Press Releases

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

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

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

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

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

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

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

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

 

The Honorable Alex M. Azar II

Department of Health and Human Services

Office of the Secretary

200 Independence Avenue, S.W.

Washington, D.C. 20201

 

Dear Secretary Azar:

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

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

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

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

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

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

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

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

Sincerely,

###

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

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

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

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

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

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

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

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

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

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

 

Mr. Roger Severino                                                                

Director, Office for Civil Rights

Department of Health and Human Services

200 Independence Ave SW

Washington, DC 20201

Dear Director Severino,

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

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

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

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

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

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

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

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

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

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

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

Sincerely,

###

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

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

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

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

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

A copy of the bill is available here.

###

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

 

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

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

In the time since then, two things have happened.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

###

 

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

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

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

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

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

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

###

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

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

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

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

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

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

A copy of the letter can be found below.

 

Dear Secretary Azar and Administrator Verma:

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

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

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

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

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

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

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

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

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

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

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

Sincerely,

###

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

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

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

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

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

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

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

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

 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

The list goes on.

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

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

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

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

Thank you, Madam President.

###

 

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

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

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

 

###

 

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

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

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

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

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

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

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

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

 

October 16, 2019

Mark C. Christie                                 

Commissioner                                    

State Corporation Commission          

P.O. Box 1197                                     

Richmond, Virginia 23218      

Judith Williams Jagdmann

Commissioner

State Corporation Commission

P.O. Box 1197

Richmond, Virginia 23218

Patricia L. West

Commissioner

State Corporation Commission

P.O. Box 1197

Richmond, Virginia 23218

Dear Commissioners Christie, Williams Jagdmann and West:

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

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

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

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

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

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

Sincerely,

###

WASHINGTON – U.S. Sen. Mark R. Warner (D-VA) led 39 Senators today in urging the U.S. Department of Health and Human Services (HHS) and the Centers for Medicare & Medicaid Services (CMS) to protect individuals with preexisting conditions by limiting the proliferation of “junk plans” – short-term insurance plans that can exclude coverage for essential benefits and provide no protections for Americans with preexisting conditions.

“We have heard from patients, physicians, independent experts, and other health care stakeholders that individuals with preexisting conditions are being negatively impacted by your Administration’s actions. More recently, we have seen the real world negative impact on individuals who have unknowingly enrolled in these deceptively marketed junk plans,” wrote the Senators. “Just this month, Bloomberg reported Arizona resident David Diaz unknowingly purchased a short-term health plan that did not cover preexisting conditions and placed ambiguous limits on emergency room care and other essential health care services. His family has been left with hundreds of thousands of dollars in medical debt. The Washington Post similarly reported on Jesse Lynn, who purchased a short-term health plan not realizing his back problem would be considered a preexisting condition. Jesse’s insurance company refused to cover his care – forcing his family into bankruptcy.”

They continued, “The Administration’s rule on state waivers allows taxpayer dollars to go to these junk plans, accelerating the problems we are already seeing with junk plans and leaving fewer resources for people who purchase high quality insurance. Additionally, the Administration’s new rule weakens coverage by allowing waivers that increase premiums and out-of-pocket costs for those who need health care most. We have worked tirelessly to protect individuals with preexisting conditions from barriers to coverage. We urge you to do the same, including by limiting the proliferation of short-term junk plans and ensuring that consumers in every state are protected by federal consumer protections for people with preexisting conditions.”

The Trump Administration recently issued a rule that allows states to ignore federal consumer protections and use taxpayer dollars to subsidize junk insurance plans that cover less and cost more. These junk plans can exclude coverage of essential benefits like prescription drugs, emergency room visits, maternity care, or mental health care. Additionally, under this rule, states can give insurance companies the green light to discriminate against Americans with preexisting conditions by increasing costs, limiting coverage, or denying coverage altogether.

In their letter, the Senators urged HHS Secretary Alex Azar and CMS Administrator Seema Verma to limit the spread of short-term junk plans and safeguard Affordable Care Act (ACA) protections that increase access to affordable and comprehensive health insurance, and forbid insurance companies from discriminating against individuals with preexisting conditions.

Sen. Warner has been a fierce leader in the fight to protect health care from the Trump Administration’s efforts to dismantle our nation’s health care law. Earlier this year, Sen. Warner introduced a Congressional Review Act resolution to stop the Trump Administration from promoting junk plans, and last month, he filed a discharge petition that will force the Senate to vote before November 12 on whether to roll back the waiver rule allowing these harmful changes.

Joining Sen. Warner in writing this letter are Sens. Tammy Baldwin (D-WI), Cory A. Booker (D-NJ), Sherrod Brown (D-OH), Maria Cantwell (D-WA), Benjamin L. Cardin (D-MD), Thomas R. Carper (D-DE), Robert P. Casey, Jr. (D-PA), Christopher A. Coons (D-DE), Tammy Duckworth (D-IL), Richard J. Durbin (D-IL), Dianne Feinstein (D-CA), Kirsten E. Gillibrand (D-NY), Kamala D. Harris (D-CA), Margaret Wood Hassan (D-NH), Martin Heinrich (D-NM), Mazie K. Hirono (D-HI), Doug Jones (D-AL), Tim Kaine (D-VA), Amy Klobuchar (D-MN), Patrick J. Leahy (D-VT), Joe Manchin III (D-WV), Edward J. Markey (D-MA), Robert Menendez (D-NJ), Jeff Merkley (D-OR), Christopher Murphy (D-CT), Patty Murray (D-WA), Gary C. Peters (D-MI), Jack Reed (D-RI), Jacky Rosen (D-NV), Brian Schatz (D-HI), Charles E. Schumer (D-NY), Jeanne Shaheen (D-NH), Tina Smith (D-MN), Debbie Stabenow (D-MI), 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 letter can be found below and a PDF is available here.

 

October 3, 2019

The Honorable Alex Azar

Secretary

U.S. Department of Health and Human Services

200 Independence Avenue, SW

Washington, DC 20201

The Honorable Seema Verma

Administrator

Centers for Medicare & Medicaid Services

7500 Security Boulevard

Baltimore, MD 21244

Dear Secretary Azar and Administrator Verma:

We write to express our concern with the Administration’s repeated efforts to weaken protections for Americans with preexisting conditions and increase costs for millions, including through a new rule  which allows for harmful waivers that weaken protections for vulnerable populations and exacerbate the damage already being caused by the expansion of short-term, limited-duration insurance, or “junk” plans. We have heard from patients, physicians, independent experts, and other health care stakeholders that individuals with preexisting conditions are being negatively impacted by your Administration’s actions. More recently, we have seen the real world negative impact on individuals who have unknowingly enrolled in these deceptively marketed junk plans.

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

The Patient Protection and Affordable Care Act (ACA) established clear protections to prohibit insurance companies from discriminating against individuals with preexisting conditions, and ensure that more Americans have access to affordable and comprehensive health insurance. The junk plans your Administration has sought to expand and promote provide none of these protections and can legally increase premiums, exclude benefits, and deny coverage altogether to individuals with preexisting conditions. These plans place arbitrary coverage limits and many don’t cover essential health benefits, such as mental health care and maternity care.

The Administration’s rule on state waivers allows taxpayer dollars to go to these junk plans, accelerating the problems we are already seeing with junk plans and leaving fewer resources for people who purchase high quality insurance.

