WASHINGTON – U.S. Sens. Mark R. Warner and Tim Kaine, a member of the Senate Health, Education, Labor, and Pensions (HELP) Committee, joined Senators Tammy Baldwin (D-WI), Bernie Sanders (I-VT) and Ron Wyden (D-OR) in calling on the Biden Administration to swiftly enact and continue to strengthen a proposed rule to limit the availability of short-term limited duration insurance (STLDI) plans, which are commonly referred to as “junk plans.” Junk plans provide inadequate coverage and deny coverage to people with pre-existing conditions.

In July, following pressure from Sens. Warner, Kaine, and their colleagues, the Biden Administration released new draft regulations to roll back a 2018 Trump Administration effort that made junk plans more widely available to consumers. Since 2018, these plans have continued to proliferate. However, they are not required to adhere to important standards, including protections for people with pre-existing conditions and coverage for essential health benefits like maternity care or mental health services. Once finalized, the Biden Administration’s rule will restore a 90-day limit on the use of junk plans, instead of the current four-year maximum, so they can only be used on a temporary basis as intended, such as when people are transitioning from one plan to another.

In a letter to Department of Health and Human Services Secretary Xavier Becerra, Department of Labor Acting Secretary Julie Su, and Department of Treasury Secretary Janet Yellen, the senators urged the Biden Administration to swiftly enact the proposed rule, continue to strengthen protections, and increase transparency on junk plans to protect Americans from this inadequate coverage. 

“We applaud your efforts to protect Americans who may have been duped into these junk plans, and urge the Biden Administration to swiftly finalize the rule and bolster our collective efforts to expand access to affordable, comprehensive health coverage,” wrote the senators. “With this new proposal, the Biden Administration is taking action to better protect consumers and promote access to affordable, comprehensive health insurance.”

In addition to expressing support for the Biden Administration’s proposed rule, the senators urged administration leaders to take further measures to protect consumers as they finalize the new rule on STLDI plans, including cracking down on the practice of “stacking,” or repeatedly enrolling the same consumer in junk plans across different issuers. The senators also called on the Biden Administration to bring greater transparency to junk plans through disclosure and reporting requirements and to consider additional protections for individuals shopping for coverage during the annual Open Enrollment period, which is set to begin November 1.

“For too long, junk plans were able to proliferate unchecked, resulting in increased exposure to financial harm for consumers. By finally limiting the duration of these plans and providing better protections for consumers, we are helping ensure that when families spend their hard-earned dollars on health insurance, they get the high-quality coverage they deserve,” concluded the senators.

Joining Sens. Warner, Kaine, Baldwin, Sanders, and Wyden in signing the letter were Senators Michael Bennet (D-CO), Richard Blumenthal (D-CT), Cory Booker (D-NJ), Bob Casey (D-PA), Catherine Cortez Masto (D-NM), Dianne Feinstein (D-CA), Maggie Hassan (D-NH), John Hickenlooper (D-CO), Ben Ray Luján (D-NM), Ed Markey (D-MA), Robert Menendez (D-NJ), Christopher Murphy (D-CT), Alex Padilla (D-CA), Jeanne Shaheen (D-NH), Tina Smith (D-MN), Debbie Stabenow (D-MI), Chris Van Hollen (D-MD), Elizabeth Warren (D-MA), and Peter Welch (D-VT).

A full version of the letter is available here and below.

Dear Secretaries Becerra, Su, and Yellen:

We write in support of the Department of Health and Human Services (HHS), the Department of Labor, and the Department of the Treasury’s (collectively, the Departments’) long-awaited proposal to address short-term limited duration insurance (STLDI) plans. In 2018, the previous administration sought to sabotage the Affordable Care Act (ACA) by expanding access to STLDI plans that can deny coverage to people with preexisting conditions and fail to provide adequate health care coverage when Americans need it most. While STLDI plans have their purpose, such plans provide junk coverage when compared to high-quality, comprehensive coverage. We applaud your efforts to protect Americans who may have been duped into these junk plans, and urge the Biden Administration to swiftly finalize the rule and bolster our collective efforts to expand access to affordable, comprehensive health coverage.

In 2018, regulations issued by the previous administration rewrote the definition of STDLI coverage, allowing these plans to expand their term of coverage from three months to 364 days with the option to renew for up to three years. Unlike marketplace plans, STLDI plans are not required to comply with consumer protections that limit out-of-pocket costs or coverage of essential health benefits, including mental health services, treatment for substance-use disorder, prescription drugs, and maternity care. Furthermore, these plans engage in discriminatory practices, such as retroactive coverage rescissions, medical underwriting, and lifetime and annual caps, which were commonplace before the ACA. Since 2018, many consumers shopping for coverage may not have understood that they were buying a plan that puts them at risk for pre-existing conditions and coverage gaps.

With this new proposal, the Biden Administration is taking action to better protect consumers and promote access to affordable, comprehensive health insurance. We appreciate the Department’s efforts to hold true to a definition of “short-term” that is just that – short term. STLDI policies were originally intended to temporarily fill gaps in coverage while people transition between jobs or when students were required to disenroll from student health coverage over the summer months. As such, we believe these plans should be strictly limited to three months without the option for extensions.

We also strongly support the proposal to prevent insurance companies or brokers from repeatedly enrolling the same consumer in STLDI coverage, a practice known as “stacking,” and request that the Administration do more to prohibit stacking of STLDI plans across different issuers. In addition, as we continue to ensure that Americans have access to affordable coverage, it is critically important for Congress, state regulators, researchers, stakeholders, and federal departments to understand the true impact of the junk insurance market on the ACA marketplaces and other forms of high-quality coverage. As a part of this rulemaking, we strongly urge the agencies to implement policies that would bring greater transparency to these products including disclosure and reporting requirements for intermediary entities such as brokers, associations, and lead generators.

Finally, we urge the Administration to consider additional protections for individuals who may be shopping for coverage during the ACA’s annual Open Enrollment (OE) period.

Fraudsters, always looking for opportunities to take advantage of consumers, are enrolling individuals into plans without their consent, and numerous studies have documented the use of deceptive and misleading marketing to lure consumers into junk plans. We urge the Departments to proactively work with state insurance commissioners to address misleading marketing practices. High-quality insurance coverage is now more affordable than ever before thanks to the enhanced premium tax credits passed as part of the American Rescue Plan Act and the Inflation Reduction Act, as well as the Administration’s efforts to fix the “family glitch” which eliminated the subsidy cliff that impacted over five million Americans. It is our responsibility to ensure that the OE period, which is set to begin on November 1, is as successful as possible in promoting access to high-quality, affordable coverage.

