordability, and public awareness. The office would also coordinate with key Federal agencies, including the CDC, the Department of Defense, USDA, and EPA to protect Americans from these diseases.

Second, our bill would reauthorize the Regional Centers for Excellence in Vector-Borne Disease, which Congress established in 2017 in response to the Zika outbreak. Since then, tick-borne diseases have accounted for three out of four vector-borne diseases in our country, and these centers have been effective in leading the scientific response. The Collins-Smith bill would reauthorize these centers for another 5 years at $10 million per year.

Finally, our bill would establish CDC grants, which would be awarded to State health departments to improve data collection and analysis, support early detection and diagnosis, improve treatment and heighten public awareness. The TICK Act takes a comprehensive approach to address tick-borne diseases.

Mr. President, I ask unanimous consent to have printed in the Record at the conclusion of my remarks letters of support signed by more than 2 dozen organizations supporting our bill, including the Midcoast Lyme Disease and Support Education organization, the LivLyme Foundation, the Northeast Regional Center for Excellence in Vector-Borne Diseases, the National Association of County and City Health Officials, and the Entomological Society of America.

I urge all of our colleagues to support this important legislation.

Mr. President, I am pleased to be joining Senator Blunt in introducing the Ensuring Children's Access to Specialty Care Act.

According to the American Association of Child and Adolescent Psychiatry, there are currently only 8,300 child and adolescent psychiatrists (CAPs) in the United States--many of whom are not practicing full time--far short of the estimated need of over 30,000 CAPs. On average, patients wait almost two months to see a CAP, a startling concern given that the incidence rates of mental illness and behavioral disorders among children in the United States continue to grow. Fifty percent of all lifetime cases of mental illness begin at age 14; seventy-five percent by age 24.

The National Health Service Corps Loan Repayment Program (NHSCLRP) was created by Congress over forty years ago to help recruit and place trained individuals in underserved communities to provide needed health care services. Licensed health care providers may earn up to $50,000 toward

student loans in exchange for a two-year commitment at an NHSC-approved site, within two years of completing their residency. Accepted participants may serve as primary care medical, dental, or mental/ behavioral health clinicians.

NHSCLRP provides critical relief to physicians who have completed pediatrics or psychiatry residency training programs; however, pediatric subspecialists, such as child and adolescent psychiatrists, are effectively barred from participating due to the extra training these physicians are required to take after completing their residency. This extra training, which often results in increased student debt, typically consists of a fellowship that takes place in the two-year window of eligibility for NHSCLRP. The creation of NHSCLRP preceded the expansion of many pediatric subspecialties, not taking into account the extra years of training required for these physicians.

The Ensuring Children's Access to Specialty Care Act would correct this loophole and allow pediatric subspecialists practicing in underserved areas to benefit from the NHSCLRP. By so doing, this bill would increase access to specialty care for children and improve mental health parity for children.

Providers across the spectrum of care support this bipartisan legislation including: the American Association of Child and Adolescent Psychiatry, the American Academy of Pediatrics, the Arthritis Foundation, Children's Hospital Association, March of Dimes, and the National Alliance on Mental Illness. I look forward to working with these and other stakeholders as well as Senator Blunt and our colleagues to pass the Ensuring Children's Access to Specialty Care Act in order to help ensure children have greater access to the health care they need.

Mr. President, I am pleased to be joining Senator Blunt in introducing the Ensuring Children's Access to Specialty Care Act.

According to the American Association of Child and Adolescent Psychiatry, there are currently only 8,300 child and adolescent psychiatrists (CAPs) in the United States--many of whom are not practicing full time--far short of the estimated need of over 30,000 CAPs. On average, patients wait almost two months to see a CAP, a startling concern given that the incidence rates of mental illness and behavioral disorders among children in the United States continue to grow. Fifty percent of all lifetime cases of mental illness begin at age 14; seventy-five percent by age 24.

The National Health Service Corps Loan Repayment Program (NHSCLRP) was created by Congress over forty years ago to help recruit and place trained individuals in underserved communities to provide needed health care services. Licensed health care providers may earn up to $50,000 toward

student loans in exchange for a two-year commitment at an NHSC-approved site, within two years of completing their residency. Accepted participants may serve as primary care medical, dental, or mental/ behavioral health clinicians.

NHSCLRP provides critical relief to physicians who have completed pediatrics or psychiatry residency training programs; however, pediatric subspecialists, such as child and adolescent psychiatrists, are effectively barred from participating due to the extra training these physicians are required to take after completing their residency. This extra training, which often results in increased student debt, typically consists of a fellowship that takes place in the two-year window of eligibility for NHSCLRP. The creation of NHSCLRP preceded the expansion of many pediatric subspecialties, not taking into account the extra years of training required for these physicians.

The Ensuring Children's Access to Specialty Care Act would correct this loophole and allow pediatric subspecialists practicing in underserved areas to benefit from the NHSCLRP. By so doing, this bill would increase access to specialty care for children and improve mental health parity for children.

Providers across the spectrum of care support this bipartisan legislation including: the American Association of Child and Adolescent Psychiatry, the American Academy of Pediatrics, the Arthritis Foundation, Children's Hospital Association, March of Dimes, and the National Alliance on Mental Illness. I look forward to working with these and other stakeholders as well as Senator Blunt and our colleagues to pass the Ensuring Children's Access to Specialty Care Act in order to help ensure children have greater access to the health care they need.

Mr. President, I thank Senator Collins for her leadership on this issue. I am very happy to have a chance to work with her on this.

Today, my colleague Senator Collins and I are introducing a bill to help fight Lyme disease, so we are introducing this bill today here in the Senate as many Minnesotans and Mainers get ready to head out to our beautiful national parks, lakes, and coastline to go fishing, hiking, and all of the things that we love, love, love to do.

In Minnesota, we have more than 10,000 lakes and a lot of space for outdoor activities, and we also have a growing tick population due to warmer summer months. With so many lakes and our excitement to get outside after a long winter, Minnesotans have become more at risk of contracting Lyme disease and other vector-borne illness.

A vector-borne illness means an illness that is carried by an insect, like ticks. Unfortunately, the number of Lyme disease cases in Minnesota is on the rise. Over the past 10 years, the number of reported cases has increased by nearly a third.

Our bill, the TICK Act, aims to reduce the number of cases by establishing an interagency office of oversight and coordination to target, prevent, and treat Lyme disease and other vector-borne illnesses. In our legislation, we made sure to enable collaboration between universities and public health agencies, and it is important we train and equip our public health first responders in how best to prevent and treat vector-borne illnesses.

The TICK Act is supported by a coalition of researchers, as Senator Collins just said, also frontline medical professionals and government officials from across the country, so I urge my colleagues to listen to the professionals on the ground fighting vector-borne diseases and quickly take up and pass this bill.

May is Lyme disease awareness month. We must be aware of and prepare for future vector-borne disease outbreaks, and this bill will be an important first step.

So I want to thank Senator Collins, my colleague on the HELP Committee, for her leadership on this important issue. I am glad we are able to work together on this bill.