Additionally, the Administration’s new rule weakens coverage by allowing waivers that increase premiums and out-of-pocket costs for those who need health care most.

We have worked tirelessly to protect individuals with preexisting conditions from barriers to coverage. We urge you to do the same, including by limiting the proliferation of short-term junk plans and ensuring that consumers in every state are protected by federal consumer protections for people with preexisting conditions. Thank you and we look forward to your response.

Sincerely, 

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WASHINGTON – U.S. Sen. Mark R. Warner (D-VA) today filed paperwork that will force a Senate vote to protect people with pre-existing conditions from another attempt by the Trump Administration to gut the Affordable Care Act. 

“Under the pretext of so-called ‘short-term’ plans, the Trump administration is pushing healthcare plans that once again allow insurance companies to discriminate against Americans based on their medical history. These skinny plans, or how I refer to them as ‘junk plans,’ also undermine the Affordable Care Act’s requirements that insurance cover things like emergency room visits, maternity care, and other essential benefits,” said Sen. Warner on the Senate floor. “Let me be clear, the reason that this market has suddenly been flooded with these junk plans, many cases advertising in low-income markets that these are ACA, or Obamacare plans, is not because Congress passed any law. The President tried and failed twice to pass legislation ending these protections for folks with pre-existing conditions. And since they couldn’t get their way in Congress, now they’re using executive action to try to undermine the Affordable Care Act.”

Today, Sen. Warner filed a discharge petition on a Congressional Review Act (CRA) resolution that would roll back the 1332 waiver rule, another Trump Administration effort to sabotage Americans’ health care and undermine the critical pre-existing condition protections that 130 million Americans rely on. The rule gives states the green light to use taxpayer dollars to push junk health insurance plans that cost more and cover less. Under these plans, insurance companies can charge people more if they have a pre-existing condition, can deny specific benefits – or they can deny them coverage altogether.

“In Virginia alone – more than one million people live with a pre-existing condition. Before the Affordable Care Act, an insurance company had every right to deny these individuals coverage, charge them unaffordable premiums, or when they got that condition, terminate their plan. I think we all agree we cannot go back to those days. The Administration knows perfectly well that these ‘junk plans’ don’t offer real benefits. They’ve been warned repeatedly by hundreds of patient groups, physicians, hospitals, and insurers including the American Heart Association, AARP, The American Academy of Pediatrics, just to name few of the organizations who have come out against these plans,” Sen. Warner continued. “My Republican colleagues insist that they actually support protections for folks with pre-existing conditions. Ok, with this CRA I think there’s a chance to prove it. This resolution we are introducing today will force an up-or-down vote on these junk plans that explicitly undermine protections for pre-existing conditions. If my Republican colleagues truly support these protections, they should vote yes. It’s that simple.” 

Congressional Review Act resolutions exercise Congress’ authority to review and overturn rules implemented by the executive branch. Once a rule is finalized, the Congressional Review Act provides Congress 60 legislative days to vote on it. Unlike other legislation on the Senate floor, a Congressional Review Act resolution only needs a simple majority to pass and can be brought to the Senate floor for a vote with 30 signatures. As a result of the petition filed by Sen. Warner today, Senators must vote on overturning the rule by November 12.

 

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

Mr. President, I want to turn now to protections for people with pre-existing medical conditions, because these protections are under threat by this President.

Under the pretext of “short-term” plans, the Trump administration is pushing healthcare plans that once again allow insurance companies to discriminate against Americans based on their medical history.

These “junk plans” would also undermine the Affordable Care Act’s requirements that insurance cover things like emergency room visits, maternity care, and other essential benefits.

Let me be clear, this is not a law passed by Congress. The President tried and failed twice to pass legislation ending these protections.

Since they couldn’t get their way in Congress, now they’re using executive action to undermine the Affordable Care Act.

Mr. President, I’ve introduced a resolution under the Congressional Review Act, which would stop this deliberate effort to destabilize the health insurance market, and weaken protections that Americans count on.

And today I’m filing a discharge petition to that will bring this resolution to the Senate floor for an up-or-down vote.

The truth is, every member of this body knows someone with a pre-existing condition – if we don’t have one ourselves.

In Virginia alone – more than one million people live with a pre-existing condition. Before the Affordable Care Act, an insurance company had every right to deny those individuals coverage, charge them unaffordable premiums, or terminate their plan.

We cannot go back to those days.

The Administration knows perfectly well that these “junk plans” don’t offer real benefits.

They’ve been warned repeatedly by hundreds of patient groups, physicians, hospitals, and insurers — The American Heart Association, AARP, The American Academy of Pediatrics, the list goes on.

All of these stakeholders are telling us the same thing: the Trump Administration’s plan will weaken consumer protections and disproportionately hurt sick and older Americans.

My Republican colleagues insist that they actually support protections for folks with pre-existing conditions.

Ok, then. Here’s their chance to prove it.

This resolution we are introducing today will force an up-or-down vote on these junk plans that explicitly undermine protections for pre-existing conditions.

If my Republican colleagues truly support these protections, they should vote yes. It’s that simple.

Instead of undermining the stability of the healthcare market, let’s focus on targeted, bipartisan fixes that will bring down costs and expand access to affordable health care coverage.

Thank you, Mr. President.

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WASHINGTON – U.S. Sen. Mark R. Warner (D-VA), Vice Chairman of the Senate Intelligence Committee and co-founder of the Senate Cybersecurity Caucus, wrote to the CEO of TridentUSA Health Services today to ask about the company’s data security practices as they relate to Health Insurance Portability and Accountability Act (HIPAA) compliance. The letter comes in light of a report that MobileXUSA – an affiliate of TridentUSA Health Services – left an unencrypted server online, exposing the medical data of millions of Americans.

“It appears that the information held by MobileXUSA was made accessible due to sloppy cybersecurity practices— no software vulnerabilities were involved, and no explicit hacking was required,” wrote Sen. Warner. “While HIPAA lays out some guidelines for secure data storage and transfer, it is not always clear who bears responsibility for securing the data and ensuring the use of proper controls. However, it is certainly the responsibility of companies like yours to control and secure sensitive medical data, maintain an audit trail of medical images, and to ensure the information is not publicly accessible.”

According to recent reports, many unsecured picture archiving and communication servers (PACS) left the names, dates of birth, medical images, and medical procedures of more than one million Americans accessible to anyone with basic computer expertise. As part of the report, researchers identified 187 servers in the U.S. – including that of MobileXUSA – that were unprotected by passwords or basic security precautions.

In the letter to TridentUSA Health Services, Sen. Warner stressed the importance of protecting Americans’ privacy and personal health information. He also posed the following questions for TridentUSA Health Services:

  1. HIPAA requires audit trails for PACS, which stores the data in centralized auditing databases with multiple audit layers. What audit and monitoring tools do you use to analyze the data to remain HIPAA compliant? 
  2. PAC server vulnerabilities are well known, however, their use of the DICOM protocol makes them easily accessible via the Internet. DICOM also enables PACS to communicate with neighboring systems in a medical or clinical process within a network of IP-enabled devices. Does your company require neighboring systems to comply with current standards and use access management controls? 
  3. What are your identity and access management controls for IP-addresses and/or port filters?
  4. Do you require VPN or SSL to communicate with your PACS?
  5. What is the frequency of your vulnerability scans and HIPAA-compliant audits?
  6. What are your server encryption practices?
  7. Do you have an internal security team or do you outsource it?

