Press Releases

WASHINGTON – U.S. Sen. Mark R. Warner (D-VA) released the following statement on President Trump's State of the Union address:

"Rather than taking this evening as an opportunity to attempt to unify a deeply divided nation, President Trump instead delivered a State of the Union address that seemed focused solely on rallying his own political supporters behind him. 

"I'm especially stunned that the President walked into the House chamber tonight and declared that he wants to protect Americans with preexisting health conditions, despite the fact that he has spent three years undermining the Affordable Care Act, putting those protections at risk for the more than 3 million Virginians who have a preexisting condition. 

"If the President really means what he says about protecting people with preexisting conditions, he should immediately direct the Department of Justice to reverse its support for a lawsuit designed to take down the health care law in its entirety, and instead work with Democrats to lower health care and prescription drug costs and end surprise medical billing." 

Sen. Warner, a longtime champion of access to health care, has been outspoken about the Trump Administration’s effort to overturn the Affordable Care Act in court. Last year, he introduced legislation to allow Virginia, and any other states that expanded Medicaid after the 2014 deadline, to receive the same federal matching funds as states that expanded earlier under the terms of the Affordable Care Act. According to the Virginia Hospital & Healthcare Association, this bill would save Virginia’s hospitals an estimated $300 million per year in the first three years of implementation. 

Additionally, in October, Sen. Warner forced a Senate vote on a Congressional Review Act (CRA) resolution that would have overturned a Trump Administration waiver rule that destabilizes the nation’s health insurance market and weakens protections for 3 million Virginians with preexisting conditions.  

In his speech tonight, President Trump called on Congress to pass legislation to lower prescription drug prices. The Senate Finance Committee, of which Sen. Warner is a member, in a bipartisan 19-9 vote last year approved legislation that would help address the rising cost of prescription drugs by taking on industry price hikes and protecting seniors with the highest out-of-pocket costs. However, despite support from Republican Committee Chairman Chuck Grassley (R-IA), whom the President named as a partner on the issue in tonight's address, the Senate Majority Leader has declined to bring the bill to the full Senate floor for a vote.

In Congress, Sen. Warner has long pushed for policy changes to help lower prescription drug costs for Virginia seniors and families. Last year, Sen. Warner re-introduced legislation to allow Medicare to negotiate prescription drug prices—a move that would cut costs for nearly 43 million seniors enrolled in Medicare Part D.

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WASHINGTON – Today, U.S. Sens. Mark R. Warner and Tim Kaine (both D-VA) requested information from four U.S. Department of Veterans Affairs (VA) medical centers in Virginia and Washington, D.C. regarding their strategies for preventing suicide among the veterans and families they serve. In letters to Salem VA Medical Center, Hunter Holmes McGuire VA Medical Center, Hampton VA Medical Center, and Washington DC VA Medical Center, the Senators pushed the medical centers to take a more integrated approach to suicide prevention and asked for more information regarding each facility’s outreach efforts.

“We are writing to request more information on your efforts to prevent suicide in the veterans population you serve in the Commonwealth of Virginia,” wrote the Senators. “It is clear that a new and more creative approach is necessary to combat this crisis, especially given that only six out of the nearly 20 veterans who take their own lives everyday received healthcare services at the VA.”

According to a 2019 veteran suicide prevention report by the VA, more than 6,000 veterans per year have died by suicide across the United States since 2008 – an average of nearly 20 current or former servicemembers each day. Additionally, an estimated 135 surviving individuals are affected by each suicide, including include family members, friends, and coworkers, among others. The number of veteran suicides per year has risen by 6 percent since 2005, despite hundreds of millions of dollars set aside for suicide prevention efforts by the VA during this period of time.

In their letters, the Senators asked for more information regarding each facility’s efforts to lower suicide rates among veterans. Specifically, they requested information on how each facility is employing social media and technology, as well as partnerships with various community stakeholders and veteran services organizations to reach more veterans. The Senators also asked about each facility’s use of community-specific public health data to tailor its approach to suicide prevention, and about the provision of additional suicide prevention training for community and clinical service providers.

Noting that a significant portion of the veteran population does not qualify for VA healthcare based on socioeconomic or disability prerequisites, the Senators also underscored their efforts to address this problem. In the letters, they highlighted a piece of bipartisan legislation introduced by Sen. Warner to establish a new grant program to expand the reach of veteran suicide prevention services, as well as bipartisan legislation introduced by Sen. Kaine to explore innovative mental health treatment options to help veterans combat Post Traumatic Stress Disorder (PTSD) and other mental health issues.

In December, Sen. Warner visited the Hampton VA Medical Center, where he urged Director David Collins to quickly resolve high wait times and staffing challenges at the medical center. In his visit, Sen. Warner also expressed support for a partnership between the medical center and Virginia Beach Police to help lower suicide rates. Last week, language from a bipartisan bill introduced by Sen. Warner to help address the alarming rate of veteran suicide was included in comprehensive legislation passed by the Senate Veterans Affairs Committee to expand veterans’ access to mental health services.

Through his work on the Senate Armed Services and Health, Education, Labor, and Pensions (HELP) Committees, Sen. Kaine has been an advocate for investments in mental health services and suicide prevention efforts. In July 2018, Sen. Kaine urged Defense Secretary Jim Mattis to release data on suicide rates among military families.

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WASHINGTON – Today, U.S. Sen. Mark R. Warner (D-VA) announced that he will be inviting a Medicaid recipient and health care advocate from Chesapeake, Va. as his guest to the President’s State of the Union address on Tuesday evening. Terry “Bean” White, who lost his private insurance in 2008 when severe arthritis forced him to give up his job in the Newport News shipyards, is one of nearly 400,000 Virginians who gained coverage under Virginia’s Medicaid expansion and who are in danger of losing their health care coverage if the Trump Administration is successful in its effort to overturn the Affordable Care Act (ACA) in court.

Mr. White, who has congestive heart failure and has been previously treated for prostate cancer, became eligible for coverage after the Commonwealth expanded Medicaid at the beginning of last year – a move that was made possible under the ACA. Prior to that, Mr. White incurred an enormous amount of medical debt and had no choice but to move in with his sister, her daughter, and her two-year-old granddaughter.

“Despite the Trump Administration’s best efforts to dismantle our nation’s health care law, people like Mr. White are proof that Obamacare is working for Americans, and that Medicaid expansion is thriving in Virginia,” said Sen. Warner. “Bean was a hard worker who lost his health insurance through no fault of his own and soon found himself drowning in health care debt – all while struggling to manage his medical conditions. Thankfully, he was able to access coverage after Virginia voted to expand Medicaid under the ACA. But now, under the Republican-backed lawsuit that seeks to wipe out our nation’s health law, hundreds of thousands of Virginians like Bean are at risk of losing the coverage that in many cases keeps them alive and stands between them and bankruptcy. I hope that his presence will serve as a reminder of the potentially devastating consequences if the Trump Administration’s shameful lawsuit succeeds in overturning the health care law Congress passed back in 2010.”

“It is an honor to be invited to the State of the Union and I would like to thank Senator Warner,” said Mr. White. “The senator understands that without the ACA some of us, like myself, wouldn't be here. I am diabetic and recently survived prostate cancer. If it weren’t for Medicaid expansion, I would pay about $7,000 a month in medication costs.”

In December, the Fifth Circuit Court of Appeals struck down the individual mandate as unconstitutional and remanded the Texas vs. United States lawsuit to the lower court, instructing it to rule on which parts of the ACA should be eliminated. If the President’s lawsuit is successful, more than 20 million Americans and nearly 400,000 Virginians could lose their health coverage, with costs going up for millions.

In Virginia, Medicaid expansion made more than 400,000 Virginians like Mr. White eligible for low- or no-cost health care coverage. As of January 2020, more than 375,000 people have actually enrolled in the program. Prior to this expansion, these individuals fell into a “coverage gap” due to incomes that were too high to be eligible for Medicaid, but too low to receive tax credits to purchase affordable coverage in the health care marketplace.

Sen. Warner has been a champion of health care access for all Virginians amid this Administration’s relentless efforts to dismantle our nation’s health care law in Congress and now in court. Last week, Sen. Warner denounced a new plan by the Trump Administration to allow and incentivize states to cut Medicaid funding, thereby undermining Medicaid’s critical financing structure and putting care for vulnerable Americans on the chopping block. Last year, Sen. Warner introduced legislation to allow Virginia, and any other states that expanded Medicaid after the 2014 deadline, to receive the same federal matching funds as states that expanded earlier under the terms of the Affordable Care Act. According to the Virginia Hospital & Healthcare Association, this bill would save Virginia’s hospitals an estimated $300 million per year in the first three years of implementation. Additionally, in October, Sen. Warner forced a Senate vote on a Congressional Review Act (CRA) resolution that would have overturned a Trump Administration waiver rule that destabilizes the nation’s health insurance market and weakens protections for three million Virginians with preexisting conditions.  

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WASHINGTON – Today, U.S. Sen. Mark R. Warner (D-VA) issued the following statement after the Trump Administration announced a new plan to allow and incentivize states to cut Medicaid funding, thereby undermining Medicaid’s critical financing structure and putting care for vulnerable Americans on the chopping block:

“I am very troubled by the Medicaid demonstration program announced today by the Trump Administration. Instead of focusing its efforts on improving and expanding access to health care coverage, this Administration continues down the road of undermining our nation’s health care system – this time by unveiling a proposal that will disrupt access to affordable health care for millions of Americans.

“It is clear the Administration is going to keep ignoring the repeated warnings of our physicians, hospitals and leading health experts across the country who have emphatically stated that such a proposal will lead to increased health care costs and reduced health care coverage. Plain and simple – this new demonstration program will allow states to cut essential and legally mandated health care benefits including coverage for behavioral health and substance use disorder, while increasing costs for other services across the board. Additionally, this rule will harm our ongoing efforts to combat the opioid and addiction epidemic and will increase the number of Americans without access to affordable health care coverage.”

In addition to allowing states to cut key Medicaid benefits and increasing costs for Medicaid expansion enrollees, the new Trump Administration rule allows states to deny retroactive health care coverage and payments to newly enrolled beneficiaries.

Sen. Warner, a longtime champion of access to health care, has been outspoken about the Trump Administration’s most recent effort to overturn the Affordable Care Act in court. Last year, he introduced legislation to allow Virginia, and any other states that expanded Medicaid after the 2014 deadline, to receive the same federal matching funds as states that expanded earlier under the terms of the Affordable Care Act. According to the Virginia Hospital & Healthcare Association, this bill would save Virginia’s hospitals an estimated $300 million per year in the first three years of implementation. Additionally, in October, Sen. Warner forced a Senate vote on a Congressional Review Act (CRA) resolution that would have overturned a Trump Administration waiver rule that destabilizes the nation’s health insurance market and weakens protections for three million Virginians with preexisting conditions.  

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WASHINGTON – A bipartisan bill introduced by U.S. Sens. Mark R. Warner (D-VA) and John Boozman (R-AR) to help address the alarming rate of veteran suicide is one step closer to becoming law. Today, the Senate Veterans Affairs Committee included language from the Senators’ IMPROVE Well-Being for Veterans Act as a provision in a comprehensive bill that expands veterans’ access to mental health services. The legislation unanimously passed the committee and now awaits consideration by the full Senate.

“Our nation’s veterans have faithfully served our country, and they deserve to know that, as they face the invisible wounds of war, we will do everything we can to make sure they receive the help they need. Currently, we are facing an alarming rate of suicide deaths among our veteran population and we’ve got to make tackling this issue a priority. With today’s markup of our bill, we are one step closer to making sure veterans get the services and resources they need,” said Sen. Warner.

“This is a great step in the right direction to getting our veterans the resources, services and care they need. Coordinating and sharing information between the VA and veteran-serving organizations that have the common goal to save lives will have a positive impact,” said Sen. Boozman.

 The IMPROVE Well-Being for Veterans Act creates a new grant program to enable the Department of Veterans Affairs (VA) to conduct additional outreach through veteran-serving non-profits in addition to state and local organizations. Additionally, the bipartisan bill enhances coordination and planning of veteran mental health and suicide prevention services and would better measure the effectiveness of these programs in order to reduce the alarming number of veteran suicides.

The VA estimates that around 20 veterans die by suicide each day. That number has unfortunately remained roughly unchanged despite drastic increases in funding. Over the last ten years, Congress has more than tripled the VA’s funding for suicide prevention efforts to $222 million.

Only six of those 20 veterans were receiving healthcare services from the VA before their death. That’s why Sens. Warner and Boozman are empowering the VA to share information with veteran-serving non-profits and requiring it to develop a tool to monitor progress so that resources can be concentrated on successful programs.

The IMPROVE Well-Being for Veterans Act was introduced in June 2019. Days later, VA Secretary Robert Wilkie called the bill “key” to unlocking the veteran suicide crisis at a committee hearing.

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WASHINGTON – Today, U.S. Sens. Mark R. Warner and Tim Kaine (both D-VA) joined Sen. Patty Murray (D-WA) and 28 of their Democratic Senate colleagues in requesting updates on the Administration’s response to the outbreak of Novel Coronavirus (2019-nCoV) and information on the steps being taken to keep families safe.

This letter comes on the heels of an announcement by the Virginia Department of Health (VDH), which earlier today ruled out Novel Coronavirus in two of three Patients Under Investigation, who met both clinical and epidemiologic criteria for the coronavirus. Test results for a third individual from Northern Virginia are expected to be received later this week.

“We write to express concern about the rapidly evolving 2019 Novel Coronavirus (2019-nCoV), to urge your continued robust and scientifically driven response to the situation, and to assess whether any additional resources or action by Congress are needed at this time. A quick and effective response to the 2019-nCoV requires public health officials around the world work together to share reliable information about the disease and insight into steps taken to prevent, diagnose, and treat it appropriately,” wrote the Senators.