For too long, junk plans were able to proliferate unchecked, resulting in increased exposure to financial harm for consumers. By finally limiting the duration of these plans and providing better protections for consumers, we are helping ensure that when families spend their hard-earned dollars on health insurance, they get the high-quality coverage they deserve.

Sincerely,

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CLICK HERE TO DOWNLOAD HIGH-QUALITY VIDEO OF SEN. WARNER ON THE SENATE FLOOR

WASHINGTON – Today, U.S. Sen. Mark R. Warner (D-VA), Chairman of the Senate Select Committee on Intelligence, spoke on the Senate floor to celebrate the confirmation of Michael C. Casey to serve as Director of the National Counterintelligence and Security Center.

“Mike’s understated style, compassion, intelligence, and deep knowledge of security and intelligence issues has been essential to the Committee’s smooth and bipartisan functioning for many years,” said Sen. Warner on the floor of the U.S. Senate. “So it is with a mixture of both regret and pride that we say goodbye to Mike as he embarks on this new role.”  

Sen. Warner’s remarks as prepared for delivery:

Mister President:

I rise today to say a few words about someone who has been an essential part of the Senate community for many years now.

I proud to note that earlier this week [Tuesday evening], the Senate unanimously confirmed the nomination of Mike Casey to serve as Director of the National Counterintelligence and Security Center. 

At a time when the U.S. is facing tremendous foreign intelligence and security threats, it is enormously important to have a Senate-confirmed leader at the head of the NCSC, which is charged with protecting against insider threats, supply chain risks, and other counterintelligence issues.

The position has been vacant since the end of the last administration, so as Chairman of the Senate Intelligence Committee, I’m glad that we’ll now have a Senate-confirmed leader in place to lead efforts to protect against foreign threats… protect U.S. critical infrastructure… and advance the counterintelligence and security mission. 

But while I can recognize that this development is good for our national security… it is also a tremendous loss for the Senate Intelligence Committee, where Mike Casey has ably served as staff director for the last eight years. 

He began his service 28 years ago in the House of Representatives, eventually joining the staff of the House Armed Services Committee before Senator Feinstein lured him over to the upper chamber to serve as Staff Director for the Senate Intelligence Committee in 2016. 

I’ve worked closely alongside Mike ever since. He was an indispensable part of the three-and-a-half year Russia investigation… working alongside his counterparts in what was then- the Committee’s Republican majority to produce the Committee’s bipartisan and definitive report on Russia’s interference in the 2016 Presidential election. 

That was a task which he embraced with the dedication and thoroughness for which Mike is known. Even though the Committee’s staff generally prefers to do their work quietly and behind the scenes, they never buckled or wavered, despite unprecedented media and political scrutiny. The result of that work speaks for itself, and is a testament in no small part to Mike’s leadership as staff director. 

Mike’s understated style… compassion…  intelligence…  and deep knowledge of security and intelligence issues has been essential to the Committee’s smooth and bipartisan functioning for many years. 

I am convinced at this point that Mike knows virtually everything and everyone in the intelligence community, which, as my colleagues can imagine, is an enormous asset in making sure that the Committee is able to conduct our bipartisan oversight work in a robust fashion.  

So it is with a mixture of both regret and pride that we say goodbye to Mike as he embarks on this new role.

As Director of the National Counterintelligence and Security Center, Mike will face many of the same challenges with which we have wrestled on the Intelligence Committee. 

The truth is, national security is no longer simply about how has the most planes, ships, tanks, and guns. It’s also about artificial intelligence… quantum computing… 5G… cybersecurity… fusion energy… and all of the other innovations that our fueling both our economic and our national security... because whoever leads in technology will have an edge in the national security competition of the future. 

And that is not the only challenge that awaits Mike as he embarks on this new chapter… as he’ll be charged with helping to implement badly-needed reforms to our security clearance systems… so that we can do a better job of protecting our nation’s secrets from further unauthorized disclosures… while also making sure that our intelligence agencies are able to quickly and efficiently hire and retain the best and the brightest workforce.  

So, while Mike Casey might be leaving my staff… it’s safe to say he won’t be leaving my speed dial.

We’ll miss you, Mike. 

And remember: don’t screw it up.

Thank you, Mister President.

WASHINGTON – Today, U.S. Sens. Mark R. Warner (D-VA) and John Thune (R-SD) led a group of colleagues in a letter to Anne Milgram, Administrator of the Drug Enforcement Administration (DEA), expressing support for the agency’s new engagement on a potential special registration for telehealth but sharing serious concerns over the agency’s proposed rules on the future of prescribing controlled substances via telehealth. Despite efforts by Sen. Warner to ensure continued access to telehealth services following the end of the COVID-19 Public Health Emergency (PHE), the DEA’s rules as proposed would drastically affect patient care.

Joining Sens. Warner and Thune in this letter are U.S. Sens. Catherine Cortez Masto (D-NV), Shelley Moore Capito (R-WV), Sheldon Whitehouse (D-RI), and Dan Sullivan (R-AK).

At the start of the pandemic, the DEA acted swiftly to take advantage of exceptions detailed in the Ryan Haight Online Pharmacy Consumer Protection Act that allowed the agency to waive in-person requirements for prescribing controlled substances in the case of a Public Health Emergency (PHE). With the expiration of the COVID-19 PHE earlier this year, however, the DEA announced a proposed rule detailing their plans for prescribing these medications via telehealth going forward that would limit the ability of doctors to prescribe controlled substances without an in-person visit and place unnecessary requirements on care providers. The proposed rule would only allow a 30-day supply of a schedule III-V non-narcotic medication prior to an in-person medical evaluation, and would not permit any initial supply for schedule II or schedule III-V narcotic medication.

The senators wrote, “Although we appreciate the limited flexibilities proposed by the rule, they are insufficient to meet the health care needs of our constituents and the needs of the providers who care for them. We support the Drug Enforcement Administration (DEA) extending the full set of telehealth flexibilities through November 2023 and are encouraged by the upcoming public listening sessions on the proposed regulations. We urge the DEA to consider feedback from health care stakeholders and apply the lessons learned from the COVID-19 pandemic to ensure patients maintain access to care through telehealth, while still minimizing diversion and fraud.”

Highlighting the difficulty patients have scheduling in-person appointments, the senators continued, “We have concerns about our constituents’ ability to obtain in-person appointments within 30 days of starting a new medication, and the potential consequences to their health of starting a new medication and abruptly ending it should they not be able to obtain such an appointment. It takes on average 26 days to schedule a new patient appointment with a health care provider. Therefore, a 30-day supply could result in patients going without their medication while they wait for an in-person appointment or will turn to higher-acuity and higher-cost settings of in-person care to meet this deadline, such as emergency departments.” 

The senators also called attention to a rule Congress created as part of the SUPPORT for Patients and Communities Act that requires the DEA create a registration for telemedicine practitioners who would not be subject to mandatory in-person medical evaluations. The goal of this special registration is to allow medical evaluations over telehealth more broadly, which the senators state this DEA rule does not accomplish.

