BOLD Infrastructure for Alzheimer's Reauthorization Act of 2024

Madam President, I rise today to introduce legislation to reauthorize the Building Our Largest Dementia, BOLD, infrastructure for Alzheimer's Act, legislation I authored that was signed into law in 2018.

The Building Our Largest Dementia, BOLD, Infrastructure for Alzheimer's Reauthorization Act of 2024, which I am pleased to introduce today with my colleagues Catherine Cortez Masto, Shelley Moore Capito, and Tim Kaine, would continue our important work to create a public health infrastructure to combat Alzheimer's disease and preserve brain health.

Public health plays an important role in achieving population-level improvements, but for too long Alzheimer's and other dementias have been viewed as just a normal part of aging and not as the public health crisis it warrants. Through the BOLD Act, we started to change this narrative and for the first time put resources behind the interventions that can help improve the health and quality of life for people living with Alzheimer's, as well as reduce the costs associated with the disease.

Still, Alzheimer's disease remains one of the greatest public health threats of our time. Approximately 6.7 million Americans are living with the disease, and, barring any major breakthroughs to prevent, slow down, or cure Alzheimer's, that number is expected to more than double. In addition to the human suffering it causes, Alzheimer's is one of our Nation's most expensive diseases, costing an estimated $345 billion last year. In my home State of Maine, more than 29,000 seniors are living with the disease, and unfortunately that number is only increasing. In addition, more than 51,000 loved ones are providing care valued at nearly $1.9 billion. Every State across the country is experiencing a similar story, underscoring the need to invest in the development of a robust Alzheimer's public health infrastructure on a State, local, and Tribal level to combat this growing public health crisis.

Through coordinated Federal investments and a national strategy created by the National Alzheimer's Project Act I authored, we have accelerated our understanding of this complex disease and unlocked steps we can take to increase early detection and diagnosis, reduce risk, prevent avoidable hospitalizations, and support dementia caregivers. Groundbreaking research has also now led to a new age of treatment, with disease-modifying therapies now available to patients. These promising treatments could substantially change how the disease is perceived and managed, increasing the urgency to educate the public, and promote early diagnosis.

Now, after decades of increasing investments in biomedical research for Alzheimer's, we are nearing the next phase of effectively preventing, treating, and curing Alzheimer's--translating research into real-world interventions. The BOLD Infrastructure for Alzheimer's Act accelerated a multipronged public health approach for the prevention, treatment, and care of Alzheimer's and related dementias. The bill we are introducing today would reauthorize the BOLD Infrastructure for Alzheimer's Act for 5 years in order to ensure that these critical activities can continue to reach communities across the country.

Specifically, the BOLD Infrastructure for Alzheimer's Act directed CDC to establish Alzheimer's and Related Dementias Public Health Centers of Excellence, provide Federal funding to support State, local, and Tribal public health departments, and increase data analysis and timely reporting in order to inform interventions, research, and public policy.

The CDC's Centers of Excellence are now working to promote effective Alzheimer's disease management and caregiving interventions, as well as educating the public on Alzheimer's disease, cognitive decline, and brain health. Each center is focused on a key issue related to dementia--from risk reduction to early detection to

caregiving. The three current centers have established themselves as national resources and are supporting nationwide implementation of the actions outlined in the CDC's Healthy Brain Initiative's Road Map. This includes identifying, translating, and disseminating promising research findings and best practices for nationwide uptake. Our legislation would reauthorize the Alzheimer's Disease and Related Dementias Public Health Centers of Excellence and add a new focus on implementation science, which is essential to bridging the gap between research findings and practical application in real-world settings.

In addition, building upon the CDC's Healthy Brain Initiative and its Public Health Road Map, the BOLD Infrastructure for Alzheimer's Act has provided public health departments with the funding and support necessary to implement effective Alzheimer's interventions in communities across the country, including a focus on reducing the risk of dementia, increasing early detection and diagnosis, and supporting caregivers. Forty-three public health departments across the United States are now promoting a strong public health approach to Alzheimer's disease and related dementia with the support of BOLD awards.