They continued, “Unfortunately, the 2019-nCoV outbreak follows troubling proposals from the Trump Administration to cut the budgets of core public health programs at home and abroad. Yet, outbreaks like this serve as a solemn reminder of the need for an unwavering commitment to global health security and the need for strong public health programs worldwide.”

Despite repeated calls by the Trump Administration for cuts to public health programs, the December budget deal backed by Sens. Warner and Kaine increased funding for the Centers for Disease Control and Prevention (CDC) and its Infectious Disease Rapid Response Reserve Fund, which provides the agency with an immediate source of funding to prevent, prepare for, or respond to an infectious disease emergency either at home or abroad.

Sen. Kaine has introduced the Saving Lives Through Better Data Act, bipartisan legislation to modernize public health data infrastructure so clinicians, state health departments, and the CDC can work together more quickly and seamlessly to identify and respond to health threats like the coronavirus.

In their letter to the Department of Health and Human Services (HHS), the Senators also requested that the Department provide information regarding the severity of the disease, the country’s capacity to diagnose cases, the steps being taken to prepare U.S. health care workers, the screening systems in place at U.S. airports, the status of a novel coronavirus vaccine, and more.

In addition to Sens. Warner, Kaine and Murray, the letter was signed by Sens. Maria Cantwell (D-WA), Sherrod Brown (D-OH), Dick Durbin (D-IL), Tammy Duckworth (D-IL), Tammy Baldwin (D-WI), Chris Murphy (D-CT), Jacky Rosen (D-NV), Jack Reed (D-RI), Kirsten Gillibrand (D-NY), Amy Klobuchar (D-MN), Michael Bennet (D-CO), Bob Casey (D-PA), Chris Van Hollen (D-MD), Richard Blumenthal (D-CT), Ed Markey (D-MA), Tina Smith (D-MN), Elizabeth Warren (D-MA), Maggie Hassan (D-NH), Kamala Harris (D-CA), Tom Carper (D-DE), Debbie Stabenow (D-MI), Chuck Schumer (D-NY), Jeff Merkley (D-OR), Robert Menendez (D-NJ), Ron Wyden (D-OR), Angus King (I-ME), Dianne Feinstein (D-CA), and Cory Booker (D-NJ).

A copy of the letter is available here and below.

 

Dear Secretary Azar,

We write to express concern about the rapidly evolving 2019 Novel Coronavirus (2019-nCoV), to urge your continued robust and scientifically driven response to the situation, and to assess whether any additional resources or action by Congress are needed at this time. A quick and effective response to the 2019-nCoV requires public health officials around the world work together to share reliable information about the disease and insight into steps taken to prevent, diagnose, and treat it appropriately.

Chinese health officials confirmed the first case of 2019-nCoV in Wuhan, Hubei Province, China in December 2019. Since then, the case count has exploded in China, with nearly 3,000 confirmed cases as of the writing of this letter. At least 80 people have died. Cases have now been confirmed on four continents. On January 21, the first U.S. case was confirmed in Washington state, where state and local public health officials quickly responded with support from the Centers for Disease Control and Prevention (CDC). A second U.S. case was confirmed in Chicago on January 24. Subsequently, CDC confirmed two cases in California and one in Arizona, bringing the total U.S. case count to five. Airport screening procedures have been put in place to screen all passengers arriving in the U.S. from Wuhan. In Wuhan, and across China, officials have enacted travel restrictions and canceled planned festivals to celebrate the Lunar New Year. Even with these steps, the case count in China is expected to continue to rise, along with additional cases in the U.S. and around the globe. The World Health Organization is monitoring the situation closely, but has determined it is too early to formally designate this as a Public Health Emergency of International Concern. A quick, robust, and comprehensive approach to this outbreak is critical, while also remaining aware that, according to CDC, “the immediate health risk from 2019-nCoV to the general American public is considered low at this time.”

Unfortunately, the 2019-nCoV outbreak follows troubling proposals from the Trump Administration to cut the budgets of core public health programs at home and abroad. Yet, outbreaks like this serve as a solemn reminder of the need for an unwavering commitment to global health security and the need for strong public health programs worldwide.

We recognize the situation is evolving quickly and appreciate the information you have already provided. We ask you keep us apprised of developments as they occur, including any information related to the following questions:

1)      What can Congress do to fully support the U.S. Government response to this outbreak?

2)      How many HHS officials are currently engaged in the 2019-nCoV response domestically and abroad and in what capacities?

3)      What is HHS's best current judgment about the clinical severity of this disease? 

4)      What is the current domestic diagnostic capacity? How many facilities across the country are able to diagnose 2019-nCoV?

5)      What is currently known about the risk 2019-nCoV poses to health care workers? How is CDC communicating with U.S. health care facilities to ensure providers remain healthy and safe? What additional guidance is being supplied to health care providers?

6)      How many passengers have been screened by the airport screening procedures that are in place at American airports? How many potential cases have been identified as a result of this screening? Are there any planned changes to airport screening procedures?

7)      What progress has been made on the development of a 2019-nCoV vaccine?

Thank you for your attention to this urgent issue.

Sincerely,

 

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WASHINGTON – Today, U.S. Sen. Mark R. Warner (D-VA) expressed concern with repeated delays by the Drug Enforcement Administration (DEA) that are preventing providers from being able to properly treat their patients via telehealth. In a letter, Sen. Warner urged the DEA Acting Administrator to finalize a long-delayed rule that will ensure providers can successfully use telehealth to treat individuals with substance use disorders.

“Providers across the country have been frustrated in their inability to provide adequate care as they wait for Congressionally-mandated guidance from your agency to clarify the process whereby health care professionals can legally use telehealth to better treat patients suffering from substance use disorder,” wrote Sen. Warner. “The DEA’s failure to promulgate the rule has meant that – despite Congress’ best efforts – many patients suffering from substance use disorders remain unable to access treatment via telehealth. These patients cannot afford to wait and we are concerned the DEA is standing in the way of treatment for individuals that cannot access a provider in person – particularly those in rural and underserved areas.”

“The opioid and addiction epidemic has devastated communities nationwide, with a particularly devastating impact on rural and medically underserved areas,” he continued. “Expanding telehealth services to individuals suffering from substance use disorder can bridge the distance between patients and care and ensure increased access to services they need.”

In order to crack down on the online proliferation of dangerous controlled substances online, the Ryan Haight Act of 2008 prohibited the delivery, distribution, or dispensing of a controlled substance by means of the internet without a prior in-person exam. However, this prevented providers from properly using telehealth to treat individuals – particularly those in rural communities who rely on this service to obtain timely access to health care.

Sen. Warner helped draft and pass the Senate’s comprehensive substance abuse treatment bill, which included a provision directing the Department of Justice, in consultation with the Department of Health and Human Services, to create a process for exempting certain health care providers for the purpose of providing telehealth services for substance use disorder. In addition – that legislation included four other provisions led by Sen. Warner that use telehealth to expand access to treatment for individuals suffering from substance use disorder. The bipartisan legislation was signed into law in 2018; however, the Attorney General failed to finalize a rule by the October 2019 deadline. For provisions of this legislation to be most effective, the DEA must complete its rulemaking process.

In the letter to Acting Administrator Uttam Dhillon, Sen. Warner emphasized the wide disparity in opioid deaths between urban communities and rural communities, which have a 45 percent higher rate of deaths by opioids. Sen. Warner also requested that the DEA provide an explanation if it does not intend to promulgate rulemaking on this issue in a timely manner.

A copy of the letter can be found here and below.

 

Mr. Uttam Dhillon

Acting Administrator

Drug Enforcement Administration (DEA)

U.S. Department of Justice

800 K Street NW Suite 500

Washington, D.C. 20001

Acting Administrator Dhillon,

I am writing regarding the Drug Enforcement Agency’s (DEA) implementation of critical provisions in the Ryan Haight Online Pharmacy Consumer Protection Act of 2008 (Ryan Haight Act) (Public Law 91-513) and the recently passed SUPPORT for Patients and Communities Act (SUPPORT Act) (Public Law 115-271) that ensure individuals with substance use disorders can successfully access medical treatment via telehealth.

As you likely know – the Ryan Haight Act prohibits the delivery, distribution, or dispensing of a controlled substance online without first conducting an in-person exam. The intent of this law is to prevent illegitimate entities from selling dangerous controlled substances online while maintaining the ability for legitimate healthcare providers to treat patients in need.

The Ryan Haight Act also directed the DEA to promulgate rules exempting certain health care professionals from this requirement with the goal of ensuring patients have access to care via telehealth. However, in the 10 years since passage, the DEA has not promulgated rules to this effect. Congress further expressed its intent in passing the SUPPORT Act in 2018, which allows Medicare-eligible individuals suffering from substance use disorder to be diagnosed and treated via telehealth. The SUPPORT Act – similar to the Ryan Haight Act – mandated rulemaking by October 2019. Another deadline that has been missed.

Providers across the country have been frustrated in their inability to provide adequate care as they wait for Congressionally-mandated guidance from your agency to clarify the process whereby health care professionals can legally use telehealth to better treat patients suffering from substance use disorder. The DEA’s failure to promulgate the rule has meant that – despite Congress’ best efforts – many patients suffering from substance use disorders remain unable to access treatment via telehealth. These patients cannot afford to wait and we are concerned the DEA is standing in the way of treatment for individuals that cannot access a provider in person – particularly those in rural and underserved areas.

The opioid and addiction epidemic has devastated communities nationwide, with a particularly devastating impact on rural and medically underserved areas. According to the Centers for Disease Control and Prevention (CDC), there were more than 70,000 overdose deaths in 2017 – a 9.6 percent increase from 2016.   Furthermore, the CDC cites opioid deaths as 45% higher in rural areas, compared to urban communities. 

Expanding telehealth services to individuals suffering from substance use disorder can bridge the distance between patients and care and ensure increased access to services they need.

As detailed above, Congress passed the SUPPORT Act in 2018 and instructed the Attorney General – in consultation with the Department of Health and Human Services (HHS) – to promulgate rules on health care professional exemptions for prescribing controlled substances via telemedicine. This rule will ensure providers can successfully use telehealth to treat patients with substance use disorders. HHS has previously published suggestions on the potential uses of telehealth to diagnose and treat substance use disorder, but until the DEA takes action, providers will continue to face significant barriers in using telehealth to treat patients with substance use disorders. 

I strongly urge the DEA to promulgate rulemaking on this issue as soon as possible so that patients suffering from substance use disorders can receive the care they need. Furthermore, I ask that if you do not intend to promulgate this rule in a timely manner you respond in writing with an explanation of your decision. Thank you for your consideration of this request and I look forward to your response.

Sincerely,

 

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WASHINGTON – Today, U.S. Sen. Mark R. Warner (D-VA), co-chair of the bipartisan Senate Cybersecurity Caucus, urged the Defense Health Agency to remove sensitive medical data belonging to servicemembers exposed online, where it remains vulnerable due to insecure data practices at Ft. Belvoir Medical Center, Ireland Army Health Clinic, and the Womack Army Medical Center.

“As a matter of national security, the sensitive medical information of our men and women of the armed services is particularly vulnerable and should be, at a minimum, protected by robust security controls and routine scans,” wrote Sen. Warner. “The exposure of this information is an outrageous violation of privacy and represents a grave national security vulnerability that could be exploited by state actors or others.”

He continued, “We owe an enormous debt to our armed forces, and at the very least, we ought to ensure that their private medical information is protected from being viewed by anyone without their express consent. Whenever data moves from one entity to another it should be protected by encryption, proper hashing, segmentation, identity and access controls, and vulnerability management capabilities that include diligent monitoring, auditing, and logging practices.”

In September 2019, Sen. Warner sought answers from TridentUSA Health Services regarding reports that many unsecured picture archiving and communication servers (PACS) left the names, dates of birth, medical images, and medical procedures of more than one million Americans accessible to anyone with basic computer expertise. Following that letter, the images were removed but millions of records were left online. Nearly two months later, Sen. Warner called out the U.S. Department of Health and Human Services (HHS) for its failure to act following the exposure.

Since the letter to HHS, 16 systems, 31 million images and 1.5 million exam records have been removed from the internet. However, a significant number of personally identifiable and sensitive medical information belonging to servicemembers remains online, due to unsecured Army PACS.

In his letter to the Assistant Secretary, Sen. Warner asked the agency to remediate the situation immediately and posed the following questions for Assistant Secretary Thomas McCaffery:

  1. Please describe the information security management practices at military medical hospitals. Do you require organizations to operate on a segmented network? To implement micro-segmentation? To implement access controls? If so, what kind? Do you require the hospitals to implement multifactor authentication, logging, and monitoring?
  2. Do you audit and monitor logs? 
  3. Do you require full-disk encryption and authentication for PACS?
  4. Do you require the hospitals to have a Chief Information Security Officer?
  5. Please describe what steps you took to address this issue, and when you were able to remove these systems from the internet.  

A copy of the letter can be found here and below.

 

Mr. Thomas McCaffery

Assistant Secretary of Defense for Health Affairs

Defense Health Agency

7700 Arlington Boulevard

Falls Church, VA 22042

Dear Mr. McCaffery,

As the healthcare sector becomes increasingly reliant on technology to deliver essential services to patients, it also faces rising threats from malicious actors that seek to compromise the personally identifiable and other sensitive information of Americans. As a matter of national security, the sensitive medical information of our men and women of the armed services is particularly vulnerable and should be, at a minimum, protected by robust security controls and routine scans. It is with great alarm that I recently learned that unsecured Picture and Archiving Servers (PACS) at Ft. Belvoir Medical Center, Ireland Army Health Clinic, and the Womack Army Medical Center have left personally identifiable and sensitive medical information available online for anyone with a DICOM viewer to find.

