Issue Position: Health Care

Issue Position

Issue Position: Health Care

I want to make quality, affordable health care available to every Nevadan by cutting costs, improving quality, and expanding access. I am also committed to protecting Nevadans from existing and emerging threats to health by funding research on diseases and preparing the nation for a potential pandemic.

Quality Health Care for All Nevadans

I want to make quality, affordable health care available to every Nevadan by cutting costs, expanding coverage, and improving health care quality. I am also committed to investing in the future by funding promising medical research and protecting the nation against serious threats to the public's health.

Health Insurance and Prescription Drugs
Everyone agrees that when it comes to health care, we have a crisis in the United States. The number of uninsured Americans has ballooned to nearly 46million, including 400,000 in Nevada. Over 100,000 uninsured Nevadans are children. Unfortunately, we are all struggling with the burden of increasing health care costs. These costs not only make it harder for Nevada's families to afford necessary care and seniors to afford their prescriptions. They also weaken our economy and undermine America's competitiveness in the world.

As a Nevadan, I know that we must fix this crisis. As the Senate Majority Leader, I am committed to developing and passing solutions that will take the nation's health care system in a new direction. One of our first steps will be reauthorizing the State Children's Health Insurance Program (SCHIP), called Nevada Check Up in our state.

Health Care Coverage
Health care costs increase for everyone as the number of Americans without health care coverage rises. The uninsured are more likely to forego cost-effective preventive treatments and to seek care in an emergency room where it is more expensive. More importantly, they do so at potentially great harm to their health. As the national debate on health care moves forward, I will continue to be committed to the principle that all Americans should have affordable, quality health care coverage, regardless of their income, age, employment, or health status.

Children's Health Insurance Program (Nevada Check Up)
The time to chart a new course for the nation's health care system is now. I had hoped our next step would be the reauthorization of the Children's Health Insurance Program (CHIP) in the first session of the 110th Congress. Also known as Nevada Check-Up in our state, this program provides comprehensive health insurance coverage to millions of Americans across the country, including nearly 40,000 Nevadans.

Last year, Congress passed bipartisan legislation (H.R. 976 and H.R. 3963) with overwhelming, bipartisan support to extend and improve CHIP. Unfortunately, both bills were vetoed by the President, despite the strong consensus in Congress and broad support across the nation. Although we had to enact a temporary extension through March 2009 as a result of the President's vetoes, I remain committed to continuing to work for a strong reauthorization bill when Congress revisits this issue in the near future. In the meantime, the extension we recently passed (S. 2499) will continue the vital Nevada Check-Up program in our state.

Medicare
I have long supported adding prescription drug coverage under Medicare. Unfortunately, the legislation that created the drug program in Medicare was deeply flawed, so I opposed the final version of that legislation because I thought we should do better. Even so, now that the drug benefit is in place, I am committed to improving it and to making it work.

Like the many Nevadans who worked to smooth the bumpy first stages of implementation, I will keep working to improve the Part D drug benefit for Nevada's seniors and people with disabilities. They should always come before the powerful special interests.

As one critical first step, I believe Congress should give Medicare more tools to obtain lower prescription drug prices. Currently, Medicare is banned from using the power of its 43 million beneficiaries to negotiate lower prices. This prohibition should be repealed so that we can save money for our seniors, people with disabilities, and American taxpayers. As a next step, I would like to improve access to the subsidies that can significantly lower costs for lower-income beneficiaries.

In Congress, we are also considering other improvements to the Medicare program, including ensuring that health care providers are fairly reimbursed, that beneficiaries are able to afford Medicare's services, and that the long-term stability of the program is assured.

Small Businesses
Although every sector of our economy is affected by the high cost of health care, small businesses often suffer from these costs more acutely. Many employers have been forced to pass additional health care costs onto their workers, and others have had to cut health care benefits altogether. I am committed to finding solutions that will work for both small employers and their employees while maintaining important consumer protections. During the 109th Congress, I sought to pass the Small Employers Health Benefits Program Act to establish a program that offers small businesses and self-employed individuals the same kind of coverage options available to Members of Congress. I am continuing to pursue solutions in the 110th Congress that will address the needs of Nevada's small employers.

Medicaid
The Medicaid program provides access to necessary, affordable, and quality medical care to 160,000 Nevadans. Despite its vital role in our health care system, Medicaid's future is repeatedly threatened by proposals to severely cut its federal funding and to impose changes that would undermine the program's mission. I fought to protect Medicaid against these spending cuts in previous years, and I will continue to oppose similar proposals in the future.

