WASHINGTON – U.S. Sens. Mark R. Warner and Tim Kaine (both D-VA) applaud the congressional passage of legislation to fund our country’s defense, security, health, education, transportation, and housing programs. This package supports a number of Warner and Kaine priorities, including affordable housing, safer airways, improved infrastructure, medical research, servicemember pay, and shipbuilding. These five bipartisan bills fund Defense; Financial Services and General Government; Labor, Health and Human Services (HHS), Education, and related agencies; National Security, Department of State, and related programs; and Transportation, Housing and Urban Development (HUD), and related agencies for Fiscal Year 2026.

“I’m proud to provide over $93 million to 78 critical community projects across Virginia that support affordable housing, expanded health care access, transportation safety and modernization, and job entry and development programs,” said Sen. Warner. “This bill is far from perfect, but we were able to make headway on important national priorities including supporting Ukraine, lowering health care and prescription drug costs, boosting medical research, and funding public housing.”

“I’m glad that we passed legislation to fund important priorities like pay for military servicemembers, and reauthorize my bipartisan legislation—named in honor of Charlottesville native and physician Dr. Lorna Breen—to support the mental health of the health care workforce,” said Sen. Kaine. “I’m also thrilled that it includes over $93 million in federal funding that Senator Warner and I secured to expand access to health care, make critical infrastructure improvements, and more. I look forward to getting on the road to celebrate these investments in our communities.”

As part of the Fiscal Year 2026 appropriations process, members of Congress are able to work with the communities they represent to request funding for local community projects, otherwise known as congressionally directed spending, in a manner that promotes transparency and accountability. This process allows Congress to dedicate federal funding for specific projects in Virginia. This package contains $93.267 million for 78 specific projects in Virginia.

Through strong advocacy, the senators secured funding in the relevant spending bills for the following Virginia projects: 

1. For projects in Central Virginia, click here.
2. For projects in Hampton Roads and the Eastern Shore, click here.
3. For projects in Northern Virginia, click here.
4. For projects in the Shenandoah Valley and the Highlands, click here.
5. For projects in Southwest Virginia and Southside, click here.
6. For statewide projects, click here.

This funding is in addition to the $112.14 million in federal funding that Sens. Warner and Kaine previously secured for projects in Central Virginia, Hampton Roads and the Eastern Shore, Northern Virginia, Shenandoah Valley and the Highlands, Southwest Virginia and Southside, and across Virginia as part of other government funding legislation.

In addition to community-specific projects, this legislation includes funding for the following Warner and Kaine priorities: 

Supporting public housing: Provides $48.4 billion to the Office of Public and Indian Housing, including $38.4 billion for tenant based rental assistance; $8.3 billion for the Public Housing Fund; $206.4 million to help families get good paying jobs; and $1.4 billion to support housing in Tribal and Native Hawaiian communities.

Supporting community investment, affordable housing, and homelessness prevention: Provides $13.3 billion for the Office of Community Planning and Development, including $3.3 billion for the Community Development Block program to give Virginia cities and counties reliable funding for housing repairs, neighborhood revitalization, and community development; $4.4 billion for Homeless Assistance Grants to expand permanent supportive housing, rapid rehousing, and prevention efforts; $1.25 billion for the HOME Investment Partnerships program to help states and cities build and preserve affordable housing; $65 million for the Self-Help and Assisted-Homeownership Opportunity program to help low-income families build or buy their first home; and $30 million for the SUPPORT for Patients and Community Recovery Housing Program to fund housing for people recovering from substance use disorders.

Improving access to housing: Provides $19.9 billion to the Office of Housing, including $18.5 billion to keep rents affordable in privately owned apartment buildings for low-income tenants; $1 billion for Housing for the Elderly; and $287 million for Housing for Persons with Disabilities.

Improving air safety: Provides $22.2 billion to the Federal Aviation Administration, including funds to support the addition of new air traffic controllers and the prioritization of modernizing outdated systems in the National Airspace. Also provides $2 million for an independent study on the airspace in the National Capital Region and the coordination between the FAA and Department of Defense in response to the tragic Flight 5342 accident in January 2025.