Following a report  in September of 2019 highlighting the exposure of sensitive medical images belonging to millions of American through unsecured PACS, I wrote letters  to two healthcare entities that controlled the PACS, and those images were removed. However, millions of records remained online. The following month, I wrote  to the Department of Health and Human Services (HHS) Office of Civil Rights (OCR) regarding the remaining exposure of the personally identifiable information belonging to 6 million American patients. Since that letter, 16 systems, 31 million images and 1.5 million exam records were removed from the internet. However, I recently learned that a significant number of medical records belonging to servicemembers remain online. This information was discovered by the German researchers at Greenbone Networks, who accessed the information using German IP addresses; this itself should have triggered alarms by the hospital information security systems.

The exposure of this information is an outrageous violation of privacy and represents a grave national security vulnerability that could be exploited by state actors or others. We owe an enormous debt to our armed forces, and at the very least, we ought to ensure that their private medical information is protected from being viewed by anyone without their express consent. Whenever data moves from one entity to another it should be protected by encryption, proper hashing, segmentation, identity and access controls, and vulnerability management capabilities that include diligent monitoring, auditing, and logging practices. To better understand how this happened, I would like information about your organization’s oversight of the information security practices at military hospitals, particularly at Ft. Belvoir Medical Center and Womack Army Medical Center.

I ask that you immediately remediate this situation, and remove the vulnerable PACS from open access to the internet. To understand how these records have been exposed and accessed repeatedly by a German IP address, please also answer the following questions:

  1. Please describe the information security management practices at military medical hospitals. Do you require organizations to operate on a segmented network? To implement micro-segmentation? To implement access controls? If so, what kind? Do you require the hospitals to implement multifactor authentication, logging, and monitoring?
  2. Do you audit and monitor logs? 
  3. Do you require full-disk encryption and authentication for PACS?
  4. Do you require the hospitals to have a Chief Information Security Officer?
  5. Please describe what steps you took to address this issue, and when you were able to remove these systems from the internet.

Given the gravity of this issue, I would appreciate a response within two weeks.

Sincerely,

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WASHINGTON – U.S. Sen. Mark R. Warner (D-VA) released the following statement after the Fifth Circuit Court of Appeals ruled the individual mandate of the Affordable Care Act (ACA) unconstitutional, sending the case back to the lower courts:

“Despite the millions of Americans who have gained health care coverage thanks to the Affordable Care Act and the critical protections for individuals with pre-existing conditions, Republicans remain determined to throw out our existing health care system with no viable options to replace it.

“The uncertainty created by this court ruling and the repeated attacks on our nation’s health care laws place essential health care coverage for American families in serious jeopardy. As I have said before – the Trump Administration and Republicans in Congress should be working in a bipartisan fashion to strengthen existing law, not engaging in misguided attempts to take away people’s health care.

“Should Republicans succeed in their campaign of health care sabotage, millions of Americans would be without insurance, have higher costs, and have fewer protections. In light of this ruling – I remain committed to strengthening our health care law and will do everything I can to protect it.”

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WASHINGTON – Today, U.S. Sen. Mark R. Warner (D-VA), a member of the Senate Finance Committee, made the statement below after Finance Committee leaders announced a path forward for an improved version of a bipartisan bill to lower the cost of prescription drugs. Sen. Warner supported the original version of this legislation in July, when it passed the Committee by a bipartisan vote of 19-9.

“I applaud Finance Chairman Grassley and Ranking Member Wyden for reaching a bipartisan agreement on drug pricing legislation we drafted in the Senate Finance Committee earlier this year. This bill will produce billions in savings for seniors by placing a cap on their out-of-pocket spending. It will also prevent drug companies from unfairly jacking up the costs of their products by penalizing companies that increase their prices above the rate of inflation,” said Sen. Warner. “I’m proud to know that this legislation includes language from a bill I authored to reauthorize an independent nonprofit corporation established to save Americans money on their health care costs. This improved bill also extends other important federal funding streams to strengthen our nation’s rural and safety net hospitals, increases access to quality home care for seniors, and improves our nation’s foster care system.”

He continued, “This legislation will bring much-needed relief to Virginians who are struggling to deal with the crushing burden of their health care and prescription drug costs, and will also extend critical programs that support continued health care access and affordability for millions of Americans. I look forward to working with Chairman Grassley and Ranking Member Wyden to pass this overdue legislation through the Senate and get it to the President’s desk for his signature.”

The modified version of the Prescription Drug Pricing Reduction Act of 2019 (PDPRA) – a bipartisan bill passed by the Senate Finance Committee earlier this year – includes language from Sen. Warner’s bipartisan legislation to reauthorize for ten years the Patient Centered Outcomes Research Institute (PCORI), an independent nonprofit corporation established to help patients better understand their diagnostic and treatment options. The modified bill utilizes the savings it creates to pay for this and other important health extenders, including a permanent payment rate increase for low-volume and Medicare dependent hospitals, three-year extensions for the National Quality Forum, the Independence at Home (IAH) program, the Temporary Assistance for Needy Families (TANF) program, and State Health Insurance Assistance Programs. The bill also stops scheduled payment rate cuts to Medicaid Disproportionate Care hospitals that serve a higher percentage of vulnerable individuals.

Like the version of the bill that passed earlier this year, this legislation will lower the cost of prescription drugs by overhauling the Medicare Part D program. It will create a $3,100 yearly out-of-pocket cap to protect seniors with high drug costs and penalize pharmaceutical companies that raise the cost of a prescription drug faster than the rate of inflation. This bill includes an additional provision to further reduce seniors’ out-of-pocket costs by reducing their required cost sharing from 25 percent to 20 percent in the initial coverage phase. It also includes a provision similar to Sen. Warner’s bipartisan legislation that would allow state Medicaid programs grappling with rising drug costs to explore value-based pricing arrangements that peg the price of a drug to its effectiveness.

A recent report on the cost of prescription drugs in Virginia found that the annual cost of prescription drug treatment increased by 57.8 percent between 2012 and 2017, dramatically outpacing the 8.5 percent growth in Virginians’ incomes over the same period.

In Congress, Sen. Warner has long pushed for policy changes to help lower prescription drug costs for Virginia seniors and families. Last month, Sen. Warner introduced a bipartisan bill to reauthorize PCORI and help Americans save on their health costs. In January, Sen. Warner reintroduced legislation to allow Medicare to negotiate prescription drug prices—a move that would cut costs for nearly 43 million seniors enrolled in Medicare Part D.

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WASHINGTON – Today, U.S. Sens. Mark R. Warner (D-VA) and Tim Scott (R-SC) introduced the Ensuring Seniors Access to Quality Care Act to help senior living facilities caring for aging adults to better screen, hire, and retain quality staff. The Ensuring Seniors Access to Quality Care Act would provide nursing home operators with access to the National Practitioner Data Bank (NPDB) – an existing national criminal background check system – a move that would give employers greater ability to screen and vet potential employees to ensure that caregivers do not have a history that would endanger the seniors under their care.

“Anyone with a loved one in a senior living facility should have the peace of mind of knowing that they are receiving care from compassionate, dependable, and well-qualified staff as they live out their golden years,” said Sen. Warner. “This bipartisan legislation will help provide these facilities with the tools they need to hire experienced staff and to continue to meet the demands of high quality care without losing staffing levels.”

Our senior citizens, and their families, know the importance of having well-qualified, compassionate and trustworthy caregivers in senior living facilities,” said Sen. Scott. “The Ensuring Seniors Access to Quality Care Act will help these facilities more efficiently hire the best candidates, and, in turn, provide better care for seniors everywhere.” 

Currently, senior living facilities are not authorized to use the NPDB and instead must rely on state-level criminal background checks that can often omit key details about an employee’s background.

Additionally, the bipartisan legislation amends overly restrictive regulations that bar certain senior living facilities from conducting training programs for in-house Certified Nurse Assistants (CNAs) – individuals who assist patients with their daily activities – for a two-year period after a care facility is found to have deficiencies, such as poor conditions or patient safety violations. Under existing regulations by the Centers for Medicare and Medicaid Services (CMS), senior living facilities that receive a civil monetary penalty (CMP) over $10,000 are automatically prohibited from conducting CNA staff training programs for a period of two years.

According to the Bureau of Labor and Statistics, the need for nursing assistants to care for the growing aging population is projected to rise 9 percent from 2018 to 2028. With this growing need for caregivers, in-house CNA education at senior living facilities often helps meet the need for CNAs. But with the existing two-year lockout period, it can make it more difficult for senior care facilities to properly train new employees and retrain existing employees. Research by CMS also indicates that there is a direct correlation between facilities that are staffed adequately and the high-quality care they provide.

Specifically, the legislation would allow senior living facilities to reinstate its CNA training program if:

    • The facility has corrected the deficiency for which the CMP was assessed;
    • The deficiency for which the CMP was assessed did not result in an immediate risk to patient safety and is not the result of patient harm resulting from abuse or neglect;
    • And the facility has not received a repeat deficiency related to direct patient harm in the preceding two year period.

“CNAs are essential to the quality care provided in long term care facilities. In addition, the jobs provided by nursing homes and assisted living communities are important to many communities, especially rural areas, where they are often a major employer,” said Mark Parkinson, President and CEO of the American Health Care Association/National Center for Assisted Living. “This bill does two important things. First, it will help ensure that long term care providers have the ability to provide training programs for CNAs. Just as important, it will allow skilled nursing facilities access to the National Practitioner Data Bank, providing a better way to conduct background checks on potential employees. We applaud Senator Warner and Senator Scott for taking this important step to address the worker recruitment and retention challenges facing providers.”

“Workforce development is crucial to our members’ ability to provide top-notch care. The loss of nurse aide training authority is an obstacle to quality improvement for nursing homes, and particularly when increased staffing levels are needed,” said Katie Smith Sloan, President and CEO, LeadingAge. “We have for years advocated for changes to the training lockout mandated under the Nursing Home Reform Act of 1987. This legislation, like similar legislation in the House (H.R. 4468), offers a much-needed solution to help alleviate the severe workforce shortage in long term care. CNAs, who provide direct care to residents, are the backbone of every nursing homes’ team.”

“LeadingAge Virginia applauds Senators Mark Warner and Tim Scott for introducing legislation that will enable training of certified nursing assistants (CNAs). Under federal law, nursing homes are inspected annually and fines are assessed for any deficiencies in compliance with federal regulations. If these fines exceed a certain level, a nursing home automatically loses its authority to train CNAs for two years,” said Melissa Andrews, President and CEO of LeadingAge Virginia. “This ‘CNA Training Lockout’ runs counter to a nursing home’s ability to provide the highest quality of care and we appreciate the Senators for introducing legislation to overcome this barrier.”

“Having started my career in long term care as a nursing assistant, I know how critical they are to providing direct care to thousands of patients and residents every day. Ending the CNA training lockout will have a tremendously positive impact on our ability to train more caregivers to work in our nursing homes,” said David Tucker, Chairman of Virginia Health Care Association – Virginia Center for Assisted Living (VHCA-VCAL) and President and COO of Commonwealth Care of Roanoke.

“Westminster Canterbury Richmond believes that a qualified workforce is crucial for the overall success of a nursing home to provide the highest quality of care. The training lockout is an obstacle to achieving this goal, and we believe this legislation is a positive step forward,” said John Burns, President and CEO of Westminster Canterbury Richmond, and a member of the LeadingAge Virginia Board of Directors.

“At a time where we need more individuals to choose the important and meaningful work of service to older adults throughout this country, limiting the ability to train future generations of care workers is not the answer,” said Rob Liebreich, President and CEO, Goodwin House Incorporated.

“Having access to the National Practitioner Data Bank would be extremely beneficial for us. It would help prevent bad actors from hopping from state to state,” said Melissa Green, Chief Clinical Officer of Trio Health Care, LLC, Hot Springs, VA and a nursing home operator who has facilities close to neighboring states. She cites an incident when it was revealed that an employee had stolen an identity to work as a nurse—without access to the NPDB there was no way to know the actual nurse’s identity was stolen even though the nursing home completed the required background checks.

“Because of the CNA training lockout, we’ve reduced the number of qualified CNAs entering in the workforce, which has had a trickle-down effect on a facility the size of ours,” said Keith Denson, Administrator, Snyder Nursing Home, Inc., Salem, VA. “If we’re not training our people to take care of our unique and wonderful residents, who will do it? Training programs in the community lack the continuity of care and the CNA to resident experience that provider programs offer. I am very appreciative of the trust Sen. Warner has in our ability to train our staff to take care of our residents.”

Sen. Warner has been a longtime advocate of improving long-term care for seniors. In 2000, Sen. Warner’s mother was diagnosed with Alzheimer’s, passing away in 2010 after battling the disease. Her diagnosis and the family’s subsequent struggle to find qualified care and support resources inspired Sen. Warner to launch SeniorNavigator.com, an online information and referral network for older Virginians and their caregivers. In the Senate, Sen. Warner serves as a Co-Chair of the Alzheimer’s Caucus and has helped lead efforts to secure robust funding for Alzheimer’s research, prevention, and treatment. He’s also introduced bipartisan legislation designed to give people with serious illnesses new tools to plan for their care, and empower them to have those choices honored. Sen. Warner has also sponsored legislation that allows seniors with multiple chronic conditions to receive enhanced care in their homes – an effort to decrease hospital readmissions – and expand telehealth services for seniors to increase access to primary care services in rural communities. The Senate unanimously passed this bill in September of 2017, and the bill was signed into law in 2018.

The text of the Ensuring Seniors Access to Quality Care Act is available here.

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WASHINGTON – Today, U.S. Sen. Mark R. Warner (D-VA) joined 35 members of the U.S. Senate and 161 members of the U.S. House of Representatives fin filing an amicus brief in the case of June Medical Services LLC v. Gee, which is currently pending before the Supreme Court of the United States and represents a direct challenge to the Supreme Court’s landmark ruling in Roe v. Wade. 

June Medical Services LLC v. Gee addresses the impact of Louisiana’s Act 620, an extreme anti-abortion law that forces abortion providers to obtain admitting privileges at a hospital within 30 miles of their clinic. The law provides no medical benefit and would harm patients by stifling access to abortion care. If the law goes into effect, only one clinic and one abortion provider would remain in Louisiana – a state with over 360,000 women of reproductive age.

