Press Releases

WASHINGTON, D.C. - Today, U.S. Senators Mark R. Warner and Tim Kaine announced $524,670 in federal funding through the U.S. Department of Health and Human Services (HHS) for Centra Health, a regional nonprofit healthcare system based in Lynchburg. This funding will allow Centra Health to expand medication assisted treatment (MAT) for patients struggling with addiction.

“Substance abuse has had a devastating effect on our communities,” the Senators said. “We hope this funding can help Centra Health offer life-saving treatment to patients struggling with addiction throughout central and southern Virginia.”

This funding was awarded through HHS’s Center for Substance Abuse Treatment (CSAT). CSAT’s mission is to promote community-based substance abuse treatment and recovery services for individuals and families in every community. CSAT provides national leadership to improve access, reduce barriers, and promote high-quality, effective treatment and recovery services.

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WASHINGTON – Today U.S. Sens. Mark R. Warner (D-VA), Ben Cardin (D-MD), Jeanne Shaheen (D-NH), and Tammy Baldwin (D-WI) introduced the Protecting Americans with Pre-existing Conditions Act, legislation that would prevent the Trump Administration from promoting “junk” health care plans that lack protections for people with pre-existing conditions and would increase costs for millions of Americans.

“Junk plans will increase health care costs for millions of consumers while weakening protections for individuals with pre-existing conditions,” said Sen. Warner. “The Trump Administration should stop trying to undermine the success of the Affordable Care Act, and instead work with Congress on targeted, bipartisan fixes that will lower health care costs and expand access to comprehensive, affordable health care coverage.”

Under new rules promulgated by the Trump Administration, states would be permitted to use federal subsidies to pay for these subpar health plans by utilizing a section of the Affordable Care Act (ACA) intended to give states additional flexibility to implement targeted improvements that expand coverage, reduce costs and provide more comprehensive benefits. Under the Trump Administration’s proposed policy, states will be permitted to increase out-of-pocket maximums and reduce the value of coverage, weaken essential health benefits, and implement changes increasing health care costs for the majority of beneficiaries as long as they can demonstrate that some people will see lower costs. As a result of this guidance, some Americans will have health coverage that doesn’t meet the ACA’s minimum standards, and millions of other Americans with pre-existing conditions could see their health care costs rise.

As 42 Senators made clear in a December letter to Administration leaders, the Administration’s plan runs contrary to the intent of Congress in drafting and passing Section 1332 of the ACA. The Protecting Americans with Pre-existing Conditions Act would prohibit the Trump Administration from implementing the guidance released on October 22, 2018 weakening protections for pre-existing conditions.

“The Trump Administration’s efforts to expand the use of junk insurance plans is bankrupt of all sense and morality. Congress must act to protect Americans from being left with higher out-of-pocket costs for less services, which can put their health in jeopardy,”said Sen. Cardin. “Improving our health care system requires serious leadership and ideas, but so far, all the Trump Administration has done is continually attempt to undermine protections for people with preexisting conditions.”

“The Trump Administration’s continued efforts to sabotage the Affordable Care Act are increasing health care costs for millions of Americans,” said Sen. Shaheen. “By incentivizing consumers to choose junk health insurance plans, the administration is taking us back to a time when Americans could be denied health coverage for pre-existing conditions like cancer and diabetes and be forced to pay sky-high medical bills out of pocket. The American people don’t want to go back to those dark days. Our legislation will block the administration from promoting or providing tax incentives for these junk plans. This commonsense bill will ensure that we maintain the protections that patients count on. It’s time for the Trump Administration to stop sabotaging health care and instead work with Democrats to try and lower prescription drug prices and expand access.”

“The Trump Administration has rewritten the rules on guaranteed health care protections that millions of Americans depend on. They have expanded of junk insurance plans that can deny coverage to people with pre-existing conditions and don’t have to cover essential services like prescription drugs, emergency room visits and maternity care,” Sen. Baldwin said. “Anyone who says they support health care coverage for people with pre-existing conditions should support this legislation. This is an opportunity for Democrats and Republicans to protect people’s access to quality, affordable health care when they need it most.”

In October, Senators forced a vote in the Senate on a discharge petition that would have blocked the Trump Administration’s rule to expand “junk insurance” plans. The measure was supported by 50 Senators, including one Republican. Ultimately, the petition did not receive the simple majority needed to pass the Senate and send it to the U.S. House of Representatives.

The Protecting Americans with Pre-existing Conditions Act has been endorsed by Families USA, the American Lung Association, the American Cancer Society Cancer Action Network, the Leukemia & Lymphoma Society, the Epilepsy Foundation, and the American Heart Association. A copy of the bill is available here, and companion legislation has been introduced in the House of Representatives by Reps. Annie Kuster (D-NH), Don Beyer (D-VA), and Joe Courtney (D-CT).

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WASHINGTON – U.S. Sens. Mark R. Warner (D-VA), member of the Senate Finance Committee, and Susan Collins (R-ME), Chairman of the Senate Aging Committee, reintroduced bipartisan, bicameral legislation to reduce duplicative filing costs for small businesses seeking to make retirement plans available to their employees. The bill was sponsored in the House by Reps. Linda Sánchez (D-CA), member of the House Committee on Ways and Means, and Phil Roe (R-TN), member of the House Committee on Education and Labor.

“Employer-provided retirement plans give workers stability and strengthen our economy in the long run, but the process of offering these plans can be expensive and complex for smaller employers,” said Sen. Warner. “This bill would remove an unnecessary impediment and reduce filing costs, thereby making it easier for employers to promote the retirement security that workers deserve.”

“Faced with an alarming $7.8 trillion shortfall in personal retirement savings, Americans simply aren’t saving enough to be able to afford a comfortable retirement,” said Sen. Collins. “When employers provide their employees with access to retirement plans, approximately 80 percent of them contribute. This bipartisan bill will help promote retirement security by making it easier and less expensive for small businesses to establish retirement plans, increasing their accessibility to employees and helping to ensure that those who worked hard for decades do not spend their retirement in poverty.”

“Too many Americans simply aren’t putting enough money away to be able to afford a secure retirement. It is no secret that women, especially women of color, are even farther behind in building adequate retirement savings due to continued pay inequality. By helping more small businesses provide workplace retirement plans we can give millions of hardworking families more financial peace of mind,” said Rep. Sánchez. “I’m proud to introduce this bipartisan, bicameral legislation to make it easier and less expensive for small businesses to establish retirement plans for their workers. This common sense legislation will help provide greater retirement security to more Americans.”

“It is imperative we do everything we can to encourage affordable and accessible retirement savings for all Americans,” said Rep. Roe. “This commonsense legislation will make it easier and less costly for small businesses to provide retirement plans for their workers by alleviating duplicative reporting requirements for plan administrators. I am proud to support this bill, which will promote a secure retirement for hardworking Americans.”

A 2016 report by the Pew Charitable Trusts showed that only 22 percent of workers at small companies have access to a workplace savings plan or pension, compared to 74 of workers at firms with 500 or more employees.

This legislation would allow employers and sole proprietors who participate in retirement plans to file a single aggregated Form 5500 – a required annual return that that provides compliance information to the Department of Labor (DOL) and the Treasury Department. Currently, employers are required to file separate forms to satisfy reporting requirements under the Employee Retirement Income Security Act and the Internal Revenue Code. By eliminating the need to report these two forms separately, this bill will remove unnecessary red tape and reduce costs for small businesses who wish to provide workers with retirement security. Under this bill, retirement plans would need to have the same trustee, fiduciary, plan administrator, plan year and investment menu in order to be eligible to file an aggregated Form 5500.

According to a 2016 survey conducted by the Transamerica Center for Retirement Studies, in collaboration with Aegon Center for Longevity and Retirement, only one-third of self-employed respondents indicated that they make sure they are saving for retirement. These self-employed workers, along with sole proprietors and small business owners, are the most likely to benefit from this legislation, as they are the most likely to establish retirement plans that meet the requirements necessary to file an aggregated Form 5500.

To provide DOL and Treasury time to implement this change, this bill has an effective date of no later than January 1, 2023. A copy of the legislative text is available here.

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Washington, D.C. – U.S. Senator Catherine Cortez Masto (D-Nev.) joined Senator Mike Crapo (R-Idaho) in a letter urging the Administration to stabilize the Medicare Advantage program that provides quality health care to 21 million seniors and individuals with disabilities. The senators wrote to Centers for Medicare and Medicaid Services (CMS) Administrator Seema Verma requesting she consider how to strengthen the program, innovate with technology and ensure predictability for enrollees.

“Millions of our constituents depend on Medicare Advantage for quality, patient-centered health care,” the senators wrote. “Beneficiary enthusiasm for the program remains strong, with more than one in three seniors enrolled…For plan year 2020, we encourage the Administration to implement policies that promote innovation, provide predictable funding to support long-term, value-based arrangements and ensure that any substantive changes include sufficient time for thorough evaluation and stakeholder engagement.”

