Resident Physician Shortage Reduction Act of 2023

Mr. President, before I make a unanimous request on this important bipartisan, bicameral bill, I wish to talk for a moment about why it is so critical that the Senate pass this urgently needed legislation.

For hundreds of thousands of Americans and their families waiting for a transplant, this is not an abstract issue. We are talking about life and death. More than 100,000 people are on the waiting list to receive a transplant, and, on average, 17 people die each day waiting for an organ transplant. In the first half of this year alone, more than 2,200 Americans have died while waiting for a transplant.

The inadequacies of the current system are especially harmful to minority populations who are disproportionately represented on the organ transplant waitlist, yet, on average, wait longer for a transplant and are at a higher risk of death while waiting.

I would just say to my colleagues that this is morally repugnant, and this legislation begins, finally, to root out this bias against our minority communities.

For the last 40 years, the same contractor has had a stronghold on this contract. The lack of competition has not been in the best interest of patients, and this fall the contract will be up for renewal.

In last year's bipartisan investigation, the Finance Committee found shocking failures with the current contractor who oversees the entire system: long wait times for patients on transplant lists, viable organs being lost or damaged in transit. We saw pictures of these organs lying around in airport hangars. There has just been a lack of accountability when the problems happen, technology failures, and even patient deaths.

The last place anybody wants to hear about gross mismanagement and incompetence is in the business of saving lives. It is time for real accountability and real change.

This bill would build on the administration's recently announced plans to modernize the program and clarify that there is the ability to award multiple contracts for these key functions. This would create real competition for these contracts and ensure the best-in-class organizations can be awarded contracts to support this critical system.

The bill, which passed in the other body last week, would bring much needed change and modernization of the organ transplant system by supporting the administration's efforts and codifying, in the black letter law, modernization efforts where we aren't going to turn back the clock. We are not going to go back. We are going to go forward.

I would like to thank a number of Members on both sides of the aisle who have been on the frontlines in this fight, particularly Senator Grassley, Senator Cardin, and Senator Young, who always worked in a bipartisan way. Senator Grassley, in particular, has been a longtime leader on this issue, an outspoken advocate for fixing a broken organ transplant system. I believe he had a challenging schedule, as many Senators did tonight, but I wanted to thank Senator Grassley. And I want to also thank my friend from Vermont, Senator Sanders, and his very talented staff for their commitment to help us get to this point, and we are going to continue to work in the future.

Let's be clear about what is on offer. Every Member of Congress wants Americans to have the best-in-class organ transplant system. Our legislation is written from top to bottom to ensure competition for technical functions like those that will help this program perform to the highest possible level.

I said we were going to pull out all the stops to get this passed because the patients deserve it. This is the final stop after all of these years of foot-dragging and excuses. And tonight, this is the final stop. Let's send the Securing the U.S. Organ Procurement Transplantation Network Act to the President's desk today.

Mr. President, I ask unanimous consent that the Senate proceed to the immediate consideration of H.R. 2544, which was received at the House and is at the desk; further, that the bill be considered read a

third time and passed and the motion to reconsider be considered made and laid upon the table with no intervening action or debate.

I thank my colleague for all his leadership, and I am certainly planning to speak on the very strong merits of what you described. And if you would like to continue, we will go through that shortly.

Would the gentleman like to yield to me?

I thank my colleague for being our leader here in the Congress and, frankly, for this Nation because he has consistently made the point that given the demographics of where we are going to have so many more older people, where we have so many young people at risk, we desperately need Chairman Sanders to do what he is talking about, which is to address this massive shortage of healthcare workers in America.

Addressing healthcare workforce shortages means we are going to have to have fresh, big league ideas to get these workers all across our country, and it is vitally important that we address several of the biggest ideas Chairman Sanders and I are talking about.

For example, expanding funding for the Medicare Graduate Medical Education Program--what is called GME--would grow the number of doctors, especially primary care physicians and psychiatrists.

This evening, Chairman Sanders, I want to make it clear that our two committees--yours doing important work, what is known as HELP, and ours on the Finance Committee--we are committed to bipartisan legislation that is going to increase investments in the Medicare Graduate Medical Education Program. We are also going to focus on incentivizing healthcare providers to partner with schools to train and develop healthcare professionals from medical assistants to advanced practice nurses.

We are also going to have to address expanding the number of behavioral health providers because we know we have an enormous mental health program challenge in America. We have to increase access to maternal health programs in rural areas and invest in the direct care workforce to ensure the health and safety of older Americans and those with disabilities.

What Senator Sanders is talking about is an all-hands-on-deck approach with our two committees, the two lead committees in the healthcare area working together to increase the number of workers.

Tonight, Chairman Sanders, as chair of the Finance Committee, I want to make clear that I intend to work very closely with you on these issues. We are going to be partners in the effort in the Finance and HELP Committees to bring forward legislation in the fall to address the healthcare workforce crisis in America. And I want to hear the rest of your remarks and hope then we can have a lifting of the objection and pass the bill.

Reserving the right to object

Let me begin by thanking Chairman Wyden for his leadership on the need to fundamentally reform our Nation's organ transplant program. I share his concerns. A 2020 bipartisan Finance Committee investigation that Chairman Wyden co-led with respect to the current system found ``lapses in patient safety, misuse of taxpayer dollars, and tens of thousands of organs going unrecovered or not transplanted . . . resulting in fraud, waste, and abuse of our Nation's Medicare program and American taxpayer dollars.''

That is unacceptable and that has got to change. The legislation Senator Wyden would like to pass in the Senate today by unanimous consent, while not perfect, includes important reforms to the current system that I support. Once it is signed into law, there may need to be some technical changes to it that I look forward to working with Chairman Wyden and my other colleagues on.

