▶ 0:16:28Chair Cassidy: The senate committee on health, education, labor, and pensions will please come to order. I talk a lot about the high cost of health care and come to this issue not only as a senator budd as a doctor of his practice medicine in a hospital -- doctor who has practiced medicine in a hospital for the insured and uninsured for years. We see the inability to afford health care is impacting the ability of small businesses to provide health insurance for their employees. The cost of being insured has gone up. Premiums are climbing.
▶ 0:16:57Chair Cassidy: Particularly for the 62% of americans getting insurance from small business. Even those with insurance often have large deductibles for coverage truly kicks in. And so a family delays care or face a significant financial strain or puts it on the credit card and somehow they are never able to pay off the credit card balance. We owe it to our fellow americans to help.
▶ 0:17:25Chair Cassidy: Let's put aside the feckless partisan politics, do our job, and pass legislation to make americans's lives better. We are doing that today. The bills will allow family access to affordable quality health care. It is going to make pricing easily morph edible and able to pick the highest quality affordable option for care.
▶ 0:17:51Chair Cassidy: Say a mother in lafayette, louisiana, says search an urgent care near me. Which one has the best price? She can go to that one. She can go to that one and save her money that can be substantial because we made this information available. The bill also gives employers access to the data, allowing them to develop innovative plan designs, driving down costs, and benefiting employees.
▶ 0:18:16Chair Cassidy: The legislation is so important and something I have been telling as part of my money and value for patients agenda to lower cost for health insurance for families. Expedited access act by senator paul increases market competition, lowers drug prices, and in the minutes costly and redundant political study requirements.
▶ 0:18:40Chair Cassidy: The manager's abutment includes a policy from senator moody to eliminate government red tape that slows down fda's review of bio. One act caps on much patients pay for insulin.
▶ 0:19:01Chair Cassidy: And the national pen for epilepsy act is for 3.4 million americans living with epilepsy, improving research, diagnosis, care. The title eight nursing workforce reauthorization act and the empower for health act from senators murkowski and reed strengthens the health care workforce, dressing shortages that limit families's access to care, especially in rural areas.
▶ 0:19:32Chair Cassidy: The same drugs act championed by centrist banks and the clear labels act include commonsense policies that patients understand what is in their drugs, whether they are compounded by the pharmacy down the street or manufactured at a manufacturing plant and help fda and states better track when the problem occurs.
▶ 0:19:54Chair Cassidy: The making families food safe r act gives safety regulators ability to better respond to food worn investigations -- foodborne investigations. Many of these bills were raised as priorities by members of this committee, but also by other senators and our member day hearing in march. Health committee senators can come and present their priorities.
▶ 0:20:20Chair Cassidy: It markup shows a it markup shows the success we can have when we work together on shared priorities. In that spirit, we are also marking up senator sanders's childhood diabetes reduction act. This is about ultra processed food and restricts targeting junk food ads to kids. I don't think it is a perfect bill but it is a starting bill for bipartisan changes we need to make to how food is originated and allows us to have a productive markup today.
▶ 0:20:49Chair Cassidy: I will continue to work and other initiatives in this space, including the need for a national uniform standard for food regulations rather than a patchwork of wildly different -- widely different state laws. Lastly, lastly but most importantly, I acknowledge the unbelievable amount of staff work in this markup.
▶ 0:21:16Chair Cassidy: In some cases, members of my staff have worked on a piece of legislation for over six months. These member priorities will not be moving forward without their expertise, commitment, and sacrifice, so I publicly thank kristin. I always have to work at the last name.
▶ 0:21:38Chair Cassidy: Catherine, matthew, dominic, caroline, and liz for their work on this markup. [applause]
▶ 0:21:53Chair Cassidy: Thank you, senator marshall. I appreciate my colleagues's efforts on these bills, advancing a pro-patient, profamily, and pro-worker agenda. I look forward to supporting them. With akamai recognize senator sanders.
▶ 0:22:07Sen. Sanders: Mr. chairman, thank you very much. I want to applaud the staff on the health side as well for their work. I intend to support all the bills before us this morning. But I do want to say in response to something you did say that at the end of the day as a nation we will have to ask ourselves one very simple question about health care. Is health care a human right? Or is it not? And I would suggest, Mr.