In September 2020, the Maine Department of Health and Human Services received one of the first BOLD Program Awards. This investment has allowed for the implementation of the Maine State Plan for Alzheimer's Disease and Related Dementias, as well as advancements in Maine's public awareness of brain health, early detection and diagnosis of Alzheimer's disease, and access to care and support. Maine's Department of Health and Human Services has even been able to publish county- specific data on cognitive decline to better understand risk factors and prevention across the State. In addition, the Bangor Public Health & Community Services Department and partners have educated its employees on how to respond to the Alzheimer's public health crisis, emphasizing early detection and diagnosis and brain health. Efforts such as these play a key role in bringing awareness to and ultimately reducing the growing prevalence of dementia in the State.

In September 2023, Maine received a second BOLD award from the CDC for Alzheimer's prevention programs. This implementation funding will allow Maine to build on its initial investments and carry out the Maine Alzheimer's Prevention Program and the CDC's Healthy Brain Initiative Road Map.

There continues to be an urgent need to translate what science tells us about the opportunity to reduce risk, delay onset, and ultimately reduce prevalence into effective public health practice. However, unless Congress acts to reauthorize these effective programs, BOLD programming is set to expire on September 30. The BOLD Infrastructure for Alzheimer's Reauthorization Act would continue our investment in a nationwide Alzheimer's public health response so that States, including Maine, can sustain the critical work being done in communities across the country and ensure this work has a real-world impact in the years ahead.

As founder and cochair of the Congressional Task Force on Alzheimer's Disease, the fight against Alzheimer's for me is both personal and a matter of crafting effective public policy. Virtually every family in the country has been touched by this disease, and I know the gravity of this disease firsthand as I lost my father, grandfather, and two uncles to Alzheimer's. I remain committed to advancing research, care, and support for individuals and families living with this devastating disease. Reauthorization of the BOLD Infrastructure for Alzheimer's Act will ensure communities across the country have access to resources to promote effective Alzheimer's interventions and better cognitive health that can lead to improved health outcomes.

This bipartisan legislation is endorsed by the Alzheimer's Association, the Alzheimer's Impact Movement, and UsAgainstAlzheimer's. I urge my colleagues to support this critical legislation.

Madam President, I rise today to introduce legislation to reauthorize the Building Our Largest Dementia, BOLD, infrastructure for Alzheimer's Act, legislation I authored that was signed into law in 2018.

The Building Our Largest Dementia, BOLD, Infrastructure for Alzheimer's Reauthorization Act of 2024, which I am pleased to introduce today with my colleagues Catherine Cortez Masto, Shelley Moore Capito, and Tim Kaine, would continue our important work to create a public health infrastructure to combat Alzheimer's disease and preserve brain health.

Public health plays an important role in achieving population-level improvements, but for too long Alzheimer's and other dementias have been viewed as just a normal part of aging and not as the public health crisis it warrants. Through the BOLD Act, we started to change this narrative and for the first time put resources behind the interventions that can help improve the health and quality of life for people living with Alzheimer's, as well as reduce the costs associated with the disease.

Still, Alzheimer's disease remains one of the greatest public health threats of our time. Approximately 6.7 million Americans are living with the disease, and, barring any major breakthroughs to prevent, slow down, or cure Alzheimer's, that number is expected to more than double. In addition to the human suffering it causes, Alzheimer's is one of our Nation's most expensive diseases, costing an estimated $345 billion last year. In my home State of Maine, more than 29,000 seniors are living with the disease, and unfortunately that number is only increasing. In addition, more than 51,000 loved ones are providing care valued at nearly $1.9 billion. Every State across the country is experiencing a similar story, underscoring the need to invest in the development of a robust Alzheimer's public health infrastructure on a State, local, and Tribal level to combat this growing public health crisis.

