Access to Counsel Act of 2021

Mr. President. as many of my colleagues know. the transition from military to civilian life can be very difficult. To address these kinds of challenges. Vet Centers were created in the wake of the Vietnam War to provide critical services for veterans. service members. and their families in community-based settings separate from other Veterans Health Administration facilities. Today. there is a need to enhance these Centers to continue to realize that original vision-- which is why I am reintroducing the Vet Center Improvement Act.

This legislation is the product of a Government Accountability Office (GAO) investigation that Senator Tester and I requested into allegations that changes to performance metrics at Vet Centers may have negatively impacted quality of care as well as additional concerns that we had about their staffing practices. The GAO report concluded that recent changes ``have the potential to negatively affect care and create undue burden and stress on counselors providing that care at some Vet Centers.'' This report included recommendations to improve care, transparency. and hiring and staffing methods that are the foundation for our legislation.

Specifically, the Vet Center Improvement Act requires periodic review and reform of performance standards at Vet Centers; the creation and periodic reevaluation of a staffing model, along with standardization of position descriptions and responsibilities across Vet Centers; the creation of a working group to implement changes to improve quality of care for veterans and recruitment and retention of staff; and the GAO to review Vet Center infrastructure and examine what future investments are needed. Additionally, our legislation creates a $50 million pilot program to provide grants to combat food insecurity and provide necessary heating and cooling assistance to veterans and their families. Unfortunately, the COVID-19 pandemic has further underscored the need for this legislation--to ensure that we are providing high quality counseling services and offering programs that help our veterans meet their daily needs, like feeding their families and heating their homes.

I would like to thank Senator Tester for joining me in introducing this important legislation and the attention he has paid to this issue as Ranking Member and now Chairman of the Senate Veterans Affairs Committee. Our legislation has received support from such organizations as the Veterans of Foreign Wars (VFW), American Veterans (AMVETS), National Community Action Foundation (NCAF), National Association for State Community Services Programs (NASCSP). the National Energy & Utility Affordability Coalition (NEUAC),

and the URI Feinstein Center for a Hunger Free America. I look forward to continuing our partnership on this and other measures to improve care for our veterans. and I hope our colleagues will join us in this endeavor.

Mr. President, today I am introducing legislation to reauthorize the John H. Chafee Blackstone River Valley National Heritage Corridor for the next fifteen years. This legislation will continue to preserve the industrial, natural, and cultural heritage of the Blackstone River Valley for generations to come.

In 1986, Congress designated the Blackstone River Valley as a National Heritage Corridor, recognizing the region's critical contributions to the American Industrial Revolution. Indeed, in 1793. Samuel Slater initiated the American Industrial Revolution in Rhode Island when he built his historic mill along the Blackstone River, Today, the mills and villages throughout the Corridor reflect the legacy of this key chapter in American history.

Encompassing both Rhode Island and Massachusetts, the John H. Chafee Blackstone River Valley National Heritage Corridor links twenty-four communities along the Blackstone River from Providence to Worcester. The Corridor has also served as a critical partner to the Blackstone River Valley National Historical Park, resulting in the recovery of dozens of historic villages, waterways, and rural landscapes throughout the Blackstone River Valley, which includes thousands of acres of beautiful lands and waters that are home to diverse wildlife.

I urge my colleagues to join me in supporting this legislation to ensure the continued preservation of the Blackstone River Valley for the benefit of our natural resources and our country's history.

Mr. President, I am pleased to introduce the ``San Francisco Bay Restoration Act.'' Thank you to Senator Padilla for cosponsoring and I am happy to be once again be working with Congresswoman Jackie Speier, who is leading the bill in the House.

This legislation would create a San Francisco Bay Program within the Environmental Protection Agency dedicated to conserving and protecting the San Francisco Bay estuary ecosystem--the largest estuary in the western United States.

The San Francisco Bay estuary is truly a national treasure, and it is vital to the nation's environmental and economic health. It is home to more than 1,000 plant and wildlife species, roughly 77% of California's remaining perennial estuarine wetlands, and an important stopover for birds along the Pacific Flyway. The Bay region produces more than $370 billion in goods and supports more than 4 million jobs.

Unfortunately, during the last 150 years, the water quality and health of the San Francisco Bay has been diminished. According to the United States Geological Survey, the Bay has lost 95% of its wetlands, which serve as both habitat for vulnerable species and as an important barrier to protect against climate change impacts such as rising sea levels and extreme weather events made only more common by global warming.