End Insurance Discrimination Against Women
Women of reproductive age pay 68 percent more in out-of-pocket medical expenses than men, largely due to their reproductive health-care needs. Legislation that I have long supported, the Equity in Prescription and Contraception Coverage Act, would require private insurance plans that provide coverage for prescription drugs to provide the same coverage for prescription contraceptives.

This legislation to ensure equity and fairness in contraception coverage is also a critical component of the Prevention First Act (S. 21). The Prevention First Act will improve women's health, increase Nevadans' access to family planning services, and reduce the number of unintended pregnancies -- all while saving scarce public health dollars.

Increase Access to Mental Health Care
Mental illnesses are just as real as physical illnesses and deserve to be treated as such. That is why the Senate passage of the Mental Health Parity Act of 2007 (S. 558) is an important victory for all those who are affected by mental illnesses. This legislation is the culmination of many years of work to build on and strengthen the 1996 mental health parity act. It is a good compromise that will ensure that plans covering mental health services cannot provide different financial requirements or treatment limitations than they would for medical or surgical benefits. This legislation is long overdue and I will continue to work to ensure it is enacted as soon as possible.

Given Nevada's tremendous population growth and a statewide suicide rate that is consistently among the nation's highest, it is increasingly critical to improve our mental health care system. I have been working to ensure that these efforts include suicide intervention and prevention strategies because the need for them is so great in Nevada. In fact, I introduced the Stop Senior Suicide Act (S. 1854) to provide a comprehensive response to reducing suicide among our seniors, a group that is particularly vulnerable. Specifically, this bill will improve the geriatric mental health delivery system, establish grants for senior suicide prevention and early intervention programs, and improve access to outpatient mental health services under Medicare.

Prescription Drug Safety
In September 2007, Congress passed and the President signed the Food and Drug Administration Revitalization Act (Public Law 110-85), which extends the legal authority for the Food and Drug Administration (FDA) programs for approving prescription drugs and medical devices. While this new law will improve prescription drug and food safety for all Americans, it also will improve programs focused just on our children. These improvements represent a victory for consumers and patients who depend on our nation's system for ensuring that life-saving drugs and devices come to market in a timely and safe way.

Medical Research
Our nation's major commitment to health research will likely bring stunning new treatments for cancer, deadly diseases, chronic conditions, and other ailments. I am committed to making the investments necessary to accelerate the pace of current progress and to spur on new discoveries.

Unlocking the Potential of Stem Cell Research
Millions of Americans suffer from debilitating diseases and conditions, including Parkinson's, spinal cord injury, heart disease, and diabetes. Although embryonic stem cell research holds great promise, President Bush announced on August 9, 2001 that he would limit government funding for research to the stem cell lines that already existed at the time of his announcement. This policy will not allow federal researchers to fully realize the life-saving potential of stem cells because scientists have concerns about the quality, longevity, and availability of the eligible embryonic stem cell lines.

I introduced the Stem Cell Research Enhancement Act (S. 5) on the first legislative day of the 110th Congress. This legislation would expand the President's embryonic stem cell research policy and would allow for federally-funded research on stem cell lines from excess embryos that were originally created for fertility treatments, were willingly donated by patients, and would otherwise be discarded. The Stem Cell Research Enhancement Act would ensure that stem cell research is conducted under ethical guidelines that are stricter than the President's current policy for embryonic stem cell research.

During the previous 109th Congress, the House of Representatives passed the Stem Cell Research Enhancement Act by a vote of 238 to 194. I am proud to have played an instrumental role in the Senate passing this House-passed bill on July 18, 2006. Unfortunately, the President vetoed the bipartisan Stem Cell Research Enhancement Act less than 24 hours of its passage. I am especially disappointed that the President did not heed the calls for him to consider the views of the major medical and scientific associations, 80 Nobel laureates and thousands of other scientists, research universities and institutions, patient organizations, and all of the Nevadans who support this landmark legislation before he made a final decision. The House subsequently considered a motion to override the President's veto, but the vote (235 to 193) did not meet the two-thirds threshold required to override a veto.

In the 110th Congress, working with colleagues on both sides of the aisle, I will continue seeking to enact the Stem Cell Research Enhancement Act. Doing so will open new doors in the scientific world and generate hope for thousands of Nevadans and millions of Americans suffering from debilitating diseases.