Supporting regional airports: Provides $514 million for the Essential Air Service program, which provides critical support for passenger service for Shenandoah Valley Regional Airport.

Improving roads and highways: Provides $64.3 billion to the Federal Highway Administration, including $350 million for bridge repair and $200 million for the Tribal Transportation program.

Improving rail travel: Provides $2.9 billion for the Federal Railroad Administration, including $137 million for Consolidated Rail Infrastructure and Improvements grants; $1.6 billion for Amtrak’s National Network grants for State-Supported routes and Long-Distance routes; and $850 million for Amtrak’s Northeast Corridor.

Boosting capital transit: Provides $16.5 billion to the Federal Transit Administration, including $1.7 billion for the Capital Investment Grants program.

Supporting medical research: Provides $48.7 billion for biomedical research, including $3.9 billion for Alzheimer’s disease and related dementia research as well as a $10 million increase for diabetes research.

Investing in child care and early learning: Provides $8.8 billion for the Child Care and Development Block Grant (CCDBG), an $85 million increase, which will help families in Virginia and across the country find and afford child care. Also provides $12.36 billion for Head Start, an $85 million increase, which will support Head Start teachers and staff throughout the country. Sen. Kaine has championed efforts in Congress to increase funding for the CCDBG program.

Boosting education: Provides $70.9 billion for the Department of Education, including $18.4 billion for Title I schools and $15.19 billion for the Individuals with Disabilities Education Act. Both received a $20 million increase.

Improving social security: Provides $15 billion for the Social Security Administration’s administrative expenses, a $554 million increase from the prior year. The legislation includes instructions for SSA to utilize the funding to take steps to avoid field office closures, reduced office hours, and delays for appointments at field offices.  

Increasing servicemember pay: Provides a 3.8% across-the-board pay raise for servicemembers. Also funds a 1% pay raise for civilians.

Supporting defense communities: Provides $70 million for Impact Aid programs, which provide federal assistance to local school districts that face financial disadvantages due to federal land ownership or high enrollment of federally connected children. Also provides $30 million for the Defense Community Infrastructure Program, which addresses deficiencies in community infrastructure that can or does support a military installation’s readiness and lethality.

Supporting environmental mitigation: Provides $159 million above the President’s request for PFAS cleanup, which removes “forever chemicals” from water and soil. Also provides $20 million above the President’s request for the Readiness and Environmental Protection Integration program, which preserves military missions by supporting cost-sharing to avoid land use conflicts near military installations, address environmental restrictions that limit military activities, and increase military installation resilience.

Supporting international partnerships: Provides $400 million to support Ukraine; reaffirms Congress’s support for NATO; provides $1 billion for the Taiwan Security Cooperation Initiative; makes available $3.3 billion to support the United Nations and other international organizations, rejecting the President’s request to eliminate support; includes $343 million to support regional partners in countering ISIS; and provides $1.1 billion for drug interdiction and counter-drug activities.

Providing humanitarian and global health assistance: Provides $9.4 billion for global health programs to combat HIV/AIDS, malaria, tuberculosis, and polio; $5.5 billion for humanitarian assistance to meet most urgent needs around the globe; and $15 million for rigorous impact evaluations to ensure humanitarian programs are efficient and delivering results for vulnerable communities.

Supporting shipbuilding: Provides $27.15 billion to support shipbuilding, including a $5.9 billion increase for Columbia- and Virginia-class submarine programs; $1.676 billion for the completion of last year’s shipbuilding programs; and an additional $1.75 billion for DDG-51 destroyers advance procurement and industrial base support.

Boosting military capacity: Provides $2.947 billion in additional munitions and industrial capacity across the military services, including $500 million to develop and procure additional solid rocket motors.

Expanding telehealth: Extends Medicare telehealth flexibilities for two years; requires HHS to issue guidance with best practices on providing telehealth services accessibly; continues for four years virtual access to the Medicare Diabetes Prevention Program; allows cardiopulmonary rehabilitation services to be provided by telehealth in Medicare in 2026 and 2027; and directs HHS to help health care providers learn how to screen for medication-induced movement disorders over telehealth.