“Act 620, disguised as an effort to promote women’s health, provides no medical benefit and instead will only create significant obstacles for women seeking abortions,” the lawmakers wrote in the brief. 

Lawmakers emphasized in the brief that, just three years ago in Whole Woman’s Health v. Hellerstedt, the Court struck down a materially identical Texas law because it imposed significant burdens on abortion access without providing health or safety benefits. Since then, the facts, the law and the Constitution have remained the same. Lawmakers urged the court to uphold its precedent in Roe, Planned Parenthood v. Casey and Whole Woman’s Health and strike down Act 620.

“There is no compelling reason here to upend this settled precedent, and no change of circumstances between Whole Woman’s Health and this action that justifies a different outcome … Laws like Act 620, enacted in defiance of this Court’s constitutional pronouncements, undermine our nation’s confidence in the legislative process and the rule of law,” wrote the lawmakers in the brief.

Read the amicus brief here.  

 

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WASHINGTON – Today, U.S. Sens. Mark Warner and Tim Kaine (both D-VA) applauded $299,456 in federal funding from the Office of National Drug Control Policy (ONDCP) for Virginia Tech to conduct research on community-based ways to combat the opioid epidemic and facilitate cooperation between law enforcement and public health agencies. The grant was awarded through the ONDCP’s Combating Opioid Overdose through Community-Level Intervention (COOCLI) grant program.

“Communities throughout the Commonwealth and across the country continue to feel the devastating effects of the opioid epidemic, which is why we’re so glad to see this federal funding go towards conducting potentially lifesaving research at Virginia Tech,” said the Senators. “We’re proud to know that with this grant, the Commonwealth will continue to play a vital role in making sure that our nation is better prepared to mitigate this crisis and fight opioid addiction.”

In 2018, the Virginia Department of Health estimated that 1,059 people died in Virginia as a result of a fentanyl, heroin, or prescription opioid overdose. Fatal drug overdoses are now the leading cause of accidental death in the United States, surpassing car accidents and gun violence.

Grants issued under the COOCLI program support efforts to: 1) undertake research activities that entail implementing and evaluating community-based efforts to fight the opioid overdose epidemic; and 2) support and promote the partnership of law enforcement and public health agencies, whose collaboration is critical to reducing overdose and other harms of opioid abuse.

Sens. Warner and Kaine have long advocated for increased federal funding to combat the opioid epidemic in Virginia. Last year, the Senators successfully passed a bipartisan bill to help communities across Virginia by improving opioid treatment and recovery efforts and providing new tools for law enforcement. Additionally, in 2016, Sens. Warner and Kaine successfully advocated for the inclusion of several Virginia counties into the High Intensity Drug Trafficking Area (HIDTA) program.

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WASHINGTON – Today, U.S. Sens. Mark R. Warner (D-VA), Bill Cassidy (R-LA), Chris Van Hollen (D-MD) and Shelley Moore Capito (R-WV) introduced bipartisan legislation to reauthorize the independent nonprofit corporation established to save Americans money on their health care costs and help patients better understand their diagnostic and treatment options. The Patient-Centered Outcomes Research Institute (PCORI) helps inform health care decisions by providing evidence on the effectiveness, benefits and harms of different treatment options for a condition.

“As medical care and innovation continues to advance, patients have a right to know whether their particular treatment is effective, or whether a different course of action might work better for them,” said Sen. Warner. “Frankly, nobody wants to spend time or money on a procedure they don’t need, but too often, folks don’t have the information they need to make that determination. That’s why I’m proud to introduce this legislation today to help make sure that this crucial institute can continue its work of providing patients and their health care providers with an independent look at their options.” 

“One-size-fits-all medicine does not work. Patients deserve effective and efficient care tailored to them,” said Dr. Cassidy. “Health care costs are lowered when patients have information and can choose what is right for them.”

“This innovative Institute was created to provide patients with the high-quality information they need to make better-informed decisions about their health care. Their work is producing more reliable research to guide health care decisions that increasingly rely on personalized diagnosis and treatments,” said Sen. Van Hollen. “This bill provides the roadmap for the next ten years so they can conduct cutting edge research to improve patient outcomes and save lives.”

“In making health care decisions, it is essential patients have as much useful information as possible,” Sen. Capito said. “PCORI allows patients and their families to compare different treatment options, their effectiveness, and their costs to make more informed decisions. This hopefully helps them not only improve their care, but also spend limited health care dollars more wisely.”

PCORI is an independent nonprofit tasked with examining the relative health outcomes, clinical effectiveness and appropriateness of different medical treatments. Findings from PCORI funded studies are made public so that patients, health care providers and payers can use this information to improve patient care and reduce their health costs. PCORI funded research does not determine coverage or reimbursement decisions at the Centers for Medicare and Medicaid Services (CMS), but CMS can consider PCORI’s research alongside other factors and public input when deciding what procedures it will cover.

Since 2012, PCORI has approved more than $2.3 billion in grants to advance research on patient-centered outcomes. Since PCORI’s authorization, several studies have contributed to significant changes in decision-making and healthcare spending, including helping reduce patient out-of-pocket costs, health spending on unneeded care, unnecessary hospital stays and intensive medical tests. Additionally, research by PCORI has helped to better inform physicians and patients on a broad array of treatments, including opioid prescribing and substance use disorder treatments, obesity weight loss surgery, telehealth use and more. 

The bipartisan Senate legislation would extend PCORI’s funding through FY2029. The bill would also:

Ensure PCORI conducts additional research on rising health care costs by directing researchers to collect data on the potential burdens and economic impacts of the utilization of medical treatments, items and services on different stakeholders and decision-makers. These potential burdens and economic impacts include medical out-of-pocket costs, non-medical costs to the patient and family, effects on future costs of care, workplace productivity and absenteeism and healthcare utilization.

Establish an ‘Expert Advisory Panel for High-Impact Research’ to assist and advise PCORI on ways to better take into account and target diseases, conditions and care interventions that have a high-impact on national health spending.

Improve PCORI’s ability to study the relative cost and effectiveness of prescription drugs, medical devices and other health care interventions by ensuring appropriate patient coverage for PCORI funded clinical trials and studies. The legislation also requires the Government Accountability Office (GAO) to report on remaining barriers to conducting clinical trials and studies.

Direct PCORI to maintain its commitment to robust and meaningful patient engagement, including in the selection of national priority topics and research questions.

Strongly encourage PCORI and AHRQ to maintain their commitment to disseminating and implementing research findings and provide strategies to facilitate the adoption of PCORI-funded research into practice.

“We applaud the introduction of this important piece of legislation to reauthorize the Patient-Centered Outcomes Research institute (PCORI). Continuing their existing funding streams for ten years will ensure that PCORI can continue its vital work producing information patients need to decide the care that is best for them.  We particularly support the emphasis on strengthening the way PCORI engages patients and patient organizations and guidance on using a wide variety of outcomes data to ensure patients’ needs are considered in research,” said Marc Boutin, JD, Chief Executive Officer, National Health Council.

“At the University of Virginia School of Medicine, PCORI is funding projects in rural and underserved areas, including studies intended to reduce cancer disparities in rural Appalachian communities and to compare childhood obesity treatments in the Dan River region. Such work is critical to finding effective health care solutions in these communities. The Patient-Centered Outcomes Research Institute Reauthorization Act will ensure that invaluable health care information and its scientific findings can continue to be generated and disseminated to patients and providers, allowing them to make needed decisions to choose the best treatments,” said Dr. David S. Wilkes, M.D., Dean of the University of Virginia School of Medicine.

“I am grateful for the leadership of Sens. Warner, Cassidy, Van Hollen, and Capito in introducing this legislation,” said Dr. Peter Buckley, M.D., Dean, Virginia Commonwealth University (VCU) School of Medicine, and Executive Vice President for Medical Affairs, VCU Health System. “The Patient-Centered Outcomes Research Institute (PCORI) is a critical, independent funder of research that is truly patient-centered – a key value of the VCU Health System. Reauthorizing PCORI for another ten years and maintaining its unique funding mechanism will ensure continued advances in care and our understanding of what works – and for whom – when it comes to treating disease.”

“PCORI has changed how clinical research is conducted at Johns Hopkins and throughout the United States. Through research networks created by PCORI and standalone studies funded by PCORI, the power of including patients in the design, conduct, and analysis of the studies has been demonstrated multiple times. PCORI-funded studies evaluate the concerns of patients directly important to them and provide the evidence we all need to make better decisions about treatment options. Reauthorization of PCORI will provide the evidence American needs in the next decade to create a health system that delivers effective, patient-centered, and high-value care,” said Dr. Daniel Ford, M.D., M.P.H., Vice Dean for Clinical Investigation, Johns Hopkins School of Medicine.  

The text of this legislation is available here. 

 

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WASHINGTON – Today, U.S. Sen. Mark R. Warner (D-VA), Vice Chairman of the Senate Intelligence Committee and co-founder of the Senate Cybersecurity Caucus, wrote to the Department of Health and Human Services (HHS) regarding a proposed rule by the Centers for Medicare and Medicaid Services (CMS) that would require CMS-funded health plans (including ACA marketplace plans) to allow patients to access their personal health information electronically through third-party consumer applications. In his letter, Sen. Warner urged HHS to include clear standards and defined controls for accessing patient data in order to address the potential for misuse of these interoperability features.

“In just the last three years, technology providers and policymakers have been unable to anticipate – or preemptively address – the misuse of consumer technology which has had profound impacts across our society and economy. As I have stated repeatedly, third-party data stewardship is a critical component of information security, and a failure to ensure robust requirements and controls are in place is often the cause of the most devastating breaches of sensitive personal information,” wrote Sen. Warner. “It is critical that there are proper safeguards are in place to protect patient privacy and sensitive health information. Moreover, there should be more work done by HHS to facilitate greater access to, and transfer of, electronic health information that does not inadvertently enable dominant IT providers to leverage their control over user data outside of the health care context into nascent markets for personalized health products.”

“Across all sectors – including health care – innovative products and services, increasingly dependent upon machine learning, rely on user data as the single most important productive input to innovation and customization. Importantly, however, any approach must balance innovation and ease of access with privacy, security, and a commitment to robust competition. Further, any effort must ensure that such access redounds to the benefit of patients – and that data, once shared with new providers, is not commercialized in ways that benefit those providers without direct benefits or compensation to users,” he continued. “As CMS and HHS move forward with this needed rule – I urge you to include clear standards and defined controls for all stakeholders that ensure third party software applications accessing patient data through APIs are effectively protecting patient information and that patients are appropriately (and routinely) informed, in clear and particularized ways, how their data is used.”

Under the proposed Interoperability and Patient Access rule, CMS would require Medicare Advantage (MA) organizations, state Medicaid and Children’s Health Insurance Program (CHIP) Fee-for-Service (FFS) programs, Medicaid managed care plans, CHIP managed care entities, and qualified health plans (QHPs) on the federally-facilitated exchanges (FFEs) to allow patients to access their personal health information electronically through open application programing interfaces (APIs). APIs would allow third-party software applications to connect to, process, and make the data available to patients.

In the letter, Sen. Warner emphasized the importance of allowing patients to easily access their health information. He also noted the similarities between the proposed rule and the ACCESS Act – bipartisan legislation introduced by Sen. Warner that would promote market-based competition among social media platforms by requiring the largest social media companies to make user data portable, and their services interoperable, with other platforms. The ACCESS Act would also allow users to designate a trusted third-party service to manage their privacy and account settings, if they so choose. Additionally, Sen. Warner urged that, at a minimum, the final rule include the following standards:

  • Patient Access to Data – A guarantee that patients will have ready access to their personal health data and an ability to regularly monitor and ensure the accuracy of such information. Patients should be informed of all commercial uses of their data, including any third parties their data has been shared with (even if it has alleged to have been anonymized). Patients should also have the right to withhold consent for their data to be shared with third parties, or used in new ways without their consent. Patients should also reserve the right to have third party users dispose of their data upon request.
  • Adequate Privacy and Security Safeguards – Ensure participating stakeholders can adequately safeguard patient information by using existing best practices for secure storage and complying with applicable breach notification requirements. Moreover, HHS must work with the FTC and state attorneys general to develop mechanisms to report, supervise, and prosecute privacy and security lapses.
  • Documentation of the open API specifications and required security controls – Provide clear attestation of the open API specifications as defined for patient data, the security requirements and controls imposed on healthcare providers, and the third-party platform obligations in managing patient data. 
  • Patient Consent and Terms of Use – CMS and HHS should work proactively with the patient, provider and payer community to ensure users have informed proactive consent when user data is shared with a third party. In addition – there should be clear protections in place to ensure third party vendors use patient data solely for purposes in which the patient has expressly given informed proactive consent, including cases where patient information may be sold, and that patients retain the right to direct any party that has acquired their data to delete it upon request. Further, those accessing patient data should be prohibited from conditioning continued access on agreement by the patient to share their data with third parties. 

Sen. Warner has been a longtime critic of poor cybersecurity practices that compromise Americans’ personal information. Last week, Sen. Warner raised concern with HSS’ failure to act, following a mass exposure of sensitive medical images and information by health organizations. In September, he wrote to TridentUSA Health Services to inquire about the company’s data security practices, following reports that a company affiliate exposed medical data belonging to millions of Americans. Earlier that month, Sen. Warner demanded answers from U.S. Customs and Border Protection (CBP) and South Korean company Suprema HQ, following separate incidents that affected both entities and exposed the personal, permanently identifiable data of many Americans. Sen. Warner has introduced legislation to empower state and local government to counter cyberattacks, and to increase cybersecurity among public companies.

The letter text can be found below and a PDF is available here.

