Floor Statements

I yield the floor.

Mr. President, I, too, come to speak today regarding pharmaceutical costs and what we can do to make lifesaving medications--and sometimes these medications make our lives a little bit better--more affordable to the average American.

I happen to be a doctor, and I will approach these remarks as a fellow who has seen medicine evolve, who has seen the incredible, positive benefits of pharmaceutical innovation, but also as a doctor who sometimes saw that patients were unable to afford innovation. The question in my mind is, How do we give the patient the power to afford these innovative medicines, because if she cannot afford them, it is as if the innovation never occurred, and for her, it never did occur. So give the patient power.

Let me make some remarks about pharmaceutical companies. There are some incredible examples.

When I was in medical school, cutting away a part of one's stomach-- not the belly but part of the stomach; as I would tell patients, where the food goes after you swallow it--cutting away a part of the stomach because of ulcerative disease was one of the most common procedures done in surgery. Then histamine blockers came along, H2 blockers. Cimetidine was the first. All of a sudden, a surgery that was done multiple times a week was scarcely ever done. Those medicines are now sold over the counter.

This morning, I got a little bit of arthritis, so I took my nonsteroidal anti-inflammatory, which used to be sold by prescription and now is over the counter, along with my H2 blocker, my Pepcid, which used to be sold by prescription but now is over the counter. I take them in the morning, and my back feels better. All of these are medicines that are generic, routine, and we almost--in fact, we indeed take the innovation for granted.

I can go on. I am a liver doctor. Hepatitis C used to be an incurable disease which, in a certain percentage of those affected, would lead to cirrhosis, vomiting blood, liver cancer, and death. Now hepatitis C is cured by taking pills for several weeks. Amazing.

Human immunodeficiency virus, AIDS. When I was in residency, if you got HIV, you died. There was no cure whatsoever. Now people live with it for decades. It is a disease you live with but do not die from. We speak of actually now developing cures for HIV.

That is the promise of a vibrant pharmaceutical industry--people who not only live when otherwise they would have passed away but who also have a better quality of life.

Now, that said, if the patient doesn't have the power, the patient has no leverage in this situation.

I was recently with others in a conversation with the new head of the Congressional Budget Office. The CBO head said: You know, everybody has leverage in the healthcare marketplace except the patient. Everybody has leverage but not the patient.

That is so true. Let me give some examples of how the patient lacks leverage in the pharmaceutical marketplace.

First, I will say, if I go to church--and I do go to church regularly--and there is a Bernie Sanders supporter yanking on this lapel and a Donald Trump supporter yanking on this lapel and they are complaining about the same thing, they are talking about either surprise medical bills or the high cost of drugs. It is something that touches each American, but it doesn't have to be that way.

Consumer Reports did an article over 1 year ago now in which they sent secret shoppers out to retail pharmacies to buy five generic medications, a prescription for each type--again, generic, like the over-the-counter pills I am taking. They went, and they paid anywhere from $66 to $900 for the same five drugs. Now, we can assume that the acquisition cost was about 60 bucks, because you could buy it someplace--an independent pharmacy or online--for $66, but three or four chain pharmacies were charging $900 for medications that they could acquire for less than $60.

You could argue, why did the patient pay? Because we have so little advertising, if you will, cost competition, on what a generic medicine would cost. So imagine you have a health savings account, and you are going to buy your prescriptions, and you get charged $900 for something that should cost $60. This is the situation in which the patient has no leverage.

By the way, you can ask, why didn't insurance cover it? It is because these patients were posing as uninsured. So the chain pharmacy figured out that it is the uninsured who do not have somebody working on their behalf who are going to be the most ripe for the picking for the high prices. The uninsured are the ones we are going to exploit, the ones paying cash. That is wrong. That is not the patient having the power; it is the patient being used as a victim.

There are other things we can see. One is called evergreening. You have a drug, and you make just a little bit of a tweak to it that doesn't improve its importance or the efficacy of the drug--no clinical benefit--but it extends the intellectual property protections. Now laws that were conceived of and passed by Congress to reward innovation and to encourage creativity are instead being used to stifle competition and to extend patent lives so that we, the patients and the taxpayers, have to pay more--not for innovation but, rather because, somebody figured out how to evergreen it.