▶ 0:22:38Sen. Sanders: Chairman, that the overwhelming majority of the american people understand that health care is a human right, whether you are rich, poor, young, or old. People have a right to get the health care that they need. And I hope that the day will come sooner than later that the united states of america, our great country, the wealthiest nation on earth, joins every other major country, guaranteeing health care to every man, woman, and child.
▶ 0:23:05Sen. Sanders: And by the way, despite the fact that 85 million americans are underinsured or uninsured today, Mr. m as the chairman will note, we are spending close to double what other nations are spending on health care, and the issue we ultimately will have to deal with is the function of health care to make the insurance companies and drug companies menominee companies meno phenomenally rich but to provide quality care to all people as a human right.
▶ 0:23:37Sen. Sanders: Mr. chairman, let me focus my remarks now on one of the pieces of legislation that you mentioned. A piece that I introduced called the childhood diabetes reduction act. This legislation will require the fda to put strong warning labels on ultra processed foods that are high in sugar, salt, and saturated fats.
▶ 0:24:01Sen. Sanders: Importantly, it would also be in junk food ads targeted at children, similar to what congress did to the tobacco industry nearly 30 years ago. Mr. chairman, in america today, we have an obesity epidemic and a diabetes epidemic. They are both directly related, and they are both getting worse. More than 35 million americans have type 2 diabetes. Over 10% of our population.
▶ 0:24:33Sen. Sanders: Diabetes is not only a serious illness unto itself, but is a computing factor to heart disease, stroke, amputations, blindness, and kidney failure. And the cost, the cost of treating that disease is staggering. According to the american diabetes association, the total cost of diabetes in the U.S. is over $400 billion a year to treat diabetes. $400 billion a year. It is an extraordinary amount of money.
▶ 0:25:04Sen. Sanders: And when we talk about the type 2 diabetes epidemic, a huge increase in new faces, we must also talk about the epidemic of obesity in america. About 90% of people with type 2 diabetes are overweight or obese. These two epidemics go hand in hand. The time is long overdue for us to pose some very simple questions. How did it happen that according to a cdc report in 2022 the rate of childhood obesity in america has tripled since the 1970's?
▶ 0:25:37Sen. Sanders: Tripled since the 1970's, and has gotten so bad that one out of every five kids in america is now obese. How has it happened that over 40% of adults in our country today are obese? And in my view, the answers to these questions are not very complicated. For decades, congress and the fda allowed large corporations to make huge profits by enticing children and adults to consume ultra processed food and beverages loaded up with sugar, salt, and saturated fat.
▶ 0:26:07Sen. Sanders: We can begin to turn that around today by passing this legislation. There is growing evidence including testimony before this committee a few years ago that these foods are deliberately designed to be addictive, similar to cigarettes and alcohol, and lead to a higher risk of type 2 diabetes. Shockingly, according to a study published in the british medical journal in 2022, ultra processed foods make up an incredible 73% of our nation's food supply.
▶ 0:26:36Sen. Sanders: Bottom line, much of the food that we as americans are now consuming are making is unhealthy and are contributing to the fact that our life expectancy is significantly lower than many other healthy countries. None of this is happening by accident. The food and beverage industry spending over $11 billion a year on advertising, pushing these unhealthy products onto the american consumer.
▶ 0:27:01Sen. Sanders: Even worse, nearly $2 billion of this money is spent to directly advertise these unhealthy products to our kids in order to get them hooked at an early age. According to the root center for food policy and obesity, children and teens view about 4000 food and beverage ads on television each year and an average of 10 advertisements each day. Last year for example, coca-cola spent over $5 billion on advertising while raking in over $11 billion in profits.
▶ 0:27:31Sen. Sanders: Not one of their ads will tell you a 20 ounce bottle of coke contains more than 15 teaspoons of sugar. 15 teaspoons of sugar. Over twice the recommended daily limit for kids. Given this reality, which has been widely discussed by scientists and doctors for decades, the question that arises, what has the fda done to address these epidemics which have impacted the health of millions of americans and cost us hundreds of billions every year? The answer is not much.
▶ 0:28:01Sen. Sanders: So, Mr. chairman, under the bill that we are now considering, the fda would be required to put a warning label on sugary drink that says, food and drug administration warning, drinking beverages with added sugar can contribute to obesity, type 2 diabetes, and tooth decay, not recommended for children. Similar warning labels will be put on foods with high-end salt and saturated fats. This is not a radical idea. Chile implement a similar law.