Sen. Warner has been a champion for cybersecurity throughout his career, and has been an outspoken critic of poor cybersecurity practices that have led to the compromise of Americans’ personal information. Last week, Sen. Warner demanded answers from U.S. Customs and Border Protection (CBP) and South Korean company Suprema HQ, following separate incidents that affected both entities and exposed the personal, permanently identifiable data of many Americans. He also introduced legislation earlier this year to empower state and local government to counter cyberattacks, and to increase cybersecurity among public companies.

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

 

Andrei Soran, CEO

TridentUSA Health Services

930 Ridgebrook Rd.

Sparks Glencoe, MD 21152

Dear Mr. Soran,

It has come to my attention that one of your affiliated companies, MobileXUSA, recently left an unencrypted server online, exposing sensitive medical images and health data of Americans. According to recent reporting, researchers found 13.7 million data sets and 303.1 million images in medical image storage systems have been freely accessible online with no authentication requirements to access or download the images.  This left the MRI’s, X-rays, and CT scans of millions of Americans exposed on the internet, not because of a breach, but simply because they were stored on 187 unprotected picture archiving and communication servers (PACS) including yours.  Additionally, along with the sensitive medical images, according to the research, your server displayed the names of more than a million patients. 

My colleagues and I in the Senate have been concerned about negligent cybersecurity practices in the health care space for a long time. Cybersecurity risks within the health care sector represent a growing threat, with 285 breaches reported between January and June of this year.  According to one report, there has been at least one healthcare-related data breach a day since 2016.  Just recently, the Senate Cybersecurity Caucus, of which I am a co-founder, convened a briefing that focused on healthcare and cybersecurity, particularly on the security of healthcare records which further highlighted the need for more robust cyber hygiene practices, and possibly additional standards.

It appears that the information held by MobileXUSA was made accessible due to sloppy cybersecurity practices— no software vulnerabilities were involved, and no explicit hacking was required. While HIPAA lays out some guidelines for secure data storage and transfer, it is not always clear who bears responsibility for securing the data and ensuring the use of proper controls. However, it is certainly the responsibility of companies like yours to control and secure sensitive medical data, maintain an audit trail of medical images, and to ensure the information is not publicly accessible.

To better understand how exactly millions of private medical scans were left open on the internet, I would appreciate your answers to the following questions:  

  1. HIPAA requires audit trails for PACS, which stores the data in centralized auditing databases with multiple audit layers. What audit and monitoring tools do you use to analyze the data to remain HIPAA compliant? 
  2. PAC server vulnerabilities are well known, however, their use of the DICOM protocol makes them easily accessible via the Internet. DICOM also enables PACS to communicate with neighboring systems in a medical or clinical process within a network of IP-enabled devices. Does your company require neighboring systems to comply with current standards and use access management controls? 
  3. What are your identity and access management controls for IP-addresses and/or port filters?
  4. Do you require VPN or SSL to communicate with your PACS?
  5. What is the frequency of your vulnerability scans and HIPAA-compliant audits?
  6. What are your server encryption practices?
  7. Do you have an internal security team or do you outsource it?

It is critical that the privacy of the individual– including their personal health information – is appropriately protected.  I look forward to hearing your response by October 9th, 2019. Any further questions can be directed to Leisel Bogan in my office at Leisel_Bogan@warner.senate.gov

Sincerely,

###

 

WASHINGTON – U.S. Sens. Mark R. Warner and Tim Kaine (both D-VA) released a statement today following a decision by the Office of National Drug Control Policy (ONDCP) to include Warren County in the High Intensity Drug Trafficking Areas (HIDTA) Program:

“Despite increased public awareness about the dangers of opioids, this epidemic continues to devastate families all across the Commonwealth,” said the Senators. “We applaud the Office of National Drug Control Policy for including Warren County in the Washington/Baltimore HIDTA Program. We look forward to seeing these federal resources put to use to prevent future tragedies in Warren County as we continue working to channel additional federal dollars to fight this ongoing crisis.”

Opioid overdoses have surpassed car accidents and gun violence as the leading cause of accidental death in Virginia, with more than 1,500 overdose-related deaths in 2017. In Warren County alone, pharmacies distributed an average of 45 opioid pills per person, per year between 2006 and 2012.

HIDTA, a program created by Congress, is designed to facilitate law enforcement coordination at the federal, state, local, and tribal level in areas designated as critical drug-trafficking regions. In addition to facilitating law enforcement cooperation, HIDTA aims to enhance the sharing of intelligence among law enforcement agencies, facilitate the design of effective enforcement strategies and operations, and support coordinated law enforcement strategies in order to reduce the supply of illegal drugs in the United States.

Sens. Warner and Kaine have long advocated for increased federal funding to combat the opioid epidemic in Virginia. Last year, the Senators worked to successfully pass bipartisan legislation to help communities across Virginia by improving opioid treatment and recovery efforts and providing new tools for law enforcement. In 2016, Sens. Warner and Kaine also successfully advocated for the inclusion of other Virginia counties into HIDTA.

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WASHINGTON – Today, U.S. Sen. Mark R. Warner (D-VA) urged the Senate Committee on Environment and Public Works (EPW) to bring up for approval the leasing prospectuses for two VA outpatient clinics in Hampton Roads and Fredericksburg when Congress returns in September. Both prospectuses received the approval of the Office of Management and Budget earlier this month and must now get a green light from both the Senate EPW Committee and the House Committee on Transportation and Infrastructure.

“These clinics are essential for veterans in the Commonwealth who face long wait-times due to insufficient capacity at existing VA medical facilities and a fast-growing veteran population,” wrote Sen. Warner. “The facilities in Hampton Roads and Fredericksburg will enable the VA to expand primary care, mental health and specialty care services, among other services to our veterans.”                                                                             

In 2017, Congress approved leases for 28 Veterans Affairs (VA) facilities around the country, including two in Virginia, thanks to Sen. Warner’s successful bipartisan efforts. To ensure timely completion of the facilities, the VA passed off procurement authority for six of the projects, including the Hampton Roads clinic, to the General Services Administration (GSA) while the new outpatient in Fredericksburg remained under the purview of the VA.

Following Sen. Warner’s multiple calls and letter to the Office of Management and Budget (OMB) Director Mick Mulvaney pushing the agency to swiftly review and approve the leasing prospectus in their possession, OMB signed off on the Hampton Roads and Fredericksburg clinics on July 30th and August 6th, respectively. Now, the prospectuses must be approved by the EPW and the House Transportation and Infrastructure committee in markup, signaling the last congressional approval step required to get the clinics open and operational.

Sen. Warner has long pushed the VA and GSA to get these clinics up and running quickly. Most recently, Sen. Warner wrote the VA and GSA to express outrage at “the glacial pace” of the two lease procurement projects, and to demand real plans from both for quickly completing the delayed projects.

“For many years I have worked hard to get these additional VA facilities built, with great frustration at the exceedingly slow pace of these projects. I have pressured the Department of Veterans Affairs and the U.S. General Services Administration to find ways to expedite their timelines for the building of these facilities. As of now, their timelines have the two facilities being finished in the fall of 2023, approximately six years after the leases were approved by Congress,” continued Sen. Warner. “I ask that under your leadership, your committee do everything possible to keep the process moving by reviewing and approving these prospectuses as soon as possible.”