Lowering drug costs by reining in PBM middlemen: Reforms Pharmacy Benefit Managers (PBMs) to lower drug costs for Americans and protect access to local pharmacies. Also includes two of Sen. Warner’s bills, the PBM Reporting Transparency Act and the Patients Before Middlemen (PBM) Act.

Protecting rural health labor and delivery services: Includes a provision of Sen. Warner’s Keeping Obstetrics Local Act to require State Medicaid programs to conduct studies on the costs of providing maternity, labor, and delivery services in rural hospitals and hospitals that serve a high proportion of Medicaid beneficiaries, and submit a report detailing the results of this study to the Department of Health and Human Services (HHS).

Improving mental health: Includes the Dr. Lorna Breen Health Care Provider Protection Reauthorization Act, legislation sponsored by Sen. Kaine and cosponsored by Sen. Warner, that reauthorizes programs that support efforts to improve the mental health of health care providers.

Addressing pediatric cancer: Provides $12.6 million to fund childhood cancer research through the Gabriella Miller Kids First Research Act, named after a child from Loudoun County who died from brain cancer in 2013. 

Supporting individuals with Long COVID: Provides $10 million to the Agency for Healthcare Research and Quality (AHRQ) to continue its work to support multidisciplinary Long COVID clinics to address comprehensive, coordinated, person-centered care for people living with Long COVID.

Modernizing public health infrastructure: Provides $185 million to the Centers for Disease Control and Prevention to modernize America’s public health data systems.

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* High-quality photographs of Sen. Mark R. Warner are available for download here *

Photos may be used online and in print, and can be attributed to ‘The Office of Sen. Mark R. Warner’

WASHINGTON – U.S. Sens. Mark R. Warner and Tim Kaine (both D-VA) announced that a lease has been awarded for a new Department of Veterans Affairs (VA) medical facility in Hampton Roads. The awarding of this lease for a new, state-of-the-art outpatient clinic will improve veterans’ access to care in this region and follows years of congressional action and advocacy by the senators.

“We are thrilled to announce the awarding of this new clinic lease in Hampton Roads,” said the senators. “The veteran population in the region continues to grow, and this facility will fill a critical gap by expanding access to high-quality, convenient care for the veterans who have served our country. Virginians need and deserve this facility, and we will do everything we can to ensure that it is properly staffed despite President Trump’s plans to eliminate 35,000 health care positions at VA facilities across America.”

While this lease was originally authorized under the PACT Act, which both senators strongly supported, updated cost estimates and rent bids prompted the VA and the General Services Administration (GSA) to seek reauthorization from four congressional committees for this proposed facility and 17 others. In June, Sens. Warner and Kaine urged the Senate Committee on Environment and Public Works to swiftly take up and reapprove all pending major VA medical facility leases. They subsequently pushed for the final committee, the House Veterans’ Affairs Committee, to put forward their approval. In late July, the senators announced that approval for the leases had cleared all committees. From there, the administration needed to award a contract for the lease.

Sens. Warner and Kaine have long fought to expand health care access and benefits for Virginia’s nearly 700,000 veterans. The senators have fought to strengthen and expand mental health care and suicide prevention efforts for veterans. Sen. Warner has been outspoken on the need to reduce the disability claim backlog at the Department of Veterans Affairs (VA), ensure the VA is appropriately staffed to improve access to care and benefits, strengthen the VA’s ability to increase capacity and build new medical centers, and improve women veterans’ access to health care. Sen. Kaine has called President Trump out for firing more veterans than any other president, and has introduced legislation to reinstate veterans who were fired from their federal jobs as part of the Trump Administration’s indiscriminate and mass layoff of federal employees. Sen. Kaine has also been a vocal opponent of the Trump Administration’s decision to eliminate 35,000 health care positions at VA clinics.  