▶ 0:28:34Sen. Sanders: Israel, mexico also have similar laws. Mr. president, that time is now for us to do things to put strong labels on products to protect our kids and to make sure that tv advertising does not hook kids on unhealthy foods.
▶ 0:28:53Chair Cassidy: Thank you, senator sanders. I will now begin consideration of today's bill. For the awareness of all senators and staff, we intended the amendment as raised but we will hold a vote on passage of both bills until the end of the session. We will keep them as of the staff abated on the timing of the vote for final passage.
▶ 0:29:15Chair Cassidy: I will ask colleagues to limit remaster two minutes were discussing either of the bills or offering amendments as there are a lot of amendments to process. As a reminder when discussing an amendment, please identify which amendment you are discussing by its name and number. We are going to do the price bill first, but senator marshall has had to leave, so we are going to hold that until he returns. We will begin now with consideration of s. 1414, the expedited access to bio similars act.
▶ 0:29:47Chair Cassidy: Approving access to affordable bio similar medications. I think senator moody, who championed legislation incorporated in this bill. At our april hearing on the biosimilars drug market, we heard how biosimilars lacked regulatory certainty. In the 15 years since the biosimilars biosimilar revelatory framework was created, we have learned a lot about how to ensure they are safe and work for patients, and the laws have not kept up.
▶ 0:30:15Chair Cassidy: This bill addresses these problems by reducing data requiring law that in many cases in requiring law that in many cases is unnecessary and requires clear rules for biosimilar developers and establishes a clear consistent process for when fda needs to require additional studies. It also eliminates a redundant requirement that multiple fda offices review each biosimilar before approved. I am glad to see this legislation for this committee. We have an amendment to s. 1414.
▶ 0:30:48Chair Cassidy: I moved to adopt the amendment and have been considered original text for the purpose of further amendments. All in favor, say aye. Opposed, no. The ayes have it. The motion is agreed to. This any senator wish to speak on the bill?
▶ 0:31:04Sen. Paul: Prescript and drug spending is mostly on drugs like hormone therapy, cancer treatments, and monoclonal antibodies. Biologics are only 5% of prescriptions but account for 51% of spending. My bill seeks to reduce the cost of biologic drugs by removing the blank requirement for comparative efficacy trials in biosimilar develop and which are often unnecessary.
▶ 0:31:30Sen. Paul: Trials are like stage iii three trials that attempt to engage with a biosimilar and the reference biologic are equally effective. A review of over 600 studies published in the journal pharmaceuticals found that no biosimilar with proven analytical similarity has ever failed and efficacy study. The average cost of biosimilar development is $100 million compared to $300 million compared to other studies that cost $20 million.
▶ 0:31:58Sen. Paul: Removing these unnecessary studies as they have already done in europe and england dues development costs by 10%. Additionally, the studies can take up to three years to complete and biosimilar development can take up to nine years. Delaying treatment for the sake of conducting unnecessary studies harms the very people we intend to help. The fda has realized the burdensome nature of these studies and in its recent guidance, the agency waived comparative efficacy studies for therapeutic proteins like monoclonal antibodies.
▶ 0:32:27Sen. Paul: We have worked with the fda on this bill because when a biosimilar is proven to be safe and effective, there is no reason to delay care to patients and regulatory certainty to manufacturers. I urge my colleagues to support my bill to significantly lower the cost and time to biosimilar develop.
▶ 0:32:41Chair Cassidy: Does anyone else wish to speak? The officer raises his hand, but I am thinking, no, he is just checking in his hairpiece. We will now begin consideration of the insolent act of 2026. I thank senator colleagues, shaheen, and warnock for their leadership on this legislation.
▶ 0:33:10Chair Cassidy: I am pretty the effort to make lifesaving insulin more affordable. I recognize this legislation may need more refinement and may encounter policy and procedural hurdles be on this committee. I am pleased we were able to advance into the next stage of the legislator process. We have a managers amendment to s. 4189. I moved to adopt the managers amendment and the nature of a substitute and having it considered original text for you and all in favor, please say aye. All opposed, say nay.
▶ 0:33:41Chair Cassidy: The ayes have it. The motion is agreed to. Do any members wish to speak on the bill? Senator collins.