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

 

Dear Chairman Barrasso and Ranking Member Carper:

I write to request that two prospectus documents and accompanying housing plans recently submitted to the Senate Committee on Environment and Public Works (EPW) be included in the next markup your Committee holds in September. The two lease prospectus documents are for the procurement of two Community Based Outpatient Clinics for the Department of Veterans Affairs in Hampton Roads and Fredericksburg, both in Virginia. 

In 2017 Congress authorized leases for 28 VA facilities around the country, two of which – Hampton Roads and Fredericksburg – are in the Commonwealth of Virginia. These clinics are essential for veterans in the Commonwealth who face long wait-times due to insufficient capacity at existing VA medical facilities and a fast-growing veteran population. The facilities in Hampton Roads and Fredericksburg will enable the VA to expand primary care, mental health and specialty care services, among other services to our veterans.

At VA’s request, U.S. General Services Administration (GSA) is running the lease procurement to deliver a Community Based Outpatient Clinic in South Hampton Roads in Virginia. Pursuant to Title 40, on August 1, 2019, GSA submitted a lease prospectus and housing plan for this project to the Senate EPW for its review and consideration. Additionally, on August 9, GSA submitted a lease prospectus and housing plan for a Community Based Outpatient Clinic in Fredericksburg, VA. GSA is seeking authorization to delegate its leasing authority to the VA so that they can run this lease procurement for Fredericksburg. I would request that the Committee pass resolutions authorizing GSA to move forward with both procurements.   

For many years I have worked hard to get these additional VA facilities built, with great frustration at the exceedingly slow pace of these projects. I have pressured the Department of Veterans Affairs and the U.S. General Services Administration to find ways to expedite their timelines for the building of these facilities. As of now, their timelines have the two facilities being finished in the fall of 2023, approximately six years after the leases were approved by Congress.

I ask that under your leadership, your committee do everything possible to keep the process moving by reviewing and approving these prospectuses as soon as possible. Thank you for your attention to this critical matter. If you or your staff have any questions about these facilities please contact Caroline Wadhams at Caroline_Wadhams@warner.senate.gov, or at 4-2418.

Sincerely,

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WASHINGTON – U.S. Sens. Mark R. Warner (D-VA) and Rob Portman (R-OH) reintroduced bipartisan legislation to improve burdensome employer reporting requirements under the Patient Protection and Affordable Care Act (ACA). The Commonsense Reporting Act of 2019 would streamline and modernize ACA reporting requirements, ensuring that the Treasury Department has the necessary data to determine availability of affordable coverage, while cutting down on unnecessary paperwork and administrative costs for businesses. Companion legislation was introduced in the House of Representatives by U.S. Reps. Mike Thompson (D-CA) and Adrian Smith (R-NE).

“Businesses in Virginia and across the nation are working hard to comply with our nation’s health care law, and we need to make sure they’re not being penalized due to flaws in the law,” said Sen. Warner. “By improving and modernizing the employer reporting system, this bipartisan legislation will take an important step towards making sure that our health care system works for everyone, including employers who strive to provide suitable coverage for their workers.”  

“We thank Senator Mark Warner for his leadership to improve the employer reporting system under the Affordable Care Act. Local businesses are challenged by extensive reporting requirements and paperwork mandates, especially with a flexible workforce. Capital Ale House supports commonsense, bipartisan legislation to streamline the employer reporting system and we appreciate Senator Warner’s efforts on this issue,” said Matthew Simmons, Co-Founder and President, Capital Ale House in Richmond, Va.

“The IRS’s employer reporting requirements offer a significant, complex challenge to Virginia small businesses and employees. With new legislation, Congress can take immediate action to relieve employers and employees of this annual reporting burden and unintended tax implications. We thank Senator Warner for advancing a bipartisan, streamlined solution under the Commonsense Reporting Act,” said Eric Terry, President, Virginia Restaurant, Lodging & Travel Association.

“The Commonsense Reporting Act moves employers to a voluntary reporting system and decreases the amount of information requested by the IRS and other agencies. This bipartisan legislation provides individual consumers with much-needed safety nets, employers with relief from the burdensome reporting requirements, and state and federal Exchanges with an additional tool to verify tax credit and subsidy eligibility. The federal government can lend businesses and workers a helping hand by streamlining burdensome reporting requirements and enacting this important reform, as employers would only need to report on employees that have purchased coverage through an Exchange rather than reporting for the entire workforce,” said Gary Cox, Ideal Insurance.

“I have heard from hundreds of employers in Ohio that have spent hundreds of administrative hours attempting to comply with the reporting requirements in the Affordable Care Act. This added time and resources has not improved the quality of health insurance employers offered but only further discouraged employers from offering health insurance and hiring more workers. This bipartisan bill will help streamline the reporting process by allowing employers to report information to the IRS prospectively, easing the burden for employers and employees,” said Sen. Portman.

“It’s critical to ensure that we are making health care as accessible as possible for patients and as easy as possible for businesses to offer. That’s why I am proud to reintroduce the Commonsense Reporting Act, a bipartisan bill to streamline the health insurance reporting process for employers and protect patients from unfair claw backs of their insurance subsidies by making tax credit determinations more accurate. This is a simple way to improve health care access for our communities and ensure businesses can better provide coverage,” said Rep. Thompson.

“Too often employers who provide health insurance are burdened with arbitrary reporting mandates such as those created by the Affordable Care Act. This legislation would create a more efficient reporting system, reducing the risk of surprise financial penalties for both employers and employees. I look forward to working with my colleagues to see this commonsense bill signed into law,” said Rep. Smith.

Currently, employers and insurers are required under the ACA to report health insurance coverage information to the Internal Revenue Service (IRS) at the end of the tax year. However, these retrospective reporting requirements create a heavy back-end burden for employers and can lead to reporting discrepancies that end up subjecting employers to IRS tax penalties as well as additional compliance costs and burdens.

The Commonsense Reporting Act of 2019 directs the Treasury Department to implement an alternative, voluntary reporting system that allows employers to report pertinent information about their health plan to the IRS before open enrollment begins. It also modernizes the system by allowing electronic transmission of employee and enrollee statements rather than requiring that this information be sent through the mail. The legislation also limits the collection of useless data and safeguards personally identifiable information by clarifying that the IRS can accept full names and dates of birth in lieu of dependents’ and spouses’ Social Security numbers.

The Commonsense Reporting Act has also been endorsed by American Hotel & Lodging Association, American Rental Association, American Staffing Association, Associated Builders and Contractors, Inc., Associated General Contractors of America, Auto Care Association, the Council of Insurance Agents & Brokers, Food Marketing Institute, HR policy Association, International Franchise Association, National Association of Health Underwriters, National Association of Wholesaler-Distributors, National Restaurant Association, National Retail Federation, Retail Industry Leaders Association, Society for Human Resource Management, NATSO for America’s Truck and Travel Stops, and National Association of Home Builders.

A summary of this legislation can be found here. The full text is available here.