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WASHINGTON – Today, U.S. Sen. Mark R. Warner (D-VA) released the statement below after voting to preserve the health care tax credits that are set to expire at the end of this year. The legislation, which would have extended these tax credits for three years, failed to advance in the Republican-led Senate by a vote of 51-48.

“Enhanced Premium Tax Credits have put health insurance within reach for millions of Americans, including small business owners and employees, gig workers, and many other people who cannot count on employer-provided health care. The legislation put forth by Democrats today would have extended these tax credits for three years, providing Americans with certainty while allowing Congress to focus on improving our health care system and fixing its flaws. Today is a sad day for middle-class families, for parents with vulnerable children, and for people whose lives are better because they can buy their medications every month and see a doctor when they need to.

“As my Republican colleagues prepare to leave town and spend the holidays with their loved ones, I’m thinking of the millions of American families who will be counting down the New Year knowing they’ll have to pay more, settle for less, or perhaps forgo health insurance altogether when the clock strikes midnight.”

WASHINGTON – Today, U.S. Sens. Mark Warner (D-VA), Bill Cassidy, M.D. (R-LA), Maggie Hassan (D-NH), and John Cornyn (R-TX) reintroduced the Health Care Cybersecurity and Resilience Act to protect Americans’ health data by strengthening cybersecurity. This legislation is a product of the senators’ bipartisan health care cybersecurity working group launched in 2023.  

“Cyberattacks on our health care organizations threaten the sensitive information of millions of Americans and can have life-or-death consequences on the care patients receive,” said Sen. Warner. “I’m glad to join my colleagues in introducing this bill to strengthen our cybersecurity, protect patients, and provide additional tools for rural health care providers in Virginia.”

“Cyberattacks on our health care sector not only put patients’ sensitive health data at risk but can delay life-saving care,” said Dr. Cassidy. “This bipartisan legislation ensures health institutions can safeguard Americans’ health data against increasing cyber threats.”  

“Cyberattacks in the health care sector can have a wide range of devastating consequences, from exposing private medical information to disrupting care in ERs – and it can be particularly difficult for medical providers in rural communities with fewer resources to prevent and respond to these attacks,” said Sen. Hassan. “Our bipartisan working group came together to develop this legislation based on the most pressing needs for medical providers and patients, and I urge my colleagues to support it.”

“Patients deserve absolute confidence that their sensitive medical data stored online is protected and shielded from cybersecurity breaches or ransomware attacks,” said Sen. Cornyn. “This legislation would strengthen interagency coordination and improve security practices for rural providers, ensuring Texans’ health care is not delayed or compromised by cyberattacks.” 

The Health Care Cybersecurity and Resiliency Act of 2025:  

• Strengthens cybersecurity in the health care sector by providing grants to health entities to improve cyberattack prevention and response.   
• Provides training to health entities on cybersecurity best practices.   
• Supports rural communities by providing best practices to rural health clinics and other providers on cybersecurity breach prevention, resilience, and coordination with federal agencies.  
• Improves coordination between the Department of Health and Human Services (HHS) and Cybersecurity and Infrastructure Security Agency (CISA) to better respond to cyberattacks in the health care sector.  
• Modernizes current regulations so entities covered under the Health Insurance Portability and Accountability Act (HIPAA) use the best cybersecurity practices.  
• Requires the HHS Secretary to develop and implement a cybersecurity incident response plan.  

Click here for full bill text. 

BACKGROUND 

Health records, unlike other personal records like credit card numbers, are more valuable on the black market since health conditions are permanent and cannot be reissued.     

There were more than 730 cyber breaches last year, affecting over 270 million Americans. This includes the attack on Change Healthcare, the largest health care cybersecurity incident in history. This attack exposed the data of over 190 million people, leading to significant delays in care and electronic prescribing.  