▶ 0:33:48Sen. Collins: Thank you, Mr. chairman. First, I want to thank senator shaheen for our long-standing partnership on this bill as cochairs of the senate diabetes caucus, which I founded in 1997 to increase research funding and promote better health care for people with diabetes. I also want to thank senators kennedy and warnock for their contributions.
▶ 0:34:16Sen. Collins: Beginning in 2015 I chaired eight hearings on prescription drug prices when I chaired the senate aging committee. We heard countless stories from americans who were struggling to afford the medicine they needed and the unaffordable cost of insulin was featured prominently at almost every signal hearing. The bill we are marking up today is the culmination of these efforts.
▶ 0:34:49Sen. Collins: Recent decisions by manufacturers to cut their listed prices on insulin is encouraging. There is still more work to be done. Our bill would cap the cost of insulin at $35 a month for individuals who are on commercial insurance plans. According to the american diabetes association, nearly 40% of people with diabetes have rationed or skipped insulin doses due to the costs.
▶ 0:35:19Sen. Collins: One of my constituents from chelsea, maine, skipped doses of insulin when she was unable to afford it and ended up in the emergency room. The insulin act would help people like her afford the insulin they need to survive.
▶ 0:35:38Sen. Collins: The ball not only caps the amount of pocket costs -- the out-of-pocket costs patients but addresses the lack of biosimilar competition that contributes to high list prices for insulin. Although the bill has some other issues in it that I would like to go through, including citizen petitions which are largely backed by brand-name
▶ 0:36:08Sen. Collins: Manufacturers who were behind the 86% of them, which is why fdi denied more than nine out of 10 of them, I am mindful of the chairman's request we keep our remarks brief. So I would like to end by thinking our committee cosponsors of this bill, senators markowski, turberville, banks, baldwin, kaine, blunt rochester, hickenlooper, and alsobrooks.
▶ 0:36:38Sen. Collins: I want to thank all the patient groups that have endorsed our bill. Thank you.
▶ 0:36:43Chair Cassidy: Senator paul.
▶ 0:36:44Sen. Paul: I respect the intentions and motives of those who like to seal over insulin prices in the bill, but historically, price controls don't work. If you want to see examples of where we have extensive price controls, look to venezuela, look to the soviet union. The old story and the soviet union was a guy goes into a store and says, are you the story that does not have things? The guy says, no, that is across the street. We are the store that does not have toilet paper.
▶ 0:37:16Sen. Paul: Because they were so used to having shortages of things. We want people to have the basics of life, food. Do we have a right to food and health care, as the ranking member would say? You can say that and set prices, but it does not work. What happens in capitalism is you have a fluctuating price. Are pharmaceuticals fluctuating prices? No, most of it is interrupted by an intermediary.
▶ 0:37:43Sen. Paul: The government is an eating the government is an ea intermediary and the insurance companies are an intermediary. The price applies to 30% or 40% of people that have no insurance. Not something I am recommending. Almost all the prices are already set. It is about the system. I think this is well-intentioned. I think the history of price controls is not a good one, and I will oppose it.
▶ 0:38:06Chair Cassidy: Senator baldwin. Does anybody else wish to speak on the bill? Ok. >> Mr. chairman.
▶ 0:38:17Chair Cassidy: Senator baldwin.
▶ 0:38:18Sen. Baldwin: I want to start by expressing how excited I am to have the insulin act on this markup today. This bill will make insulin more accessible for millions of americans and significantly reduce the cost of insulin. No one should have to go without the medication they need to stay healthy, and that is why I introduced my amendment, baldwin collins number one.
▶ 0:38:43Sen. Baldwin: This bipartisan amendment would restore a pilot program for uninsured patients to access insulin for $35 a month and a resource center to help patients afford an access affordable insulin.
▶ 0:39:01Sen. Baldwin: Both of these policies were in the original text of the insulin act, but unfortunately are not in the amendment before us today, so I ask for the support of all of my colleagues on this amendment to ensure that patients without insurance are not left behind and that patients have access to resources to help them find information about access to insulin. Mr.
▶ 0:39:27Sen. Baldwin: Chairman I asked for a vot on my amendmente -- I asked on my amendmente -- I aske for a vote on my amendment.