Over the course of the COVID-19 pandemic, tremendous progress was made to ensure that patients could receive care without interruption. Reinstating these hard limits on telehealth would be taking a step backwards, and have serious impacts on the care options for thousands of patients. Sen. Warner has consistently led efforts to expand telehealth accessibility, introducing legislation to expand telehealth services and repeatedly calling on congressional leadership to extend telehealth services after the end of the pandemic.

A copy of the letter is available here and text is below:

Dear Administrator Milgram:

On behalf of our constituent patients, health care providers, and pharmacists, we’re writing to share strong concerns with the notice of proposed rulemaking on the future of controlled substances prescribing over telehealth. Although we appreciate the limited flexibilities proposed by the rule, they are insufficient to meet the health care needs of our constituents and the needs of the providers who care for them. We support the Drug Enforcement Administration (DEA) extending the full set of telehealth flexibilities through November 2023 and are encouraged by the upcoming public listening sessions on the proposed regulations. We urge the DEA to consider feedback from health care stakeholders and apply the lessons learned from the COVID-19 pandemic to ensure patients maintain access to care through telehealth, while still minimizing diversion and fraud.

Proposed Rule

As you know, the Ryan Haight Online Pharmacy Consumer Protection Act of 2008 (“Ryan Haight Act”) offered seven exceptions to the in-person medical evaluation requirement when providers are engaged in the “practice of telemedicine;” a public health emergency is one such exception, and we’re grateful the DEA moved swiftly to utilize that exception during the COVID-19 pandemic.

However, we are concerned that the proposed rule undermines the gains made during the PHE that saw expanded access to critical health care services through telehealth

Initial supply: Prior to an in-person medical evaluation, the proposed rule permits a DEA-registered prescriber to provide an initial 30-day supply of a controlled substance for non-narcotic schedule III-V medications. We have concerns about our constituents’ ability to obtain in-person appointments within 30 days of starting a new medication, and the potential consequences to their health of starting a new medication and abruptly ending it should they not be able to obtain such an appointment. It takes on average 26 days to schedule a new patient appointment with a health care provider. Therefore, a 30-day supply could result in patients going without their medication while they wait for an in-person appointment or will turn to higher-acuity and higher-cost settings of in-person care to meet this deadline, such as emergency departments.

Despite the 180-day grace period after the end of the PHE, new and existing patients will be seeking in-person appointments simultaneously in a health care system that is already burdened by a shortage of health care providers. According to the U.S. Department of Health and Human Services, 163 million Americans live in Mental Health Care Health Professional Shortage Areas.  Approximately 8,200 additional psychiatrists would be needed nationwide just to remove this shortage designation.  Nationwide averages also obscure the variation among states and territories; for example, Arizona has only 8.5% of its psychiatric health care needs met and would need 227 psychiatrists to meet 100% of these needs.  And beyond mental health care, 100 million Americans live in Primary Care Health Professional Shortage Areas, with more than 17,000 primary care providers needed at a minimum to remove the designation. 

Medical societies representing health care providers and their patients nationwide have encouraged a window of longer than 30 days for an initial prescription in order to provide enough time to obtain an appointment: the American Medical Association (AMA) and the American Psychiatric Association recommend 180 days, with the Association of American Medical Colleges (AAMC) urging no less a 90-day maximum when the provider believes it is appropriate. In addition, the AMA and the AAMC recommend that existing patients have one year to fulfill the in-person appointment requirement.

Provider safety: The proposed rule requires the prescribing provider to report their physical address at the time of the telemedicine appointment. Health care providers have shared they sometimes do telemedicine appointments from their home and have safety and privacy concerns with their home address being on the prescription. We urge you to allow providers to use the business address of their DEA registration.

Referrals:

• Referring providers: The proposed rule requires that an in-person medical evaluation be performed by a DEA-registered provider before a referral to another DEA-registered provider who would be permitted to prescribe a controlled substance over telehealth. We are concerned that individuals without adequate in-person access to a DEA-registered provider will see their health care treatment options limited should they be referred to a specialist for a telehealth appointment, or instead a second in-person medical evaluation would be required with a DEA-registered provider prior to seeing a specialist, which would increase costs to the patient and the health care system as a whole. We urge you to work with health care providers to ensure patients do not encounter any truly unnecessary barriers to care.  
• Prescribing practitioner: The proposed rule requires a referring provider to specifically include the name and National Provider Identifier (NPI) of the prescribing practitioner to which the referring prescriber is referring the patient. In practice, patients are often referred to a group practice where they see whichever specialist has a first available appointment. Or, referrals may not have a provider indicated at all, as the patient often has to explore insurance network coverage and new patient availability. This requirement may prevent patients from receiving the legitimate health care services they need.

Recordkeeping: Finally, we have heard widespread concerns about additional recordkeeping and other administrative burdens required from providers and pharmacies. This additional administrative burden will strain an already exhausted workforce could also deter providers from being able to provide this care. Stakeholders have shared that existing recordkeeping requirements should be sufficient for the purpose of DEA being able to combat diversion and fraud, and we encourage you to work with providers on the least burdensome path forward.

Special Registration

In addition to the PHE exception to the Ryan Haight Act discussed above, Congress also created a “special registration” exception, not as an option for DEA to utilize but a requirement to do so most recently in the SUPPORT for Patients and Communities Act (“SUPPORT Act”). We do not believe this NPRM fulfills DEA’s obligation to create a special registration.

Congress envisioned this special registration to allow certain health care providers to be cleared and registered to use their clinical judgment when a medical examination can be done over telehealth for the purposes of a controlled substances prescription. DEA envisioned this to be the case, as well: in the preamble to Ryan Haight Act implementation regulations, DEA wrote:

“Special registration for telemedicine—a practitioner who is engaged in the practice of telemedicine within the meaning of the Act is not subject to the mandatory in-person medical evaluation requirement of 21 U.S.C. 829(e) (although such practitioner remains subject to the requirement that all prescriptions for controlled substances be issued for a legitimate medical purpose.”

Although we appreciate DEA not requiring a special registration for the initial prescriptions currently proposed, we are concerned that the proposed rule does not include the special registration directed to be created by Congress and even envisioned by the DEA. However, we are pleased to see DEA recently indicate further consideration of a special registration process that would allow clinicians to prescribe a controlled substance via telemedicine without an in-person visit. We appreciate the continuation of the comment process via public listening sessions, and encourage the DEA to review and incorporate stakeholders’ feedback in future rulemaking related to telemedicine prescribing.