WASHINGTON – U.S. Sen. Mark R. Warner (D-VA), a member of the Senate Finance Committee, today issued the following statement after successfully pushing the Centers for Medicare & Medicaid Services (CMS) to provide more options to Medicare Advantage seniors who lose network access to their doctors in the middle of the year:

“Navigating the health care landscape is hard enough as is – we shouldn’t be forcing seniors to jump through hoops in order to continue seeing the doctors they know and trust. I’m glad to see CMS heed our call by proposing new measures that would allow Medicare Advantage enrollees to change their coverage more easily when they experience mid-year provider network changes. I’ll keep working with CMS to get this proposed rule finalized and ensure that elderly Americans can count on the continuity of care they need.”

CMS currently has the ability to allow affected Medicare Advantage enrollees to switch plans as part of a “special enrollment period” when a significant number of doctors or hospitals no longer accept their insurance in the middle of the year. However, the circumstances for how these special enrollment periods are determined are currently opaque, and there is minimal notice to the public, states, and enrollees. In November, Sen. Warner joined Sen. Ron Wyden (D-OR) in calling on CMS to clarify how these special enrollment periods are determined and provide seniors enrolled in Medicare Advantage with more information about plan changes.

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WASHINGTON – Today, U.S. Sens. Mark R. Warner (D-VA) and Ron Wyden (D-OR), Ranking Member of the Senate Finance Committee, called on the Centers for Medicare & Medicaid Services (CMS) to provide seniors enrolled in Medicare Advantage with more information when a significant number of doctors or hospitals no longer accept their insurance in the middle of the year.

“We write to you today to express our concerns about increasing turmoil and uncertainty for seniors and people with disabilities enrolled in the Medicare Advantage program,” wrote the senators. “As of April 2025, there have been at least 13 states with ‘significant network changes,’ triggering a special enrollment period for MA enrollees in these states. These types of interruptions to the network cannot only affect enrollees' access to care that may already be planned or scheduled, leaving them without an in-network provider, but also leave MA enrollees confused about their coverage options.”

When a senior enrolled in a Medicare Advantage plan loses a significant number of health providers from their plan in the middle of the year, CMS may allow them to switch plans in a “special enrollment period.” However, the circumstances for how these special enrollment periods are determined are opaque, and there is minimal notice to the public, states, and enrollees.

The letter calls on CMS to clarify how these special enrollment periods are determined, describe how seniors in Medicare are notified about plan changes, and additional information to improve transparency around these challenging circumstances.

The full letter can be found here.

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WASHINGTON – U.S. Sen. Mark R. Warner (D-VA) and 21 of his Senate colleagues sent a letter to Department of Health and Human Services (HHS) Secretary Robert F. Kennedy Jr. pressing him for answers about how many families will be pushed into medical debt-induced bankruptcy nationwide by the Trump Administration’s massive health care cuts and failure to address soaring health insurance premiums.

“Republicans have shut down the government instead of participating in a bipartisan process to make sure 15 million Americans don’t get kicked off their health care and even more see their health insurance premiums double,” wrote the senators. “If Republicans continue with their health care cuts, medical debt will almost certainly skyrocket.”

The senators criticized the Trump Administration’s Consumer Financial Protection Bureau (CFPB) for supporting the reversal of a rule to eliminate medical debt from consumer credit reports: “Despite the rule’s vital role in protecting consumers from medical debt burdens, on April 30, the CFPB joined industry groups opposed to it in a joint motion to have it overturned—putting corporate profits ahead of the American people. This means even more families will face economic hardships because of medical events outside of their control.”

The senators concluded with two questions for Secretary Kennedy, requesting answers by November 1, 2025:

1. How many Americans will be pushed into medical debt-induced bankruptcy by the Trump Administration’s health care cuts?
2. How many of these Americans will be pushed into medical debt-induced bankruptcy due to the expiration of the ACA enhanced premium tax credits that President Trump and Congressional Republicans refuse to extend?