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WASHINGTON – Today, U.S. Sen. Mark R. Warner (D-VA) led the Senate Democratic Caucus in introducing a Congressional Review Act resolution to stop the Trump Administration from pushing “junk plans” that don’t fully protect Americans with pre-existing conditions. Under the Trump Administration’s 1332 waiver rule, these junk plans once again allow insurance companies to discriminate against Americans based on their medical history in an effort to undermine the Affordable Care Act. Under the Congressional Review Act (CRA), this resolution must be considered within 60 legislative days of July 15 and can pass the Senate with the support of a simple majority of Senators. 

“It’s clear that the Trump Administration is determined to limit Americans’ access to health care and undermine protections for millions of people with pre-existing conditions,” said Sen. Warner. “The junk plans pushed forward by this Administration will inevitably disrupt our health care system, stripping basic coverage while increasing costs for Virginia families. Congress should protect coverage for vital services like prescription medicines, visits to the emergency room, and maternity care by overturning the Administration’s ill-advised plan to expand the use of junk plans. We have an opportunity here to send a message to the President that instead of attacking the Affordable Care Act, he must work with Congress on targeted, bipartisan fixes that will lower health care costs and expand access to comprehensive, affordable health care coverage.”

The resolution mirrors Sen. Warner’s legislation, Protecting Americans with Pre-existing Conditions Act, 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.

Sen. Warner was joined on the resolution by Sen. Tim Kaine (D-VA), Senate Democratic Leader Chuck Schumer (D-NY), and the entire Senate Democratic Caucus.

“After failing to repeal the Affordable Care Act through Congress, the Trump Administration has taken a series of steps to sabotage it, like pushing the use of plans that can discriminate against people with pre-existing conditions,” said Sen. Kaine. “With this resolution, we are standing up against the Administration’s attacks on health care and working to protect people with pre-existing conditions.”

“President Trump is proving yet again that we have to believe what he does, not what he says. That he can claim to care about protecting Americans with pre-existing conditions, while simultaneously rolling back pre-existing condition protections, reeks of the utmost hypocrisy,” said Senate Democratic Leader Chuck Schumer (D-NY). “I challenge my Republican colleagues who claim to support pre-existing condition protections to actually do something about it, and join us in voting in favor of our resolution to get rid of this harmful rule. When Senate Democrats force a vote on this resolution, we will see if Republicans finally put their money where their mouth is.”

The following organizations support the resolution: National Multiple Sclerosis Society, American Heart Association, Cystic Fibrosis Foundation, Pulmonary Hypertension Association, Mended Little Hearts, Hemophilia Federation of America, Chronic Disease Coalition, American Diabetes Association, American Cancer Society Cancer Action Network, Juvenile Diabetes Research Foundation, National Organization for Rare Disorders, WomenHeart: the National Coalition for Women with Heart Disease, Susan G. Komen, Crohn’s & Colitis Foundation, COPD Foundation, Muscular Dystrophy Association, National Hemophilia Foundation, Arthritis Foundation, Leukemia & Lymphoma Society, National Psoriasis Foundation, Alpha-1 Foundation, ALS Association, National Alliance on Mental Illness, Immune Deficiency Foundation, March of Dimes, American Liver Foundation, National Health Council, National Patient Advocate Foundation, Protect Our Care, and the National Coalition for Cancer Survivorship.

Democrats in the House of Representatives also announced support for the measure to block the Trump Administration from weakening pre-existing condition protections. An identical resolution will be introduced in the House by Rep. Annie Kuster (D-NH) when the House of Representatives returns to Washington in September.

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Washington, D.C. – Today, U.S. Senator Patty Murray (D-WA) and 43 of her fellow Democratic senators sent a letter to Department of Health and Human Services (HHS) Secretary Alex Azar slamming the Trump-Pence Administration’s new gag rule that compromises the Title X family planning program and the health care of millions of people who rely on Title X-funded providers for cancer screenings, STI screenings, contraceptive care, family planning services, and more. The letter came as the Administration’s minimal and conflicting guidance about its harmful rule has caused confusion and concern among providers. The Senators called on the Trump Administration to reverse course on the rule and maintain the essential care Title X-funded clinics provide for over four million patients nationwide.

“Over the past few weeks, the Department of Health and Human Services (HHS) has provided minimal and conflicting guidance to health care providers about how and when the Department intends to enforce the Trump Administration’s Title X rule. This rule will undermine the essential confidential nature of the patient-provider relationship at the nearly 4,000 health centers receiving Title X funding. It will also needlessly compromise health care for the millions of people who rely on the critical services provided by those centers, including comprehensive family planning and screening for diseases such as HIV and cancer. In light of this dangerous impact and the many concerns raised by health care providers, patients, and other stakeholders throughout the development of this rule, we believe the rule should be rescinded,” wrote the Senators.

“Four million patients who rely on Title X-funded programs now face limited options, as clinics and providers recognize the new regulation will force them to choose between receiving federal funds and upholding the confidential relationship between patient and health care provider,” the Senators warned.

The Trump Administration’s gag rule undermines the historically bipartisan Title X family planning program and will impact roughly 4,000 Title X-funded clinics operating in all 50 states. The rule interferes with the essential confidential nature of the patient-provider relationship and needlessly compromises health care for the millions of people—particularly poor and low-income patients—who seek care at Title X-funded clinics.

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

Read the full letter below or access the PDF version HERE:

 

July 26, 2019
 
The Honorable Alex M. Azar II                    
Secretary        
U.S. Department of Health and Human Services      
200 Independence Avenue, SW
Washington, DC 20201
 
Dear Secretary Azar, 

Over the past few weeks, the Department of Health and Human Services (HHS) has provided minimal and conflicting guidance to health care providers about how and when the Department intends to enforce the Trump Administration’s Title X rule. This rule will undermine the essential confidential nature of the patient-provider relationship at the nearly 4,000 health centers receiving Title X funding. It will also needlessly compromise health care for the millions of people who rely on the critical services provided by those centers, including comprehensive family planning and screening for diseases such as HIV and cancer.

In light of this dangerous impact and the many concerns raised by health care providers, patients, and other stakeholders throughout the development of this rule, we believe the rule should be rescinded. 

For decades, Title X-funded clinics have provided high quality health care to patients. The historically bipartisan program is intended to offer a full range of confidential and unbiased family planning services. Title X-funded clinics not only provide access to contraception, allowing women to choose whether and when to start a family, but also offer cancer and HIV screenings, STI screenings and treatment, and related preventive services. Four million patients who rely on Title X-funded programs now face limited options, as clinics and providers recognize the new regulation will force them to choose between receiving federal funds and upholding the confidential relationship between patient and health care provider. That is why health care providers, including the American Medical Association, Planned Parenthood, and the National Family Planning and Reproductive Health Association, and nearly half of all States have filed lawsuits against HHS to challenge this rule. 

In fact, health care providers have indicated the ideology-based restrictions put them in the untenable position of deciding between offering substandard care and withdrawing from the program, potentially compromising health care access for the poor and low-income patients who rely on them. Six in ten of the women who obtain publicly funded contraceptive care at a safety-net health center, receive that care through a Title X-funded center.  HHS should be seeking to increase access to contraceptive care, not advancing policies that sow confusion and make it harder for women to access the health care they need. 

We urge you to reconsider this harmful rule and instead work with health care providers to maintain policies that will help ensure that women have access to the family planning services, cancer screenings, and STI screenings and treatment that they rely on Title X-funded clinics to provide. Please contact Laurel Sakai with Senator Murray’s HELP Committee staff with any questions at (202) 224-7675.  