In addition to Senators Cortez Masto and Mike Crapo, Johnny Isakson (R-Ga.), John Cornyn (R-Texas), Kyrsten Sinema (D-Ariz.), James Inhofe (R-Okla.), Roy Blunt (R-Mo.), Doug Jones (D-Ala.), Richard Blumenthal (D-Conn.), James Risch (R-Idaho), Pat Roberts (R-Kan.), Jeffrey Merkley (D-Ore.), Jeanne Shaheen (DN.H.), John Boozman (R-Ark.), Thom Tillis (R-N.C.), Angus King (I-Maine), Brian Schatz (D-Hawaii), John Barrasso (R-Wyo.), Jon Tester (D-Mont.), John Hoeven (RN.D.), Mark Warner (D-Va.), Amy Klobuchar (D-Minn.), Todd Young (R-Ind.), Marsha Blackburn (R-Tenn.), Michael Bennet (D-Colo.), Bob Casey (D-Pa.), Rob Portman (R-Ohio), Cory Gardner (R-Colo.), Gary Peters (D-Mich.), Tina Smith (D-Minn.), Cindy Hyde-Smith (R-Miss.), Lamar Alexander (R-Tenn.), Joe Manchin (DW.Va.), John Kennedy (R-La.), Susan Collins (R-Maine), Mazie Hirono (D-Hawaii), Rand Paul (R-Ky.), Roger Wicker (R-Miss.), Thomas Carper (D-Del.), Deb Fischer (R-Neb.), Marco Rubio (R-Fla.), Ben Sasse (R-Neb.), Bill Cassidy (R-La), Christopher Murphy (D-Conn.), Tom Cotton (R-Ark.), David Perdue (R-Ga.), John Thune (RS.D.), Shelley Capito (RW.Va.), Steve Daines (R-Mont.), Ron Johnson (R-Wis.), Lindsey Graham (RS.C.), Tim Scott (RS.C.), Michael Rounds (RS.D.), Dan Sullivan (R-Alaska), Joni Ernst (R-Iowa), James Lankford (R-Okla.), Mitt Romney (R-Utah), Richard Burr (RN.C.), Michael Enzi (R-Wyo.), Tom Udall (DN.M.), Martin Heinrich (DN.M.), Martha McSally (R-Ariz.), Josh Hawley (R-Mo.), Mike Braun (R-Ind.), Jacky Rosen (D-Nev.) and Kevin Cramer (RN.D.) also signed onto the letter.

The full text of the letter is available HERE and below:

Dear Administrator Verma:

We write to express our strong support for Medicare Advantage and the high-quality care it provides to more than 21 million seniors and individuals with disabilities. We appreciate the Administration’s recognition of the value of Medicare Advantage and its work to encourage innovation for these private health plans. As annual updates are considered for 2020, we ask you to continue to strengthen and grow this proven part of the Medicare program by proposing policies that provide stability and predictability.

Millions of our constituents depend on Medicare Advantage for quality, patient-centered health care. Beneficiary enthusiasm for the program remains strong, with more than one in three seniors enrolled. This is due, in part, to private plans’ ability to leverage best practices in care delivery, use robust data analytics, and implement proven value-based care and care management models. Medicare Advantage enrollees report a 91 percent satisfaction rate, with 74 percent of enrollees in plans rated four Stars and above.

The Centers for Medicare and Medicaid Services recently announced average Medicare Advantage premiums are estimated to decrease by six percent in 2019. Meanwhile, beneficiary enrollment has increased by eight percent in the past year and 79 percent since 2010, a testament to the affordability, high-quality care coordination, disease management and community-based programs, and supplemental benefits such as vision and dental coverage provided by Medicare Advantage plans. Further, bipartisan efforts are helping to reduce beneficiary costs by increasing the use of telemedicine, promoting value-based insurance design, and expanding benefits that address social determinants of health by including transportation, nutrition, and other non-medical needs that enhance quality of life.

For plan year 2020, we encourage the Administration to implement policies that promote innovation, provide predictable funding to support long-term, value-based arrangements, and ensure that any substantive changes include sufficient time for thorough evaluation and stakeholder engagement.

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Washington, D.C. – U.S. Senators Susan Collins (R-ME), the Chairman of the Aging Committee, and Mark Warner (D-VA) introduced the SIMPLE Plan Modernization Act to provide greater flexibility and access to small businesses and their employees seeking to utilize the popular SIMPLE plans as an option for saving for retirement.

“Financial advisors from Presque Isle to Portland have shared their concerns that neither employees nor their employers are in a good position to save for retirement,” said Senator Collins. “The SIMPLE Plan Modernization Act is a win-win proposition for retirement security, encouraging small business owners and their employees to take steps to save for retirement.”

“The changing nature of work has made it more challenging for many Americans to plan for their retirement,” said Senator Warner.“This commonsense legislation will make it easier for small businesses to support their workforce in saving for retirement.”

Congress established SIMPLE (Savings Incentive Match Plan for Employees) retirement plans in the Small Business Job Protection Act of 1996 to encourage small businesses to provide their employees with retirement plans. Retirement plans among small employers continue to be scarcer than among medium and large employers. While these smaller businesses have access to tax-favored retirement savings plans (including traditional 401(k)s), those plans are more expensive to administer.

Businesses with 100 or fewer employees may currently create SIMPLE retirement savings accounts for their employees, so long as the employers do not have another employer-sponsored retirement plan.

The proposed legislation would increase the contribution limit for SIMPLE plans. Increasing the limit would achieve two basic goals: 1) Encourage more small business employers to offer a retirement savings benefit to their employees and 2) Allow small business employees to save even more each year on a tax-deferred basis.

The SIMPLE Plan Modernization Act would:

Raise the contribution limit for SIMPLE plans from $12,500 to $16,000 (halfway between current SIMPLE plans and traditional 401(k)s) for the smallest businesses (1 to 25 employees), with a corresponding increase in the catch-up limit from $3,000 to $4,500.

Give businesses with 26 to 100 employees the option of the higher contribution limits, and, in order to continue to encourage them to transition to 401(k)s when they can do so, increase their SIMPLE plan mandatory employer contribution requirements by one percentage point if they elect the higher limits.

Allow for a reasonable transition period for employers that grow beyond 25 employees.

Make the limit increases unavailable if the employer has had another defined contribution plan within the past three years (to encourage businesses that already have qualified plans to retain them).

Modernize SIMPLE plan form filing requirements and modify the transition rules from SIMPLE plans to traditional plans to facilitate and encourage such transitions.

Direct Treasury to study the use of SIMPLE plans and report to Congress on such use, along with any recommendations.

WASHINGTON—U.S. Senators Bill Cassidy, M.D. (R-LA), and Mark Warner (D-VA) today released a draft version of the Patient Affordability, Value and Efficiency Act, bipartisan legislation they are developing to facilitate new and innovative payment models for pharmaceuticals and other medical services so that patients have better access to treatment, the health care market is more efficient, and drug prices are more affordable.

Cassidy and Warner are requesting feedback from all interested parties to ensure highly technical changes enabling value-based arrangements are thoroughly vetted, and that important oversight protections are preserved. Submissions should be emailed to Dr. Cassidy’s office at paveact@cassidy.senate.gov and to Sen. Warner’s office at paveact@warner.senate.gov by February 19, 2019.

“To lower the cost of health care, we should leverage new ideas and new approaches, and I’m proud Louisiana is helping to lead the way,” said Dr. Cassidy. “We are crafting this legislation to implement innovative, market-based solutions to increase patient access to care and make medications more affordable.”

“In recent years, skyrocketing prescription drug prices and health costs have made it more difficult for Americans and communities to access lifesaving care,” said Sen. Warner. “That’s why I’ve teamed up with Sen. Cassidy to re-align the way Americans are charged for prescription drugs and other health care costs. With input from experts and key stakeholders, we’ll be able to ensure that pharmaceutical companies and medical device manufacturers are incentivized to develop more effective treatments at a better price.”

The Cassidy-Warner proposal increases the ability to move toward value-based arrangements, which directly connect pricing for prescription drugs and medical devices to the clinical effectiveness of their products. Current healthcare law unintentionally restricts the ability of insurers, hospitals and clinics to pay for prescription drugs or medical devices based upon their proven effectiveness. The Patient Affordability, Value and Efficiency Act would provide for narrowly tailored exemptions to help drive down prescription drug and medical device costs while incentivizing manufacturers to create products that effectively treat patients.

In October, Dr. Cassidy coauthored an article for the Journal of the American Medical Association(JAMA) with Mark Trusheim of the Massachusetts Institute of Technology and Dr. Peter Bach of the Memorial Sloan Kettering Cancer Center explaining their idea for a “Netflix” model to pay for drugs. This draft legislation restructures current barriers to allow the implementation of these kinds of innovative models.

Cassidy and Warner’s efforts are supported by a number of patient groups:

CureDuchenne
Cure Sanfilippo Foundation
Debra of America
Friedreich’s Ataxia Research Alliance
Global Genes - Allies in Rare Disease
MLD Foundation
MTM-CNM Family Connection
Myotonic Dystrophy Foundation
Parent Project Muscular Dystrophy – PPMD
Prevent Cancer Foundation
Power for Parkinson’s
Soft Bones, The Hypophosphatasia Foundation
The Michael J. Fox Foundation
The Joshua Frase Foundation

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WASHINGTON, D.C. - Today, U.S. Senators Mark Warner and Tim Kaine announced $2,238,496 in federal funding through the U.S. Department of Health and Human Services (HHS) for the Loudoun Community Health Center. This funding will enable Loudoun County to provide accessible, quality health care to patients regardless of their ability to pay.

“We’re pleased to announce federal funding to ensure the Loudoun Community Health Center can continue to offer valuable care to those in need of support,” the Senators said. “The Health Center helps ensure that patients of any economic background can access the medical, dental, and mental health services they need.”

This funding was awarded through HHS’s Health Resources & Services Administration Health Center Program. More than 27 million people in the U.S. rely on HRSA-funded health centers for affordable primary health care.