 

The Honorable Alex M. Azar II

Department of Health and Human Services

Office of the Secretary

200 Independence Avenue, S.W.

Washington, D.C. 20201

 

Dear Secretary Azar:

I am writing regarding the proposed rule from the Center for Medicare and Medicaid Services (CMS) on Interoperability and Patient Access that would enable third party consumer applications to access sensitive patient and health plan data through application programming interfaces (APIs) [1]. I share the goals of advancing interoperability in patient health information and believe that – implemented appropriately – this proposal could represent a significant step in that direction. However, I urge CMS to take additional steps to address the potential for misuse of these features in developing the rules around APIs. In just the last three years, technology providers and policymakers have been unable to anticipate – or preemptively address – the misuse of consumer technology which has had profound impacts across our society and economy. As I have stated repeatedly, third-party data stewardship is a critical component of information security, and a failure to ensure robust requirements and controls are in place is often the cause of the most devastating breaches of sensitive personal information.

Congress passed the 21st Century Cures Act (P.L. 114-255) with a key objective of improving the protected exchange of electronic health records across the care continuum. Notably, Section 4003 and 4004 included specific provisions to establish a trusted health information exchange framework and reduce information blocking; it stated that there should be regulation over unreasonable practices to interfere with, prevent, or materially discourage access, exchange, or use of a patient’s electronic health records. While your agency has taken substantial steps to implement fundamental aspects of this legislation, it is critical that there are proper safeguards are in place to protect patient privacy and sensitive health information. Moreover, there should be more work done by HHS to facilitate greater access to, and transfer of, electronic health information that does not inadvertently enable dominant IT providers to leverage their control over user data outside of the health care context into nascent markets for personalized health products.

In your proposed rule CMS would specifically require Medicare Advantage (MA) organizations, state Medicaid and Children’s Health Insurance Program (CHIP) Fee-for-Service (FFS) programs, Medicaid managed care plans, CHIP managed care entities, and qualified health plans (QHPs) on the federally-facilitated exchanges (FFEs) to allow patients to access their personal health information electronically through an open application programming interface (API). Data should be made available through an API so that third party software applications can connect to, process, and make the data available to patients.

I agree that patients should have an ability to easily acquire their health information. The rule is in many ways consistent with bipartisan legislation I have introduced in Congress – the Augmenting Compatibility and Competition by Enabling Service Switching (ACCESS) Act, which requires our nation’s largest social media companies to make user data portable, and make their services interoperable with other platforms.

Common to both my bill and the proposed rule is a recognition that consumers should have a right to possess their data – and share it with authorized third parties that will protect it. Both proposals also seek to address the control over consumer data that incumbents wield, often to the detriment of new, innovative providers. Across all sectors – including health care – innovative products and services, increasingly dependent upon machine learning, rely on user data as the single most important productive input to innovation and customization. Importantly, however, any approach must balance innovation and ease of access with privacy, security, and a commitment to robust competition. Further, any effort must ensure that such access redounds to the benefit of patients – and that data, once shared with new providers, is not commercialized in ways that benefit those providers without direct benefits or compensation to users.

 As CMS and HHS move forward with this needed rule – I urge you to include clear standards and defined controls for all stakeholders that ensure third party software applications accessing patient data through APIs are effectively protecting patient information and that patients are appropriately (and routinely) informed, in clear and particularized ways, how their data is used. Such standards in a final rule should include at a minimum:

  • Patient Access to Data – A guarantee that patients will have ready access to their personal health data and an ability to regularly monitor and ensure the accuracy of such information. Patients should be informed of all commercial uses of their data, including any third parties their data has been shared with (even if it has alleged to have been anonymized). Patients should also have the right to withhold consent for their data to be shared with third parties, or used in new ways without their consent. Patients should also reserve the right to have third party users dispose of their data upon request.
  • Adequate Privacy and Security Safeguards – Ensure participating stakeholders can adequately safeguard patient information by using existing best practices for secure storage and complying with applicable breach notification requirements. Moreover, HHS must work with the FTC and state attorneys general to develop mechanisms to report, supervise, and prosecute privacy and security lapses.
  • Documentation of the open API specifications and required security controls – Provide clear attestation of the open API specifications as defined for patient data, the security requirements and controls imposed on healthcare providers, and the third-party platform obligations in managing patient data. 
  • Patient Consent and Terms of Use – CMS and HHS should work proactively with the patient, provider and payer community to ensure users have informed proactive consent when user data is shared with a third party. In addition – there should be clear protections in place to ensure third party vendors use patient data solely for purposes in which the patient has expressly given informed proactive consent, including cases where patient information may be sold, and that patients retain the right to direct any party that has acquired their data to delete it upon request. Further, those accessing patient data should be prohibited from conditioning continued access on agreement by the patient to share their data with third parties. 

Thank you for your consideration your commitment to advancing interoperability to improve patient care. I believe the outline I have shared would strengthen and ensure the rule achieves its intended purpose.  It is my hope and belief that we can achieve both a higher level of interoperability and patient access to their data, as well as, strong protections for that information. I look forward to continued work with you on this important issue and our shared goals.

Sincerely,

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WASHINGTON – U.S. Sen. Mark R. Warner (D-VA), Vice Chairman of the Senate Intelligence Committee and co-founder of the Senate Cybersecurity Caucus, today raised concern with the U.S. Department of Health and Human Services (HHS)’s failure to act, following a mass exposure of sensitive medical images and information by health organizations. In a letter to the HHS Director of the Office for Civil Rights, Sen. Warner identified this exposure as damaging to individual and national security, as this kind of information can be used to target individuals and to spread malware across organizations.

“I am alarmed that this is happening and that your organization, with its responsibility to protect the sensitive personal medical information of the American people, has done nothing about it,” wrote Sen. Warner. “As your agency aggressively pushes to permit a wider range of parties (including those not covered by HIPAA) to have access to the sensitive health information of American patients without traditional privacy protections attaching to that information, HHS’s inattention to this particular incident becomes even more troubling.”

“These reports indicate egregious privacy violations and represent a serious national security issue -- the files may be altered, extracted, or used to spread malware across an organization,” he continued. “In their current unencrypted state, CT, MRI and other diagnostic scans on the internet could be downloaded, injected with malicious code, and re-uploaded into the medical organization’s system and, if capable of propagating, potentially spread laterally across the organization. Earlier this year, researchers demonstrated that a design flaw in the DICOM protocol could easily allow an adversary to insert malicious code into an image file like a CT scan, without being detected.”

On September 17th, a report revealed that millions of Americans had their private medical images exposed online, due to unsecured picture archiving and communication servers (PACS) that utilize the Digital Imaging and Communications in medicine (DICOM) protocol. Along with the medical images, these PACS also exposed the names and social security numbers of those affected, leaving this information open to anyone with basic computer expertise, as these required no authentication to access or download.

This exposure was uncovered by German researchers, who contacted the German Federal Office for Information Security (BSI). BSI then alerted the United States Computer Emergency Readiness Team (US-CERT), who confirmed the exposure and reached out to HHS. However, if they received this information, HHS has failed to act on it, even failing to list TridentUSA Health Services – one of the main companies responsible for the exposure – on its breach portal website.

In his letter to Director Roger Severino, Sen. Warner also raised alarm with the fact that TridentUSA Health Services successfully completed an HHS Health Insurance Portability and Accountability Act (HIPAA) Security Rule compliance audit in March 2019, while patient images were actively accessible online.

Sen. Warner also posed the follow questions for HHS regarding the incident, and its current cybersecurity requirements and procedures:

  1. Did HHS receive a notice from US-CERT regarding the open PACS ports available with diagnostic imaging available on the internet without any restrictions?
    1. If so, what actions were taken to address the issue?
  2. What evidence do you require organizations to produce during a HIPAA Security Rule audit? Are organizations asked to turn over their audit logs? How does OCR review the logs?
    1. Does OCR have information security experts on staff or does it rely on external consultants as part of these audits? 
  3. What are the follow-up procedures if an organization’s log files reveal access to sensitive data from outside the United States, such as in this case?
  4. Please describe your information security audit process.
  5. Please describe your oversight of the DICOM protocol and PACS security. Do you require organizations to implement access controls? If so, what kind? Do you require full-disk encryption and authentication for PACS? Are the DICOM protocol implementations included in the audits?

Sen. Warner has been a champion for cybersecurity throughout his career, and has been an outspoken critic of poor cybersecurity practices that compromise Americans’ personal information. In September, Sen. Warner wrote to TridentUSA Health Services to inquire about the company’s data security practices, following reports that a company affiliate exposed medical data belonging to millions of Americans. Earlier that month, Sen. Warner demanded answers from U.S. Customs and Border Protection (CBP) and South Korean company Suprema HQ, following separate incidents that affected both entities and exposed the personal, permanently identifiable data of many Americans. Sen. Warner has introduced legislation to empower state and local government to counter cyberattacks, and to increase cybersecurity among public companies.

The letter text can be found below and a PDF is available here.

 

Mr. Roger Severino                                                                

Director, Office for Civil Rights

Department of Health and Human Services

200 Independence Ave SW

Washington, DC 20201

Dear Director Severino,

As the health care industry increasingly harnesses internet connectivity and software, including machine learning systems, to improve patient care, a long overdue focus on data privacy and information security has come into sharper focus. This is particularly evident in light of reports that sensitive medical records of potentially millions of Americans were recently exposed online – and that your agency has done little to address this issue. Prompting even greater concern, one of the companies that left the data exposed online also successfully completed one of your Health Insurance Portability and Accountability Act (HIPAA) Security Rule compliance audits in March. I am alarmed that this is happening and that your organization, with its responsibility to protect the sensitive personal medical information of the American people, has done nothing about it. As your agency aggressively pushes to permit a wider range of parties (including those not covered by HIPAA) to have access to the sensitive health information of American patients, without traditional privacy protections attaching to that information, HHS’s inattention to this particular incident becomes even more troubling.

On September 17th ProPublica published a shocking report that the sensitive medical images of millions of American patients were exposed online through unsecured picture and archiving and communications servers (PACS) that utilize the Digital Imaging and Communications in medicine (DICOM), protocol. The publicly-accessible information that had been accessed from Germany included MRI’s, X-rays, and CT scans, as well as names and social security numbers of the patients. The 13.7 million images found on the internet required absolutely no authentication to access or download. As of writing this letter, there are 779 million image records attached to 21.6 million patient records, impacting an estimated 5 million patients in 22 states. The largest system accessed holds 61 million diagnostic images attached to 1.23 million exam records of American patients and remains available on the internet.

In late August, German researchers initiated an investigation to determine the global accessibility and remote access capabilities of PACS. On September 9th, the researchers concluded their two week inquiry and submitted their findings to the German Federal Office for Information Security (BSI). By September 17th, BSI had addressed the affected systems which were removed from the internet prior to the publishing of the ProPublica report.

After US-CERT was notified of the problem by BSI, US-CERT contacted the German researchers at Greenbone Networks, confirming they received the data on September 20th. US-CERT stated the agency would convey the information to the U.S. Department of Health and Human Services (HHS). According to the researchers, however, there has been no further communication from US-CERT or HHS, even though data privacy authorities from other countries like France and the UK contacted Greenbone Networks following the publication of ProPublica’s report.

On September 23rd, I wrote to TridentUSA Health Services expressing my concern regarding the issues raised in the ProPublica report, and pointed out that MobilexUSA, a TridentUSA Health Services affiliate, was identified as controlling one of the unsecured PACS. On October 15th, the German researchers demonstrated to my office a number of US-based PACS have open ports, supporting unencrypted communications protocols, exposing images to the internet like chest X-rays and mammograms, and identifying details like names and social security numbers. Those images and medical records continue to be accessible.

These reports indicate egregious privacy violations and represent a serious national security issue -- the files may be altered, extracted, or used to spread malware across an organization. Earlier this year, researchers demonstrated that a design flaw in the DICOM protocol could easily allow an adversary to insert malicious code into an image file like a CT scan, without being detected. The researchers who discovered the flaw in the DICOM protocol were able to use a polyglot file, which can contain more than one stream of data with different file formats, and hide the malicious code in the scan. In their current unencrypted state, CT, MRI and other diagnostic scans on the internet could be downloaded, injected with malicious code, and re-uploaded into the medical organization’s system and, if capable of propagating, potentially spread laterally across the organization.

In their response to my letter, TridentUSA Health Services noted that they successfully completed the Department of Health and Human Services audits, confirming compliance with the HIPAA Security Rule, the last of which concluded in March 2019, while patient images were accessible online.

While the information security lapses by the medical companies using the PACS are clear, it is unclear how your agency has addressed this issue. As of the writing of this letter, TridentUSA Health Services is not included on your breach portal website, and I have seen no evidence that, once contacted by US-CERT, you acted on that information in any meaningful way.

To understand how such an enormous oversight in your organization has allowed medical companies to leave insecure ports open to the internet and accessed repeatedly by a German IP address, I ask that you answer the following questions:

1.      Did HHS receive a notice from US-CERT regarding the open PACS ports available with diagnostic imaging available on the internet without any restrictions?
a.      If so, what actions were taken to address the issue?
2.      What evidence do you require organizations to produce during a HIPAA Security Rule audit? Are organizations asked to turn over their audit logs? How does OCR review the logs?
a.      Does OCR have information security experts on staff or does it rely on external consultants as part of these audits? 
3.      What are the follow-up procedures if an organization’s log files reveal access to sensitive data from outside the United States, such as in this case?
4.      Please describe your information security audit process.
5.      Please describe your oversight of the DICOM protocol and PACS security. Do you require organizations to implement access controls? If so, what kind? Do you require full-disk encryption and authentication for PACS? Are the DICOM protocol implementations included in the audits?

The American people deserve to have their sensitive private information protected and their government held accountable for enforcing the rules in place to keep that information private. I hope that you will share what immediate actions you are taking, along with answering the questions above. I look forward to hearing your response no later than November 18, 2019.