Sincerely,

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WASHINGTON – Today, U.S. Sen. Mark R. Warner (D-VA) voted in the Senate Finance Committee to approve bipartisan legislation to lower the cost of prescription drugs, sending the legislation to the full Senate for consideration. One recent report on the cost of prescription drugs in Virginia found that the annual cost of prescription drug treatment increased by 57.8 percent between 2012 and 2017, dramatically outpacing the 8.5 percent growth in Virginians’ incomes over the same period. The Prescription Drug Pricing Reduction Act of 2019 (PDPRA), which was approved by a bipartisan Committee vote of 19-9, will help address the rising cost of prescription drugs by taking on industry price hikes and protecting seniors with the highest out-of-pocket costs.

The Prescription Drug Pricing Reduction Act of 2019 takes key steps to lower prescription drug costs by overhauling the Medicare Part D program and creating a $3,100 yearly out-of-pocket cap to protect seniors with high drug costs. In addition, the legislation creates a price hike penalty for pharmaceutical companies if they raise the cost of a prescription drug faster than the rate of inflation. The bill also includes a provision similar to Sen. Warner’s bipartisan legislation that would allow state Medicaid programs grappling with rising drug costs to explore value-based pricing arrangements that peg the price of a drug to its effectiveness.

According to the non-partisan Congressional Budget Office (CBO), the Prescription Drug Pricing Reduction Act of 2019 (PDPRA) will save seniors $27 billion in out-of-pocket costs and will generate more than $100 billion in taxpayer savings over the next 10 years.

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

Following today’s Committee vote, Sen. Warner released the below video statement:

 

“Hi, I’m Senator Mark Warner and I want to talk about out-of-control prices on prescription drugs.

“I think every family in Virginia has seen increasing costs on prescription drugs. Matter of fact, the overall cost of drugs in our country have doubled since 2002. I hear on a regular basis from Virginians who say they have to choose between paying for their drugs or paying for food or rent. In a country like ours, that’s just unacceptable.

“I also know how many families have to deal with, particularly, family members who’ve got pre-existing conditions. My three daughters – I’ve got one daughter with juvenile diabetes and another daughter with asthma – and I’ve seen the cost of their drugs go up exponentially. One of the worst cases has been the enormously increasing costs on insulin – a drug that’s been around, literally, for close to one hundred years, yet we’ve seen its prices almost quadruple.

“Now, I’m pretty lucky because I’ve got insurance that takes care of that. But too many families across Virginia and across our country – they don’t have full coverage in insurance, or even within Medicare, many of our seniors are confronted with something called the donut hole where they have to pay too much in out-of-pocket costs.

“Now, in a country like ours, that shouldn’t be the case. So I’m actually proud to report that as a member of the Senate Finance Committee, today we passed legislation that will start to put a cap on drug prices.  We’ve put plans in place to make sure that drug prices can’t rise faster than inflation. Matter of fact, the bill that we passed out today ends up saving seniors over $27 billion dollars.

“Now, this legislation doesn’t go as far as I’d like. I actually believe that in America we ought to be able to negotiate for drug prices the same way that other governments do around the world and I’m going to continue to work towards that, but this first step of legislation that we’ve taken today will end up creating savings and put downward pressure on the increasing price of drugs. Now, there’s more work we need to do. We need to get this bill out of the Senate Finance Committee – which we did today – get it to the floor of the Senate, get it passed, and get it to the President’s desk.

“There’s no issue that more Virginians and more Americans face on a daily basis than increasing drug prices and we’ve got to make sure that we continue bipartisan efforts to both bring these costs down and to make sure that as new drugs come to the market, they don’t come to the market with extraordinarily high prices.

“I’ll do all I can to continue this fight but today we took an important first step forward.

“Thanks so much.”

 

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WASHINGTON – U.S. Sens. Mark R. Warner and Tim Kaine (both D-VA) today applauded the passage of a bill to continue providing financial support to those who suffered physical harm or families of those who were killed as a result of the September 11, 2001 terrorist attacks or ensuing debris removal efforts. With the September 11th Victim Compensation Fund (VCF) set to expire in 2020, the bipartisan Never Forget the Heroes: James Zadroga, Ray Pfeifer, and Luis Alvarez Permanent Authorization of the September 11th Victim Compensation Fund Act will secure funding for the VCF through Fiscal Year 2090 and ensure that all first responders and victims suffering from certified 9/11 illnesses can continue to count on this crucial program.

“Virginians will never forget 9/11 or the brave individuals who put their lives on the line in service of their fellow Americans. Unfortunately, many first responders and survivors today are reminded of that fateful day by the health issues they now face,” said the Senators. “While we can never repay the sacrifices of our first responders or their families, we can at least ensure that they receive the financial support they deserve. We applaud the passage of this important bill and urge the President to sign it into law as soon as possible.”

During the September 11th terrorist attacks, thousands of first responders and survivors were exposed to toxic materials, including burning chemicals, pulverized drywall and powdered cement. As a result of this exposure, many victims and first responders have become injured, fallen ill or lost their lives. The VCF provides compensation for those affected and has awarded more than $5 billion in benefits, with approximately 21,000 claims pending. From the Pentagon, 152 responders and 69 non-responders filed claims. Of those, the fund approved 36 claims by responders and thus far paid 32. It has also approved 16 claims from non-responders and paid all 16. In addition to reauthorizing funding, this legislation will also modify the VCF by allowing claims to be filed until October 2089 and adjusting the annual limit on economic loss compensation to account for inflation.

The bipartisan bill, introduced in the House of Representatives by Rep. Carolyn Maloney (D-NY), passed through the House earlier this month by a 402-12 vote. It passed through the senate by a vote of 97-2.

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WASHINGTON – Today, U.S. Sen. Mark R. Warner (D-VA) sent a letter to the Office of Management and Budget (OMB) urging it to review and approve the leasing prospectus submitted more than two months ago by the General Services Administration (GSA) for a new Veterans Affairs (VA) medical facility in Hampton Roads. While GSA had initially anticipated receiving OMB sign-off on the project by the end of last month, nearly three weeks later, the project is still awaiting review at OMB, further delaying plans to complete the much-needed new facility in South Hampton Roads by the fall of 2023.

“This clinic is essential to reducing VA wait times in a region with one of the fastest-growing veterans populations in the country. From 2012 to 2016, patient visits at the Hampton VA Medical Center increased by 21.4 percent, a rate nearly triple the national average of 7.3 percent. As of March 2019, patients were waiting an average of 57 days to access primary care at the Hampton VA Medical Center,” wrote Sen. Warner in today’s letter to OMB Director Mick Mulvaney. “Meanwhile, at the region’s other VA facility, an outpatient clinic in Chesapeake, veterans experienced wait times of 59 days for primary care. Any further delays constructing and opening this new health facility will only exacerbate the VA’s existing capacity challenges in Hampton Roads, where the veterans population is anticipated to increase approximately 22 percent between 2017 and 2027.”

In 2017, Congress approved leases for 28 VA facilities around the country, including two in Virginia. In an effort to ensure timely completion of the facilities, the VA passed off procurement authority for six of the projects, including the Hampton Roads clinic, to the GSA, which has been conducting the lease procurement process for the Hampton Roads facility since March 2018 and is currently in the ‘prospectus authority’ phase of the project. On May 8, 2019, GSA submitted a lease prospectus document to OMB, which must approve the plan in order to proceed with the design and construction of the Hampton Roads VA medical facility.