So on the one hand, I am going to praise pharmaceutical companies for lifesaving drugs that have meant so much to me, my family, and everyone who is listening today, but I must also ask, why should we reward that which is not innovative but which is merely arbitraging laws meant to encourage innovation? We should not encourage arbitraging laws.

There are other issues, such as patent abuse, where companies file large numbers of patents on parts of their drugs that are not innovative but are byproducts of the production process in order to keep out competition; citizen petitions, which typically come on 6 months before a drug is about to become generic, so all of a sudden, we have all these petitions that must be navigated by the companies seeking to

introduce the generic; and the rebate system, which works to preserve market share but also to increase prices and to keep them high so patients do not benefit from competition.

If we are going to say the patient should have the power in order to have lower prices, we can say right now that the system seems to be aligned against the patient.

What can we do? Well, my office and others have several proposals in the current pieces of legislation going through, such as the so-called real-time benefit analysis. A prescription is ordered for a patient. The patient scans a barcode, and it would say: At this point, with your deductible and your copay, this is how much this drug is going to cost you, but there is a generic available, and you can get that generic instead. That would be a real-time benefit analysis that would save the patient money.

We just talked to the folks at Blue Cross California. They are coming up with so-called gainsharing. If a patient selects a lower cost medication, the patient receives some of the savings that would otherwise have all gone back to the insurance company--another great idea. Senator Braun was speaking about the patient having skin in the game. In this case, there will be skin in the game because the patient shares the benefit with the payor for being cost-conscious. That is the patient having the power.

We can also add value-based arrangements, which pharmaceutical companies, to their credit, have proposed. If you are the pharmaceutical company, you get paid only if the medicine works. If the medicine doesn't work, you don't get paid. If it does work, you do. That is a value-based arrangement. We have a bill with Senator Warner that would do that.

I would also mention attempting to cap Part D exposure. If there is a senior citizen who is in the catastrophic portion of her policy, then you can cap the amount the senior might be exposed to. Under current law, she might be paying 5 percent of $100,000 worth of medicine. She is taking an essential drug to treat cancer, and she is paying 5 percent of that $100,000, in addition to 5 percent of the other medications she is receiving. This is something many seniors cannot afford and this is something we as Congress can find mechanisms by which we can cap that exposure but still hold taxpayers whole.

We have to enhance existing markets. As you might guess, my theme is that we should enhance it in terms of giving the patient the power, but we also have to preserve the innovation that has led to the great drugs I spoke about earlier. If all we do is steal intellectual property from the pharmaceutical companies, we will lose these innovative drugs. But, again, we need to have the drugs affordable for the patients. This is the tension--promote innovation but ensure affordability.

We have a number of solutions, such as those I have just mentioned, in the HELP Committee and now in the Finance Committee. Republicans have solutions. My office continues to work on those. I look forward to working with my colleagues on their implementation.

Mr. President, I yield the floor.

Mr. President, today I wish to acknowledge the 150th anniversary of the founding of Tangipahoa Parish in my home State of Louisiana. It is a parish filled with hard-working and patriotic citizens who work day in and day out to better our State and our Nation.

Tangipahoa Parish is located in the section of the State known as the Florida Parishes. The word Tangipahoa means ``those who gather corn'' and refers to a sub-Tribe of Native Americans called the Acolapissa. The parish is 823 square miles, with the Mississippi State line serving as its northern border and Lakes Maurepas and Pontchartrain at its southern border.

This part of our State is rich with history. The Natives used this area as part of a route to travel between Mobile and Pensacola and through Pass Manchac to Illinois and the Great Lakes. The Acolapissa Tribe also led Bienville and Iberville through Manchac, where they named two nearby lakes ``Maurepas'' and ``Pontchartrain'' to honor the French finance ministers who supported the New World colony, which Bienville named New Orleans.