WASHINGTON, D.C. - Today, U.S. Senators Mark Warner and Tim Kaine announced $5,788,425 in federal funding through the U.S. Department of Health and Human Services (HHS) to support HIV relief efforts in Norfolk. The goal of the project is to enhance access to effective, cost efficient, community-based care for low-income individuals and families with HIV.

“We are pleased to announce federal funding to help those with HIV in Norfolk get the care they deserve,” the Senators said.

The funding was awarded through HHS’s HIV Emergency Relief Project Grant program. The grant program provides funding to communities that have been the most affected by the HIV epidemic in order to improve access to comprehensive care and increase support for minority populations.

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WASHINGTON – Sen. Mark R. Warner (D-VA) led Sens. Tim Kaine (D-VA), Ben Cardin (D-MD) and Chris Van Hollen (D-MD) today in urging the U.S. Office of Personnel Management (OPM) to do everything in its power to prevent the termination of dental and vision insurance coverage for federal employees affected by the partial government shutdown. In a letter to OPM, the Senators stood up for the federal employees who risk losing their coverage unless they pay out of pocket for premiums that would usually be deducted from their paychecks.

“Your guidance to employees has been insufficient and fails to account for the significant financial strain already placed on these employees and their families,” wrote the Senators. “If the status quo persists, you are undoubtedly risking the health and wellness of federal workers, their spouses, and children enrolled in federal vision and dental plans. We have already heard from individuals who are worried about what this will mean for them and their health care needs.”

“We believe it is unreasonable to expect unpaid employees to take on this financial responsibility,” continued the Senators. “Instead, we ask that you immediately work with federal contractors administering these dental and vision benefits to develop alternative payment arrangements that ensure continuous coverage at no risk of terminated benefits. In addition, we ask that – upon any such agreement – you immediately reissue guidance to employees who are in jeopardy of having their benefits terminated.”

OPM recently announced that many federal employees enrolled in the Federal Employees Dental and Vision Insurance Program will be billed directly for their premiums after the date of their second missed pay period – as soon as this Friday. This notice places additional financial pressure on strained government employees who are already struggling to pay for expenses like childcare and mortgages.

The full text of the letter is available here and below.

January 23, 2019

Margaret Weichert

Acting Director

U.S. Office of Personnel Management

1900 E Street NW, Washington, DC 20415

Dear Acting Director Weichert:

We write today concerning federal employees that may lose their dental and vision health insurance benefits as a result of the government shutdown. As you may know, if the current lapse in government funding continues more than 800,000 federal employees will miss their second pay period. From this time forward – federal employees with dental and vision insurance must also begin to pay their premiums directly to BENEFEDS or risk having their coverage terminated.

Recent guidance from the U.S. Office of Personnel Management to federal employees’ enrolled in the BENEFEDS dental and vision plans states:

“Payroll deductions will cease for any employee that does not receive pay. BENEFEDS will generate a bill to enrollees for premiums when no payment is received for two consecutive pay periods. The enrollee should pay premiums directly billed to him/her on a timely basis to ensure continuation of coverage.”

The above guidance will require federal employees to tap into their savings and pay these costs or risk having their coverage terminated. We are alarmed that unpaid federal employees will be required to incur this additional financial hardship during a time when they can least afford it. This is unacceptable.

Your guidance to employees has been insufficient and fails to account for the significant financial strain already placed on these employees and their families. If the status quo persists, you are undoubtedly risking the health and wellness of federal workers, their spouses, and children enrolled in federal vision and dental plans. We have already heard from individuals who are worried about what this will mean for them and their health care needs. We also understand that certain insurers are willing to allow individuals to continue their coverage without payment, and we encourage OPM to continue to work with all insurers to help members maintain continuity of coverage.

We believe it is unreasonable to expect unpaid employees to take on this financial responsibility. Instead, we ask that you immediately work with federal contractors administering these dental and vision benefits to develop alternative payment arrangements that ensure continuous coverage at no risk of terminated benefits. In addition, we ask that – upon any such agreement – you immediately reissue guidance to employees who are in jeopardy of having their benefits terminated.

Thank you for your attention to this letter. If our offices can be further helpful in resolving this matter please do not hesitate to contact us.

Sincerely,

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WASHINGTON – Today U.S. Sens. Mark R. Warner (D-VA), Ben Cardin (D-MD), Jeanne Shaheen (D-NH), and Tammy Baldwin (D-WI) led a group of 38 Senators in calling on the Trump Administration to withdraw recent changes that makes it easier for states to promote “junk” plans. These health care plans typically lack protections for people with pre-existing conditions and would increase costs for millions of Americans. Under the Administration’s new guidance, states can use federal subsidies to pay for these subpar plans by utilizing a section of the Affordable Care Act (ACA) intended to give states additional flexibility to implement targeted improvements that expand coverage, reduce costs and provide more comprehensive benefits. The Senators argue that the Administration is improperly using Section 1332 to allow states to do the exact opposite.

“We have serious concerns they will increase health care costs for millions of consumers while weakening protections for individuals with pre-existing conditions. In light of substantive concerns that we have with the impact on patients, and procedural concerns that we have with the manner in which these significant policy changes have been promulgated, we ask that you immediately withdraw this guidance and re-engage with stakeholders, states, and Congress,” said the Senators in a letter to Health and Human Services Secretary Alex Azar, Centers for Medicare & Medicaid Services Administrator Seema Verma, and Treasury Secretary Steve Mnuchin.

The Senators made it clear these actions did not reflect Congress’ intent in creating the 1332 waiver program, stating “the Administration’s recent guidance significantly changes enforcement of these four important guardrails, undermining Congressional intent and posing a significant risk to consumers that now have affordable and comprehensive health coverage.”

Additionally the proposed changes, which were outlined in guidance provided by the Administration and a discussion paper released a few months back, will allow states to increase out-of-pocket maximums and reduce the value of coverage, weaken essential health benefits, and implement changes that increase health care costs for the majority of beneficiaries if a state can demonstrate costs will be lower for some.

“We ask that you immediately withdraw this guidance and work with us and other stakeholders on policies that maintain protections for individuals with pre-existing conditions and improve affordability,” concluded the Senators.

In addition to Sens. Warner, Cardin, Shaheen, and Baldwin, the letter was signed by Sens. Tom Carper (D-DE), Tim Kaine (D-VA), Amy Klobuchar (D-MN), Maggie Hassan (D-NH), Richard Blumenthal (D-CT), Jeff Merkley (D-OR), Chris Coons (D-DE), Bob Casey (D-PA), Chris Murphy (D-CT), Michael Bennet (D-CO), Elizabeth Warren (D-MA), Kamala Harris (D-CA), Debbie Stabenow (D-MI), Bob Menendez (D-NJ), Ron Wyden (D-OR), Gary Peters (D-MI), Chris Van Hollen (D-MD), Ed Markey (D-MA), Mazie Hirono (D-HI), Tina Smith (D-MN), Patty Murray (D-WA), Angus King (I-ME), Cory Booker (D-NJ), Bernie Sanders (I-VT), Dick Durbin (D-IL), Jack Reed (D-RI), Maria Cantwell (D-WA), Sherrod Brown (D-OH), Doug Jones (D-AL), Tammy Duckworth (D-IL), Martin Heinrich (D-NM), Patrick Leahy (D-VT), Tom Udall (D-NM), Kirsten Gillibrand (D-NY), Sheldon Whitehouse (D-RI), Dianne Feinstein (D-CA), Catherine Cortez-Masto (D-NV), and Brian Schatz (D-HI).

The full text of the letter can be found here and below.

The Honorable Seema Verma

Administrator

Centers for Medicare & Medicaid Services

7500 Security Boulevard

Baltimore, MD 21244

The Honorable Alex Azar

Secretary

U.S. Department of Health and Human Services

200 Independence Avenue, SW

Washington, DC 20201

The Honorable Steven Mnuchin

Secretary

U.S. Department of the Treasury

1500 Pennsylvania Avenue, NW

Washington, DC 20220

Dear Secretary Azar, Administrator Verma and Secretary Mnuchin:

We write to express concern with the Administration’s October 22 guidance and November 29 discussion paper on new options for states pursuing a Section 1332 waiver under the Patient Protection and Affordable Care Act (ACA). The new guidance and discussion paper promote health plans that lack protections for people with pre-existing conditions and low-income families enshrined in the Centers for Medicare and Medicaid Services (CMS) guidance released in 2015 and adopt new principles that were not envisioned by Congress. We have serious concerns they will increase health care costs for millions of consumers while weakening protections for individuals with pre-existing conditions. In light of substantive concerns that we have with the impact on patients, and procedural concerns that we have with the manner in which these significant policy changes have been promulgated, we ask that you immediately withdraw this guidance and re-engage with stakeholders, states, and Congress.

Section 1332 of the ACA gives states additional flexibility to implement state-specific improvements that expand coverage, reduce costs and provide more comprehensive benefits. In fact, Congress enacted so-called “guardrails” that waiver proposals must meet in order for the Secretary to approve them. Specifically, waivers must ensure 1) health coverage is at least as comprehensive as it would be under the ACA, 2) cost-sharing and premiums are as affordable as they would be under the ACA, 3) the number of individuals with coverage remains comparable to the number of individuals covered under the ACA, and 4) the waiver does not increase the Federal deficit.