▶ 0:39:35Chair Cassidy: Ok. I commend senators collins and shaheen for their tireless work advocating on behalf of those who need insulin to survive. Largely because of their efforts, most commercial insurance companies now voluntarily cover insulin for only $35 out-of-pocket. While I support the core policy of the insulin act, I cannot support a new duplicate of program that exacerbates the problems of our health care system that drive health care costs.
▶ 0:40:05Chair Cassidy: Community health centers already provide deeply discounted insulin to patients regardless of insurance status or ability to pay. Community health centers and many others receive billions in mandatory and discretionary funding to support by participating in the 340b program. Any 340b provider is getting insulin for pennies on the dollar.
▶ 0:40:32Chair Cassidy: These savings are supposed to be passed on to the uninsured or low income patients to pay for insulin and other treatments on a sliding fee scale. The transparency and oversight concerns prevent 340b from translating to better access and lower cost for patients.
▶ 0:40:48Chair Cassidy: So rather than holding covered entities accountable to ensure that existing resources are being used as congress intended, this amendment creates another source of funding and enabled for the diversion of 340b revenue away from that which congress originally intended. I will note that the trump administration strongly opposes this provision. I acknowledge members on both sides of the aisle may support the amendment.
▶ 0:41:16Chair Cassidy: And I share the goal having practice medicine in a hospital for the uninsured and underinsured to have affordable insulin. But I will say the hospital where I practiced used 340b the way and was supposed to be used and give the medicine for free to those who came in, and I would say this amendment is giving cover for 340b entities, which is not using the program the way that we intended it to. They are using it as a money grab.
▶ 0:41:43Chair Cassidy: I urge my college to oppose this amendment. And allow others to speak or make a motion? >> Mr. chairman.
▶ 0:41:54Chair Cassidy: Senator sanders.
▶ 0:41:55Sen. Sanders: Mr. chairman, I strongly support capping the market cost for insulin at $35 for americans. The underlying legislation as we know is not for americans that have insurance, but it does not do that -- it does that for americans that have insurance, but it does not do that for those uninsured. As we know several years ago as part of the inflation reduction act, we were able to make sure that people on medicare do not pay more than $35.
▶ 0:42:26Sen. Sanders: We also had success in substantially lowering the cost of asthma and ocd inhalers. Bottom line, we are making success -- having success making insulin available to those who need it. This is an important amendment. Let's support it.
▶ 0:42:42Sen. Collins: Mr. chairman.
▶ 0:42:44Chair Cassidy: Senator collins.
▶ 0:42:46Sen. Collins: Mr. chairman, I support the zimmerman and am pleased to be the cosponsor -- I support the bill and am pleased to be the cosponsor. In an attempt to move the bill on, we agreed to take it down and decided at the committee level, but I think it is important that we not leave this population, the most vulnerable population behind. Thank you.
▶ 0:43:14Chair Cassidy: Does anyone else wish to speak? I now make a motion to table the amendment. I shall be voting to table. The clerk shall call the role. >> senator paul. Senator collins. Senator murkowski. Senator marshall. Senator scott. Senator hawley. Senator tuberville. Senator banks. Senator husted.
▶ 0:43:45Chair Cassidy: Senator moody. Senator armstrong. Senator sanders. Senator murray. Senator baldwin. Senator murphy. Senator kaine. Senator hassan. Senator hickenlooper. Senator markey. Senator kim. Senator blunt rochester. Senator alsobrooks. Chairman cassidy.
▶ 0:44:15Chair Cassidy: Chairman cassidy is a yes and notes that senator scott is yes by proxy. >> moody is a yes. I thought we were voting on the amendment. I apologize. I thought we were voting on some thing also I will change my vote.
▶ 0:44:30Chair Cassidy: So you change it to a yes. Armstrong is a yes by proxy. And murkowski is not voting. >> I have 10 ayes, 12 nays.
▶ 0:44:44Chair Cassidy: The motion is not agreed to, not tabled. >> it is tabled.
▶ 0:44:50Sen. Sanders: The motion is not tabled. Correct? >> not tabled.
▶ 0:44:55Chair Cassidy: I now move to vote on adopting the amendment. The clerk shall call the role. I shall be voting no. >> senator paul. Senator collins. Senator murkowski. >> not voting. >> senator marshall. Senator scott.
▶ 0:45:16Chair Cassidy: No, by proxy. >> senator hawley. Senator tuberville. Senator banks. For the amendment.