“As you know, OMB approval is required for lease projects over $3.095 million. GSA cannot proceed on this lease procurement until both OMB and Congress authorize the prospectus document. However, congressional authorization cannot be sought until OMB approves the prospectus. Therefore, in order for this project to move forward, your approval is urgently needed,” continued Sen. Warner. “According to GSA estimates, this project can be completed and turned over to the VA in the fall of 2023 – approximately six years after the leases were tardily approved by Congress. However, this timeline was produced by GSA on the assumption that OMB would approve the project by the end of June. Now that we are more than halfway into the month of July, each additional day that goes by without OMB approval is one more day that Hampton Roads veterans could have to wait to see this long-promised facility up and running.”

In the letter, Sen. Warner asked OMB to approve the project within the next week, and reiterated his commitment to help expedite the process.

“The prospectus document is no more than a few pages – it should not take OMB over two months to review the proposal,” Sen. Warner noted. “Once OMB is finished, I will do my part to ensure that the Senate conducts our approval process in an expedited manner, and together I hope that we can put this lease project back on track so that veterans in need of the facility will be able to use it as soon as possible.”

Since Congress approved the Hampton Roads clinic in 2017, Sen. Warner has repeatedly pushed the VA and GSA to expedite their work to get it up and running swiftly. In a personal meeting at his Washington office in December of 2018, Sen. Warner pressed GSA leadership to provide an update on the agency’s progress in opening the new facility. Dissatisfied with the lack of headway, the following month Sen. Warner again demanded a plan from GSA to speed up the procurement and construction process for the clinic. Sen. Warner followed up with the VA and GSA last week to express his continued outrage at “the glacial pace” of the Hampton Roads project, as well as another VA medical facility awaiting construction in Fredericksburg, Va., and to demand real plans from both for completing the already-delayed projects on a faster timeline.

A copy of today’s letter can be found here and below.

 

Dear Director Mulvaney:

I write to urge the Office of Management and Budget (OMB) to expeditiously approve the prospectus on a Veterans Affairs (VA) Outpatient Clinic in the Hampton Roads area of Virginia, which was submitted on May 8, 2019 by the General Services Administration (GSA). Further delays will only prolong a process that is already significantly and unnecessarily behind schedule. 

In 2017 Congress authorized leases for 28 VA facilities around the country, two of which are in the Commonwealth of Virginia. The VA passed procurement authority to the GSA for six of the projects, including the Hampton Roads outpatient clinic, in an effort to ensure timely completion of the facilities. GSA has been conducting the lease procurement process for the Hampton Roads facility since March 2018, and is currently in the “prospectus authority” phase of the project.

This clinic is essential to reducing VA wait times in a region with one of the fastest-growing veterans populations in the country. From 2012 to 2016, patient visits at the Hampton VA Medical Center increased by 21.4 percent, a rate nearly triple the national average of 7.3 percent. As of March 2019, patients were waiting an average of 57 days to access primary care at the Hampton VA Medical Center. Meanwhile, at the region’s other VA facility, an outpatient clinic in Chesapeake, veterans experienced wait times of 59 days for primary care. Any further delays constructing and opening this new health facility will only exacerbate the VA’s existing capacity challenges in Hampton Roads, where the veterans population is anticipated to increase approximately 22 percent between 2017 and 2027.

As you know, OMB approval is required for lease projects over $3.095 million. GSA cannot proceed on this lease procurement until both OMB and Congress authorize the prospectus document. However, congressional authorization cannot be sought until OMB approves the prospectus. Therefore, in order for this project to move forward, your approval is urgently needed. According to GSA estimates, this project can be completed and turned over to the VA in the fall of 2023 – approximately six years after the leases were tardily approved by Congress. However, this timeline was produced by GSA on the assumption that OMB would approve the project by the end of June. Now that we are more than halfway into the month of July, each additional day that goes by without OMB approval is one more day that Hampton Roads veterans could have to wait to see this long-promised facility up and running.

I ask that OMB do everything possible to expedite the review and approval of this prospectus document within the next week. The prospectus document is no more than a few pages – it should not take OMB over two months to review the proposal. Once OMB is finished, I will do my part to ensure that the Senate conducts our approval process in an expedited manner, and together I hope that we can put this lease project back on track so that veterans in need of the facility will be able to use it as soon as possible.

I look forward to your response, or even better, to the notice that OMB has approved the lease prospectus.

Sincerely,

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WASHINGTON – U.S. Sen. Mark R. Warner (D-VA) sent a letter to the Secretary of the Department of Veterans Affairs (VA) and Administrator of the U.S. General Services Administration (GSA), demanding that both agencies present a plan to expedite the completion of outpatient VA medical facilities in Hampton Roads and Fredericksburg. The letter comes on the heels of a report by the Department of Veterans Affairs (VA) Office of the Inspector General (IG) that revealed severely delayed completion times for a group of VA medical clinic projects from 2014.

“I write to convey my serious concerns and frustrations with the glacial pace of two Department of Veterans Affairs (VA) lease procurement projects in the Commonwealth of Virginia: an outpatient clinic in Hampton Roads run by the General Services Administration (GSA) and an outpatient clinic in Fredericksburg run by the VA. I request that both the VA and the GSA work to expedite the timelines for both clinics to meet the urgent needs of our veterans, as well as present a plan to my office, outlining phases in the timeline that can be reduced,” wrote Sen. Warner.

Plans to build the two new VA clinics in the Commonwealth are a direct result of Sen. Warner’s successful bipartisan effort to secure congressional approval for 28 overdue VA medical facility leases in 2017. While the new outpatient in Fredericksburg is under the purview of the VA, the GSA has undertaken the procurement and construction of the new Hampton Roads clinic in an effort to accelerate the process. In his letter to the VA and GSA, Sen. Warner conveyed grave concern that both agencies’ processes for site selection and construction are far behind schedule. Currently, both agencies have indicated that the completion of the clinics may take until 2023, more than 6 years after the leases were approved.   

The veteran population in Hampton Roads, one of the fastest-growing in the country, is anticipated to increase approximately 22 percent from 2017 to 2027. As Sen. Warner emphasized in his letter, the completion of the new clinic in the region is essential to reducing wait times and expanding healthcare options for veterans.

“I am particularly outraged that of the 28 leases approved as part of the 2017 legislation, the two Virginia facilities are among the last to be scheduled for completion. The Hampton Roads area is home to one of the largest veteran populations in the country and is in particular need of additional centers. In March 2019, the Hampton Roads VA Medical Center was seeing long wait times for primary care, specifically 57 days for the Hampton VAMC and 59 days for the Chesapeake VA Outpatient Clinic. Despite additional reforms on site to help care for veterans, it is clear that from these numbers that the region desperately needs more capacity to provide care for our veterans,” continued Sen. Warner.