The Administration’s recent guidance significantly changes enforcement of these four important guardrails, undermining Congressional intent and posing a significant risk to consumers that now have affordable and comprehensive health coverage. The “waiver concepts,” published after the release of the recent guidance, suggests that the Secretary will permit states to use Federal subsidies for the purchase of short-term, limited-duration (STLDI) “junk plans” that do not meet Federal patient protections. The new guidance will also allow states to count junk plans as health insurance when determining how many individuals are enrolled in coverage.

This change will allow states to enroll more individuals in subpar plans that do not offer essential health benefits such as mental health care, maternity care, prescription drug coverage or substance use disorder treatment. Additionally, these subpar plans can discriminate against individuals with pre-existing conditions, older Americans and women by excluding these essential benefits. These plans may also charge certain customers more for their coverage, deny coverage entirely, impose annual and lifetime limits on care, and other anti-consumer practices. This use of federal tax dollars for subpar, often deceptively-marketed insurance that barely provides coverage at all is completely unacceptable.

It is important to note that hospitals, insurers, patient groups and independent health experts have all agreed that the increased use of these junk plans will increase the cost of health care coverage for many Americans, undercut protections for individuals with pre-existing conditions and erode stability in the health insurance markets.

In addition to the increased use of junk plans, the discussion paper makes clear that the Secretary will also give states more flexibility to increase out-of-pocket maximums and reduce the value of coverage, weaken essential health benefits, and implement changes that increase health care costs for those who need it most if a state can demonstrate costs will be lower in the aggregate. We have serious concerns about how these changes will impact the quality and affordability of coverage, especially for vulnerable sub-populations.

Furthermore, we are concerned that this guidance may exceed the Secretary’s legal authority by not requiring Congressional approval to change existing law and by subverting the full notice and comment rule-making process. The guidance violates the statute by allowing states to provide “access to” instead of “provision of” affordable and comprehensive coverage to at least the same number of residents. It also redefines “health insurance” to include plans that lack the ACA’s consumer protections. In addition, by forgoing Congressional approval and the rule-making process the Administration has excluded an opportunity for public comment from millions of Americans and other stakeholders that will be impacted by these changes. In contrast, the Department finalized the 2015 guidance only after taking into account feedback from stakeholders and experts. The Department finalized this new guidance immediately, without getting any vital input from affected stakeholders.

For these reasons, we ask that you immediately withdraw this guidance and work with us and other stakeholders on policies that maintain protections for individuals with pre-existing conditions and improve affordability. Thank you for your consideration of our letter and we look forward to your response.

Sincerely,

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WASHINGTON— Today, U.S. Sens. Mark R. Warner and Tim Kaine (both D-VA) announced that Virginia will receive $6,349,505 in federal funds from the U.S. Department of Health and Human Services (HHS) to combat the opioid epidemic. The funds will help Virginia communities combat this crisis by expanding access to quality substance use disorder and mental health services, including in rural populations.

“Communities across the Commonwealth have been devastated by the epidemic of opioid abuse that continues to spread across the country,” said the Senators. “These funds will help Virginia stem the alarming rise in overdose deaths and increase prevention and treatment efforts that will help save lives.”

The opioid epidemic has devastated many communities across Virginia. In 2017, the Virginia Department of Health estimated that 1,445 people died in Virginia as a result of a fentanyl, heroin, or prescription opioid overdose. Fatal drug overdoses are now the leading cause of accidental death in Virginia, surpassing car accidents and gun violence.

Last week, the Senators voted in support of a funding bill that provides approximately $5.7 billion to respond to the opioid crisis by developing non-opioid pain medication, and behavioral health workforce training. Sens. Warner and Kaine also celebrated the passage of a comprehensive opioid substance abuse bill that included their own previously introduced legislation.

The full list of grant awardees is below:

GRANTEE	CITY	TOTAL
Neighborhood Health	Alexandria	$285,000
Urban Strategies LLC	Arlington	$200,000
Blue Ridge Medical Center Inc.	Arrington	$285,000
One Care Of Southwest Virginia, Inc.	Cedar Bluff	$200,000
Free Clinic Of The New River Valley Inc.	Christiansburg	$285,000
Piedmont Access To Health Services Inc.	Danville	$285,000
Clinch River Health Services, Inc.	Dungannon	$210,000
Harrisonburg Community Health Center, Inc.	Harrisonburg	$285,000
St Charles Health Council Inc.	Jonesville	$329,250
Tri-Area Community Health	Laurel Fork	$285,000
Rockbridge Area Free Clinic	Lexington	$257,371
Johnson Health Center	Madison Heights	$285,000
Martinsville Henry County Coalition For Health And Wellness	Martinsville	$217,644
Highland Medical Center	Monterey	$224,500
Central Virginia Health Services, Inc.	New Canton	$206,750
Peninsula Institute For Community Health, Inc.	Newport News	$285,000
Portsmouth Community Health Center, Inc.	Portsmouth	$285,000
Daily Planet Inc.	Richmond	$297,500
Richmond, City Of	Richmond	$285,000
Kuumba Community Health & Wellness Center, Inc.	Roanoke	$186,133
Southwest Virginia Community Health Systems, Inc.	Saltville	$237,773
Bay Rivers Telehealth Alliance	Tappahannock	$200,000
Greater Prince William Area Community Health Center, Inc.	Woodbridge	$285,000
Virginia Department of Health	Richmond	$200,000

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WASHINGTON, D.C. – Today, U.S. Senators Mark Warner and Tim Kaine celebrated Senate passage of the Opioid Crisis Response Act of 2018, a comprehensive substance abuse treatment bill to address the national addiction crisis. The bipartisan bill passed 99-1 after months of work in several Senate committees. The Opioid Crisis Response Act of 2018 includes four proposals from Warner that initially passed out of the Senate Finance Committee as part of the Helping to End Addiction and Lessen (HEAL) Substance Use Disorders Act of 2018. This comprehensive package also includes three Kaine proposals that passed the Senate Health, Education, Labor, and Pensions (HELP) Committee as part of an earlier version of The Opioid Crisis Response Act of 2018.

“The opioid epidemic has devastated communities across Virginia. In order to save lives, we need a comprehensive strategy that tackles the opioid epidemic at all fronts, and this bipartisan legislation offers a much-needed roadmap to combat this national crisis. This bill addresses many of the challenges our health professionals and law enforcement face when confronting the opioid addiction epidemic. It also recognizes that addiction and recovery doesn’t look the same for everyone everywhere. From establishing telehealth services to better equip underserved communities with substance abuse treatment to providing specialized care for infants suffering from opioid withdrawal, this bill makes significant steps to fight the opioid epidemic,” said Warner.

“The opioid epidemic has taken lives and hurt families in Virginia and across the country. We’re past due for comprehensive legislation that can address the public health and law enforcement challenges that our communities are facing. This bipartisan, comprehensive package puts forth concrete changes that can help us begin to break the harmful cycle of addiction and address the drug overdoses that are plaguing our communities. We must tackle this crisis from all angles, including prevention, treatment, and recovery,” Kaine said.

Warner and Kaine have worked to drive forward legislation to combat the substance abuse epidemic, which in 2017 accounted for more than 72,000 deaths nationwide.

Warner, a member of the Senate Finance Committee, voted to advance the Helping to End Addiction and Lessen (HEAL) Substance Use Disorders Act of 2018 out of the Senate Finance Committee in June. The bill passed out of committee on a bipartisan 27-0 vote and included provisions from four Warner bills to:

Expand telehealth services for substance abuse treatment.
Make clear how Medicaid funds can be used for substance use disorder treatment through telehealth.
Help ensure children suffering from substance use disorders receive the assistance they need through telehealth services.
Improve data collection on substance use disorders among Medicaid recipients.

Kaine, a member of the Senate Health, Education, Labor, and Pensions (HELP) Committee, voted to pass the Opioid Crisis Response Act of 2018 out of the Senate HELP Committee in April. The bill was the result of seven bipartisan hearings and included proposals from three Kaine bills to:

Give states the resources and guidelines to ensure recovery homes are effectively helping residents sustain recovery from opioid and substance use disorders.
Incorporate job training into drug addiction recovery programs.
Afford schools the opportunity to apply for grants to directly offer trauma support services to students impacted by the opioid epidemic.

In March, Sens. Warner and Kaine voted for the omnibus bill that increased funding to the Department of Health and Human Services (HHS) to support programs related to the opioid crisis, including an additional $2.8 billion for treatment, prevention and research.

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WASHINGTON— Today, U.S. Sens. Mark R. Warner and Tim Kaine (both D-VA) cosponsored legislation to overturn President Trump’s expansion of “junk insurance” plans. The Trump Administration recently released its final regulation on allowing Short-term Limited Duration Insurance (STLD) plans to expand eligibility for bare-bones health insurance plans, which do not have to provide the same level of minimum coverage as individual policies sold under the Affordable Care Act. According to experts, this move will undermine protections for individuals with pre-existing conditions by allowing insurance companies to market and sell more plans without vital consumer protections. In addition, this change will destabilize our country’s health care system and drive up health care costs for patients by shrinking the number of individuals in plans on the individual insurance marketplace.

The resolution of disapproval introduced in the Senate and cosponsored by 44 Senators, including Sens. Warner and Kaine, would rescind the final “junk insurance” plan rule. Congressional Review Act (CRA) disapproval resolutions that obtain the support of 30 Senators on a discharge petition force a vote on the Senate floor. Senators now have the support needed to file a discharge petition and force a vote under the CRA. A simple majority vote in the Senate would pass the resolution and send it to the House of Representatives.