Sincerely,

###

WASHINGTON – Following years of efforts to try to safeguard benefits for mine workers, U.S. Sens. Mark R. Warner and Tim Kaine (both D-VA), today introduced bipartisan legislation along with Sens. Joe Manchin (D-WV), Mitch McConnell (R-KY), and Shelley Moore Capito (R-WV) to secure pensions for our nation’s retired miners. The legislation would shore up the 1974 United Mine Workers of America Pension Plan – which is currently headed for insolvency due to coal company bankruptcies and the 2008 financial crisis – ensuring that at-risk miners do not lose their healthcare due to the 2018 and 2019 coal company bankruptcies.

“After working for so long to get miners the benefits they deserve, this bipartisan legislation is an encouraging step in the right direction,” said the Senators. “Our mine workers have worked extremely hard to power our nation, often at great risk to themselves. The least we can do is make sure they are able to get their hard-earned benefits and pensions, and that once they retire, they can do so with peace of mind. We are proud to introduce this legislation along with our colleagues to help us keep our nation’s promise to miners in the Commonwealth and all across the country.”

The Bipartisan American Miners Act of 2019 will amend the Surface Mining Control and Reclamation Act of 1977 to transfer excess funds from the Abandoned Mine Land (AML) Fund to the 1974 Pension Plan to prevent its insolvency. It will also amend the Coal Act to include 2018 and 2019 bankruptcies in the miners’ healthcare fix that passed in 2017. These actions will secure the pensions of 92,000 coal miners and protect healthcare benefits for 13,000 miners.

Sens. Warner and Kaine have been longtime advocates for coal miners and their families. In August 2018, they introduced and passed into law legislation to improve early detection and treatment of black lung disease among coal miners.

The Bipartisan American Miners Act of 2019 is also co-sponsored by Senators Rob Portman (R-OH), Doug Jones (D-AL), Tammy Duckworth (D-IL), Sherrod Brown (D-OH), Bob Casey (D-PA), and Dick Durbin (D-IL), and Kyrsten Sinema (D-AZ).

A copy of the bill is available here.

###

WASHINGTON — Today, U.S. Sen. Mark R. Warner (D-VA) met with David Collins, the new Director of the Hampton VA Medical Center, at Sen. Warner’s office in Washington, D.C.

In the meeting, Sen. Warner and Director Collins discussed staffing challenges and shortages at the Hampton VA Medical Center and how these factors may have contributed to the problems raised last month by an Inspector General report related to managing and tracking supplies. Additionally, they spoke about suicide prevention efforts and strategies for reducing wait times for medical services, including primary care and mental health care. During the meeting, Sen. Warner also reiterated his commitment to increasing access for one of the fastest growing veterans populations in the nation and pushing for the completion of a new VA Community Based Outpatient Clinic in South Hampton Roads.

“Our veterans have sacrificed so much for the nation – the least we can do is to make sure they get top-notch medical care once they are back home,” said Sen. Warner. “I am committed to working with Director Collins to help mitigate the challenges at Hampton VA Medical Center. But the VA also needs more capacity in the Hampton region to meet the growing demands of our veteran population. While we may have cleared the last Congressional hurdle for approving the new clinic lease prospectus in South Hampton Roads, our work is not done until this clinic is fully-functional and serving our veterans.”

Sen. Warner has been a longtime advocate of improving care for veterans in the Commonwealth. In 2017, he successfully pushed for Congress to approve overdue medical leases on 28 major Veteran’s Affairs (VA) facilities, including one in Hampton Roads, which is projected to ease the workload at the Hampton VA Medical Center, and another in Fredericksburg. Since then, Sen. Warner has pushed to get these facilities up and running by pressuring the GSA and the VA to move these projects forward, pushing the Office of Management and Budget (OMB) to sign off on these clinics’ lease prospectuses, and successfully urging the Senate Committee on Environment and Public Works (EPW) to bring up the prospectuses for approval.

Sen. Warner has also long fought to reduce wait times for veterans in Hampton Roads. In 2015, confronted with wait times that were three times the national average, Sen. Warner successfully urged the VA to send down a team of experts to try to address the problem. He also succeeded in getting the Northern Virginia Technology Council to issue a free report, detailing how to reduce wait times.

Director Collins, who was appointed director of the Hampton VA Medical Center in August of 2019, is a 28-year Veteran of the Navy Medical Service Corps, whose recent appointments include service as the Executive Assistant to the Navy Surgeon General, Commanding Officer of the Jacksonville Naval Hospital, and Chief Operating Officer of the Naval Hospital in Bremerton, Washington. He also spent time as the Executive Officer for NATO’s Multinational Medical Unit in Afghanistan, demonstrating an ability to relate to other military Veterans with a similar background. He is a current resident of the Hampton and Chesapeake Community.

###

WASHINGTON – U.S. Sen. Mark R. Warner (D-VA) along Sens. Brian Schatz (D-HI), Ben Cardin (D-MD), Cindy Hyde-Smith (R-MS), John Thune (R-SD), and Roger Wicker (R-MS) have introduced bipartisan legislation to expand telehealth services through Medicare, improve health outcomes, make it easier for patients to connect with their doctors, and help cut costs for patients and providers. Companion legislation has been introduced in the House of Representatives by U.S. Reps. Mike Thompson (D-CA), Peter Welch (D-VT), David Schweikert (R-AZ), and Bill Johnson (R-OH).

“I’ve seen firsthand how hard it can be for Virginians to access health care in rural or underserved communities,” said Sen. Warner. “From my time as Governor through my years in the Senate, I’ve constantly pushed to use innovation to increase health care accessibility for Virginians. This legislation will allow more individuals across Virginia and our country to take advantage of telehealth services that require less travel time and provide affordable, quality care.”

 In studies, telehealth has been shown to improve care and patient satisfaction while reducing hospitalizations. The Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act of 2019 builds on the progress made in recent years to increase the use of telehealth through Medicare. Specifically, the legislation would:

  • Provide the Secretary of Health and Human Services (HHS) the authority to waive telehealth restrictions when necessary;
  • Remove geographic and originating site restrictions for services like mental health and emergency medical care;
  • Allow rural health clinics and other community-based health care centers to provide telehealth services; and
  • Require a study to explore more ways to expand telehealth services so that more people can access health care services in their own homes.

Sen. Warner, an original cosponsor of the 2016 CONNECT for Health Act, has been a longtime advocate for increased access to health care through telehealth. Last year, he successfully included a provision to expand telehealth services for substance abuse treatment in the Opioid Crisis Response Act of 2018. In 2003, then-Gov. Warner expanded Medicaid coverage for telemedicine statewide, including evaluation and management visits, a range of individual psychotherapies, the full range of consultations, and some clinical services, including in cardiology and obstetrics. Coverage was also expanded to include non-physician providers. Among other benefits, the telehealth expansion allowed individuals in medically underserved and remote areas of Virginia to access quality specialty care that isn’t always available at home.

The CONNECT for Health Act of 2019 has the support of more than 100 organizations including AARP, ACT | The App Association, Alliance for Connected Care, American College of Emergency Physicians, American Hospital Association, American Medical Association, American Medical Group Association, American Nurses Association, American Psychiatric Association, American Psychological Association, American Telemedicine Association, America’s Health Insurance Plans, Connected Health Initiative, Federation of American Hospitals, Health Innovation Alliance, Healthcare Information and Management Systems Society (HIMSS), National Alliance on Mental Illness, National Association of Community Health Centers, National Association of Rural Health Clinics, and the Personal Connected Health Alliance.

“By reducing geographic and originating site restrictions in Medicare, the CONNECT for Health Act of 2019 will bridge the miles between patients and care, mitigate workforce shortages, and most importantly improve outcomes at lower costs for our nation’s vulnerable populations. Coupled with our national priority of expanding broadband access, these efforts will enable all Americans to enjoy better health and health related prosperity,” said Dr. Karen Rheuban, Director of the UVA Center for Telehealth.

“This legislation would benefit patients by removing antiquated restrictions in the Medicare program that prevent physicians from using widely available medical technology that has become commonplace in the past decade. Increased access to telehealth is urgently needed to help meet the health needs of the swiftly changing demographics of our senior population. The CONNECT for Health Act’s expansion of telehealth coverage in the Medicare program also will spur increased investment and innovation in delivery redesign to benefit all patients,” said Patrice A. Harris, M.D., M.A., President of the American Medical Association. “The AMA strongly supports the CONNECT for Health Act of 2019 and applauds Senators Schatz, Wicker, Cardin, Thune, Warner, and Hyde-Smith for their continued leadership on telehealth issues, and we look forward to seeing this vital bill advance in Congress.”

###

WASHINGTON – Today, the Senate voted 52-43 to reject a Congressional Review Act (CRA) resolution led by U.S. Sen. Mark R. Warner (D-VA) and supported by every Senate Democrat to protect Americans with preexisting conditions. This resolution, which needed 51 votes to pass, would have overturned a Trump administration waiver rule that will destabilize the nation’s health insurance market, weaken protections for 3 million Virginians with preexisting conditions, and increase costs for millions of Americans. 

Prior to the vote, Sen. Warner spoke on the Senate floor, stressing the need to protect Americans’ health care and urging his colleagues to vote for this measure.

“These ‘junk’ plans don’t have to cover things like emergency room visits, maternity care, or other essential benefits. And they once again allow insurance companies to discriminate against Americans based on their medical history. With all due respect to my Republican colleagues, you can’t have it both ways,” Sen. Warner said on the Senate floor. “If you support protections for preexisting conditions, you can’t sit by and let the Trump administration dismantle them. You have to stand up and defend these protections because folks back home are counting on them.”

“Unfortunately, this administration has used every tool at its disposal to destabilize the market, in the hopes that it will come crashing down so they can finally repeal the ACA. The rule we’re talking about today is a perfect example. Among many others: that they have defunded cost sharing payments that reduce premiums in the marketplace, and they’ve shortened the open enrollment period and cut the budget for outreach navigators who help Americans find a plan that works best for them,” he said on the floor. “The Trump administration’s rule is not a good-faith effort to bring down costs or drive innovation. It is a direct effort to undermine the stability of the insurance market. And it is an attack on the viability of protections for Americans with preexisting medical conditions.”

The Trump administration’s waiver rule currently allows states to use taxpayer dollars to push junk plans that destabilize the health insurance market. These bare-bones plans, which can discriminate against people with preexisting conditions, are not required to cover essential benefits like prescription drugs, emergency room visits, or other essential benefits. These junk plans also raise premiums for quality insurance plans and increase costs for older Americans and people with preexisting conditions who need comprehensive coverage.

Earlier this year, Sen. Warner introduced the Protect Pre-Existing Conditions CRA resolution and successfully filed a discharge petition to bring the CRA resolution to the floor for a vote.  

Congressional Review Act resolutions exercise Congress’ authority to review and overturn rules implemented by the executive branch. Unlike other legislation on the Senate floor, a Congressional Review Act resolution only needs a simple majority to pass and can be brought to the Senate floor for a vote with 30 signatures. One Republican joined all Senate Democrats in supporting Warner’s resolution, falling short of the 51 votes needed to pass.

 

Sen. Warner’s remarks as prepared for delivery can be found below:

Mr. President, it has been just over two years since the Senate voted down legislation that would have repealed the Affordable Care Act and its protections for Americans with preexisting medical conditions.

In the time since then, two things have happened.

One: my colleagues across the aisle have read the writing on the wall. They recognized that the American people support these protections for preexisting conditions on an overwhelming, bipartisan basis.

Two: the Trump Administration released the rule we’re discussing today. A rule that would actually allow taxpayer dollars to subsidize plans that actively undermine the insurance market and jeopardize these important protections for all Americans.

These “junk” plans don’t have to cover things like emergency room visits, maternity care, or other essential benefits. And they once again allow insurance companies to discriminate against Americans based on their medical history.

With all due respect to my Republican colleagues, you can’t have it both ways.

If you support protections for preexisting conditions, you can’t sit by and let the Trump Administration dismantle them. You have to stand up and defend these protections because folks back home are counting on them.

So later today, each member of this body will have a chance to go on the record with this resolution of disapproval.

Mr. President, I fear some members of this body have forgotten what it was like before the Affordable Care Act when an unexpected surgery or a diagnosis of a chronic illness could mean a one-way ticket out of the middle class.

Unfortunately, this is not a hypothetical. Recently one of my constituents a man named Jesse received a $230,000 medical bill for his back surgery. Unbeknownst to him he had purchased a junk plan that considered his back injury as a preexisting condition.

Jesse is one of the more than 3 million Virginians with a preexisting medical condition. Nationwide, more than 130 million Americans have a preexisting condition like diabetes, asthma, or cancer.

Before the Affordable Care Act, an insurance company had every right to deny these individuals coverage, charge them unaffordable premiums, or terminate their plans. We cannot go back to those days.

Unfortunately, this administration has used every tool at its disposal to destabilize the market, in the hopes that it will come crashing down so they can finally repeal the ACA.

The rule we’re talking about today is a perfect example among many others that they have defunded cost sharing payments that reduce premiums in the marketplace and they’ve shortened the open enrollment period and cut the budget for outreach navigators who help Americans find a plan that works best for them.

Or look at the Texas v. United States lawsuit that could be decided this very week — it would strike down our health insurance system, as we know it, with no replacement plan.

The truth is if these protections for preexisting conditions are going to survive we need to have a stable insurance market.

Now, we can and should have conversations about how to make improvements to the system. I’m all for that. Short-term plans and 1332 waivers are an important part of that conversation. That’s why we wrote them into the Affordable Care Act.

In fact, more than a dozen states – from Alaska to Maine – have already submitted and received approval for 1332 waivers largely adhering to the previous guidance. The state of Maryland’s waiver for a robust reinsurance program helped them reduce premiums by an average of 13 percent in 2019.

But that is not what we are talking about today. The Trump administration’s rule is not a good-faith effort to bring down costs or drive innovation.

It is a direct effort to undermine the stability of the insurance market. And it is an attack on the viability of protections for Americans with preexisting medical conditions.

My Republican colleagues say they support protections for preexisting conditions. This is your chance to prove it.