In addition to allowing qualified health care providers to determine when a medical evaluation over telehealth is appropriate, a special registration would also provide a framework to evaluate the appropriateness of certain prescribers having the ability to prescribe over telehealth medications not covered by the post-COVID-19 proposed rule, namely Schedule II medications and Schedule III-V narcotic medications.

Health care providers across the board continue to ask for a special registration process that would provide a pathway for certain providers to provide more care involving controlled substances over telehealth than the proposed rule allows, and we implore DEA to follow its statutory requirements under the Ryan Haight Act and the SUPPORT Act and do just that.

Thank you for your consideration of these concerns, and we look forward to continuing to work with you on these important issues.

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WASHINGTON– Today, U.S. Sens. Mark R. Warner and Tim Kaine announced $17,259,239 in federal funding to improve infrastructure at airports across Virginia. The funding was awarded by the U.S. Department of Transportation’s Federal Aviation Administration (FAA)’s 2023 Airport Improvement Program (AIP) Grant Program, which funds airport infrastructure projects such as runways, taxiways, airport signage, airport lighting, and airport markings. In 2023, Virginia’s regional airports have already received $56,828,185 through the AIP.

“Our regional airports are critical for economic development in our communities,” said the senators. “We’re glad this federal funding will help improve safety and reliability by upgrading infrastructure at airports across the Commonwealth.”

The funding is distributed as follows:                                                        

• $4,875,000 for the Winchester Regional Airport to reconstruct its apron.
• $4,018,500 for the Leesburg Executive Airport to rehabilitate its apron, which Kaine recently announced in a visit to the airport.
• $3,401,884 for the Danville Regional Airport to rehabilitate its apron.
• $3,348,877 for the Manassas Regional Airport to reconstruct the taxiway.
• $951,500 for the Accomack County Airport in Melfa to construct a taxiway and light, mark, or remove non-hazardous obstructions like nearby buildings and towers in its airspace.
• $600,748 for the Lee County Airport in Jonesville to improve safety at the airport by installing navigational aids (NAVAIDS) and a runway vertical/visual guidance system, reconstructing airfield guidance signs, and rehabilitating lighting on the runway.
• $62,730 for the Mountain Empire Airport in Smyth County to reconstruct or replace the airport’s lighting vault, which houses the regulators, controls, and other equipment necessary to power and control airfield lighting systems.

Sens. Warner and Kaine have long supported Virginia’s airports. Earlier this year, the senators announced federal grants of over $44 million and $6 million to enhance airport safety and capacity. Sen. Kaine has also introduced legislation to address aviation workforce shortages by supporting the education, recruitment, and development of pilots, aviation maintenance workers, and aerospace manufacturing workers.

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WASHINGTON – Ahead of a Tuesday oversight hearing in the Senate Banking Committee with Securities and Exchange Commission (SEC) Chairman Gary Gensler, U.S. Sens. Mark R. Warner (D-VA) and Sherrod Brown (D-OH) reintroduced legislation to require publicly traded companies to disclose information regarding workforce management metrics, including investments made in skills training, workforce safety, and employee retention.

“Workers are the most valuable resource a company can have, but without a clear set of standards for reporting, the investment that public companies make in their personnel are next-to-impossible to track,” said Sen. Warner. “This legislation will help provide a clearer picture of how public companies are managing, supporting, and investing in their workers – factors that significantly influence a company’s ability to innovate and compete.”

“Big Tech and other corporations use subcontracting and outsourcing to hide their total number of workers. The result is that too many workers are invisible under current disclosure requirements,” said Sen. Brown. “The Workforce Investment Disclosure Act will finally shed some sunlight on how companies outsource and subcontract their workers and allow the public to scrutinize what these companies are doing to invest in their workers.”

Since the start of his tenure in 2021, Chair Gensler has stated disclosure of these workforce metrics would be a priority of his agenda, but a rule making this a requirement has yet to be proposed. The Workforce Investment Disclosure Act would require public companies disclose basic human capital metrics, which have an increasingly high value across industries in our 21st century economy. These metrics include workforce turnover rates, skills and development training, workforce health and safety, workforce engagement, and compensation statistics.

Specifically, the legislation would build on existing disclosure requirements by requiring companies to disclose:

• Demographic information;
• Data on temporary and contract workers;
• Employee turnover rate;
• Employee skills and capabilities;
• Workforce health, safety, and well-being, including findings of harassment or discrimination; and
• Employee compensation, benefits, and incentives.

Sen. Warner, a former entrepreneur and venture capitalist, has long stressed the importance of updating human capital disclosure requirements to reflect the priorities of modern companies. First introducing the Workforce Investment Disclosure Act in 2020, Sens. Warner and Brown have also urged the SEC to implement improvements to their human capital disclosure rules including for part-time employees.

Full text of the bill is available here. 

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WASHINGTON – Today, U.S. Sens. Mark R. Warner and Tim Kaine (both D-VA) praised an announcement by United States Trade Representative (USTR) Ambassador Katherine Tai that the Republic of India will reduce prohibitively high tariffs on U.S. turkey products – an important Virginia commodity.

“For months we’ve urged the U.S. Trade Representative to work to reduce the tariffs that make it difficult for Virginia’s producers to export poultry products to India. Today, we’re proud to report that USTR has finally come to an agreement with India to reduce these retaliatory tariffs. This move will help strengthen the strong partnership between our two nations while generating increased demand for Virginia poultry and supporting economic activity in the Valley,” said Sens. Warner and Kaine.

“The National Turkey Federation applauds the efforts by the U.S. and Indian governments to significantly reduce the tariffs. This move creates an important new market for U.S. turkey producers and will give Indians more affordable access to a nutritious, delicious protein,” said Joel Brandenberger, President and CEO of National Turkey Federation. “NTF congratulates the Office of the U.S. Trade Representative and the leadership of USDA on this accomplishment, and we thank Senators Mark R. Warner and Thom Tillis for spearheading congressional efforts to ensure U.S. turkey growers are able to effectively compete in this fast-growing marketplace.”

In 2021, Virginia was the sixth largest turkey source in America after producing 14.5 million birds. Turkey production plays a key role in the Commonwealth's poultry industry, which provides a direct economic impact of $5.8 billion and contributes $13.6 billion in economic activity in Virginia.

Sens. Warner and Kaine have been strong proponents of lowering tariffs that harm Virginia poultry producers. In June, ahead of Indian Prime Minister Narendra Modi’s visit to the United States, the Senators were joined by a number of their colleagues in urging Ambassador Tai to increase market access for U.S. turkey and poultry products. These products previously faced significant barriers to the Indian market due to prohibitively high tariff rates. Earlier this year, Sen. Warner also praised the end of retaliatory tariffs on apples, another major Virginia commodity.

