Lamar Alexander

Mr. President, I ask unanimous consent that the order for the quorum call be rescinded.

Mr. President, last month, during National Nurses Week, Ballad Health, a healthcare system in East Tennessee, announced it would be giving several thousand nurses a raise.

The head of Ballad Health announced a $10 million investment in pay increases for nurses.

He said: ``Our nurses and those who work with them in the provision of direct patient care are heroes . . . however, it is also true that . . . we face significant national shortage of these critical health care providers.''

Alan, the head of Ballad Health, said that his investment was, in part, because of a new rule proposed by the Trump administration in April.

This new rule will update the formula that determines how much Medicare will reimburse hospitals for patient care. The formula takes into account, among other things, the cost of labor in that geographic area called the area wage index.

This new rule attempts to level the playing field between hospitals in areas that have higher wages, and therefore are reimbursed at a higher rate than hospitals in areas with lower wages.

The Centers for Medicare and Medicaid Services Administrator, Seema Verma, wrote in a recent op-ed in The Tennessean in Nashville:

Many stakeholders have raised concerns that the Medicare

hospital payment system disadvantages many rural hospitals.

Our proposed rule brings payments to rural and other low-wage

hospitals closer to their urban neighbors.

I say this standing in the Senate Chamber, where we have the chairman and the ranking Democrat on the Agriculture, Nutrition, and Forestry Committee--two experts on rural areas and rural hospitals in our country.

In recent years, too many rural Americans have seen their local hospital close and their doctors leave town.

Since 2010, 107 rural hospitals have closed across 28 States and another 637--about one-third of all rural hospitals--are at risk of closing.

In Tennessee alone, 12 rural hospitals have closed since 2010.

A recent survey by the Robert Wood Johnson Foundation and the Harvard School of Public Health found that one in four Americans in rural areas couldn't access healthcare when they need it.

This new rule will help rural hospitals keep up with the cost of providing care and keep those hospitals open.

Alan from Ballad Health said: ``This proposed change indicates that Washington finally understands that rural health systems, like ours, have been historically unable to keep up with the real cost growth of nursing and other direct care providers.''

Craig Becker, who leads the Tennessee Hospital Association, wrote in The Tennessean earlier this month that this rule ``is good news for our State's hospitals and will provide much-needed relief to many of them, especially those in rural areas'' and that the rule ``finally will address the significant inequities in the Medicare area wage index--the first meaningful effort by any administration to address this flawed system.''

This new rule from CMS will help ensure Americans can access healthcare close by to their homes by leveling the playing field between urban and rural hospitals that rely on the Medicare hospital payment system.

Last month, the Senate Health, Education, Labor, and Pensions Committee, which I chair and Senator Murray of Washington State is the ranking Democrat, approved, by a vote of 20 to 3, a bipartisan package of 55 proposals from 65 Senators to lower healthcare costs that will help rural Americans.

For example, the legislation would ban anticompetitive terms that large hospital chains sometimes use in contracts with employers, such as the so-called all-or-nothing clauses. These clauses increase prices for employers and patients and can block healthcare plans from choosing hospitals based on the care quality, the patient experience, or one hospital's competitive pricing.

Banning all-or-nothing clauses will help level the playing field for smaller, independent hospitals who are not part of a large corporate chain.

Another provision in the Lower Healthcare Cost Act of 2019 will expand technology-based healthcare to help Americans in rural areas have access to specialty care.

I hope the Trump administration and CMS Administrator Verma will quickly finish this rule and give Americans better healthcare choices and outcomes at lower costs, especially in our rural areas.

I yield the floor.

Mr. President, I thank the Senator from West Virginia for working to reduce the cost of prescription drugs. That is the question I hear most often in Tennessee: How can I reduce what I pay for out of my own pocket for healthcare costs? The most obvious way to reduce what you pay out of your own pocket for healthcare costs is to reduce the cost of prescription drugs.

Shirley, from Franklin, TN, is one of those Americans who asked me that question. This is what she said:

As a 71 year old senior with arthritis, I rely on Enbrel to

keep my symptoms in check. My copay has just been increased

from $95.00 to $170.00 every ninety days. At this rate I will

have to begin limiting my usage in order to balance the

monthly budget.