All of us believe that the administration should have the flexibility it needs to fix the current system. We also believe that corporations should not be able to make an outrageous profit from the organ network.

As my good friend from Oregon knows, this bill is within the jurisdiction of the HELP Committee, a committee that I chair.

Before I withdraw my objections to the organ transplant bill, I want to raise an issue of enormous importance to the American people, and that is the need to address the very serious primary care crisis in America and the massive shortage of doctors, nurses, mental health professionals, and dentists in America.

As my colleague from Oregon knows very well, tens of millions of Americans are unable to access the primary medical care, dental care, and mental health care that they desperately need.

As everyone in America understands, we don't have enough doctors, nurses, psychologists, psychiatrists, dentists, and home healthcare workers in our country.

As the Senator from Oregon knows very well, on September 30, mandatory funding for Community Health Centers, the National Health Service Corps, and Teaching Health Centers will expire unless Congress acts, and Congress must act.

The HELP Committee is working on bipartisan legislation, not only to reauthorize these critical programs, but to significantly expand them. We need a major expansion of Community Health Centers in America to make sure that tens of millions of underserved Americans not only receive the primary care they need, but are also able to receive the high-quality mental health care and dental care they need as well.

We need a major expansion of the National Health Service Corps Program, the program that provides scholarships and debt forgiveness for doctors, nurses, dentists, and mental health providers who are prepared to work in our Nation's most underserved areas.

We need a major expansion of the Teaching Health Center Program, the Nurse Corps, and the Nurse Faculty Loan Program, among many other things.

Of particular concern is an issue I heard about from every single major medical organization in our country, and that is that over the next decade, our Nation faces a shortage of more than 120,000 doctors, including a major shortage of primary care doctors. I don't know how we can grow the number of doctors in America without expanding the Medicare Graduate Medical Education--GME--Program, a program that is within the jurisdiction of the Finance Committee.

Let's be clear. The problem is not so much about the number of doctors graduating from medical school. No, the problem--the bottleneck--is that some 6,800 applicants for a residency position don't match into a program due to a shortage of spots. As my colleague from Oregon knows, if a doctor graduates from medical school but cannot get a residency slot, that person cannot practice medicine in the United States.

In my view, it is critically important that we expand the GME Program. There is bipartisan legislation that does this: S. 1302. The Resident Physician Shortage Reduction Act of 2023, led by Senators Menendez, Boozman, Schumer, and Collins, would raise the number of GME positions by 14,000 over the next 7 years. Consistent with legislation that passed the House last Congress, I believe that a significant percentage of these additional slots should be dedicated to primary care and mental health care.

As you know, the Medicare GME Program is within the jurisdiction of the Finance Committee, and the other programs I mentioned are within the jurisdiction of the HELP Committee.

I ask my good friend and colleague from Oregon, will you commit today that as chairman of the Finance Committee, you will do everything within your ability to pass bipartisan legislation in the Senate that includes a major expansion of the Medicare Graduate Medical Education Program?

Sure.

My remarks will be brief.

I just want to thank the chairman, Senator Wyden, of the Finance Committee, for his commitment and for his leadership on these issues. I look forward to working with him to expand access to primary care in America and address the major shortage of healthcare workers in America.

Mr. President, with that commitment, I will not object.

Mr. President, the Securing the U.S. Organ Procurement and Transplantation Network Act is an opportunity for Congress to make history, an opportunity to change the lives of the more than 100,000 Americans waiting for an organ transplant.

Organ donation has always been a bipartisan issue. In 1984, Congress passed the National Organ Transplant Act. That bill was cosponsored by Senator Al Gore and Senator Orrin Hatch. I would like to thank the bipartisan group of Senate colleagues who cosponsored our bill. I would like to give special thanks to Senator Cassidy, who championed the bill in the HELP Committee. I would also like to recognize Senators Wyden, Cardin, and Young, who have worked with me for years to shine a light on the deadly failures of the Nation's organ donation system.

Thank you all for your leadership. Our bipartisan work will continue. The organ donation system has failed patients and generous donor families from all walks of life. After years of bipartisan work in the House and Senate, we have finally passed this bill. Success with this bill means patients are the winners.

For almost two decades, Congress, government watchdogs, and the media have questioned the United Network for Organ Sharing's ability to carry out its responsibilities. I have written about these issues since 2005. Since then, 200,000 Americans have died on the organ waiting list.

Those aren't numbers; those are lives. To put it in perspective, that is the population of Des Moines, IA. There is a reason I call the United Network for Organ Sharing the fox guarding the hen house.

In August of 2022, the Senate Finance Committee issued a bipartisan report that detailed vast disparities in how Organ Procurement Organizations serve their communities. Based on the findings, the organ network has worse outcomes for people of color and rural residents. This bipartisan investigation, which started when I was chairman of the Senate Finance Committee, uncovered fraud, waste, abuse, criminality, deadly patient safety issues, failure to recover organs, and retaliation against whistleblowers. The Senate Finance Committee's bipartisan report was clear: ``From the top down, the U.S. transplant network is not working, putting Americans' lives at risk.''

We must break up the monopoly that has held the U.S organ donation system hostage since 1986. Patients deserve the best possible care; it is the difference between life and death. Our bipartisan bill will help ensure they get the best care.

Earlier this week, our colleagues in the House passed this same legislation to break up the organ monopoly and serve patients instead of special interests. Today, by passing this bill, we have accomplished a major milestone in saving lives and taking care of those who need it most.