▶ 0:45:28Chair Cassidy: Adoption of the amendment. It is not for the bill. It is for the adoption of the abutment. >> abutment. Amendment. >> senator husted. Senator moody. Senator armstrong. Senator sanders. Senator murray. Senator baldwin. Senator murphy. Senator kaine. Senator hassan. Senator hickenlooper. Senator markey. Senator kim. Senator blunt rochester.
▶ 0:46:00Chair Cassidy: Senator alsobrooks.
▶ 0:46:01Sen. Sanders: Aye, by proxy. >> chairman cassidy.
▶ 0:46:07Chair Cassidy: Senator cassidy is a no. >> I have 12 ayes, 10 nays.
▶ 0:46:16Chair Cassidy: The amendment is adopted. We will now begin with consideration of s. 2355, the patients deserve price tags act. I thanked senator marshall and his colleague senator hickenlooper for their efforts on this legislation aimed at increasing transparency in health care costs. This bill has undergone extensive bipartisan negotiations over I think six months.
▶ 0:46:47Chair Cassidy: Stakeholder engagement, multiple rounds of technical feedback from the administration and three to four agencies. I am proud the process that has gone through and the staff work that has gone along with it. It is an example of the import of work we can achieve to improve the health care system when we were together. We have an amendment.
▶ 0:47:12Chair Cassidy: I moved to adopt the managers amendment in the nature of a substitute and have it be considered original text for the purpose of further amendments. All those in favor, please say aye. Aye. All opposed, say nay. The motion is agreed to. Do any members wish to speak to the bill? Senator marshall.
▶ 0:47:29Sen. Marshall: Thank you, Mr. chairman and ranking member sanders as well and all of your teams who work so hard on this bill. 500 comments we went through from hhs, department of labor, treasury. 80 redlines. Patients deserve price tags, not surprising bills. Once and for all, we will force transparency and competition into health care.
▶ 0:47:57Sen. Marshall: Could you imagine going to the grocery store, standing in front of the meat locker, and you are living credit card to credit card, you are on social security, and you cannot know what the price is between beef and chicken and pork? Could you imagine that? Could you imagine checking out and still not knowing what the price was and maybe three months later someone tells you what the price is? Health care is the only business in the world that has allowed this to go on.
▶ 0:48:27Sen. Marshall: This has been really a 15 year journey for me to work on this concept. In the eight years we have been working on it, staff has been working on it, making this bill better better, and better. It is not perfect, but it will close solely loopholes. It will force health-care providers to show the price tag up front. Not an estimate. It will show you the price upfront. Think about this. You need an mri of your knee. In one place it might be $300.
▶ 0:48:58Sen. Marshall: Another place, it might be $3000. It is the same care given at both places. A hipper placement may cost $15,000 at one location at another. When families another. At $80,000 at another. I appreciate senator hickenlooper's efforts as well and all of our cosponsors for bringing this across the finish line today. Thank you so much.
▶ 0:49:26Chair Cassidy: Thank you, senator marshall, and also thank you for staying within two minutes. I have had a light gavel to this day, but I shall start trying to enforce the two minute rule, starting of course with hickenlooper. [laughter]
▶ 0:49:41Sen. Hickenlooper: Thank you, Mr. chair and ranking member sanders. For months, we have been working alongside senator marshall and his staff. Chairman cassidy, raking member sanders to push forward this patients deserve price tags act. In 2025, americans spent $5.7 trillion on health care. In the last 25 years, health care inflation has risen by one hundred 21%, 40% more than the cost of living has gone up.
▶ 0:50:13Sen. Hickenlooper: There is no way of knowing what you need to pay for medical care, what the cost is. Patients often while sick or in severe pain have the added mental anguish that comes from a totally dark opec system. Journal of medical association has estimated about 25% of our health care spend is on administered processes, pricing failures, waste inefficiency, even assuming 10% of that is legitimate administered of
▶ 0:50:43Sen. Hickenlooper: Costs, it provides the opportunity for hundreds of billions of dollars of savings. The gaming and confusion in our health care system drives people crazy. We can put a stop to it. The lack of transparency in our health care system is the proverbial elephant in the room. It is almost unique among other services and goods americans pay for every day. No sigel company in the system is a monopoly but without transparency, health care is an aggregated monopoly.