There has never been a more exciting time in biomedical research, but that progress is meaningless if patients can't afford these new lifesaving drugs.

Last month, as Senator Capito mentioned, our Senate Health Committee passed legislation by a vote of 20 to 3 that included 14 bipartisan provisions to increase prescription drug competition as a way of lowering generic drug costs and biosimilar drugs that reach patients.

Here is what that includes: The CREATES Act--the Senator from Iowa, Mr. Grassley, is on the floor. He, Senator Leahy, and many others have proposed the CREATES Act, which will help bring more lower cost generic drugs to patients by eliminating anticompetitive practices by brand drugmakers. That is in the bill we approved. It also includes helping biosimilar companies speed drug development through a transparent, modernized, and searchable patent database. That was proposed by Senators Collins, Kaine, Braun, Hawley, Murkowski, Paul, Portman, Shaheen, and Stabenow. This legislation we have was approved 20 to 3. There are 55 different proposals by 65 different U.S. Senators--about the same number of Republicans and Democrats--all to reduce healthcare costs.

Here are some other examples. The bill improves the Food and Drug Administration's drug patent database by keeping it more up to date to help generic drug companies speed product development, a proposal offered by Senator Cassidy and Senator Durbin.

Another provision is it prevents the abuse of citizens' petitions. These are used to unnecessarily delay drug approvals. This was proposed by Senators Gardner, Shaheen, Cassidy, Bennet, Cramer, and Braun. President Trump included that in his 2020 budget.

Another provision is it clarifies that the makers of brand biological products, such as insulin, are not gaming the system to delay new, lower cost biosimilars. That came from Senators Smith, Cassidy, and Cramer.

Another provision is it eliminates exclusivity loopholes. These allow drug companies to get exclusivity and delay patient access to less costly generic drugs by just making small tweaks to an old drug. That came from Senators Roberts, Cassidy, and Smith, which President Trump also proposed in his budget.

Another provision prevents the blocking of generic drugs. This is done by eliminating a loophole that allows a first generic to submit an application to FDA and block other generics from the market. Again, the President included this in his budget.

Another provision in our bill prevents delays of biosimilar drugs by excluding biological products from compliance with U.S. Pharmacopeia standards. That sounds pretty complicated, but what it means is that it could delay patient access and lower the cost of drugs. Again, that is another proposal by President Trump.

Another provision is it increases transparency on price and quality information by banning the kind of gag clauses Senator Capito talked about. These are gag clauses in contracts between providers and health plans that prevent patients, plan sponsors, or referring physicians from seeing price and quality information.

Another provision bans pharmacy benefit managers from charging more for a drug than it paid for the same drug.

Instead of remaining stuck in a perpetual partisan argument over ObamaCare and health insurance--and I can guarantee you that is going to continue to go on for a while--we have Senators on that side of the aisle and Senators on this side of the aisle working together to lower the cost of what Americans pay for healthcare out of their own pockets.

Since January, Senator Murray and I have been working in parallel with Senator Grassley and Senator Wyden of the Finance Committee. They are continuing to work on their own bipartisan bill. Last month, the Senate Judiciary Committee also voted to lower the cost of prescription drugs. In the House, the Energy and Commerce, Ways and Means, and Judiciary Committees have all reported out bipartisan bills on the cost of prescription drugs.

As I have mentioned, President Trump and Secretary Azar have been focused on this. Last year, the administration released a blueprint on steps the President would take to lower prescription drugs. Last year, the Food and Drug Administration set a new record for generic drug approvals. Generic drugs can be up to 85 percent less expensive than brand drugs.

So I believe the cost of prescription drugs is an area where Democrats and Republicans in Congress and the administration can find common ground to help Americans reduce the cost of healthcare that they pay for out of their own pockets.

I am very hopeful that our bill, with 55 proposals from 65 Senators, which has been reported to the Senate floor, will be placed by the majority and minority leaders on the Senate floor before the end of the month. We can pass it, the House will do their job, and we can send it to the President to lower prescription drug costs.

I yield the floor.