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WASHINGTON — Today, U.S. Sens. Mark R. Warner and Tim Kaine (both D-VA) announced $16,395,565.20 in federal funding, courtesy of the Middle Mile Broadband Infrastructure Grant Program, awarded to the Mid-Atlantic Broadband Communities Corporation (MBC) to deploy broadband and expand access to high-speed internet throughout Virginia.

The funding will be used to construct approximately 130 miles of new fiber to build eight open-access middle mile fiber segments, the physical high-capacity fiber optic cables needed to connect internet service providers to larger data centers and local networks, which will support service for residential and business customers and provide critical broadband connectivity to 32 industrial and business park sites in 12 Virginia localities across Central and Southside Virginia.

“Access to high-quality, high-speed internet is crucial in the 21^st century,” said the senators. “We are proud to have played a key role in creating and passing legislation that continues to deliver substantial funding to Virginia in order to achieve universal broadband coverage across the Commonwealth.”

“We are absolutely thrilled and deeply honored to be a part of this transformative project, standing shoulder-to-shoulder with our electric cooperatives, ISPs, and other telecom providers,” said Tad Deriso, President & CEO of MBC. “The substantial infrastructure investment in middle mile fiber by the NTIA and GO Virginia represents a remarkable triumph for rural Virginia, as it paves the way for significant strides in bridging the digital divide and attracting more economic development investments to the region. MBC has a proven track record of executing fiber infrastructure projects on time and within budget, and we eagerly anticipate collaborating with our funding partners, our telecom provider customers, and the communities involved to make this project a resounding success.”

Details on the eight middle mile fiber segments are as follows:

• The South Hill to Kenbridge segment will improve the capacity of the fiber route that supports the marketability and feasibility of the Kenbridge Commerce Center site in Lunenburg County as well as residential and business customers along the route.
• The Blackstone to McKenney segment will support additional broadband capabilities at Fort Barfoot, a Virginia Army National Guard installation near Blackstone, VA for future rapidly mobilized national security operations and the expanding federal and private contractor workforce.
• The Dinwiddie to Prince George segment will enable fiber connectivity for industrial, business, education, and biotech/pharmaceutical clusters in Dinwiddie County, Prince George County, and the City of Petersburg.
• The MAMaC in Greensville County segment supports economic development in Greensville County by providing diverse fiber to enhance the marketability of the 1,600 acre MaMaC Megasite in Greensville County.
• The Heartland Innovative Technology (HIT) Park in Prince Edward County segment will provide new diverse fiber to the recently established Heartland Innovative Technology Park.
• The Sussex Mega Site in Sussex County segment will create middle mile fiber diversity for the Sussex County Mega Site, enhancing the site’s marketability for advanced manufacturing.
• The Heartland Innovative Technology (HIT) Park to Cumberland segment will provide a diverse fiber route from HIT park to the north, to tie into other fiber backbone routes that extend to Ashburn, Culpeper and Charlottesville.
• The Shannon Hill Regional Business Park in Louisa County segment will provide diverse fiber to the 700-acre Shannon Hill Regional Business Park for the park’s targeted industries of manufacturing, data centers, biotechnology, and logistics and distribution.

The Middle Mile Broadband Infrastructure Grant Program provides funding to expand and extend middle mile infrastructure to reduce the cost of connecting areas that are unserved or underserved with current broadband infrastructure. The program was created by the bipartisan infrastructure law (BIL). 

Sens. Warner and Kaine have long fought to expand access to broadband in Virginia. Last month, Sen. Warner visited Big Stone Gap to celebrate $25 million in funding for the deployment of broadband in Southwest Virginia. These announcements come in addition to over $1.4 billion in previously announced funding for the deployment of broadband throughout the Commonwealth as a result of the bipartisan infrastructure law. 

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WASHINGTON – Today, U.S. Sens. Mark R. Warner and Tim Kaine applauded $3,586,000 in federal funding for the Wise County Public Service Authority to improve the county’s water system. Currently, Wise County’s water system is unable to provide the minimum working water pressure of 20 PSI under Virginia state code. Wise County has a serious need for upgrades to its water system, and this funding will help upgrade the county’s water infrastructure to ensure the system is up to code. The funding will replace approximately 29,120 linear feet of water line and install 12 gate valves, 10 fire hydrant assemblies, and associated water appurtenances.

“Reliable water systems are critical to protect the health of our communities and support businesses in the region,” said the senators. “We’re glad this federal funding will help Wise County upgrade their water infrastructure.”

The funding is awarded by the U.S. Department of Agriculture’s Department of Rural Development’s Water & Waste Disposal Loan & Grant Program, which provides funding for clean and reliable drinking water systems, sanitary sewage disposal, sanitary solid waste disposal, and storm water drainage to homes and businesses in rural communities. In addition to the over $3.5 million grant, Wise County will receive a federal loan of $1,202,000.

Warner and Kaine have long supported efforts to improve infrastructure across the Commonwealth. Last year, the senators announced over $46 million in federal funding as part of the bipartisan infrastructure law to replace lead water lines and ensure safe drinking water throughout Virginia.

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WASHINGTON – Today, U.S. Sens. Mark R. Warner and Tim Kaine announced $1,398,428 in federal funding for the Virginia Department of Behavioral Health and Developmental Services to expand access to mental health care in Virginia. The funding was awarded by the U.S. Department of Health and Human Services’ Substance Abuse and Mental Health Services Administration’s (SAMHSA) Community Mental Health Services Block Grant program. This program allocates funding to states to provide comprehensive, community-based mental health services to adults and children with significant mental health conditions. 

“Every Virginian deserves access to high-quality, affordable mental health care,” said the senators. “The last few years have underscored the importance of access to mental health services, and we’re glad this funding will help more Virginians reach the care they need.”

States may distribute funds from this program to local government entities and nongovernmental organizations to provide community mental health services. The funding was made possible by the (BSCA), which the senators helped pass. In Fiscal Year 2023, Virginia has received over $25 million in federal funding through the Community Mental Health Services Block Grant program.

Warner and Kaine have long supported efforts to expand access to mental health care. Warner and Kaine are sponsors of the CONNECT for Health Act, which would expand coverage of telehealth services, including mental health treatment and treatment for substance use disorders. Warner has additionally successfully pressed the Drug Enforcement Agency (DEA) to finalize long-delayed regulations allowing doctors to prescribe controlled substances, including those that treat opioid use disorder, through telehealth. Kaine, a member of the Senate Health, Education, Labor, and Pensions (HELP) Committee, introduced legislation to reduce and prevent suicide, burnout, and mental and behavioral health conditions among health care professionals, which President Biden signed into law last year. Last year, the senators announced $1 million in federal funding through the BSCA to expand and enhance the 988 Suicide & Crisis Lifeline in Virginia. Kaine has also introduced legislation to support children’s access to mental health care, which was included in last year’s government funding bill that the senators helped pass.