The French and Spanish controlled their Louisiana territory for some time. However, the British controlled the Florida Parishes. The Louisiana Purchase gave Louisiana to the United States, but the Florida Parishes were not a part of the purchase. It was an international boundary between the Spanish and the United States until 1812 when Louisiana was named a State.

In the mid-1800s, the railroad industry brought development into the area. However, people felt inconvenienced by the distance they had to travel to conduct business in the nearby parishes. To solve this, citizens carved out their own parish from the four surrounding parishes. The boundaries were solidified by law in 1869, which created Tangipahoa Parish.

Tangipahoa Parish is home to the State's third largest public university, Southeastern Louisiana University. It is also known for its many festivals, including the Strawberry Festival, the Sicilian Heritage Festival, the Italian Festival, and the Oyster Festival. The pop icon Britney Spears is from the town of Kentwood, in Tangipahoa Parish.

Happy 150th anniversary to Tangipahoa Parish. You are etched in our colorful and rich history. Thank you for all of your contributions to our beautiful State that we are fortunate to call home.

Mr. President, I rise today in celebration of First Lieutenant John Stillmon Willis, Jr.'s 100th birthday and to speak on his extraordinary life and accomplishments. Mr. Willis has served his Nation honorably, and put his life on the line for the values that we hold dear as Americans. For this, we are forever grateful.

Mr. Willis was born on June 2, 1919, and was raised in Doyline, LA. He attended Louisiana State University from 1937-1940 and graduated with a degree in agronomy. Shortly after the bombing of Pearl Harbor, Mr. Willis, a member in the army infantry reserve as a lieutenant in the U.S. Army, volunteered for pilot training. He was then transferred to the Army Air Corps, in grade, as a second lieutenant, and assigned to the 452nd Bomb group in Deopham Green Airbase in Atleborough in Norfolk, England. While there, he piloted a B-17 Flying Fortress and hit strategic targets in Germany and supported ground forces across Europe after the D-Day invasion. He would later be promoted to first lieutenant. After the fighting stopped, Mr. Willis credited the survival of his crew and himself to the fact that the ``good Lord has his arms around them.''

After the war, he worked in his father's lumber business for 20 years. Mr. Willis would go on to marry Lillian Mae Life and have one daughter, Martha Lou Willis, who gave them 3 grandchildren. The Willises enjoyed a beautiful 54 year marriage. Mr. Willis worked for another 20 years at his father-in-law's business, Webb Hardware, in Minden, LA. Mr. Willis recently celebrated his 100th birthday at St. John's Episcopal Church in Minden, where he has been a lifelong member.

It is because of his long list of accomplishments and beautiful life that we celebrate First Lieutenant John Stillmon Willis Jr.'s 100th birthday. We honor and thank him for a lifetime of service to our State and country and wish him the happiest of birthdays.

Mr. President, I ask unanimous consent that the remaining votes in this series be 10 minutes in length.

Mr. President, today I rise in recognition of seersucker manufacturers and enthusiasts across the United States. I wish everyone a Happy National Seersucker Day. This uniquely American fashion has a storied history dating back to 1909. Louisiana is proud to have played an important part in introducing the country to seersucker apparel. The first seersucker suit was designed by Joseph Haspel at his Broad Street facility in New Orleans, LA.

This lightweight cotton fabric, known for its signature pucker, has been worn and enjoyed by Americans across the country during the hot summer months. Mr. Haspel said it best, ``Hot is hot, no matter what you do for a living.'' In the 1990s, Seersucker Day was established by Members of this Chamber to honor this unique American fashion. I proudly resumed this tradition in 2014 in the U.S. House of Representatives by designating Wednesday, June 11, as National Seersucker Day. I have continued this tradition in the U.S. Senate and wish to designate Thursday, June 13, as the sixth annual National Seersucker Day. I encourage everyone to wear seersucker on this day to commemorate this iconic American clothing.

Madam President, this month is Mental Health Awareness Month, and the goal of Mental Health Awareness Month is to recognize the importance for personal well-being, the need for research and education, dispelling the stigmas associated with mental illness, and to improve mental healthcare to ensure that care is available to ensure that the first episode of mental illness is the last.