“Virginians have a lot to lose if the Trump Administration is allowed to continue its policy allowing junk plans that will deny coverage to those with preexisting conditions and take away access to essential services like prescription drugs, emergency room visits, and maternity care,” said the Senators. “Congress should overturn this misguided attempt to undermine these critical consumer protections and refocus on reducing the growing insurance costs caused by the President’s ongoing attempts to sabotage the Affordable Care Act.”

The American Cancer Society Cancer Action Network (ACSCAN) has said President Trump’s rule “poses a serious threat to cancer patients’ ability to access quality, affordable health coverage.” ACSCAN also said the rule “will likely leave older and sicker Americans in the individual insurance marketplace with few, if any, affordable health coverage choices” and that “patients living with serious conditions will be left paying more for the coverage they need if they can afford coverage at all.”

For months, Sens. Warner and Kaine have been sounding the alarm on President Trump’s plans to undermine protections for people with pre-existing conditions by expanding health care plans that do not have many vital consumer protections. They have urged the Administration to take swift action to stabilize the insurance marketplace and halt the expansion of “junk” health insurance plans.

In addition to Sens. Warner and Kaine, the resolution is cosponsored by Sens. Tammy Baldwin (D-WI), Richard Blumenthal (D-CT), Cory Booker (D-NJ), Sherrod Brown (D-OH), Maria Cantwell (D-WA), Ben Cardin (D-MD), Tom Carper (D-DE), Bob Casey (D-PA), Christopher Coons (D-DE), Catherine Cortez Masto (D-NV), Joe Donnelly (D-IN), Tammy Duckworth (D-IL), Dick Durbin (D-IL), Dianne Feinstein (D-CA), Kirsten Gillibrand (D-NY), Kamala D. Harris (D-CA), Maggie Hassan (D-NH), Martin Heinrich (D-NM), Mazie K. Hirono (D-HI), Doug Jones (D-AL), Angus King (I-ME), Amy Klobuchar (D-MN), Patrick Leahy (D-VT), Ed Markey (D-MA), Claire McCaskill (D-MO), Bob Menendez (D-NJ), Jeff Merkley (D-OR), Chris Murphy (D-CT), Patty Murray (D-WA), Bill Nelson (D-FL), Gary Peters (D-MI), Jack Reed (D-RI), Bernie Sanders (I-VT), Brian Schatz (D-HI), Jeanne Shaheen (D-NH), Tina Smith (D-MN), Debbie Stabenow (D-MI), Jon Tester (D-MT), Tom Udall (D-NM), Chris Van Hollen (D-MD), Elizabeth Warren (D-MA), Sheldon Whitehouse (D-RI), and Ron Wyden (D-OR).

Text of the resolution is available here.

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WASHINGTON, D.C. – Today, U.S. Senators Mark Warner and Tim Kaine announced $416,248 in federal funding for James City County to prevent violence against women. The funds will be used toward a program that will educate domestic violence survivors about risk factors for homicide and provide them with support services, train and educate criminal justice professionals and allied agencies on best practices to investigate and prosecute crimes against women, and identify potential high-risk offenders. The money is awarded by the U.S. Department of Justice through the Violence Against Women Act.

“We are proud to announce this federal funding to help James City County address and prevent violence against women,” the Senators said. “We are thankful to local leaders who are collaborating with non-profits and criminal justice professionals to protect the community.”

In 2013, Warner and Kaine supported the reauthorization of the Violence Against Women Act, a bill that authorized the funding available in today’s grant and created essential protections for survivors of sexual violence and domestic abuse. Congress must reauthorize the law, which expires every five years, before the end of the month.

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WASHINGTON – U.S. Sen. Mark R. Warner today introduced bipartisan legislation, co-sponsored by Sens. Shelley Moore Capito (R-WV), Tim Kaine (D-VA), Joe Manchin (D-WV), Bob Casey (D-PA) and Sherrod Brown (D-OH), to boost participation in federal programs that detect and treat black lung disease among coal miners.

According to a recent study published in the American Journal of Public Health, cases of black lung are at a 25-year high in Appalachian coal mining states, with as many as one in five underground coal miners in the region having evidence of black lung. In order to address this worsening public health crisis, Sen. Warner has filed an amendment to the defense, labor, health and education spending package currently under consideration on the floor of the U.S. Senate aiming to improve the participation rate of coal miners in federal health surveillance programs that detect and treat black lung. Specifically, the amendment requires the National Institute for Occupational Safety and Health to submit a report to Congress on ways to boost outreach efforts to increase participation in the Coal Workers’ Health Surveillance Program (CWHSP) and to identify barriers that deter miners with black lung from accessing treatment. CWHSP is a national program that offers free health screening services to coal miners, including chest X-rays, lung function testing, respiratory health assessment questionnaires, and extended health surveillance. However, the current national participation rate in CWHSP is approximately 35 percent among active miners and even lower among retirees.

“Black lung is a deadly disease, but the earlier it’s detected, the better the outcomes are. Underground coal miners help keep the heat and the lights on, but often at a significant cost to their own health. By improving outreach efforts, we can make sure that more miners are getting screened so we can catch cases of black lung early, and make sure that they can get the treatment they need,” said Sen. Warner.

“West Virginia coal miners have worked tirelessly for decades to keep industries and communities in this country moving,”Sen. Capito said. “These resources dedicated to the early detection of black lung could be life-saving for thousands of hardworking West Virginians. Amazing work is being done in this area by the National Institute for Occupational Safety and Health’s Respiratory Health Division in Morgantown, and I am honored to help that work continue and provide assistance to those who have given so much to our state.”

“Virginia’s coal miners have worked for decades, often at the expense of their own health, to keep the country’s lights on, and we owe it to them to ensure they’re aware of their options to access black lung detection and treatment resources,”said Sen. Kaine.

“Coal miners sacrifice a lot to keep our lights on, heat our homes, and power our businesses, including their own health. Black lung cases are at a 25-year high and with today’s technology and our knowledge of this disease, that is simply unacceptable. Our amendment will make sure more miners participate in early detection so we can catch it and treat it quicker. The health and safety of our miners should always be our number one priority and I will be fighting for this amendment to be included in the final spending bill,” Sen. Manchin said.

“No worker should have to sacrifice their health and safety on the job to provide for their family,” said Sen. Casey. “Black lung claims too many lives but the earlier it’s detected the better chance individuals have fighting its impact. We owe it to our nation’s miners to put in place policies that help detect and prevent this fatal disease.”

“Ohio miners put their health at risk to power our country. Finding ways to increase outreach and miner participation in the screenings that help prevent and manage conditions like black lung is the least we can do,” said Sen. Brown.

“Eliminating barriers to participation in the Coal Worker’s Health Surveillance Program is a strong first step towards improving the health and wellness of active and retired coal miners in the Commonwealth of Virginia. This amendment will assist Congress in determining how to improve the Program, thereby enabling it to best serve miners. The amendment could also lead to better participation in the Surveillance Program, help save lives, improve early identification of black lung, and ultimately improve health outcomes for current and future health center patients throughout the Commonwealth of Virginia. We support this amendment to H.R. 6157 and encourage its inclusion in the final version of the appropriations package,” said Rick Shinn, Virginia Community Healthcare Association, Director of Government Affairs.

“The NIOSH Coal Workers’ Health Surveillance Program is vital to the detection of Black Lung Disease. Ensuring Program access to as many active and non-active coal miners as possible will help miners be aware of their health status, reduce continued exposure to harmful dust, and seek treatment as early as possible. This amendment will assist Congress in determining how to improve the Program, thereby enabling it to best serve miners,” said James L. Werth, Jr., PhD, Stone Mountain Health Services, Black Lung Program Director.

Sen. Warner has been a strong advocate for coal miners and their families. In 2017, Sen. Warner reintroduced the Black Lung Benefits Improvement Act to ensure black lung claims are processed fairly and quickly, and he has pushed for more funding for black lung health clinics in Virginia. In December, he joined several of his colleagues in urging Secretary of Labor Alexander Acosta to keep the Respirable Dust Rule to protect mine safety and miners health. Last year, Sen. Warner successfully fought to permanently protect more than 10,000 retired coal miners and their families in Virginia who were in danger of losing their health benefits. He has also introduced the American Miners Pension Act, which would protect the pensions of more than 7,000 retired Virginia coal miners who are in danger of losing their benefits if the 1974 UMWA Pension Plan becomes insolvent.

Text of Sen. Warner’s amendment is available here.

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WASHINGTON, D.C. – U.S. Senators Mark Warner and Tim Kaine announced $400,000 in federal funding for the Harrisonburg-Rockingham County Drug Court Program and $350,000 in federal funding for the Richmond Adult Drug Treatment Court (RADTC) Program.

“We are pleased to announce funding to ensure drug courts in Virginia can provide treatment services, enhance public safety, and reduce crime in local communities. Drug courts are a critical part of our criminal justice system because they focus on prevention and rehabilitation, so those suffering from addiction have a better chance at recovery and are less likely to commit crimes in the future, ” the Senators said.

The funding was awarded through the U.S. Department of Health and Human Services’ Center for Substance Abuse Treatment.

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WASHINGTON – Today U.S. Sens. Mark R. Warner and Tim Kaine (both D-VA) announced that the Appalachian Regional Commission (ARC) has approved $500,000 in grant funding for St. Mary’s Health Wagon, a non-profit organization that provides health services to underserved individuals. The funding will be used to construct a new healthcare clinic in Clintwood, Va. that is expected to serve 3,500 uninsured and underinsured patients annually.