Through coordinated Federal investments and a national strategy created by the National Alzheimer's Project Act I authored, we have accelerated our understanding of this complex disease and unlocked steps we can take to increase early detection and diagnosis, reduce risk, prevent avoidable hospitalizations, and support dementia caregivers. Groundbreaking research has also now led to a new age of treatment, with disease-modifying therapies now available to patients. These promising treatments could substantially change how the disease is perceived and managed, increasing the urgency to educate the public, and promote early diagnosis.

Now, after decades of increasing investments in biomedical research for Alzheimer's, we are nearing the next phase of effectively preventing, treating, and curing Alzheimer's--translating research into real-world interventions. The BOLD Infrastructure for Alzheimer's Act accelerated a multipronged public health approach for the prevention, treatment, and care of Alzheimer's and related dementias. The bill we are introducing today would reauthorize the BOLD Infrastructure for Alzheimer's Act for 5 years in order to ensure that these critical activities can continue to reach communities across the country.

Specifically, the BOLD Infrastructure for Alzheimer's Act directed CDC to establish Alzheimer's and Related Dementias Public Health Centers of Excellence, provide Federal funding to support State, local, and Tribal public health departments, and increase data analysis and timely reporting in order to inform interventions, research, and public policy.

The CDC's Centers of Excellence are now working to promote effective Alzheimer's disease management and caregiving interventions, as well as educating the public on Alzheimer's disease, cognitive decline, and brain health. Each center is focused on a key issue related to dementia--from risk reduction to early detection to

caregiving. The three current centers have established themselves as national resources and are supporting nationwide implementation of the actions outlined in the CDC's Healthy Brain Initiative's Road Map. This includes identifying, translating, and disseminating promising research findings and best practices for nationwide uptake. Our legislation would reauthorize the Alzheimer's Disease and Related Dementias Public Health Centers of Excellence and add a new focus on implementation science, which is essential to bridging the gap between research findings and practical application in real-world settings.

In addition, building upon the CDC's Healthy Brain Initiative and its Public Health Road Map, the BOLD Infrastructure for Alzheimer's Act has provided public health departments with the funding and support necessary to implement effective Alzheimer's interventions in communities across the country, including a focus on reducing the risk of dementia, increasing early detection and diagnosis, and supporting caregivers. Forty-three public health departments across the United States are now promoting a strong public health approach to Alzheimer's disease and related dementia with the support of BOLD awards.

In September 2020, the Maine Department of Health and Human Services received one of the first BOLD Program Awards. This investment has allowed for the implementation of the Maine State Plan for Alzheimer's Disease and Related Dementias, as well as advancements in Maine's public awareness of brain health, early detection and diagnosis of Alzheimer's disease, and access to care and support. Maine's Department of Health and Human Services has even been able to publish county- specific data on cognitive decline to better understand risk factors and prevention across the State. In addition, the Bangor Public Health & Community Services Department and partners have educated its employees on how to respond to the Alzheimer's public health crisis, emphasizing early detection and diagnosis and brain health. Efforts such as these play a key role in bringing awareness to and ultimately reducing the growing prevalence of dementia in the State.

In September 2023, Maine received a second BOLD award from the CDC for Alzheimer's prevention programs. This implementation funding will allow Maine to build on its initial investments and carry out the Maine Alzheimer's Prevention Program and the CDC's Healthy Brain Initiative Road Map.

There continues to be an urgent need to translate what science tells us about the opportunity to reduce risk, delay onset, and ultimately reduce prevalence into effective public health practice. However, unless Congress acts to reauthorize these effective programs, BOLD programming is set to expire on September 30. The BOLD Infrastructure for Alzheimer's Reauthorization Act would continue our investment in a nationwide Alzheimer's public health response so that States, including Maine, can sustain the critical work being done in communities across the country and ensure this work has a real-world impact in the years ahead.