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WASHINGTON – Today, U.S. Sens. Mark R. Warner and Tim Kaine announced $1,000,000 in federal funding from the U.S. Department of Commerce’s National Institute of Standards and Technology (NIST) for the A.L. Philpott Manufacturing Extension Program (MEP), also known as GENEDGE Alliance, in Martinsville. This funding will help GENEDGE support small and medium-sized medical device manufacturers across Virginia in their efforts to strengthen medical supply chain resiliency and improve product quality by providing the manufacturers increased access to specialized expertise and resources. Specifically, with this funding, GENEDGE will assist the businesses in increasing sales, creating jobs, training more experts in the medical device manufacturing process, reducing risks in the process, providing educational resources, and growing our manufacturing industry.

“Virginians rely on their medical devices every day, and supporting our medical manufacturing industry is critical to ensure patients and providers can access the products they need,” said the Senators. “The pandemic highlighted the importance of ensuring our domestic medical supply chains are strong to improve public health, lower costs, and reduce our reliance on other nations. This funding will strengthen our efforts to do just that. We’re glad these federal dollars will help GENEDGE support small and medium-sized manufacturers across Virginia by training workers, creating jobs, reducing risks in the manufacturing process, and improving the quality of medical devices.”

GENEDGE is a part of the Hollings Manufacturing Extension Partnership (MEP) National Network. In Fiscal Year 2022, the MEP National Network generated $35.80 in new sales growth for manufacturers for every one dollar received in federal funding, which is up $9.60 from Fiscal Year 2021. Last year, Sens. Warner and Kaine announced over $2 million in federal funding for GENEDGE.

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WASHINGTON — Today, U.S. Sens. Mark R. Warner and Tim Kaine (both D-VA) announced $25,000,000 in federal funding from the Department of Agriculture awarded to Scott County Telephone Cooperative to deploy broadband and expand access to high-speed internet in Southwest Virginia. Tomorrow, Sen. Warner will join Rural Utility Services Administrator Andrew Berke, members of the LENOWISCO Planning District Commission, and community leaders in Big Stone Gap, VA to celebrate this funding and touch on the importance of bringing high-speed internet to rural communities.

“For almost two decades, dating all the way back to my time as governor, I have stressed the need for access to broadband coverage and high-speed internet in every corner of the Commonwealth, and I was proud to negotiate the bipartisan infrastructure law that has made significant progress on this front,” said Sen. Warner. “Access to fast, reliable, and affordable internet is crucial to ensuring our rural communities grow and thrive, and I’m thrilled that this $25 million investment for Norton, Wise County, and Lee County will help our small businesses, students, and residents stay connected.”

“High-quality internet is crucial to reach services like health care, work, and educational opportunities,” said Sen. Kaine. “Every Virginian, no matter where they live, deserves access to affordable, reliable internet access. I’m glad this funding from the Bipartisan Infrastructure Law, which I was proud to help pass, will help thousands of Virginians in Norton, Wise County, and Lee County do just that.”

The funding will be used to deploy a fiber-to-the-premises network that will provide high-speed internet to more than 17,000 residents, 1,018 businesses, 37 farms and 49 educational facilities in Norton City, Wise County and Lee County Virginia. This funding was awarded though the U.S. Department of Agriculture’s ReConnect Program, and funded by the bipartisan infrastructure law (BIL).

Sens. Warner and Kaine have long fought to expand access to broadband in Virginia. Earlier this year, the Senators announced over $1.4 billion in funding for the deployment of broadband throughout the Commonwealth. As a key author and negotiator of the BIL, Sen. Warner also previously secured $65 billion in funding to help deploy broadband and decrease costs associated with connecting to the internet, and Sen. Kaine voted for the BIL to help make the funding possible. As part of that funding, Virginia received $5 million to help make a strategic plan to deploy coverage. 

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WASHINGTON – U.S. Sens. Mark Warner (D-VA) and Mike Crapo (R-ID), sponsors of the bipartisan Prevent All Soring Tactics (PAST) Act, today applauded a proposed rule from the U.S. Department of Agriculture’s (USDA) Animal and Plant Health Inspection Service (APHIS) to strengthen Horse Protection Act (HPA) requirements, issuing the following statement:

“As the authors of bipartisan legislation to ban the cruel and abusive practice of horse soring, we applaud today’s proposal from the USDA to strengthen the Horse Protection Act and eliminate the use of horse soring at horse shows, exhibitions, sales and auctions.” 

Soring is a process by which horse trainers intentionally apply substances or devices to horses’ limbs to make each step painful and force an exaggerated high-stepping gait rewarded in show rings. Although federal law prohibits soring, a USDA Inspector General (IG) report found that some horse trainers continue this inhumane practice. 

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WASHINGTON, D.C. – Today, U.S. Senators Mark R. Warner and Tim Kaine celebrated the one year anniversary of the InflationReduction Act becoming law. Last August, the senators voted to pass the Inflation Reduction Act, legislation to lower health care and prescription drug costs, bring down energy bills, and tackle climate change—all while lowering the deficit.

“From capping the cost of insulin to $35 per month for seniors on Medicare to helping more families make energy efficient home improvements, the Inflation Reduction Act is already lowering costs for hundreds of thousands of Virginians in the year since it became law,” said the senators. “In the years ahead, we look forward to seeing the law’s impacts, including a $2,000 annual cap on out-of-pocket costs for prescription drugs for Medicare recipients. We remain committed to making sure communities across Virginia continue to benefit from the law’s many provisions." 

Below is a list of provisions that have already taken effect in the year since the law was enacted.

Health Care

• Black lung benefits: The law permanently extends the black lung excise tax at a higher rate, providing more certainty for miners, miner retirees, and their families who rely on the fund to access benefits. In Virginia, thousands of miners and their families have received benefits through the trust fund since it was established, including approximately 2,600 Virginians in 2021. Watch here to learn more about what this means for miners and miner retirees like Mr. James Gibbs, a Bristol native, the At-Large International Vice President of the United Mine Workers of America (UMWA), and Kaine's guest to the 2023 State of the Union.
• $35 cap on the cost of insulin: Out-of-pocket costs for insulin—regardless of how much a patient needs—is capped at $35 per month under Medicare. Thanks to the Inflation Reduction Act, 36,461 Virginians on Medicare who use insulin now pay no more than $35 per month. Click here to learn how seniors like Mrs. Marguerite Bailey Young of Fredericksburg, who was Warner’s guest to the 2023 State of the Union, are benefiting from the $35 cap. 
• Free vaccines for Medicare recipients: People with Medicare no longer have to pay to receive vaccines under Medicare Part D, which includes vaccines for shingles, HPV, MMR, diphtheria, and pertussis. 1,095,331 Virginia seniors on Medicare are able to receive the shingles vaccine and other recommended vaccines at no cost.
• Extension of ACA subsidies: During the pandemic, Congress enhanced subsidies under the Affordable Care Act (ACA) to help lower health care premiums for millions of Americans. The Inflation Reduction Act extended these enhanced subsidies through 2025 to help make Virginians’ health insurance more affordable. 304,469 Virginians with ACA coverage are receiving assistance to lower the cost of their premium. In 2022, Virginians saved an average of $508 per month on their health insurance premium.
• Penalties on drug manufacturers that increase prices: Manufacturers are required to keep the increase in the cost of their drugs at or below inflation.