“Every year, the Health Wagon helps thousands of Virginians get access to healthcare they otherwise could not afford. As Governors and as Senators, we have been proud to support the important work of the Health Wagon. Worthy projects such as this clinic are why we have fought so hard in Washington to protect funding for the Appalachian Regional Commission. This new facility in Dickenson County will allow the Health Wagon to continue providing health, vision and dental services to underserved patients in Southwest Virginia,” said the Senators.

“We are so pleased that ARC chose to fund a much-needed construction grant for a brand-new stationary free health clinic in Dickenson County, the county where St. Mary’s Health Wagon began almost forty years ago. The Health Wagon is the region’s only free clinic, serving Lee, Scott, Wise, Dickenson, Buchanan and Russell Counties and is a medical home to over 10,000 patients. The new free clinic will be located in Clintwood, Virginia, and will bring a variety of new innovative patient resources and economic benefits such as medical tourism and new jobs to the region. The new clinic will have dedicated optometry, dental, ultrasound and x-ray suites,” said Dr. Teresa Tyson, Health Wagon Executive Director.

The current Health Wagon clinic in Clintwood has only two exam rooms, limiting the ability of physicians to accommodate patient needs. Construction of the new 5,000-square foot clinic will provide additional exam rooms for medical, dental, and vision care services, as well as administrative offices and spaces for x-ray, pharmacy, laboratory and telehealth use. Governor McAuliffe recommended funding for this project at the end of tenure, which has now been formally approved by ARC.

ARC project grants are awarded to local and state government entities and non-profits. The ARC funds are then matched by local funding sources. In addition to the ARC funds, local sources will provide $730,600, bringing the total project funding to more than $1.2 million. Since its inception in 1965, ARC has generated over 300,000 jobs and $10 billion for the 25 million Americans living in Appalachia. ARC has provided funding and support for job-creating community projects across the 13 Appalachian states, producing an average of $204 million in annual earnings for a region often challenged by economic underdevelopment. President Trump’s 2018 budget proposed eliminating the program entirely. Warner and Kaine have continued to vote to fully fund ARC.

As Governors, Warner and Kaine both advocated for additional funding for the Health Wagon, a partner in the annual Remote Area Medical (RAM) clinic that provides dental care, exams and treatment at no cost.

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WASHINGTON, D.C. - Today, U.S. Senators Mark Warner and Tim Kaine (both D-VA) announced a $2.5 million dollar loan for Eastern Shore Rural Health System, Inc. to open a new health care facility in Eastville, Virginia offering affordable medical and dental care. The new center will replace the aging Bayview and Franktown Community Health Center with a facility that offers expanded operating hours, more lab services, increased access to dental care, and opportunity to incorporate telemedicine in their practice.

“We are pleased to support efforts to launch a new health care facility on the Eastern Shore to help meet the shortage of medical and dental care in the area and encourage more health care providers to expand coverage to the region,” the Senators said.

The funding is awarded through the U.S. Department of Agriculture’s (USDA) Office of Rural Development. Additional funding for the health care facility comes from Eastern Shore Rural Health System Inc., as well as private corporations and foundations.

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(Washington, D.C.) – Today, the Office of Inspector General of the Department of Health and Human Services (HHS)announced it would conduct a comprehensive review of the Office of Refugee Resettlement’s (ORR) Unaccompanied Alien Children (UAC) program after Senator Patty Murray (D-WA), ranking member of the Senate Health, Education, Labor, and Pensions (HELP) Committee, Senator Dick Durbin (D-IL), and 39 other Senate Democrats sent a letter to the Office of Inspector General requesting they look into the issue. The request for an investigation follows weeks of uncertainty about the Health Department’s ability to appropriately care for children placed in its custody as a result of President Trump’s family separation policy, as well as the Department’s lack of clarity around plans to reunite children and parents.

“We write to request a comprehensive review of the operations of the Department of Health and Human Services (HHS) Office of Refugee Resettlement’s (ORR) Unaccompanied Alien Children (UAC) program, particularly focused on how the Office has approached and responded to President Trump’s family separation policy. We are alarmed by the uncertainty and pain inflicted on thousands of families arriving at the U.S. border, particularly the mental and physical harm inflicted on immigrant children and their parents by this policy, and we are deeply troubled by recent reports of maltreatment of children while under ORR custody. While we are encouraged by the announcement of recent efforts to prioritize family reunification, we also have significant questions about how the Department is working to accomplish this goal. It is equally important that we understand what measures, if any, HHS undertook to prioritize the health, safety, and wellbeing of children in its custody as it implemented the family separation policy, both before and after President Trump’s June 20 Executive Order to reverse the policy,” wrote Senator Murray.

The letter was signed by Senators Patty Murray (D-WA), Dick Durbin (D-IL), Dianne Feinstein (D-CA), Ron Wyden (D-OR), Tom Udall (D-NM), Elizabeth Warren (D-MA), Edward Markey (D-MA), Patrick Leahy (D-VT), Catherine Cortez Masto (D-NV), Martin Heinrich (D-NM), Tina Smith (D-MN), Cory Booker (D-NJ), Tammy Duckworth (D-IL), Angus King (I-ME), Jeanne Shaheen (D-NH), Sheldon Whitehouse (D-RI), Richard Blumenthal (D-CT), Maria Cantwell (D-WA), Bernie Sanders (I-VT), Tammy Baldwin (D-WI), Chris Coons (D-DE), Amy Klobuchar (D-MN), Tim Kaine (D-VA), Brian Schatz (D-HI), Chris Van Hollen (D-MD), Maggie Hassan (D-NH), Michael Bennet (D-CO), Bill Nelson (D-FL), Kamala Harris (D-CA), Chris Murphy (D-CT), Mazie Hirono (D-HI), Jack Reed (D-RI), Kirsten Gillibrand (D-NY), Bob Casey (D-PA), Robert Menendez (D-NJ), Jeff Merkley (D-OR), Gary Peters (D-MI), Debbie Stabenow (D-MI), Sherrod Brown (D-OH), Mark Warner (D-VA), and Tom Carper (D-DE).

The full text of the letter is below and the PDF can be found HERE.

June 27, 2018

The Honorable Daniel R. Levinson

Office of Inspector General

Department of Health and Human Services

330 Independence Avenue, SW

Washington, DC 20201

Dear Inspector General Levinson:

We write to request a comprehensive review of the operations of the Department of Health and Human Services (HHS) Office of Refugee Resettlement’s (ORR) Unaccompanied Alien Children (UAC) program, particularly focused on how the Office has approached and responded to President Trump’s family separation policy. We are alarmed by the uncertainty and pain inflicted on thousands of families arriving at the U.S. border, particularly the mental and physical harm inflicted on immigrant children and their parents by this policy, and we are deeply troubled by recent reports of maltreatment of children while under ORR custody. While we are encouraged by the announcement of recent efforts to prioritize family reunification, we also have significant questions about how the Department is working to accomplish this goal. It is equally important that we understand what measures, if any, HHS undertook to prioritize the health, safety, and wellbeing of children in its custody as it implemented the family separation policy, both before and after President Trump’s June 20 Executive Order to reverse the policy.

Under President Trump’s family separation policy, thousands of children who arrived in this country with their parents were placed in ORR custody while their parents were detained separately awaiting immigration proceedings. On June 20, 2018, President Trump signed an Executive Order purportedly to reverse the policy, but the path forward to execute the Order remains unclear. The Executive Order instructs the Secretary of Defense to provide “facilities available for the housing and care of alien families.” Later on June 20, the Department of Defense (DoD) issued a memo announcing that HHS had asked whether DoD has the ability to house up to 20,000 children at military installations between July and December 2018, in order to accommodate HHS’s need to rapidly increase its capacity.[1] As HHS addresses an increased number of children in its custody at HHS-contracted UAC program facilities, it is unclear what steps are being taken to ensure that HHS contractors and facilities are meeting established standards for ensuring the safety and wellbeing of children in their care—including meeting requirements related to background checks, inspections, qualifications, training, and licensure.

Recent press reports have also detailed concerning allegations of abuse of children in HHS-contracted UAC program facilities, raising concerns about the Department’s oversight of the UAC program, especially as it seeks to ramp up capacity.[2] One report from a Virginia facility described aggressive and routine use of physical force to restrain children.[3] Another story from a Texas site recounted coerced use of numerous psychotropic drugs on children, including through forced injections and medications disguised as vitamins.[4] These allegations are deeply worrisome and merit intense scrutiny of the quality of care in HHS-contracted UAC program facilities, particularly as the Administration is separating and detaining more and more children.

The forced separation of immigrant children from their parents is a serious, traumatizing event that should never have occurred. Forced separation can over-activate the body’s stress-response system, creating a constant “fight-or-flight” mode that can disrupt a child’s brain chemistry and create potentially long-term or lifelong health consequences as documented in the Centers for Disease Control and Prevention’s (CDC) Adverse Childhood Experiences (ACEs) study.[5]^,[6] As the Department responsible for children’s health and wellbeing, HHS should be dedicating resources to ensuring children are receiving the medical and mental health care they need. HHS has the tools to measure capacity in its facilities and to assess the potential needs of children in their custody. Yet, we remain concerned about whether the Department is ensuring children receive the care they need and whether the services and treatments they receive are trauma-informed and evidence-based.