Research Funding
Throughout my career in the Senate, I have supported increased funding for life-saving medical research. While I am proud that we have doubled our national medical research budget over the five year period of 1998 to 2003, I am particularly disappointed about spending proposals in recent years that would reverse this trend. We need to continue to invest in medical research that will lead to immeasurable contributions in the fight against a number of serious illnesses, including cancer, diabetes, Alzheimer's, and Parkinson's. At a time when we are the verge of major new breakthroughs and the burden of chronic disease continues to grow, we should not shortchange a priority as important as promising medical research.

Breast Cancer and Environmental Research Act
Breast cancer takes a serious toll on patients, families, and communities. It is estimated that more than 1,600 Nevadans will be diagnosed with the disease this year alone. Unfortunately, we still do not know what causes breast cancer. Because many women, and men, have no family history, or known genetic links, to breast cancer, it is generally believed that the environment plays a role in the development of breast cancer. However, we still do not understand the extent of that role.

On February 14, 2007, I introduced the Breast Cancer and Environmental Research Act to spur research on the possible links between the environment and breast cancer, which has been limited to date. It will boost the federal research investment on breast cancer and also establish a national research strategy. This bill reached a critical milestone in the 109th Congress when it passed the Senate Health, Education, Labor, and Pensions Committee, but unfortunately, it was blocked from passing in the full Senate despite support from a bipartisan majority of Senators. I will continue to work for the swift passage of this legislation in the 110th Congress.

ALS Registry Act
On May 14, 2007, I reintroduced the ALS Registry Act to improve our understanding of amyotrophic lateral sclerosis (ALS) and help determine its causes. My bill will establish a single, national ALS patient registry at the Centers for Disease Control and Prevention (CDC), thus centralizing existing data and facilitating the collection of new information about the epidemiological and demographic factors associated with ALS. With $900,000 in funding that I helped to secure in the Fiscal Year 2006 Departments of Labor, Health and Human Services, and Education, and Related Agencies Appropriations Act (Public Law 109-149), the CDC is already beginning to gather data for the registry. Moving forward, I will continue working to see this national registry established because it will significantly enhance the nation's efforts to ultimately cure ALS.

Inflammatory Bowel Disease Research Act
Crohn's disease and ulcerative colitis, collectively known as inflammatory bowel disease, are chronic disorders of the gastrointestinal tract that represent a major cause of morbidity from digestive illness and have a devastating impact on patients and families. I am the author of the Inflammatory Bowel Disease Research Act, which will expand federal research on IBD and direct the Centers for Disease Control to provide a comprehensive approach to addressing the burden of this debilitating disease in the United States. By increasing our investment in these areas, my bill will offer hope to millions of Americans who suffer from IBD and save millions of dollars in net health care expenditures through reduced hospitalizations and surgeries.

Fallon Cancer Cluster
In April 2001, I brought the Senate Environmental and Public Works Committee Fallon, Nevada for a field hearing. The purpose of this hearing was to investigate why a number of children in this small community had been diagnosed with Acute Lymphoblastic Leukemia.

In response to the Fallon hearing, I introduced legislation to establish a national network to track and correlate chronic diseases and environmental exposure. The bill would also create a public health rapid response capability to help small communities like Fallon respond to high incidences of disease. The lack of such a tracking and response system was a focal point of testimony at the hearing.

This bill, the Coordinated Environmental Health Network Act, will help put in place a system to finding answers to these horrible questions and to preventing public health crises before they occur. I have also worked to secure over $100 million for a number of states, including Nevada, to begin the process of establishing tracking and response programs called for in this legislation.

Health Care Quality
Quality health care should be in the reach of every American, not just the select few. From modernizing the health information technology infrastructure to eliminating disparities in care, there is a number of goals that have been achieved and more work remaining to be done.

Medical Errors
The Institute of Medicine has estimated that between 44,000 and 98,000 people die each year in hospitals as a result of medical errors. I supported the passage of legislation, the Patient Safety and Quality Improvement Act of 2005, that is designed to reduce the incidence of these errors. This law establishes a new national system for voluntarily reporting events that may adversely affect patient safety and authorizes grant programs to improve the quality of patient care. As I monitor its implementation, I will also continue to watch for future opportunities to improve patient safety and prevent medical mistakes.