The program created within EPA to focus on the San Francisco Bay Estuary would increase federal investment into the San Francisco Bay Estuary to ensure that it can continue to support the environment, agriculture, and economy for generations to come.

A 2018 General Accounting Office report on the San Francisco Bay Delta Watershed found that the lack of sufficient Federal funding is one of the biggest risks to long-term restoration efforts, and a major factor limiting habitat restoration and water quality improvement.

The GAO noted that while Bay Area voters established a local funding source through a bond measure for some Bay restoration, local funding ``needs to be leveraged by significant state and Federal dollars to meet the estimated $1.5 billion needed for restoration in the Bay Area.''

This bill recognizes the important restoration work that must be done to protect and restore the iconic San Francisco Bay Estuary. It authorizes $50 million per year for five years for the creation of the San Francisco Program office.

This program office would work with local stakeholders to compile an annual list of project and study priorities that advance the goals of the National Estuary Program for the San Francisco Bay estuary.

Funds would be distributed by the agency in a competitive grant program, prioritizing projects that improve water quality, provide wetland restoration, promote endangered species recovery, and support adaptation to climate change.

This legislation would bring the Federal funding investment in line with other major estuaries in the country, like the Chesapeake Bay, Great Lakes, and Puget Sound.

This is another example of the type of front-end investment in green infrastructure and natural resources that will only pay dividends in the future and, most importantly, for future generations.

I urge my colleagues to join me in supporting this bill.

Thank you, Mr. President, I yield the floor.

Mr. President, I rise today to reintroduce legislation with my colleague from Maryland, Senator Ben Cardin, to increase access to preventive bone density screenings and to improve osteoporosis diagnosis and treatment in the process.

May is National Osteoporosis month. Approximately 54 million Americans have osteoporosis or low bone mass. Women are disproportionally affected, accounting for 71 percent of osteoporotic fractures and 75 percent of health costs related to osteoporosis.

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 Diseases 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 identify the link between the broken bone and osteoporosis, the chance to make a diagnosis with a bone density test and begin a treatment program may be lost.

Our legislation, the Increasing Access to Osteoporosis Testing for Medicare Beneficiaries Act of 2021, 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 to this test, 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. It is not surprising that this inadequate reimbursement has led to a decline in screenings.

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, the result of reduced screenings due to declining reimbursements produces real harm. It is estimated that more than 40,000 additional hip fractures occur each year, resulting in nearly 10,000 additional hip fracture-related deaths. Keep in mind that these painful and costly fractures, and even deaths, are all occurring at a time when early diagnosis and treatment of osteoporosis are proven to reduce fracture rates dramatically.

With osteoporosis already an under-diagnosed condition in the Medicare population, it is clear that we must change this trajectory I thank Senator Cardin for joining me in this effort to increase patient access to osteoporosis screening and diagnosis, while lowering cost and consequences resulting from a lack of diagnosis. I encourage my colleagues to support its adoption. Thank you, Mr. President.

Mr. President, I rise to introduce the ``Access to Counsel Act.''

This legislation would ensure that all individuals with a legal right to be in the United States and are detained by Customs and Border Protection at ports of entry or airports have access to legal counsel.

This legislation would ensure that individuals who have legal status in the U.S. and are detained by Customs and Border Protection in secondary inspection at airports or other points of entry for more than an hour are granted an opportunity to access legal counsel and an interested party. An interested party is defined as a family member, sponsor, or organization with a connection to the individual.

The bill provides no obligation for the Federal government to pay for counsel and allows counsel the ability to advocate on behalf of the individual by providing information or documentation in support of the individual.

It also invalidates any effort by CBP to persuade someone to relinquish their legal status if that person has been denied access to counsel or voluntarily waives in writing their right to counsel.

The Trump Administration's immigration policies often caused unnecessary chaos and confusion.

One vivid example of this is when the first Muslim Ban was implemented, in early 2017, and thousands of U.S. citizens, green card holders, and others with valid visas were detained at airports for hours.

They were held by Customs and Border Protection officers without any ability to call a lawyer, a relative or an advocate. Many members of Congress rushed to the airports in an attempt to help these individuals and were barred from speaking to them or connecting them with attorneys.

In addition, in early 2020, 200 Iranian Americans were held at the northern border in Blaine, WA for 12 hours without access to counsel.

While President Biden has rescinded the travel bans, it is imperative that Americans and those with a legal right to be here have access to representation if they are held at a port of entry.

Thank you, Mr. President. I yield the floor.

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