A goal with Mental Health Awareness Month is the awareness that is necessary for the programs to be implemented so that that young person with their first episode is returned to wholeness, and, again, as I said earlier, the first episode is the last. It recognizes that mental health is a societal issue associated with homelessness, crime, suicide, physical health, and public health issues.

Now, when you speak of mental health, it is a little bit almost like: Oh, my gosh, this is going to be a futile issue. It is so difficult for someone who has serious mental illness to return them to wholeness. It is so difficult that sometimes the individual, their family, and society throws up their hands and says: There is nothing to do, so why try.

You see manifestations of that with the homeless people walking around this city and every city in the United States, many of whom are mentally ill; yet there can be hope.

I called a person back home from Baton Rouge, LA, and asked her for a

story, if you will, of how someone with mental illness issues can be returned to wholeness, so let me tell you about Mary. When you walk with Mary, you can't help but feel happy, happy, happy. That is because Mary radiates the joy of how Capital Area Human Services helped change her life.

Mary says:

I go out and help the community every day. I became

successful in my life because of my faith in God and because

of the wonderful people at Capital Area Human Services. Today

I give back to the community what Capital Area has given to

me.

It wasn't always this way. For nearly 20 years before being referred to Capital Area Human Services, Mary lived in group homes and was dependent upon others for basic needs.

I am now quoting Mary:

I weighed 340 pounds. I was sick all the time, was in and

out of hospitals. I was barely able to function. I was on so

many medicines I could not keep track.

When Mary came to Capital Area Human Services in 2006, she was first helped at the Margaret Dumas Center at the Government Street location. She eventually entered the total health program, and even more dramatic changes began.

Now, let me point out as a physician--I am a doctor--I have learned from folks such as the people I am quoting now that mental health is often associated with physical health problems. So someone who is seriously mentally ill is more likely to die in their 50s than they are in their 80s with untreated hypertension, diabetes, or perhaps, because they are homeless, subject to violence on the streets.

So let me now go back to Mary's story. When she entered the total health program, she lost nearly 100 pounds, no longer needed to take blood pressure medicine, changed her diet, participated in fitness programs, and continued to attend mental health therapy sessions.

Today Mary is a different person. She lives independently in her own apartment, attends Sacred Heart of Jesus Catholic Church, walks 2 hours every day to volunteer for various duties at the St. Agnes Catholic Church soup kitchen, where she also sings for the attendees. Mary credits the nuns at St. Agnes for teaching her how to cook, prepare meals, and serve.

Also, Mary is a regular volunteer at the Society of St. Vincent de Paul and at the Baton Rouge General Hospital chapel, where she reads Scriptures for some of the services.

Mary said she loves Capital Area Human Services, tells everyone she knows about the people who helped her, particularly Kesha, John, the staff at Margaret Dumas, the staff at the Government Street location, and former total health employees Roy and Ricky.

She says:

I was motivated and didn't give up. It made me happy to do

this for myself. I proved that I could do it, and I'm doing

it. It's winter, but I'm out there anyway.

Now, I give that kind of personal story to give an example of someone with serious mental illness returned to wholeness. Now, I love that because I always tell folks when I speak that we in Washington, DC, can propose legislation, but unless there is local leadership, nothing good happens.

In 2016, I collaborated with Chris Murphy, as well as Eddie Bernice Johnson and Tim Murphy in the House, to pass the Mental Health Reform Act. It increased access to mental healthcare for adults and children, it strengthened leadership and accountability for Federal mental health and substance abuse programs, and it established new programs for early intervention. It was called by Senator Alexander the largest reform to our mental health system in decades. I continue to work with President Trump's administration to implement these reforms.

Now, none of this Federal legislation makes a difference unless there is State and local leadership, as was demonstrated in the story which I gave. Last October, I held a mental health summit in Baton Rouge and brought together Federal, State, and local leaders, and the purpose was to discuss proven methods in how to work together to improve the provision of mental health services in both Louisiana and the United States.

There is still important work to do. If we are going to return these folks to wholeness, these folks--our family members, our neighbors, our fellow Americans.