▶ 0:51:08Sen. Hickenlooper: This makes it almost impossible for people to make financially sound decisions about their health care. It hurts the 180 million americans whose health insurance are sponsored by their employers. They also don't have access to critical information. Even our nation's largest employers will be able to see what they are paying for. 180 million americans have amazing purchasing power. Let's be clear.
▶ 0:51:36Sen. Hickenlooper: The nonpartisan economic consulting firms estimate 75 billion dollars in additional tax revenue, savings and reduction of cost would be dramatically more than that, and we need to ensure that americans can seek medical care without the risk of being bankrupt. I will yield, but only after I think colin, romney, lily, max, patients rights advocates, arnold, hannah for all of their time and efforts to get their bill -- this bill in tip top shape.
▶ 0:52:05Sen. Hickenlooper: We know there is a better future for health care, and sunlight is the best disinfectant. I yield back.
▶ 0:52:09Chair Cassidy: Thank you. Senator paul.
▶ 0:52:12Sen. Paul: I commend the authors for their attention on this but it mistakes the problem for transparency and the problem is the prices are fixed. If you are on medicare, that is half the people in this country. 45% of people are on medicare. When we tell you what the price is and make the hospital publish it anywhere, does the price change? No, it is fixed. Do we force them to publish prices and all of these things and push it out there? Will that change the price of medicare? No, the price is fixed.
▶ 0:52:42Sen. Paul: If we force them to put the price of insured care out there and it is labeled everywhere, will the price of insured care change? No, it is all fixed. There is only a small amount of this market that cares about this people who don't have insurance. Once again, that is the true market place. Not saying it is a great thing, but there are apps and people beginning to ask that. I know you pay either immediately to a deductible or 25% discount.
▶ 0:53:09Sen. Paul: I think people are aware of these problems but I don't want people to think this fixes the problem. When you mandate transparency on prices that are fixed, it does not change the situation. The goal and what we need to try to strive to is where we have more patients in a situation where prices are fluctuating or prices are fixed. , it won't help.
▶ 0:53:33Chair Cassidy: Is anyone
▶ 0:53:38Chair Cassidy: Is a does anyone else wish to spea? Ok. We will move onto to the make americans food safer act. I think senator tuberville for his work. Giving them the tools to better inspect food facilities and respond to foodborne illnesses is essential to americans to have access to safe foods. This bill gives fda the ability to destroy unsafe at ports of entry.
▶ 0:54:04Chair Cassidy: We have numerous examples of unsafe products including seafood and illegal e-cigarettes entering the market without the ability to seize and destroy. I also thank senator marshall for his work insuring what goes into our food -- his work on ingredient safety. Ensuring what was into our food is safe is important and I look forward to working with him on this in the future.
▶ 0:54:31Chair Cassidy: I moved to adopt the manager's amendment in the nature of substitute and have been considered original text for purpose of the amendments. All those in favor, please say aye. All opposed, say nay. The motion is agreed to. Senator tuberville.
▶ 0:54:46Sen. Tuberville: First, I would like to thank senator kaine on this. This is really important, especially for those who have ports. It is a common sense target approach. It modernizes our food safety system. It removes outdated statutory restrictions allowing the fda to leverage accredited third-party certificates, program data from both domestic and foreign facilities to prioritize inspections that help our supply chain.
▶ 0:55:18Sen. Tuberville: It grants fda authority to immediately share vital unredacted food safety data with state, local, and tribal, and territorial health officials when public health is on the line. Finally, it grants the hhs secretary authority to order the destruction of unsafe food imports that present a significant public health concern, preventing dangerous illegal products from simply turning around and reentering the supply chains while present in full due
▶ 0:55:48Sen. Tuberville: Process rights. Supply supbasically, what this does is when bad food comes into our ports, it is turned around by our food inspectors. It goes right back out into the waters and to another port, and hopefully they get by -- and it helps them get by with murder so to speak.
▶ 0:56:12Sen. Tuberville: We want to help them destroy this food and not allow it into our country so I urge mike rawlings to support this bill -- I urge my colleagues for sup su to support this bill. >> I very much appreciate this bill. I have a unique perspective I share with hickenlooper. In the history of the united states, only 30 people have been mayors, governors, and U.S. senators. The reason that number is so small is being mayor will kill you.