To better understand HHS’s efforts to implement the family separation policy and the June 20 Executive Order, we ask that you conduct an investigation of the UAC Program and address the following questions:

1. What processes does HHS employ to assess the needs of children in the UAC program, including the capacity needed at HHS-contracted UAC program facilities and their ability to provide needed services for children of all ages and medical needs?

a. Did those processes change when President Trump’s family separation policy was implemented?

b. Did those processes change after President Trump signed his June 20 Executive Order?

c. What steps did the Department take to prepare for the arrival of children separated from their parents at the U.S. border? Was notice provided to HHS ORR in advance of President Trump’s family separation policy to allow the agency to plan for the increase in UACs in its custody?

d. Was notice provided to HHS ORR in advance of President Trump’s June 20 Executive Order to allow for HHS ORR to establish policies, train employees and contractors, and plan for family reunification consistent with federal law and court orders?

e. Were additional program or contracting staff tasked to ORR in response to the expected increase in UACs?

2. What steps did the Department take to prepare for reunification of the separated children with their parents consistent with federal law and court orders?

a. What specific steps has the Department taken to coordinate, with the Department of Homeland Security (DHS) on the reunification of children in its custody with parents in DHS’ custody? Please provide a list of procedures detailing inter-agency coordination between the Department and DHS to reunify separated families.

3. Was the Department adequately prepared to care for separated children, including by providing the range of necessary, age appropriate, medical and mental health services needed in a traumatized population of children, and to reunify families consistent with federal law and court orders?

a. Were additional medical or mental health staff tasked to ORR in response to the expected increase in UACs?

b. Does ORR have adequate staff to oversee and support the medical and mental health needs of traumatized children in the UAC program?

c. What steps did the Department take to ensure evidence-based trauma-informed services were provided to separated children? Did HHS ORR consult with any other units or programs within HHS that have expertise in the medical and mental health needs of traumatized children?

d. Did HHS ORR consult with any non-governmental entities with expertise in the medical and mental health needs of traumatized children?

e. Did HHS ORR medical staff provide guidance to HHS-contracted UAC program facilities regarding the use of psychotropic medications? Was any such guidance sufficient?

4. How did the Department ensure UACs had adequate access to qualified mental health professionals?

5. How does the Department assess the qualifications of contracted providers to deliver adequate medical and mental health care to children in their custody? Did the Department take additional steps to ensure proper oversight of the quality of care that is provided to separated children, particularly in light of the trauma experienced when separated from their parent(s)?

6. Prior to awarding new contracts to operate facilities under the UAC program, what steps does HHS ORR take to determine if the operator or facility has past allegations of abuse or neglect, including under any program under state law?

7. Press reports indicate that HHS is currently in the process of exploring opportunities to expand capacity of the UAC program.

a. What was the timeline of actions taken by HHS to assess capacity of the UAC program?

b. What information was HHS relying on to make expansion decisions?

c. Who was making decisions about when and how such expansions would occur?

8. There continues to be significant confusion across the federal government regarding implementation of President Trump’s family separation policy and of the June 20 Executive Order.

a. How have HHS staff and HHS-contracted UAC program facilities received direction about implementation of Administration policies?

b. Is that direction coming from within HHS? If not, is it coming from other federal departments or from the White House?

c. What information has HHS staff provided to HHS-contracted facilities about implementation of Administration policies?

d. What was the timeline for communication to HHS-contracted UAC program facilities on family reunification procedures that are consistent with federal law and court orders?

9. How is HHS ensuring that its contractors and facilities meet established standards for ensuring the safety and wellbeing of children in their care and after placement with a sponsor, including background checks, inspections, qualifications, training, and licensure?

10. How does HHS investigate and address allegations of mistreatment, abuse, or neglect of children at HHS-contracted facilities in the UAC program?

a. Are these measures adequate to ensure the health, safety, and wellbeing of children in the Department’s custody?

b. Were there any instances of leaving children in the physical care of a HHS-contracted UAC program facility that had an allegation of mistreatment, abuse or neglect of children? If so, for how long?

c. Under what conditions would HHS end a contract with a facility with substantiated allegations of abuse? Has HHS followed such protocols?

Thank you for your attention to this important matter, and we look forward to reviewing the findings from your investigation.

Sincerely,

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[1] https://www.nytimes.com/2018/06/21/us/politics/trump-immigration-border-family-separation.

[2] https://www.revealnews.org/article/migrant-children-sent-to-shelters-with-histories-of-abuse-allegations/

[3] https://www.12news.com/article/news/nation-now/young-immigrants-detained-in-virginia-center-allege-abuse/465-3e0ad859-d640-417a-905e-963a5002f066

[4] https://www.nbcnews.com/health/kids-health/u-s-centers-force-migrant-children-take-drugs-lawsuit-n885386

[5] https://www.cdc.gov/violenceprevention/acestudy/index.html

[6] http://pediatrics.aappublications.org/content/early/2017/03/09/peds.2017-0483

WASHINGTON – U.S. Sens. Mark R. Warner and Tim Kaine (both D-VA) released the following statement after the Trump Administration released a rule to undermine protections for people with preexisting conditions by expanding health care plans that do not have many vital consumer protections:

“This rule change is just the latest attempt by the Trump Administration to sabotage our health care system. Today’s move to expand ‘junk’ insurance plans will open up a path to weaken protections for people with pre-existing conditions and could raise costs for everybody who purchases health care through the insurance marketplace, where the long-term result is likely to be higher premiums and fewer insurers. The President has been clear: the goal in expanding these health plans is not to make health care more affordable for more people, but to destroy the Affordable Care Act. Virginians who will pay the price as a result will know exactly who is to blame. There is no doubt that insurance costs are too high for small business owners and employees, so we once again call on the Trump Administration and Republicans in Congress to work with Democrats to make health care more affordable, instead of raising costs for Virginia families.”

Today, the Trump Administration released its final regulation on association health plans (AHPs) expanding eligibility for these bare-boned plans, which do not have to provide the same level of minimum coverage as individual policies sold under the Affordable Care Act. According to experts, this move will undermine pre-existing conditions protections by making plans without vital consumer protections more readily available and drive up health care costs for other patients by shrinking the number of patients in other insurance pools, in turn destabilizing our country’s health care system.

Last month, Sens. Warner and Kaine sent a letter to U.S. Secretary of Health and Human Services (HHS) Alex Azar, urging the Administration to take swift action to stabilize the insurance marketplace.

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WASHINGTON – U.S. Sens. Mark R. Warner and Tim Kaine (both D-VA) released the following statement after Virginia Governor Ralph Northam signed into law the state budget that expands Medicaid:

“After years of working on this issue that affects families across the Commonwealth, we are thrilled that hundreds of thousands of Virginians who currently lack basic health care coverage will finally have some peace of mind. Today’s historic signing shows a good faith effort by legislators to provide health insurance for Virginians who need it the most. We are grateful for the tireless work Governor Northam and the leaders of the General Assembly have shown to ensure the stability and well-being of hardworking families. We are ready to assist the Governor and his administration as Virginia begins the process of full expansion.”

Virginia is now one of 33 states across the country that have expanded Medicaid. Up to 400,000 low-income adults in Virginia will now be eligible for Medicaid health coverage.

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WASHINGTON – U.S. Sen. Mark R. Warner (D-VA) released the following statement after the U.S. Government Accountability Office (GAO) reported that the Black Lung Disability Trust Fund, which covers medical and living expenses for coal miners diagnosed with black lung disease, will be more than $15 billion in debt by 2050, putting coal miners’ benefits at risk.

“Black lung disease has had a devastating impact on coal miners and their families across Virginia. Since my time in the Senate, I have fought on their behalf to ensure they receive their rightfully owed compensation for this debilitating illness. We must ensure that we keep our promise to the thousands of coal miners suffering with black lung. Strengthening the system’s financing does that, without shifting the cost of these important payments onto taxpayers.”

The Black Lung Disability Trust Fund was established in 1978 to pay benefits to disabled miners suffering from black lung disease when the coal company responsible for paying benefits is bankrupt, closed or otherwise not able to pay. The Fund paid out $184 million in benefits last year to 25,700 coal miners suffering from the fatal mine dust disease, and their dependents. The Fund is supported by an excise tax on coal companies, but due to a variety of factors, the Fund has often had to borrow money from the U.S. Treasury in order to cover costs, leaving the Fund in the red by billions of dollars – a problem that will be exacerbated if Congress fails to take action by the end of this year, when the tax is set to be cut by more than half.

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WASHINGTON – U.S. Sen. Mark R. Warner (D-VA), a former Governor and a current member of the Senate Finance Committee, released the following statement after the Virginia Senate voted to expand the Medicaid program under the Affordable Care Act (ACA)

“I’m thrilled that the Virginia Senate has decided partisan politics should no longer stand in the way of thousands of Virginia families getting the healthcare they need. I look forward to the House of Delegates soon doing the same.

“Governor Northam and supporters of Medicaid expansion should be proud of this bipartisan achievement, but the real winners here are the hardworking Virginians who will finally have healthcare for their families.”

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WASHINGTON — In an effort to curb the nation’s opioid epidemic, U.S. Sen. Mark R. Warner (D-VA) today introduced four bipartisan bills aimed at making it easier for people to access substance use disorder treatment using telehealth services.

“One of the main drivers of the opioid crisis is that too many people lack access to quality substance use disorder treatment,” said Sen. Warner. “Expanding access to telehealth services could not only save lives but equip rural and underserved communities with better tools to fight this epidemic.”