Health Care Disparities
The health of every community is enhanced when we work to promote health care equality for everyone, regardless of race or ethnicity. Everyone deserves equal treatment in health care, but unfortunately, there are still health disparities depending on race or ethnicity. So that we may begin to close the health care divide, I have long supported legislation that would expand the health care safety net, combat diseases that disproportionately affect racial and ethnic minorities, and help to ensure that our public health workforce reflects, understands, and respects the diversity of the people it serves.

Patients' Bill of Rights
Doctors, not insurance companies, should make medical decisions. I support a strong Patients' Bill of Rights that would ensure that all Americans have timely access to the emergency care, specialists, clinical trials and the prescription medications they need. We need to protect patients from insurance bureaucrats so that they come before profits.

Public Health and Health Care Workforce
The health and well-being of the nation, in times of calm as well as emergencies, depend on a strong health care infrastructure and workforce. Given the rapidly growing population in Nevada, we feel some problems, such as shortages of primary care providers, more acutely. The popularity of Nevada to visitors from across the world also makes our home state more vulnerable to the serious threat of pandemic flu.

Pandemic Flu
Public health experts are warning that an avian influenza outbreak could cause the next flu pandemic. While it is impossible to predict when or if the avian flu will cause a pandemic, public health experts believe that we will face at least one pandemic in this century. The human and economic costs of a pandemic could have dramatic and far-reaching consequences on every sector of our society and our economy.

Preparing against the threat of an influenza pandemic is especially critical for Nevada because our state's economy depends on the tourism and entertainment industries, which could be the hardest hit by a pandemic. In fact, according to the "Pandemic Flu and Potential for U.S. Economic Recession" report issued in March 2007 by the Trust for America's Health (TFAH), a severe pandemic flu outbreak could result in the biggest potential percent drop in economic output for Nevada compared to all other states.

I am the author of the Pandemic Preparedness and Response Act, legislation that would prepare and protect Americans from a potential flu pandemic. I have also been working in the Senate to provide funding for numerous key goals, including improving global surveillance, stockpiling antivirals, investing in the country's vaccine infrastructure, improving state and local public health systems, and improving education and outreach. To date, over $6.0 billion for pandemic flu preparedness has been directed to the U.S. Department of Health and Human Services alone. In two emergency appropriations bills for Fiscal Year 2006, I was also pleased to support the inclusion of an additional $477 million for other federal agencies and departments, such as the Department of Homeland Security. When the Senate considers future spending bills, I will keep up the pressure to fund the actions necessary to prepare and protect Nevada and the nation from the pandemic threat.

Health Care Workforce
As Nevada continues to grow, so do our health care needs. On February 14, 2007, I introduced legislation with Senator Bill Nelson (D-FL) to help ensure that communities across our state have the doctors they need and the quality care they deserve. Our bill, the Resident Physician Shortage Reduction Act, would expand the number of Medicare-supported physician residency training positions in states like Nevada that are facing significant shortages of resident physicians. Under current law, there are caps on the number of those positions. There are no exceptions to the permanent caps, and most importantly for Nevada, no adjustments are made for population growth. Our bill will allow these caps to be raised and thus allow more physicians to train in Nevada, thereby ensuring that more will stay in the state to practice.

Because Nevada is facing a nursing shortage, I will also continue to support the comprehensive Title VIII nursing education and workforce programs. These Title VIII programs merit funding because they help to encourage bright students to join the nursing profession, keep the current workforce strong, and open doors to advanced education. We also need to ensure that working conditions -- such as needlestick laws, staffing ratios, and mandatory overtime rules -- support our nurses' desire to provide the highest quality care possible.

Rural Health
The federal government's rural health programs play a critical role in sustaining and improving the fragile health care infrastructure common in Nevada's rural communities. For this reason, I have consistently worked to ensure funding for programs like the rural outreach grants and the State Offices of Rural Health. Title VII Health Professions programs have been especially important to Nevada, improving access to primary care for medically underserved populations and supporting the health care workforce. Nevadans directly benefit from Title VII programs that work to alleviate the shortages of primary care doctors, dentists, nurses, and other allied health professionals.

Health Care Infrastructure
Nevadans should not have to travel far away to receive the high quality health care they deserve and need. Not only have I been working to improve rural Nevadans' access to health care, I worked to secure millions of dollars of federal support to improve the health care infrastructure in our state so we may meet the increasing needs of our growing population.

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