As founder and cochair of the Congressional Task Force on Alzheimer's Disease, the fight against Alzheimer's for me is both personal and a matter of crafting effective public policy. Virtually every family in the country has been touched by this disease, and I know the gravity of this disease firsthand as I lost my father, grandfather, and two uncles to Alzheimer's. I remain committed to advancing research, care, and support for individuals and families living with this devastating disease. Reauthorization of the BOLD Infrastructure for Alzheimer's Act will ensure communities across the country have access to resources to promote effective Alzheimer's interventions and better cognitive health that can lead to improved health outcomes.

This bipartisan legislation is endorsed by the Alzheimer's Association, the Alzheimer's Impact Movement, and UsAgainstAlzheimer's. I urge my colleagues to support this critical legislation.

Madam President, today I am reintroducing the Preserving Homes and Communities Act with Senators Brown, Wyden, Smith, and Merkley. This legislation would reform Federal Housing Administration, FHA, Fannie Mae, and Freddie Mac note sale programs to protect homeowners from foreclosure and keep properties in the hands of families and local civic institutions.

FHA, Fannie Mae, and Freddie Mac began selling nonperforming and reperforming loans after the great recession to strengthen their balance sheets. These transactions, known as note sales, transfer mortgage ownership to bulk purchasers, including private equity firms and institutional investors. The sale of nonperforming and reperforming loans may reduce financial risk for FHA, Fannie Mae, and Freddie Mac and help purchasers turn a profit, but they often directly harm homeowners by taking homes from families and moving properties into the single-family rental market.

Loans insured by FHA or securitized by Fannie Mae or Freddie Mac have strong foreclosure protections for borrowers. Companies that service these mortgages must offer specific loss mitigation options to eligible borrowers before they can begin foreclosure proceedings, which helps many borrowers avoid foreclosure and catch up on their payments. But while these foreclosure protections are effective, they are drastically reduced when a mortgage is included in a note sale.

Unfortunately, the lack of robust, required protections after a note sale has very real consequences for homeowners. Over 80 percent of homeowners whose nonperforming loans were sold by FHA ultimately lost their homes after their new servicers reached a final loan resolution, and the U.S. Government Accountability Office has found that nonperforming loans sold by FHA are more likely to face foreclosure than comparable loans that FHA keeps on its own balance sheet. The majority of homeowners with nonperforming loans sold by Fannie Mae and Freddie Mac have also lost their homes after servicers reached a final resolution. It is abundantly clear that note sales do not help most borrowers remain in their homes.

Making matters worse, note sale purchasers are predominately private equity firms and institutional investors, which often move foreclosed properties out of the owner-occupied market. Indeed, approximately one- third of properties foreclosed upon or voluntarily turned over to a lender after a Fannie Mae or Freddie Mac nonperforming loan note sale are sold to an investor, held by the purchaser for rental, or become real estate owned. In other words, one-third of these homes may be taken out of the owner-occupied market, reducing home ownership opportunities for families and shifting property ownership to large corporations that often drive up rents.

The Preserving Homes and Communities Act tackles these problems. It would protect homeowners by, one, requiring mortgage servicers complete Agency-required loss mitigation actions before FHA, Fannie Mae, or Freddie Mac can sell a nonperforming mortgage, and two, by improving loss mitigation protections for these mortgages after purchasers acquire them. It would similarly protect communities by giving local entities with public missions, including States, municipalities, and nonprofits, the first opportunity to purchase nonperforming and reperforming mortgages--ahead of private equity and institutional investors--while requiring purchasers that foreclose on nonperforming note sale properties to prioritize owner-occupants and low- and moderate-income households when selling or renting these homes. In sum, our legislation seeks to keep homeowners in their homes, support home ownership opportunities, and preserve the supply of available and affordable homes for families.

I thank the National Consumer Law Center, on behalf of its low-income clients, and the National Community Stabilization Trust for their support. I urge my colleagues to cosponsor this legislation and support its passage.