Clean Energy 

• Boosts to clean energy investments: Clean energy manufacturers can apply for expanded tax credits that incentivize investment in and production of renewable energy technologies like solar power and offshore wind. The Inflation ReductionAct set aside $4 billion in credits for businesses that make these investments in energy communities that have seen closures of coal mines or retirements of coal-fired power plants in recent years. This means that communities in Virginia, especially Southwest Virginia, are well-positioned to benefit from many of these tax credits and funding opportunities.
• Improvements to home energy efficiency: Homeowners can receive up to 30 percent back through tax credits for making energy efficiency improvements to their home—generally up to a maximum of $1,200 per year but potentially up to $3,200 if improvements include heat pumps, heat pump water heaters, or biomass stoves. 
• Increased access to electric vehicles: Qualified individuals can get up to a $7,500 consumer credit for the purchase of new electric vehicles. There are additional incentives to help ensure those vehicles are produced in North America. Qualified individuals can receive a tax credit of up to $4,000 for certain used electric vehicles and plug-in hybrids purchased through a dealership. In order to qualify for the full value of the credit, the vehicle must: have a battery capacity of at least 7kW hours; generally be a model at least two years old; and be sold by a participating dealer that is licensed in the jurisdiction. For new vehicles, eligible taxpayers include single filers with incomes under $150,000 annually and households with joint incomes under $300,000 annually if the head of household earns under $225,000 annually. The vehicle’s price is limited to $55,000 for compact vehicles and $80,000 for SUVs, vans, and pick-ups. For used EVs, single filers must have an income under $75,000 annually or $150,000 as a household, as long as the head of household makes under $112,500 annually. The used vehicle’s price is limited to $25,000.

While many provisions in the Inflation Reduction Act have already been implemented, there are additional provisions that will begin later this year or in the years to come.

• Medicare drug price negotiation: On September 1, 2023, the Centers for Medicare & Medicaid Services (CMS) will release a list of the first 10 drugs covered under Part D eligible for the Medicare drug price negotiation program. The Inflation Reduction Act provided Medicare with the ability to negotiate lower prescription drug prices for the first time in history. The negotiated prices will go into effect in 2026.
• Free vaccines for Medicaid recipients: On October 1, 2023, Medicaid and CHIP will cover vaccines for Medicaid-covered adults. Currently, vaccine coverage is optional for states. 2,040,696 Virginia Medicaid recipients will have access to expanded vaccine coverage.
• Cap on out-of-pocket costs on prescription drugs: Beginning in 2025, there will be a $2,000 cap on out-of-pocket costs on prescription drugs for seniors covered under Medicare Part D. Some estimates have shown that Virginia seniors on Medicare will save an average of $440.62 on out-of-pocket costs on prescription drugs thanks to this cap. Watch here to hear what this cap will mean for seniors like Mr. Irv Varkonyi from Fairfax.

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WASHINGTON – U.S. Sen. Mark R. Warner (D-VA), Chairman of the Senate Select Committee on Intelligence, today urged CEOs of several prominent artificial intelligence (AI) companies to address reports that their chatbots are easily exploited to provide detailed instructions that promote eating disorders. In a series of letters to the CEOs of Open AI, Google, and Snap, Sen. Warner called attention to concerning responses and urged each company to immediately stop disseminating harmful content.

According to a recent study from the Center for Countering Digital Hate, OpenAI’s ChatGPT, Google’s Bard and Snapchat’s My AI consistently generate content that promote eating disorders. When prompted, these chatbots provide detailed information on hiding uneaten food from parents, instructions to trigger a gag reflex, and promote “chewing and spitting” as an extreme weight loss method, among other troubling examples. 

“The failure of your company to implement adequate safeguards to protect vulnerable individuals, especially teens and children, from well-established and foreseeable harms is of grave concern, and I urge you to quickly take steps to fix this glaring problem,” Sen. Warner wrote. 

The letters raise concerns specific to each chatbot’s troubling responses and highlight the high occurrence and fatality rates of eating disorders. Research from Sen. Warner’s office further showed that leading datasets used for model training include harmful eating disorder content – potentially embedding harmful associations into the most powerful generative models.

“I urge you to immediately take steps to protect vulnerable users from your products by implementing safeguards that prevent your products from providing harmful advice and recommendations related to eating disorders, including securing against prompt injection techniques,” Sen. Warner continued. 

The letters also raise concern with the inability of leading generative AI companies to implement adequate safeguards from well-established and foreseeable harms. Each letter concludes with a request for a written plan from each company on their efforts to eradicate these harmful model behaviors.

Sen. Warner, a former tech entrepreneur, has been a vocal advocate for responsible AI development and deployment. Earlier this week, he wrote to Google CEO Sundar Pichai to raise concerns about Google’s testing of new AI technology in real medical settings. Last month, he called on the Biden administration to work with AI companies to develop additional guardrails around the responsible deployment of AI. In April, Sen. Warner directly expressed concerns to several AI CEOs – including Sam Altman and Sundar Pichai – about the potential risks posed by AI, and called on companies to ensure that their products and systems are secure.  He has also introduced several pieces of legislation aimed at making tech safer and more humane, including the RESTRICT Act, which would comprehensively address the ongoing threat posed by technology from foreign adversaries; the SAFE TECH Act, which would reform Section 230 and allow social media companies to be held accountable for enabling cyber-stalking, online harassment, and discrimination on social media platforms; and the Honest Ads Act, which would require online political advertisements to adhere to the same disclaimer requirements as TV, radio, and print ads.

Copies of each letter can be found here. 

WASHINGTON – U.S. Sen. Mark R. Warner (D-VA), Chairman of the Senate Select Committee on Intelligence, today urged Google CEO Sundar Pichai to provide more clarity into his company’s deployment of Med-PaLM 2, an artificial intelligence (AI) chatbot currently being tested in health care settings. In a letter, Sen. Warner expressed concerns about reports of inaccuracies in the technology, and called on Google to increase transparency, protect patient privacy, and ensure ethical guardrails.