Sen. Warner was joined by Sens. Elizabeth Warren (D-MA), Raphael Warnock (D-GA), Leader Chuck Schumer (D-NY), Ron Wyden (D-OR), Bernie Sanders (I-VT), Patty Murray (D-WA), Amy Klobuchar (D-MN), Sheldon Whitehouse (D-RI), Kirsten Gillibrand (D-NY), Richard Blumenthal (D-CT), Mazie Hirono (D-HI), Angus King (I-ME), Ed Markey (D-MA), Cory Booker (D-NJ), Tammy Duckworth (D-IL), Tina Smith (D-MN), Jacky Rosen (D-NV), John Hickenlooper (D-CO), Peter Welch (D-VT), Adam Schiff (D-CA), and Andy Kim (D-NJ).

Read the full letter here.

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WASHINGTON – Today, U.S. Sens. Mark R. Warner and Tim Kaine (both D-VA) released the following statement after new data from the Virginia health care marketplace showed that Virginians are facing huge increases in 2026 health care premiums because Republicans are blocking an extension of the enhanced tax credits that have helped keep coverage affordable:

“The numbers don’t lie. Preliminary cost estimates are showing what we’ve been warning about for months: huge spikes in premium costs for Virginians enrolled in health care through the Affordable Care Act marketplace. If Republicans continue to refuse to act on ACA tax credits, then many Americans will be forced to forgo health insurance next year. This will lead to more people turning to emergency rooms for preventive health care, further stress being placed on health care providers, and health care costs rising even more. Republicans must come to the table now to protect Americans’ health care and reopen the government.”

Preliminary cost estimates show Virginians are seeing higher health care premiums due to the expiration of the enhanced premium tax credits at the end of the year.

WASHINGTON – Today, U.S. Sens. Mark R. Warner and Tim Kaine (both D-VA) underscored the urgent need to extend the enhanced premium tax credits under the Affordable Care Act (ACA) after a new analysis from the Commonwealth Fund showed that the expiration of these tax credits will have disastrous effects on Virginia:

“Americans don’t want higher health care costs, but if Republicans refuse to join Democrats in extending critical Affordable Care Act tax credits, that’s exactly what they’ll get. This latest analysis is further evidence that the expiration of these tax credits will force people off their health insurance, including many small business owners and employees, and hurt our economy. It’s time for Republicans to acknowledge what many of them have admitted in public and private—that we need to find a path forward to protect Americans’ health care and reopen the government.”

The enhanced premium tax credits expire at the end of the year, and Republicans have refused to extend them to prevent health care costs from skyrocketing and keep millions of Americans from losing their health insurance. Democrats have asked Republicans for months to address the expiration of the ACA tax credits, and have proposed legislation to extend them and reopen the government. However, Republicans have blocked the bill’s passage.

The Commonwealth Fund’s analysis shows not extending the tax credits will lead to:

• 94,000 Virginians unenrolled in health insurance through the ACA marketplace.
• 50,000 Virginians uninsured.
• $295 million lost in federal funding.
• $434 million lost in state Gross Domestic Product (GDP).
• 3,400 jobs lost.
• $31 million lost in state and local tax revenue.

With the government shut down, Warner and Kaine continue to push to reopen the government and protect Americans’ health care. Earlier this month, the senators sounded the alarm about the rise in monthly health care costs for Virginians under the ACA. The effort to prevent health care premiums from skyrocketing comes just months after President Donald Trump and congressional Republicans slashed Medicaid to offset the cost of billionaire tax cuts in the Republican budget law.

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WASHINGTON – U.S. Sens. Mark R. Warner and Tim Kaine (both D-VA) are issuing a warning today about an impending catastrophe for Federally Qualified Health Centers (FQHC) – the community-based health care providers that deliver comprehensive primary and preventative health services to low-income families and those who are underserved and uninsured.

“Between the changes being brought on by the Big, Ugly Bill and the looming expiration of health care tax credits for Americans, there is a terrifying storm brewing for health care in the Commonwealth,” said the senators. “This could be the start of a vicious cycle where tens of thousands of Virginians lose coverage, leaving community-based health care providers in dire financial straits and with no choice but to serve fewer people, eliminate important health services, or shut operations entirely. We can’t afford to turn our backs on the health centers that prevent folks from falling through the cracks, and we can’t afford the widespread consequences this will have on health care costs and our economy.  Our Republican colleagues who supported tax cuts for billionaires should act to save the health care tax credits that make it possible for many Virginians to afford their health insurance.”