###

 

WASHINGTON – Senate Democratic Leader Chuck Schumer (D-NY) and Senator Mark Warner (D-VA), along with Senate Committee on Health, Education, and Labor Ranking Member Patty Murray (D-WA), and Senate Committee on Finance Ranking Member Ron Wyden (D-OR), today announced that Senate Democrats will use their authority under the Congressional Review Act to force a vote on the Senate floor this week, as early as Wednesday, on a resolution to that would roll back the Trump administration’s rule on 1332 waivers, which the Trump Administration is using to sabotage Americans’ health care and undermine the critical pre-existing condition protections that more than 130 million Americans rely on. The Trump administration’s rule, if left in place, allows states to greenlight junk insurance plans that don’t fully protect people with pre-existing conditions, don’t cover essential health benefits like prescription drugs and maternity care, and raise out-of-pocket costs on many American families. The rule also lets states promote junk plans that can charge people more if they have a pre-existing condition or refuse to offer coverage for specific benefits. These plans would destabilize our insurance markets and could limit insurance access and raise costs for millions of Americans.

The vote on the resolution to overturn the Trump administration’s rule, which Democrats will force under the Congressional Review Act,  is one of the most significant policy changes the Senate will consider in Majority Leader McConnell’s legislative graveyard. Leader McConnell – long before the House impeachment inquiry – turned the Senate into a legislative graveyard for the priorities of the American people.

“Earlier this year, I was proud to lead the effort to introduce a CRA resolution to overturn the Trump Administration’s latest attempt to undermine our healthcare system,” said Senator Warner. “Today, I’m glad to announce that as a result of this effort, we’ll be able to give every Senator the opportunity to stand up for folks with pre-existing conditions. Many of my colleagues on the other side of the aisle have said that they support the Affordable Care Act protections that so many folks count on. Well, this vote is an opportunity for them to prove it. I urge my colleagues to stand with the millions of Americans with pre-existing conditions by voting to reverse this harmful effort by the Trump Administration.”

“This week, the Senate will hold one of the most significant votes of the year: we will finally see where Republicans stand on the Trump administration’s efforts to sabotage the health care of millions of Americans with pre-existing conditions. It is preposterous that the Trump administration claims to care about preserving pre-existing condition protections for millions of Americans while simultaneously peddling shoddy, substandard junk plans that undermine and weaken those very protections,” said Leader Schumer.  “I say to my Republican colleagues: stand up to the sabotage or stop swindling the American people with your empty promises of support for protections for Americans with pre-existing conditions. With this vote, the Senate Republicans who say they care about preserving pre-existing condition protections will have a chance to prove it to the American people. I urge my colleagues to step up to the plate and join Senate Democrats in supporting this critical resolution.”

“Democrats are putting an end to Republicans’ transparent health care charade and forcing every Senator to go on the record once and for all about whether they will fight for families’ health care and stand up for patients with pre-existing conditions—even if it means standing up to President Trump,” said Senator Murray. “Families and patients across the country are going to be watching very carefully and taking note of who votes to protect their health care, and who sides with President Trump and big insurance companies by voting to uphold his rule promoting junk plans and undermining protections for pre-existing conditions.”

“Americans want to know where their elected officials stand on protecting those with pre-existing conditions. This week they will have an answer,” said Senator Wyden. “The Senate will be voting on a Trump rule that throws the door open to discrimination, leaving those who need health care most at the mercy of unscrupulous insurance companies. I urge my colleagues to join Democrats and end this perversion of the law – people with pre-existing conditions are counting on it.”

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WASHINGTON – Today, U.S. Sens. Mark R. Warner (D-VA), Jeanne Shaheen (D-NH), and Tammy Baldwin (D-WI) sent a letter urging Health and Human Services (HHS) Secretary Alex Azar and Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma to do more to prevent third-party web brokers from steering individuals towards junk health insurance plans – short-term insurance plans that provide no protections for Americans with preexisting conditions.

On the HealthCare.gov website, CMS includes a link that directs customers towards third-party web broker sites for health care enrollment. The junk plans offered by many of these brokers are not Affordable Care Act (ACA)-compliant and do not have to offer the protections that the ACA mandates, including protections for people with preexisting conditions, such as cancer, diabetes and asthma, or coverage for essential health benefits, including maternity care, substance use disorder treatment and prescription medications. Web brokers have a significant financial incentive to enroll individuals in these deficient plans, and are often able to earn commissions up to four times higher than they would earn enrolling customers in ACA-compliant plans.

In their letter, the Senators highlighted the alarming consequences brought about by the lack of federal oversight of brokers in their letter.

“While federal rules prohibit brokers from displaying junk plans side-by-side with ACA-compliant qualified health plans (QHP), brokers can structure their webpages in ways that steer consumers toward higher-commission products, like junk plans,” wrote the Senators. “Equally concerning, web brokers’ online screening tools can fail to identify instances where a customer is eligible for Medicaid.  In other instances, the screening tools may identify potential Medicaid eligibility, but the web broker platform may continue to push a customer to purchase a junk plan.”

“An effective and well-functioning health insurance market is only possible if consumers are provided transparent information regarding the scope and cost of coverage available, the tax credits available to consumers to offset premiums for comprehensive health plans and the incentives that brokers have for selling various products. Availability of this transparent information is particularly critical in light of your agency’s decision to reduce funding for Health Insurance Marketplace advertising, outreach and education efforts by approximately 90 percent compared to 2016 levels. Your regulatory oversight in this area is vitally important to achieving this effective insurance market. We urge you to take this oversight responsibility seriously,” concluded the Senators.

Sen. Warner has continued to fight against the Trump Administration’s efforts to dismantle health coverage for the more than 3 million Virginians with preexisting conditions. Earlier this month, Sen. Warner urged the HHS and the Centers for Medicare & Medicaid Services (CMS) to limit the proliferation of junk plans. In July, Sen. Warner led the entire Democratic Caucus in a Congressional Review Act resolution to stop the Trump Administration from promoting junk plans. Last month, Sen. Warner filed a discharge petition that will force the Senate to vote on whether to protect Americans with preexisting conditions. The Senate is expected to vote on the resolution next week.

A copy of the letter can be found below.

 

Dear Secretary Azar and Administrator Verma:

We are writing to raise concerns regarding the lack of oversight from the Centers for Medicare and Medicaid Services (CMS) relating to activities by web brokers to steer individuals toward “short-term limited-duration insurance plans,” also known as “junk plans,” that fail to provide protections for pre-existing conditions or comprehensive coverage of health benefits that patients need. As the 2020 Open Enrollment Period for Health Insurance Marketplace coverage approaches, we are also concerned that CMS has failed to establish any requirements for brokers to disclose to consumers the significantly higher commissions that brokers will receive for enrolling an individual in a junk plan versus an Affordable Care Act (ACA)-compliant qualified health plan (QHP).  

CMS includes a link on the HealthCare.gov website to funnel customers toward third-party web broker sites for direct enrollment. For consumers who are re-directed away from HealthCare.gov and toward the web broker site, it is not clear that CMS has any tracking mechanism in place to determine whether the customer: (1) successfully enrolled in an ACA-compliant QHP, (2) was successfully transferred to a state Medicaid program for Medicaid enrollment, (3) was steered into enrollment in a junk plan or (4) was lost in the shuffle.

The lack of CMS oversight of the connection between web brokers and junk plans is particularly concerning given the evidence that brokers have significant financial incentives to steer patients toward junk plans. The typical commission that a broker can receive for enrolling an individual in a junk plan is often four times as high as the commission that the broker would receive for enrolling a customer into an ACA-compliant QHP that provides comprehensive coverage.  Issuers of junk plans are able to offer these higher commissions because, unlike ACA-compliant QHPs, these plans are not required to meet the ACA’s minimum Medical Loss Ratio (MLR) standards. Under the MLR standards, health plans in the individual market are required to devote at least 80 percent of premium revenue toward paying for health care services for enrollees or quality improvement activities. Due to their exemption from the ACA’s MLR standards, junk plans devoted less than 65 percent of premium revenue to health care services on average in 2017.  This allows for larger administrative budgets for junk plans and more lucrative broker commission payments. Under current rules, consumers do not receive any information about the commissions that their brokers receive for facilitating enrollment in various types of health coverage.

These actions by brokers to promote junk plans are alarming. Not only are junk plans allowed to deny coverage or charge higher premiums based on an individual’s pre-existing condition, but these plans also are not required to cover the ACA’s essential health benefits, including maternity care, substance use disorder treatment and prescription medications. A recent analysis of 24 junk plans across 45 states found that only 29 percent offered prescription drug coverage and none of the plans offered maternity care coverage.  These plans are also allowed to establish arbitrary limits on the dollar value of services that will be covered annually. Junk plans are not subject to the ACA’s rules that cap how much an insurer can require an enrollee to pay out-of-pocket each year for medical care. These junk plans present real risks for consumers that are often masked on web broker internet pages and in phone calls with brokers. 

While federal rules prohibit brokers from displaying junk plans side-by-side with ACA-compliant QHPs, brokers can structure their webpages in ways that steer consumers toward higher-commission products, like junk plans.  ACA-compliant QHPs can often be presented on webpages in tabs adjacent to junk plans, with the premium information for each type of plan displayed in the tab without easily-noticeable information on the important differences in coverage and deductibles between QHPs and junk plans.

Equally concerning, web brokers’ online screening tools can fail to identify instances where a customer is eligible for Medicaid.  In other instances, the screening tools may identify potential Medicaid eligibility, but the web broker platform may continue to push a customer to purchase a junk plan. For example, on the GoHealth web broker platform,  if a customer from Manchester, New Hampshire, enters information indicating a household that is composed of a 31-year old mother and a six-year old son, with total income of $15,000, the web broker provides a pop-up notice indicating that the customer “might qualify” for Medicaid, but does not provide any links or additional information for the customer to use to contact the Medicaid program. Instead, when the customer clicks “Continue” to get rid of the pop-up notice, the customer is presented with ACA-compliant QHPs in one tab with full-cost premiums starting at $274 per month and junk plans in another tab with premiums starting at $112 per month. In this instance, the customer is not provided with readily available information warning about the junk plans’ coverage limits.

For states that have not yet expanded Medicaid, the web broker platforms also fail to consistently identify Medicaid eligibility for children that are part of a family application submitted to the broker portal.  Even in cases where the web broker identifies the child’s eligibility, the broker may still steer the customer to a junk plan for family coverage. For example, on the eHealth online platform, if a 31-year old mother from Milwaukee, Wisconsin, with annual income of $15,000 submits information for coverage for herself and her six-year old son, the eHealth portal provides notification of potential Medicaid eligibility and links for the Wisconsin Medicaid website. However, the eHealth portal also suggests that “While you wait for a decision from your state’s Medicaid authority, a short-term health plan can help bridge coverage gaps.” As a part of this same page, the eHealth portal displays a link for a junk plan with a $68 per month quoted premium and no immediate information about the coverage restrictions associated with the junk plan.  This junk plan  does not cover pre-existing conditions, has a $12,500 annual deductible for each family member and does not cover prescription drugs.

In other instances, web broker internet pages are used predominantly as a “lead generation” tool, where customers fill out contact information and then receive follow-up phone calls from a broker to discuss insurance options. For these cases, “secret shopper” research suggests that broker phone calls often involve “aggressive sales tactics, encouraging consumers to purchase [junk plan] coverage over the phone with minimal plan information.”  Broker phone calls are not recorded for subsequent oversight by CMS or other regulators. These findings further underscore the need to improve oversight of broker-based enrollment through HealthCare.gov website links and related direct enrollment agreements with CMS.

To help address the concerns raised in this letter, we request answers to the following questions:

  1. Please explain what protocols or processes, if any, CMS has in place to track whether individuals who access HealthCare.gov and click through to web broker links are ultimately enrolled in a QHP, enrolled in a junk plan, or successfully transferred to a State Medicaid Agency for enrollment in Medicaid. If no such tracking protocols exist, please explain why the agency does not support such tracking and oversight
  2. Please explain how CMS intends to ensure that individuals who access web broker platforms and are eligible for Medicaid are provided with comprehensive information about Medicaid eligibility and successfully transferred to the appropriate State Medicaid Agency.
  3.  Please explain why CMS has not included contractual requirements with its broker partners to require any disclosure to consumers of commissions that web brokers will receive for facilitating enrollment in various types of plans, including junk plans in particular.

An effective and well-functioning health insurance market is only possible if consumers are provided transparent information regarding the scope and cost of coverage available, the tax credits available to consumers to offset premiums for comprehensive health plans and the incentives that brokers have for selling various products. Availability of this transparent information is particularly critical in light of your agency’s decision to reduce funding for Health Insurance Marketplace  advertising, outreach and education efforts by approximately 90 percent compared to 2016 levels. Your regulatory oversight in this area is vitally important to achieving this effective insurance market. We urge you to take this oversight responsibility seriously.

Sincerely,

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WASHINGTON – U.S. Sen. Mark R. Warner (D-VA) took to the Senate floor today to highlight a number of Virginians with preexisting conditions who will be affected if the Senate neglects to overturn a Trump Administration waiver rule that destabilizes our health insurance market, weakens protections for Americans with preexisting conditions, and increases costs for millions Americans with quality health plans.

Today’s floor speech comes in advance of a move by Sen. Warner, who will use a legislative maneuver to force an up-or-down vote in the Senate next week, putting every Senator on the record as to whether they stand with Americans with preexisting conditions, or with the Trump Administration in its effort to undermine our nation’s health care system.

“For the last three years, this President has used every tool at his disposal to try to undermine the ACA. He tried to repeal it twice through Congress. When that failed, the Administration joined a lawsuit that would strike down the ACA with no plan to replace it. The truth is, this Administration is unfortunately actively working to destabilize the insurance market,” Sen. Warner said on the Senate floor. “One way the Administration is attempting to undermine the ACA is with these so-called “short-term” plans. Thanks to this administration, these “junk” plans allow insurance companies to once again discriminate against Americans with preexisting conditions. Make no mistake: these plans are a threat to the stability of the insurance market and to every American with a preexisting condition.”