The Mental Health Parity bill became law 10 years ago, but patients still have trouble accessing mental healthcare in the same way they access physical healthcare, caused by, among other things, the lack of mental health providers, prior authorization requirements, and reimbursement rate setting. I am committed to ensuring patients have access to the treatment so they return to wholeness.

We need the story of Mary not to be something so unusual that it is read upon the Senate floor, but something which is so common that we know it to be true. Instead of throwing up our hands--kind of, oh, my gosh, serious mental illness; there is nothing to do--instead we look to hope with a future for someone who could be returned to wholeness so that her first episode of mental illness is her last episode of mental illness.

I yield the floor.

Madam President, I am joined on the floor by my colleague Senator Sheldon Whitehouse, who has recently visited coastal Louisiana and will share his observations following my remarks. He will speak objectively about that which we in Louisiana see not only objectively but emotionally.

We see our coastline melting away, and with the loss of that coastline, increasing vulnerability to hurricanes coming off the gulf, as well as a loss of villages, beautiful oak trees as salinity kills their roots, whole communities, and ways of life. I shall elaborate because Louisiana's coastal erosion impacts local businesses, communities, and I would say even our entire Nation.

Some of the Nation's most important trade, energy, and commercial fishing assets are associated with South Louisiana. Now, every Senator gets up and is proud of his or her State, and they will make statements such as that, but these statements are objectively true.

By tonnage, 5 of the 25 largest ports in the country are located in South Louisiana and along the Mississippi River. Twenty percent of the Nation's waterborne commerce moves through Louisiana. Approximately, 11,000 vessels use the lower Mississippi annually. If you think of a map of our country, from Wyoming to Pennsylvania, that is the territory of our country drained by the Mississippi and its tributaries. If you are shipping goods from Ohio to South America, most likely you are sending it down the Mississippi. The prosperity of the farmer along the Missouri River can depend upon the navigation of the lower Mississippi. It is truly a nation-impacting resource, but coastal erosion threatens the flow of commerce that is essential and vital to all of these areas.

Approximately, 20 percent of the Nation's oil supply originates off the coast of Louisiana, and countless oilfield service companies are located in South Louisiana to process that energy. Companies like Cheniere, Tellurian, Sempra, and others are investing billions in liquefied natural gas facilities, demonstrating the value of the United States but of Louisiana, in particular, in the global LNG market.

By the way, the workers who work in these rigs or work in these industries may live in Louisiana, but sometimes they will live far inland. I saw a map where somebody commuted from Montana, coming down by airplane, working for a month, and then going back to Montana. So the folks who work in our energy industry may come from any part of our country. Coastal erosion puts this energy infrastructure in jeopardy, threatening our Nation's energy security.

Louisiana has the largest commercial fishing industry in the lower 48, harvesting and selling shrimp, crawfish, crabs, and oysters to restaurants and grocery stores around the country. Coastal erosion puts this industry and the livelihoods of the workers who depend upon it in jeopardy.

For these reasons, among many more, I fight in Congress to protect the Louisiana coastline. Senator Whitehouse frequently has a floor chart when speaking on the environmental issues and says: ``Time to wake up.'' Everyone in Louisiana is very awakened to this crisis.

Our State has developed its Coastal Master Plan to help restore and maintain our coast. I think Senator Whitehouse will refer to that. We may not be able to save every parcel of land, but it is imperative that we work to protect the vulnerable marshland, as we can, and, in turn, the businesses and communities from the effects that we see today.

By the way, oftentimes we only hear about industry and environmental organizations attacking one another, but in Louisiana, we found that without one, the other cannot survive. We have found that the environmentalists and the energy industry have a way to coexist and to work for the betterment of the other. One example is that the State receives revenues from offshore energy production and other grant programs to protect and restore our coastline. Louisiana's constitution mandates that these dollars go to coastal restoration, creating a unique partnership where the royalty payments from the energy industry fund the environmental restoration upon which my State's future depends.