Thanks to the Big, Ugly Bill, 41,357 Virginians – 27 percent of the Commonwealth’s FQHC patients – are now at risk of losing their health care coverage. This shift is projected to cause an annual revenue loss of $21,381,559 for Virginia’s FQHCs. To make matters worse, if Republicans allow enhanced premium tax credits to expire, 25,533 Virginians – 23 percent of Virginia FQHC patients – will face a potential loss of coverage due to higher marketplace rates. This shift is projected to cause an additional annual revenue loss of $10,851,618 for FQHCs.

Altogether, Virginia’s health centers could face a combined projected annual loss of $32.2 million dollars – an unimaginable quantity for health providers that regularly operate on thin margins in order to care for Virginia’s most vulnerable populations.

Leaving FQHCs with a multi-million-dollar shortfall could force these providers to scale back the number of community members served or the kind of health services offered. Under either of these reductions, more Virginians could find themselves forgoing preventative care and eventually ending up in the emergency room – a phenomenon that will increase the rate of uncompensated care and eventually skyrocket costs even for people with health insurance.

Despite holding majorities in both chambers of Congress and the White House, Republicans failed to secure a funding deal to keep the government open ahead of the September 30 deadline. With the government now closed, Sens. Warner and Kaine continue to push to reopen the government and prevent the impending expiration of essential health care tax credits that many American families rely on. The effort to prevent health care premiums from skyrocketing comes just months after Donald Trump and congressional Republicans slashed Medicaid in order to offset the cost of billionaire tax cuts in the Republican budget law.

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WASHINGTON – U.S. Sens. Mark R. Warner and Tim Kaine (both D-VA) released the following statement after Republicans blocked passage of a bill to fund the government and protect Virginians’ access to health care:

“Once again, Republicans have rejected a commonsense funding bill that would keep the government open, protect Americans’ healthcare and bring down the crushing costs they’re facing thanks to Republican policies. As soon as tomorrow, millions of families will begin receiving notices that their health care premiums and deductibles are set to skyrocket next year – direct consequences of Republican choices.

“Donald Trump once said, ‘If there is a shutdown, I think it would be a tremendously negative mark on the president of the United States. He’s the one that has to get people together.’ By his own standard, this looming shutdown is a failure of President Trump’s leadership.

“Congress cannot afford more delay. It’s well past time for the president and congressional Republicans to stop playing games, get serious, and do their jobs – before the American people are forced to pay the price.”

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WASHINGTON – U.S. Sens. Mark R. Warner (D-VA) and Susan Collins (R-ME) reintroduced bipartisan legislation to expand access to critical advance care planning (ACP) services in Medicare that allow people, especially those with serious illness, to plan for their care and have their choices honored when it matters most. The Improving Access to Advance Care Planning Act would help more Americans access critical ACP services by allowing social workers to provide ACP services, removing beneficiary cost-sharing, and promoting increased education for providers on current ACP codes and improved reporting on barriers to providing ACP services and billing the corresponding codes.

“Decisions about care planning are some of the hardest for a family to make, but they’re also some of the most important. One of my biggest regrets was not having early conversations about care planning with my own mom, who suffered from Alzheimer’s for 11 years and was unable to speak for nine of those years,” said Sen. Warner. “I’m proud to introduce this bill because folks with a serious illness deserve to have a say over what their care should look like, and families deserve the certainty of knowing they are honoring their loved ones’ wishes.”

“Unfortunately, most patients do not routinely make advance plans for their care in the event that they are diagnosed with a serious or life-threatening illness.  This can be a difficult topic for many families to address, but advance care planning has been shown to increase satisfaction and improve health outcomes because people with advance directives are more likely to get the care they want, in the setting they prefer, and avoid the care that they don’t want,” said Sen. Collins. “This bipartisan bill would help provide an opportunity for patients to have a structured discussion with their health care providers about their goals and treatment options so that they can make their choices known and develop a plan of care in consultation with their loved ones.”