“Madam President, I fear some members of this body have forgotten what it was like before the Affordable Care Act when an unexpected surgery or a diagnosis of a chronic illness could mean a one-way ticket out of the middle class. Unfortunately, this is not a hypothetical. Recently one of my constituents, a man named Jesse, received a $230,000 medical bill for his back surgery. Unbeknownst to him he had purchased a plan that he thought would cover this, but this plan was unfortunately a junk plan that considered his back injury as a preexisting condition,” he continued. “Jesse is one of the more than 3 million Virginians with a preexisting medical condition. I’ve got 3 daughters. Two of my three daughters have preexisting medical conditions that would not be covered under these junk plans. And today I want to share some of those stories to remind my colleagues of what real people will face if we allow this Administration to continue dismantling these protections that folks count on.”

In his floor speech, Sen. Warner shared several stories from Linda in Warren County; Mindy in Henrico; Sharon in Norfolk; Justine in Loudoun County; Katherine in Blacksburg; Michael in Abingdon; James in Danville; and Lynn in Lynchburg.

In July, Sen. Warner led the entire Democratic caucus in introducing the Protect Pre Existing Conditions Congressional Review Act (CRA) resolution, which, if approved, would roll back a Trump Administration waiver rule that undermines our nation’s health care law and threatens protections for Americans with preexisting conditions. Last month, Sen. Warner successfully filed a discharge petition to bring the CRA resolution to the floor for a vote.  

The Trump Administration’s waiver rule currently gives states the green light to use taxpayer dollars to push “junk plans” – bare-bones plans that don’t meet federal consumer protections and therefore raise premiums for quality insurance plans, increasing costs for older Americans and people with preexisting conditions who need comprehensive coverage. Additionally, under these junk plans, insurance companies can charge people more if they have a preexisting condition, or refuse to cover specific benefits or deny them coverage altogether.

Congressional Review Act resolutions exercise Congress’ authority to review and overturn rules implemented by the executive branch. Unlike other legislation on the Senate floor, a Congressional Review Act resolution only needs a simple majority to pass and can be brought to the Senate floor for a vote with 30 signatures.

 

Sen. Warner’s remarks as prepared for delivery can be found below:

Madam President, I’m here today because protections for Americans with preexisting medical conditions are under attack from this administration.

For the last three years, this President has used every tool at his disposal to try to undermine the ACA. He tried to repeal it twice through Congress. When that failed, the administration joined a lawsuit that would strike down the ACA — with no plan to replace it.

The truth is, this administration is actively working to destabilize the insurance market.

One way the administration is attempting to undermine the ACA is with these so-called “short-term” plans. Thanks to this administration, these “junk” plans allow insurance companies to once again discriminate against Americans with preexisting conditions.  

Make no mistake: these plans are a threat to the stability of the insurance market and to every American with a preexisting condition.

That’s why I’ve introduced a resolution that will force an up-or-down vote on the administration’s rule that pushes more of these junk plans on unsuspecting consumers and significantly increases costs for other Americans.

Madam President, I fear some members of this body have forgotten what it was like before the Affordable Care Act when an unexpected surgery or a diagnosis of a chronic illness could mean a one-way ticket out of the middle class.

Unfortunately, this is not a hypothetical. Recently one of my constituents a man named Jesse received a $230,000 medical bill for his back surgery. Unbeknownst to him he had purchased a junk plan that considered his back injury as a preexisting condition.

Jesse is one of the more than 3 million Virginians with a preexisting medical condition.

And today I want to share some of their stories…to remind my colleagues of what real people will face… if we allow this administration to continue dismantling these protections that folks count on.

Recently I got an email from Linda in Warren County, VA. She is a cancer survivor with multiple preexisting conditions. She wrote:

“Due to the housing fallout in 2008, we lost our health coverage and I could no longer get health coverage because of my cancer diagnosis.”

Mindy from Henrico is also a cancer survivor. She writes:

“Even though my cancer is in partial remission, I remain on treatment for fear of the cancer returning again. As I prepare for retirement, it scares me to think that this cancer would be considered a preexisting condition and I could be denied health care or would be required to pay through the nose for insurance.”

Sharon in Norfolk told me about her struggle with behavioral health issues. She writes:

I am a functioning member of society, however that will not last long if I lose this access to medical help. I went off my medications in 2000 as I couldn't afford a doctor and medication and it was a very thin line between me and homelessness.

Justine from Loudoun County is worried she could lose coverage for her diabetes. Here’s her message for the members of this body:

What if you or a loved one was diagnosed with a “preexisting condition?” How would you feel being denied health coverage?

It’s a good question that we should all ask ourselves, Madam President. As a father, I’ve dealt with the scary reality of having a child with juvenile diabetes and a child with asthma. But I’m also an extraordinarily lucky individual. I knew that because of insurance and because I had the resources, they would be taken care of.

Katherine in Blacksburg, VA told me about her daughter who was diagnosed at age three with juvenile diabetes. She writes:

“Until there is a cure for diabetes, I cannot imagine how costly it will be for her to stay alive and manage her health if there are limitations on coverage for people with preexisting conditions.”

Madam President, Katherine’s daughter deserves access to care just as much as mine does.

I got a letter from a pharmacist in Abingdon named Michael. He treats diabetics every day, and he also knows what it’s like… because he’s lived with the disease for 38 years. He writes:

“Without insulin we will die…If coverage for preexisting conditions goes away, you will see a large decline in the health of type 1 diabetics, and more dependence upon Medicaid.”

I have far too many of these stories to share them all today.

James from Danville told me about his 10 separate preexisting conditions.

Lynn from Lynchburg is on three separate medications due to a brain tumor. She could die if her insurance didn’t cover them.

The list goes on.

In closing, Madam President, when we talk about preexisting conditions, we are talking about people’s lives.

That’s why we must pass the resolution I’ve introduced to reverse the Administration’s harmful rule changes…and defend protections for folks with preexisting conditions.

Next week, we will all have the opportunity to go on the record with an up-or-down vote to defend these protections and restore these critical guardrails.

My colleagues across the aisle insist that they actually support protections for folks with preexisting conditions – well this will be their chance to prove it.

Thank you, Madam President.

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WASHINGTON, D.C. – Today, U.S. Senators Mark R. Warner and Tim Kaine announced $504,450 in federal funding through the U.S. Department of Health and Human Services (HHS) for the Mount Rogers Health District in Southwest Virginia, which oversees eight localities at the epicenter of the addiction crisis. The funding will allow the district to partner with researchers across the country on solutions to address the addiction crisis in Southwest Virginia. 

“The drug addiction crisis has hurt every region of Virginia. We need to invest in more resources to better understand how to prevent and combat substance use disorders,” the Senators said. “This funding will help expand services for families impacted by addiction and support studies that explore how early exposure to substance abuse affects young people.”

The Mount Rogers Health District serves Bland, Carroll, Grayson, Smyth, Washington, and Wythe counties, and the cities of Bristol and Galax. The first round of this project will build capacity at partner sites. The second round will support a ten-year longitudinal study.

 

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WASHINGTON – Today, U.S. Sens. Mark R. Warner and Tim Kaine (both D-VA) requested information from Virginia’s insurance commission on how the Trump Administration’s push for “junk” health insurance plans is affecting protections for Virginians with preexisting conditions. The “junk plans,” which are permitted to discriminate against Americans with preexisting conditions such as diabetes, asthma and cancer, are part of the Trump Administration’s overall effort to undermine the success of the Affordable Care Act and eviscerate protections for people with preexisting conditions. Senate Democrats, led by Sen. Warner, will force a vote on the Senate floor before the end of the month to overturn the Trump Administration’s rule on junk plans and protect people with preexisting conditions.

“We have heard concerning reports that individuals nationwide – particularly Americans with preexisting conditions – are unknowingly enrolling in these deceptively marketed junk plans that fail to cover many essential health care services,” wrote the Senators in today’s letter to the State Corporation Commission (SCC). “Just this month, Bloomberg reported Arizona resident David Diaz unknowingly purchased a short-term health plan that did not cover preexisting conditions and placed ambiguous limits on emergency room care and other essential health care services. His family has been left with hundreds of thousands of dollars in medical debt. The Washington Post similarly reported on Jesse Lynn, who purchased a short-term health plan not realizing his back problem would be considered a preexisting condition. Jesse’s insurance company refused to cover his care – forcing his family into bankruptcy. No family should be forced into bankruptcy because of a pre-existing medical condition or obscure coverage limits on care.”

A rule issued by the U.S. Department of Health and Human Services (HHS) under the Trump Administration allows states to ignore federal consumer protections and use taxpayer dollars to subsidize junk insurance plans that cover less and cost more. Additionally, under this rule, states can give insurance companies the green light to discriminate against Americans with preexisting conditions by increasing costs, limiting coverage, or denying coverage altogether.

The Senators continued, “The Patient Protection and Affordable Care Act (ACA) established clear protections to prohibit insurance companies from discriminating against individuals with preexisting conditions and also required insurers to spend a minimum amount of their customer’s premium dollars on medical care. We are concerned the short-term health plans HHS has touted gut these protections and empower insurance companies to deny coverage to individuals with preexisting conditions, place arbitrary coverage limits on essential health care services and charge individuals more for services such as mental health care and maternity care.”

In their letter to SCC Commissioners Mark Christie, Judith Williams Jagdmann, and Patricia West, the Senators cited a study by the National Association of Insurance Commissioners that found that junk plans spend only 39 percent of patient premiums on medical care, whereas insurance plans under the ACA are required to spend at least 80 percent of these premiums on medical care. They also requested answers to the following questions regarding the effect of junk plans on Virginians:

  1. How many Virginia residents are currently enrolled in short-term limited-duration insurance plans?
  2. Has the Commission received complaints from Virginia residents regarding the marketing practices of such plans? If so, summarize the substance of the complaints and the number of complaints the Commission has received. 
  3. How is the Commission working to ensure that individuals obtain quality, comprehensive coverage during the upcoming open enrollment period?
  4. Has the Commission taken any enforcement actions against companies that have mislead consumers as to what their plans will cover?
  5. How is the Commission collaborating with other states to limit the proliferation of junk plans and ensure that individuals have access to both the necessary information and comprehensive coverage they need?

Sens. Warner and Kaine have long fought against the Trump Administration’s efforts to dismantle our nation’s health care law. Two weeks ago, Sens. Warner and Kaine urged the HHS and the Centers for Medicare & Medicaid Services (CMS) to limit the proliferation of junk plans. Additionally, they introduced a Congressional Review Act resolution led by Sen. Warner earlier this year to stop the Trump Administration from promoting junk plans, and Sen. Warner filed a discharge petition last month that will force the Senate to vote before November 12 on whether to roll back the rule allowing these harmful changes.

The letter text can be found below and a PDF copy is available here.

 

October 16, 2019

Mark C. Christie                                 

Commissioner                                    

State Corporation Commission          

P.O. Box 1197                                     

Richmond, Virginia 23218      

Judith Williams Jagdmann

Commissioner

State Corporation Commission

P.O. Box 1197

Richmond, Virginia 23218

Patricia L. West

Commissioner

State Corporation Commission

P.O. Box 1197

Richmond, Virginia 23218

Dear Commissioners Christie, Williams Jagdmann and West:

We write to express our concern with recent reports on the expanded use of short-term limited-duration insurance (STLDI) “junk plans” that weaken protections for Americans with preexisting conditions and increase costs for millions more. As you are likely aware, the U.S. Department of Health and Human Services has made a series of recent changes to increase enrollment in short-term health plans. We have heard concerning reports that individuals nationwide – particularly Americans with preexisting conditions – are unknowingly enrolling in these deceptively marketed junk plans that fail to cover many essential health care services.

Just this month, Bloomberg reported Arizona resident David Diaz unknowingly purchased a short-term health plan that did not cover preexisting conditions and placed ambiguous limits on emergency room care and other essential health care services. His family has been left with hundreds of thousands of dollars in medical debt. The Washington Post similarly reported on Jesse Lynn who purchased a short-term health plan not realizing his back problem would be considered a preexisting condition. Jesse’s insurance company refused to cover his care – forcing his family into bankruptcy. No family should be forced into bankruptcy because of a preexisting medical condition or obscure coverage limits on care.

The Patient Protection and Affordable Care Act (ACA) established clear protections to prohibit insurance companies from discriminating against individuals with preexisting conditions and also required insurers to spend a minimum amount of their customer’s premium dollars on medical care. We are concerned the short-term health plans HHS has touted gut these protections and empower insurance companies to deny coverage to individuals with preexisting conditions, place arbitrary coverage limits on essential health care services and charge individuals more for services such as mental health care and maternity care. A recent study released by the National Association of Insurance Commissioners found that such plans spend just 39 percent of patient premiums on medical care. In contrast, insurance plans under the ACA are required to spend at least 80 percent of patient premiums on medical care.

Given the harmful effect these plans are having on families nationwide and broad agreement on their serious shortcomings we would like to gain a better understanding of how these plans are marketed and used in Virginia. To that end we would like to know:

1. How many Virginia residents are currently enrolled in short-term limited-duration insurance plans?
2. Has the Commission received complaints from Virginia residents regarding the marketing practices of such plans? If so, summarize the substance of the complaints and the number of complaints the Commission has received.
3. How is the Commission working to ensure that individuals obtain quality, comprehensive coverage during the upcoming open enrollment period?
4. Has the Commission taken any enforcement actions against companies that have misled consumers as to what their plans will cover?
5. How is the Commission collaborating with other states to limit the proliferation of junk plans and ensure that individuals have access to both the necessary information and comprehensive coverage they need?

Thank you for your consideration of this letter. We look forward to your responses to these questions and to working with you on this important issue.

Sincerely,

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