Projects funded with this revenue include the Mid-Barataria and Mid- Breton diversion projects, designed to direct more sediment from the Mississippi River to rebuild marshland lost due to coastal erosion, in part because the Mississippi River was previously leveed. Other projects seek to protect vulnerable marshland from further losses by controlling saltwater intrusion in the Houma Navigation Canal or the Calcasieu River ship channel. However, more needs to be done to protect Louisiana's coastline and the impact upon the United States' economic and energy security.

In a previous Congress, I introduced legislation in the House and now in the Senate to amend the Gulf of Mexico Energy Security Act to provide more offshore energy revenue to energy-producing States in the gulf to fund coastal restoration and other environmental protection projects. Most recently, in the Tax Cuts and Jobs Act bill and in another bill, there was an increase to the current cap on GOMESA dollars for fiscal years 2020 and 2021. I am currently working on another version of revenue-sharing legislation for the Gulf States, which I plan to introduce later this spring.

As part of that effort, working with Senator Whitehouse's staff, we have been working on legislation to create a revenue-sharing program with the Federal and State governments for offshore wind to fund coastal resiliency efforts, an issue important to us and probably about 80 percent of America's population that I roughly judge lives within 100 miles of the coastline.

I look forward to working with Senator Whitehouse and other colleagues to ensure that the coastal restoration needs important to Louisiana and to the United States are met. Again, I so appreciate Senator Whitehouse's coming to visit and learn more about coastal Louisiana. I look forward to working with him on our mutual interests to protect our environment and our communities.

I yield the floor.

Madam President, I ask unanimous consent that the postcloture time on the Barker nomination expire at 11:45 a.m., Wednesday, May 1; I further ask that if confirmed, the motion to reconsider be considered made and laid upon the table, and the President be immediately notified of the Senate's action.

Madam President, I ask unanimous consent that the Senate resume legislative session and be in a period of morning business, with Senators permitted to speak therein for up to 10 minutes each.

Madam President, I ask unanimous consent that the Foreign Relations Committee be discharged from further consideration and the Senate now proceed to S. Con. Res. 13.

I ask unanimous consent that the concurrent resolution be agreed to, the preamble be agreed to, and the motions to reconsider be considered made and laid upon the table.

Madam President, I ask unanimous consent that the Senate proceed to the immediate consideration of Calendar No. 46, S. 406.

I ask unanimous consent that the committee-reported amendment be agreed to; that the bill, as amended, be considered read a third time and passed; and that the motion to reconsider be considered made and laid upon the table.

Madam President, I ask unanimous consent that when the Senate completes its business today, it adjourn until 10 a.m., Wednesday, May 1; further, that following the prayer and pledge, the morning hour be deemed expired, the Journal of proceedings be approved to date, the time for the two leaders be reserved for their use later in the day, morning business be closed, and the Senate proceed to executive session and resume consideration of the Barker nomination, with the time until 11:45 a.m. equally divided between the two leaders or their designees.

If there is no further business to come before the Senate, I ask unanimous consent that it stand adjourned under the previous order following the remarks of Senators Durbin and Casey.

Mr. President, today I wish to acknowledge the 200th anniversary of the founding of Washington Parish in my home State of Louisiana. It is a parish filled with determined and patriotic citizens who work day in and day out to better our State and our Nation.

Washington Parish, named in honor of our first President, is located in the section of Louisiana known as the Florida Parishes. The parish government was founded on March 6, 1819, and a few years later, the town of Franklinton would become the permanent parish seat. The parish covers 676 square miles with the Mississippi State line serving as the eastern and northern borders.

The area is rich with American history. In 1814, Andrew Jackson marched with his soldiers across the Pearl River and recruited many of the local citizens to join them in the Battle of New Orleans. The ``Military Road'' constructed by General Andrew Jackson crossed the Pearl River into present-day Bogalusa. Records from the War Department show the future President and his troops made camp in the area on November 28, 1814.

As one of the most rural parts of the State, the parish is known for its pine forests, rolling hills, and many farms. The people who call Washington Parish home are incredibly proud of their local heritage, good food, and for hosting the Washington Parish Free Fair, the Nation's largest free fair.

I would like to wish the citizens of Washington Parish a very happy bicentennial and thank them for their many contributions over the last 200 years to our beautiful State and to our Nation.