Specifically, the Improving Access to Advance Care Planning Act would:

1. Codify and expand Medicare coverage of ACP services – a longtime priority for Sen. Warner, who first introduced legislation to improve planning options for patients in 2015. This bill would expand eligible providers that can bill for such services to include clinical social workers with experience in care planning.
2. Remove beneficiary coinsurance and deductibles for ACP visits – including those that happen outside of an annual Medicare Annual Wellness Visit – to ensure that beneficiaries are not deterred from seeking these services, and providers are not deterred from offering them.
3. Educate heath care providers by directing CMS to conduct an education campaign on the ACP billing options and report to Congress on such activities
4. Study areas of improvement – by directing the Medicare Payment Advisory Commission (MedPAC) to study and report to Congress on (A) barriers to providing and receiving ACP services despite the ability to bill for them, and (B) barriers to billing the code itself.
5. Make permanent the ability to provide advance care planning services over telehealth in Medicare.
6. Align the definitions of advance care planning used in the statute to ensure consistency of this service.

Bill text is available here.

This legislation has the support of a number of patient and family advocacy organizations, including the Coalition to Transform Advanced Care (C-TAC), LeadingAge, the National Partnership for Healthcare and Hospice Innovation (NPHI), the National Alliance for Care at Home, the Center for Medicare Advocacy, the Consumer Coalition for Quality Health Care, MyDirectives, and the Smarter Health Care Coalition.

“Those of us working to improve care for individuals impacted by serious illness have known that high copays for Advance Care Planning were a barrier to patient-centered care. Thanks to Senators Warner (D-VA) and Collins (R-ME), who are passionate about these issues, we will be able to help remedy this technicality in the law and increase access to critical conversations between patients and their clinicians by eliminating copays and including social workers who will be eligible to be reimbursed for these services as part of the care team. A sincere thank you the Senators and their staff for continuing to be the voice of the patient and family,” said Jon Broyles, CEO, The Coalition to Transform Advanced Care (C-TAC).

"Planning ahead can bring clarity to the often nuanced and complicated issues that sometimes arrive in critical healthcare situations or at end-of-life. Improving access to cost-effective care planning that all Americans need, as this bill will do, will bring peace of mind to millions of older adults and their family members,” said Katie Smith Sloan, president and CEO, LeadingAge, the association of nonprofit providers of aging services. “What’s more, because our nonprofit and mission-driven members deliver care across all aging services settings, LeadingAge recognizes the importance of acknowledging the preferences and beliefs of people and their families to deliver quality care. We hope greater access to these conversations will improve serious illness care through the end-of-life and help providers meet unique patient needs.”

“NPHI is proud to stand with the hospice and palliative care community in strong support of the Improving Access to Advance Care Planning (ACP) Act.” Said Carole Fisher, President of NPHI. “As a national organization comprised of nearly 120 community-based advanced illness care providers, NPHI and its members understand the importance of ensuring all Medicare beneficiaries have genuine access to counseling regarding their choices and preferences at the end-of-life. As we know, hospice services are often dramatically underutilized due in part to late referrals and a lack of prior planning. Engaging in ACP conversations earlier in the disease progression can improve quality of life for beneficiaries and lessen the burden on caregivers. We look forward to working with Congress and our partners to pass this important legislation,” said Carole Fisher President, National Partnership for Healthcare and Hospice Innovation (NPHI). 

“The National Alliance for Care at Home applauds Senators Warner (D-VA) and Susan Collins (R-ME) for reintroducing the Improving Access to Advanced Care Planning Act. As a physician who has worked directly with patients both planning for and facing serious illness, I know firsthand the role that advance care planning (ACP) plays in delivering compassionate, patient-centered support that ensures individuals’ values and preferences guide their care,” said Dr. Steve Landers, CEO of the National Alliance for Care at Home. “By making it easier for providers to engage in ACP with patients, this bill will help strengthen our healthcare system, ensuring individuals get the right care at the right time and often delivering better outcomes for less cost."

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