In April, Google began testing Med-PaLM2 with customers, including the Mayo Clinic. Med-PaLM 2 can answer medical questions, summarize documents, and organize health data. While the technology has shown some promising results, there are also concerning reports of repeated inaccuracies and of Google’s own senior researchers expressing reservations about the readiness of the technology. Additionally, much remains unknown about where Med-PaLM 2 is being tested, what data sources it learns from, to what extent patients are aware of and can object to the use of AI in their treatment, and what steps Google has taken to protect against bias.

“While artificial intelligence (AI) undoubtedly holds tremendous potential to improve patient care and health outcomes, I worry that premature deployment of unproven technology could lead to the erosion of trust in our medical professionals and institutions, the exacerbation of existing racial disparities in health outcomes, and an increased risk of diagnostic and care-delivery errors,” Sen. Warner wrote. 

The letter raises concerns over AI companies prioritizing the race to establish market share over patient well-being. Sen. Warner also emphasizes his previous efforts to raise the alarm about Google skirting health privacy as it trained diagnostic models on sensitive health data without patients’ knowledge or consent.

“It is clear more work is needed to improve this technology as well as to ensure the health care community develops appropriate standards governing the deployment and use of AI,” Sen. Warner continued.

The letter poses a broad range of questions for Google to answer, requesting more transparency into exactly how Med-PaLM 2 is being rolled out, what data sources Med-PaLM 2 learns from, how much information and agency patients have over how AI is involved in their care, and more.

Sen. Warner, a former tech entrepreneur, has been a vocal advocate for Big Tech accountability and a stronger national posture against cyberattacks and misinformation online. In April, Sen. Warner directly expressed concerns to several AI CEOs – including Sundar Pichai – about the potential risks posed by AI, and called on companies to ensure that their products and systems are secure. Last month, he called on the Biden administration to work with AI companies to develop additional guardrails around the responsible deployment of AI. He has also introduced several pieces of legislation aimed at making tech more secure, including the RESTRICT Act, which would comprehensively address the ongoing threat posed by technology from foreign adversaries; the SAFE TECH Act, which would reform Section 230 and allow social media companies to be held accountable for enabling cyber-stalking, online harassment, and discrimination on social media platforms; and the Honest Ads Act, which would require online political advertisements to adhere to the same disclaimer requirements as TV, radio, and print ads.

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

Dear Mr. Pichai,

I write to express my concern regarding reports that Google began providing Med-PaLM 2 to hospitals to test early this year. While artificial intelligence (AI) undoubtedly holds tremendous potential to improve patient care and health outcomes, I worry that premature deployment of unproven technology could lead to the erosion of trust in our medical professionals and institutions, the exacerbation of existing racial disparities in health outcomes, and an increased risk of diagnostic and care-delivery errors.

Over the past year, large technology companies, including Google, have been rushing to develop and deploy AI models and capture market share as the technology has received increased attention following OpenAI’s launch of ChatGPT. Numerous media outlets have reported that companies like Google and Microsoft have been willing to take bigger risks and release more nascent technology in an effort to gain a first mover advantage. In 2019, I raised concerns that Google was skirting health privacy laws through secretive partnerships with leading hospital systems, under which it trained diagnostic models on sensitive health data without patients’ knowledge or consent. This race to establish market share is readily apparent and especially concerning in the health care industry, given the life-and-death consequences of mistakes in the clinical setting, declines of trust in health care institutions in recent years, and the sensitivity of health information. One need look no further than AI pioneer Joseph Weizenbaum’s experiments involving chatbots in psychotherapy to see how users can put premature faith in even basic AI solutions.

According to Google, Med-PaLM 2 can answer medical questions, summarize documents, and organize health data. While AI models have previously been used in medical settings, the use of generative AI tools presents complex new questions and risks. According to the Wall Street Journal, a senior research director at Google who worked on Med-PaLM 2 said, “I don’t feel that this kind of technology is yet at a place where I would want it in my family’s healthcare journey.” Indeed, Google’s own research, released in May, showed that Med-PaLM 2’s answers contained more inaccurate or irrelevant information than answers provided by physicians. It is clear more work is needed to improve this technology as well as to ensure the health care community develops appropriate standards governing the deployment and use of AI

Given these serious concerns and the fact that VHC Health, based in Arlington, Virginia, is a member of the Mayo Clinic Care Network, I request that you provide answers to the following questions. 

1. Researchers have found large language models to display a phenomenon described as “sycophany,” wherein the model generates responses that confirm or cater to a user’s (tacit or explicit) preferred answers, which could produce risks of misdiagnosis in the medical context. Have you tested Med-PaLM 2 for this failure mode?
2. Large language models frequently demonstrate the tendency to memorize contents of their training data, which can risk patient privacy in the context of models trained on sensitive health information. How has Google evaluated Med-PaLM 2 for this risk and what steps has Google taken to mitigate inadvertent privacy leaks of sensitive health information?
3. What documentation did Google provide hospitals, such as Mayo Clinic, about Med-PaLM 2? Did it share model or system cards, datasheets, data-statements, and/or test and evaluation results?
4. Google’s own research acknowledges that its clinical models reflect scientific knowledge only as of the time the model is trained, necessitating “continual learning.” What is the frequency with which Google fully or partially re-trains Med-PaLM 2? Does Google ensure that licensees use only the most up-to-date model version?
5. Google has not publicly provided documentation on Med-PaLM 2, including refraining from disclosing the contents of the model’s training data. Does Med-PaLM 2’s training corpus include protected health information?
6. Does Google ensure that patients are informed when Med-PaLM 2, or other AI models offered or licensed by, are used in their care by health care licensees? If so, how is the disclosure presented? Is it part of a longer disclosure or more clearly presented?
7. Do patients have the option to opt-out of having AI used to facilitate their care? If so, how is this option communicated to patients?
8. Does Google retain prompt information from health care licensees, including protected health information contained therein? Please list each purpose Google has for retaining that information.
9. What license terms exist in any product license to use Med-PaLM 2 to protect patients, ensure ethical guardrails, and prevent misuse or inappropriate use of Med-PaLM 2? How does Google ensure compliance with those terms in the post-deployment context? 
10. How many hospitals is Med-PaLM 2 currently being used at? Please provide a list of all hospitals and health care systems Google has licensed or otherwise shared Med-Palm 2 with.
11. Does Google use protected health information from hospitals using Med-PaLM 2 to retrain or finetune Med-PaLM 2 or any other models? If so, does Google require that hospitals inform patients that their protected health information may be used in this manner?
12. In Google’s own research publication announcing Med-PaLM 2, researchers cautioned about the need to adopt “guardrails to mitigate against over-reliance on the output of a medical assistant.” What guardrails has Google adopted to mitigate over-reliance on the output of Med-PaLM 2 as well as when it particularly should and should not be used? What guardrails has Google incorporated through product license terms to prevent over-reliance on the output?

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