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

 

The Honorable Robert Wilkie

Secretary of Veterans Affairs

U.S. Department of Veterans Affairs

810 Vermont Avenue NW

Washington, D.C. 20420 

Emily W. Murphy

Administrator

U.S. General Services Administration

1800 F Street NW

Washington, D.C. 20405

Dear Secretary Wilkie and Administrator Murphy:

I write to convey my serious concerns and frustrations with the glacial pace of two Department of Veterans Affairs (VA) lease procurement projects in the Commonwealth of Virginia: an outpatient clinic in Hampton Roads run by the General Services Administration (GSA) and an outpatient clinic in Fredericksburg run by the VA. I request that both the VA and the GSA work to expedite the timelines for both clinics to meet the urgent needs of our veterans, as well as present a plan to my office, outlining phases in the timeline that can be reduced.  

As you know, in 2017, after extended delays, Congress finally authorized leases for 28 VA facilities around the country, two of which are in Virginia. The VA passed procurement authority to the GSA for six of the projects – one of which was the Hampton Roads outpatient clinic, largely due to the need to ensure timely completion of the facilities. 

Despite both the VA and the GSA having had ownership of these projects for roughly two years and a year and a half, respectively, neither project has posted a Solicitation for Offer. In the case of the Hampton Roads facility, GSA began working on the project in March 2018, and GSA’s current timeline anticipates awarding the lease in February 2021, nearly three years later. This is prior to construction starting. The latest timelines put both the Hampton Roads and Fredericksburg facilities’ completion dates in the fall of 2023 – more than six years after the approval of these leases. This is unacceptable and reflects poorly on the GSA, the VA and on the U.S. government overall.

I am particularly outraged that of the 28 leases approved as part of the 2017 legislation, the two Virginia facilities are among the last to be scheduled for completion. The Hampton Roads area is home to one of the largest veteran populations in the country and is in particular need of additional centers. In March 2019, the Hampton Roads VA Medical Center was seeing long wait times for primary care, specifically 57 days for the Hampton VAMC and 59 days for the Chesapeake VA Outpatient Clinic. Despite additional reforms on site to help care for veterans, it is clear that from these numbers that the region desperately needs more capacity to provide care for our veterans. 

I look forward to a response from each of you that indicates how the lease projects for the outpatient clinic in the Hampton Roads and Fredericksburg will be expedited, so that the veterans who need these facilities will be able to use them sooner than they are currently estimated to be delivered. In my last correspondence with Administrator Murphy, she indicated that GSA would in fact evaluate opportunities to expedite the delivery of this facility. I thus would ask that both GSA and the VA specifically identify these areas as well. 

I cannot stress enough how important it is to the veterans I represent in Virginia that every effort be made to expedite the procurement and building processes for these facilities. This matter is of the utmost importance to me, and I stand ready to help in any way I can.

Sincerely,           

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WASHINGTON — U.S. Sens. Mark R. Warner and Tim Kaine (both D-VA) along with Rep. Morgan Griffith (R-VA) met in Sen. Kaine’s office in Washington, D.C. with a delegation representing Lee County Hospital. The meeting included representatives from the Lee County Hospital Authority, the Virginia Department of Health, and Ballad Health, who spoke with the members of Congress about next steps in the process of reopening the Lee County Hospital.

“Folks in Lee County and in rural communities across Virginia deserve to have access to the health care services they need,” said the members of Congress. “Rural hospitals face unique challenges, but in our meeting, the delegation from Lee County laid out a plan for how we can get this done. We are cautiously optimistic that this six-year effort is reaching the finish line and we plan to do everything in our power at the federal level to get the Lee County Hospital reopened next year.”

In 2013, the Lee County hospital – then known as the Lee County Regional Medical Center – closed abruptly, leaving the county without access to a nearby hospital. This closure hurt economic development in the area and affected public safety, as patients were forced to wait longer for medical care, and community sheriffs and fire squads spent valuable time escorting individuals across county and state lines to other hospitals.

In February of 2019, Lee County Hospital Authority chose Ballad Health as a partner and announced its intent to reopen the hospital, which will focus on treating chronic problems as well as providing much-needed emergency medical care and other typical hospital services. It will also provide a line of ancillary services to meet various community needs.

Last July, Sens. Warner and Kaine, along with Rep. Griffith, met with the Lee County Hospital Authority and key stakeholders to facilitate the reopening of the hospital. Additionally, earlier this year, Sens. Warner and Kaine introduced legislation that would benefit hospitals in medically underserved areas like Lee County, where patients are more likely to be uninsured and hospitals have struggled to stay afloat financially. The States Achieve Medicaid Expansion (SAME) Act of 2019 would allow states that expanded Medicaid after 2014 to receive the same level of federal matching funds as states that expanded earlier, and according to the Virginia Hospital & Healthcare Association, it would save Virginia’s hospitals an estimated $300 million per year in the first three years of implementation.

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WASHINGTON - U.S. Senators John Boozman (R-AR) and Mark Warner (D-VA) introduced legislation to improve coordination of veteran mental health and suicide prevention services and to better measure the effectiveness of these programs in order to reduce the alarming number of veteran suicides.

 The IMPROVE (Incorporating Measurements and Providing Resources for Outreach to Veterans Everywhere) Wellbeing for Veterans Act creates a new grant program to enable the Department of Veterans Affairs (VA) to conduct additional outreach through veteran-serving non-profits in addition to state and local organizations.

“Congress has provided significant resources to the VA to decrease veteran suicides, yet the number of veterans who take their own lives everyday remains unchanged,” Boozman said. “We all share the goal of saving the lives of veterans. We must have better coordination of existing programs; a common tool to measure the effectiveness of our programs; and better information sharing, data collection and continual feedback in order to identify what services are having the most impact. Creating a framework for these necessary pieces is essential to empowering organizations to work together in the fight against veteran suicide.”  

“Of the 20 veterans who commit suicide every day in this country, roughly 14 of them don’t receive treatment from the VA,” said Warner. “This legislation will target that group by providing grant funding to private organizations with a proven track record of strong mental health and suicide prevention efforts among veterans. It’s my hope that broad coordination between the VA, state veterans affairs departments, first responders, and local leaders, will allow us to support more at-risk veterans and make a meaningful impact on reducing veteran suicide rates in this country.”

In Fiscal Year 2010, the VA requested $62 million for suicide prevention outreach. In Fiscal Year 2020, that number nearly quadrupled to $222 million. Despite the sharp increase in funding, the rate of veterans suicides has remained roughly unchanged at 20 per day. Only six of those 20 veterans are receiving healthcare services at the VA. This points to a significant need to empower the VA to work through community partners to expand outreach. At the same time, national data indicates there are more than 50,000 organizations that provide suicide prevention services for veterans, yet they are hard for veterans to find, access, apply for and use. 

To date, policymakers have assessed capacity and access to services as a measurement for effectiveness. Despite significant capacity increases, the rate of veterans suicides remains the same. There are no shared tools to measure the effectiveness of programming at improving mental resiliency and outlook, which would be indicators of reduced suicide risk.

To address these programmatic gaps, the IMPROVE Wellbeing for Veterans Act will accomplish three broad objectives:

  • Enable the VA to directly or indirectly reach more veterans than it currently does.
  • Increase coordination among currently disparate community resources that serve a wide variety of veteran needs – all of which play a part in reducing the purposelessness that ends in suicide.
  • Create and inspire broad adoption of a measurement tool that will indicate effectiveness of services provided for veterans suicide prevention.

Senators Marsha Blackburn (R-TN), Kevin Cramer (R-ND), Mike Rounds (R-SD) and Thom Tillis (R-NC) are original cosponsors of the legislation.

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