Telehealth is the provision of health care services via telecommunications technologies, such as live video interactions, that make it easier for healthcare providers to treat patients no matter where they live. However, in order for a Medicare patient to receive reimbursement for substance use disorder treatment, individuals are obligated to receive care from a Medicare approved location known as an originating site. Oftentimes individuals who need treatment live out of reach from the originating site or those centers may be filled at capacity. That is why Sen. Warner, along with Sens. John Thune (R-SD), Ben Cardin (D-MD) and John Cornyn (R-TX), introduced the Expanding Telehealth Response to Ensure Addiction Treatment (eTREAT) Act to reduce the existing barriers to expand telehealth services for substance use disorder treatment. The bill text is available here.

Virginia is a national leader in telemedicine. The University of Virginia Center for Telehealth was launched in 1994 and has since grown into a national model for the health industry. Since then, UVA and its network of 152 telemedicine partners have enabled more than 51,000 patient encounters across more than 60 specialties, saving Virginians roughly 16 million miles of travel. While the center was selected as one of 14 regional telehealth resource centers by the federal government, it still faces barriers to delivering care because outdated federal laws restricts Medicare’s coverage of telehealth services.

"The University of Virginia Health System and our Center for Telehealth commend Senator Warner for his leadership in addressing barriers that prevent patients from getting needed substance abuse treatment in a timely way by eliminating burdensome geographic originating site restrictions in Medicare. The Expanding Telehealth Response to Ensure Addiction Treatment (eTREAT) Act of 2018 will allow telehealth-- demonstrated to be an effective tool to deliver health care-- to provide such evaluation and treatment services to greater numbers of patients nationwide,” said Dr. Karen Rheuban, Director of the UVA Center for Telehealth.

In addition, Sen. Warner introduced three other bills aimed at expanding the use of telehealth services for Medicaid patients receiving substance use disorder treatment.

The Medicaid Substance Use Disorder Treatment via Telehealth Act will make clear how federal Medicaid funds can be used for substance use disorder treatment through telehealth services. Specifically, the bill will require the Secretary of Health and Human Services (HHS) to issue guidance on the reimbursement options available to state Medicaid services and treatment of substance use disorder through telehealth. The bill text is available here.

In addition, the Telehealth for Children’s Access to Services and Treatment (TeleCAST) Act will help ensure children suffering from substance use disorder receive the assistance they need through telehealth services. The bill will require the Government Accountability Office (GAO) to evaluate the population of children who utilize Medicaid treatment for substance use disorder. In addition, the bill requires that the Centers for Medicare and Medicaid Services (CMS) produce a report on reducing barriers to using telehealth services and remote patient monitoring for pediatric populations under Medicaid. The bill text is available here.

In 2003, then-Gov. Warner expanded Medicaid coverage for telemedicine statewide, including evaluation and management visits, a range of individual psychotherapies, the full range of consultations, and some clinical services, including in cardiology and obstetrics. Coverage was also expanded to include non-physician providers. Among other benefits, the telehealth expansion allowed individuals in medically underserved and remote areas of Virginia to access quality specialty care that isn’t always available at home.

The final bill, the Opioid Addiction Treatment Programs Enhancement Act, will improve data collection on substance use disorder among Medicaid recipients. The bill will require the Secretary of Health and Human Services to publish comprehensive data on the CMS website regarding the prevalence of substance use disorder within the Medicaid beneficiary population and the services provided for treatment of substance use disorders under Medicaid. By receiving the most up-to-date information, states will be better equipped to combat the growing opioid epidemic by targeting their efforts in communities that need it the most. The bill text is available here.

In the Senate, Sen. Warner has been working on ways to combat the opioid crisis that has had a devastating effect for communities in rural Southwest Virginia. In March, Sen. Warner voted in favor of the omnibus bill that provided a total of $3.3 billion in increased funding to combat the opioid crisis, including an increase of $2.8 billion in treatment, prevention and research for programs under the Department of Health and Human Services (HHS) to help communities across Virginia and the nation fight against the opioid epidemic. He has also passed into law bipartisan legislation to expand the use of federal telehealth services.

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WASHINGTON — Today, U.S. Sens. Mark R. Warner and Tim Kaine (both D-VA) sent a letter to U.S. Secretary of Health and Human Services (HHS) Alex Azar, urging him to take swift action to stabilize the insurance marketplace. On May 4, the majority of health insurers filed initial rates with the Virginia Bureau of Insurance proposing to raise premiums between 15 and 64 percent in 2019 – a move that could impact more than 400,000 Virginians who purchase their health care coverage through the individual marketplace.

“We are concerned that these substantial rate increases will negatively impact hundreds of thousands of individuals in Virginia that purchase their plans on the health insurance marketplace,” wrote the Senators. “Additionally, we are disappointed to know that these increased costs are largely a result of policies the U.S. Department of Health and Human Services (HHS) and Republicans in Congress have pursued and implemented.”

In 2017, the Trump Administration ended cost sharing reduction payments under the Affordable Care Act, a move that subsequently destabilized the individual marketplace and increased premiums for people who do not receive financial assistance on the marketplace. Since then, Congressional Republicans and the Administration have taken several steps to undermine the success of the Affordable Care Act, including repealing the individualmandate and expanding the availability of short-term health plans that don’t cover many basic health care costs such as prescription drugs, maternity care, or preventive health services. According to experts, expanding the availability of these plans – which don’t protect consumers from discrimination on the basis of age, gender, or pre-existing conditions – will draw younger and healthier consumers out of the health care marketplaces and further raise premiums for individuals who depend on the individual market to purchase their health care coverage.

In filing their proposed rates for 2019 with the Virginia Bureau of Insurance, insurers directly cited the elimination of cost-sharing reductions, the expansion of short-term plans, and the elimination of the individual mandate to justify double-digit rate increases.

“Double digit premium increases are not only unacceptable, they are also avoidable. We are committed to work with you to take proactive steps to lower premiums in Virginia and across the country. This would include prioritizing proposals that would establish a federal reinsurance program and continuing cost sharing reduction payments while adopting policies to hold harmless those people who do get financial help in the marketplace,” the Senators told Sec. Azar. “We also would encourage you to revise your recently proposed rule to expand the use of short term limited duration plans. Finally, we urge you to reverse recent policies to shorten the annual open enrollment period, slash funding for consumer outreach and assistance, and other efforts to undermine consumer protections. Without these important changes it is likely Virginians and other Americans will continue to experience significant premium increases in the future.”

In addition, according to a study by Medicare's chief actuary that was released on Tuesday, President Trump’s plan to expand short-term health insurance policies will drive up federal spending by $1.2 billion next year and by a total of $38.7 billion over 10 years – significantly more than the Trump Administration’s original estimates.

Sens. Warner and Kaine previously raised similar concerns in a public statement after Virginia insurers filed their initial rates for 2019.

The full text of today’s letter can be found below and here.

Honorable Alexander M. Azar II

Secretary

U.S. Department of Health & Human Services

200 Independence Avenue, S.W.

Washington, D.C. 20201

Dear Secretary Azar,

We write to you regarding the 2019 proposed premium rates in Virginia. The majority of insurers filed proposed rates with the Virginia Bureau of Insurance earlier this month that propose to increase premium rates for plans on the health insurance marketplace between 15 and 64 percent in 2019. We are concerned that these substantial rate increases will negatively impact hundreds of thousands of individuals in Virginia that purchase their plans on the health insurance marketplace. Additionally, we are disappointed to know that these increased costs are largely a result of policies the U.S. Department of Health and Human Services (HHS) and Republicans in Congress have pursued and implemented.

Virginia insurers have directly cited actions by HHS to eliminate cost sharing reduction payments, which increased premiums for those who don’t get financial help in the marketplace, and a recently proposed rule to expand the use of short term limited duration (STLD) plans when explaining the justification for their substantial rate increases. In addition, insurers have stated that premiums were further increased when Republicans in Congress and President Trump passed legislation repealing the individual shared responsibility provision. Together, these changes have made it more difficult – and in some cases impossible – for many Virginians to afford their health care premiums.

Doctors, hospitals, patient organizations and the medical community have raised concerns that the actions listed above will result in patients paying more money for less care. They have the potential to disproportionally hurt older Americans and individuals with pre-existing conditions by making it more difficult for them and other Virginians to get affordable plans that cover basic benefits such as hospitalization, behavioral health, prescription drugs, and maternity care. The Urban Institute estimated that the impact on premiums due to expanded STLD policies and the loss of the individual shared responsibility provision is 19 percent, while, the non-partisan Congressional Budget Office projects that repeal of the ACA’s individual shared responsibility provision alone will increase individual market premiums by 10 percent in 2019.

Double digit premium increases are not only unacceptable, they are also avoidable. We are committed to work with you to take proactive steps to lower premiums in Virginia and across the country. This would include prioritizing proposals that would establish a federal reinsurance program and continuing cost sharing reduction payments while adopting policies to hold harmless those people who do get financial help in the marketplace. We also would encourage you to revise your recently proposed rule to expand the use of short term limited duration plans. Finally, we urge you to reverse recent policies to shorten the annual open enrollment period, slash funding for consumer outreach and assistance, and other efforts to undermine consumer protections. Without these important changes it is likely Virginians and other Americans will continue to experience significant premium increases in the future.

We are willing to work with you on the steps listed above and other proposals that will stabilize the health insurance marketplace and reduce premiums for enrollees. We simply ask that you work with us, rather than against us, to achieve the important and shared goal of ensuring affordable and accessible health care coverage for Virginians. Thank you for your consideration of our letter and we look forward to your response.

Sincerely,

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