▶ 0:56:44Sen. Tuberville: But one part of this bill that is really good is the data sharing between state, local, and federal health agencies with respect to this particular issue of food safety because there is a lot of data that exists in silos. What does not get shared, we cannot do what we need to do to keep people safe, so I appreciate the portion of this that during tough times and when there are challenges, data can be shared between agencies. I appreciate my colleague for bringing this forward and I'm glad to support it.
▶ 0:57:13Chair Cassidy: Anyone else wish to speak? Ok. Do any members wish to offer an amendment? Senator baldwin.
▶ 0:57:22Sen. Baldwin: Mr. chairman, I would like to speak briefly to my amendment baldwin 12s4974. I will offer and withdraw and not ask for a vote on this. This amendment contains codifying useful regulatory definitions.
▶ 0:57:46Sen. Baldwin: The act is a bipartisan bill with my colleague from wisconsin, senator johnson, that would establish a definition of natural cheese for dairy processors and provide consumer clarity. While I will not be offering the bipartisan curd act amendment today, I want to thank the chairman and ranking member for committing to work with me and with senator johnson to find a path forward for this legislation. Thank you.
▶ 0:58:14Chair Cassidy: Thank you, senator baldwin. Thanks for offering the amendment. It is important definitely believe is accurate and does not mislead. I believe that the fda currently has the regulatory ability to make the changes in this amendment and that congress should not continuously weigh in on standards of identity. However, I commit to working with senators baldwin and johnson on advancing this policy and other legislative vehicles later this year. Are there any other amendments?
▶ 0:58:47Chair Cassidy: Seeing no other amendments. Let's move on. We will now consider s. 3788, the clear labels act. I thank senator rick scott and his co-lead, senator gillibrand, for their work on this legislation. I acknowledge senators turberville, moody, and armstrong for their contributions.
▶ 0:59:12Chair Cassidy: As chair of the aging committee, senator scott has brought increased attention to the vulnerabilities of our global supply chain. Compass must address these challenges. Customs and border protection also requires pharmacies to provide drug country of origin information to patients but pharmacies don't have this information so they cannot comply.
▶ 0:59:33Chair Cassidy: This bill addresses that gap by requiring drug manufacturers to provide information about api suppliers and other key steps in the supply chain so that pharmacies know where the products they provide the patient's come from.
▶ 0:59:47Chair Cassidy: Having this information provided to a drug label will help fill gaps in the fda's information breed right now, fda knows how much api goods imported every year in which suppliers and drug benefactors it uses but fda cannot tell you who manufactured the specific ingredients used in the pills that we take. This is common sense policy. I encourage colleagues to support the legislation. We have managers amendment to s. 3788.
▶ 1:00:17Chair Cassidy: I move to adopt the manager's amendment in the nature of substitute and have been considered original text for purpose of the amendments. All in favor, say aye. Opposed, say nay. The motion is agreed to. Do any member's wish to speak on the bill? Senator hassan.
▶ 1:00:32Sen. Hassan: Thank you, Mr. trump. I share the goal to increase the fda insight into our prescription drug supply chain. However, I have concerns about the national security implications if we require companies to list publicly the exact location of the manufacturing facility we rely on for life-saving medications. So I hope this committee will work to address those national security concerns. I think that is something we can do.
▶ 1:01:02Sen. Hassan: After this bill is reported out today, but I just wanted to raise that concern. Thank you.
▶ 1:01:06Chair Cassidy: Thank you. Senator paul.
▶ 1:01:08Sen. Paul: I think the labeling requirements are a cost to increase the cost of drugs and not necessarily change things. Most people are sort of direct in where they will buy their drugs. Listing and having it listed that it comes from china won't change anything. It is important that there is a lot that comes from china and a lot that comes from india. The pharmaceutical chain sort of shifts. The supply chain shifts.
▶ 1:01:33Sen. Paul: Every time it ships come in next year you find it is a little bit cheaper to get it from vietnam than china, you have to change your label again. I just don't think it changes the end choices on that so much so I would be wary of adding more requirements that don't in the end probably shift what kind of decisions people make because people are directed by the instrument they already have.
▶ 1:01:57Chair Cassidy: Does anyone else wish to speak?
▶ 1:01:59Sen. Collins: Mr. chairman, mindful of the chairman's admonition, I would request unanimous consent to put my comments in the record.
▶ 1:02:10Chair Cassidy: It is given. [laughter]
▶ 1:02:14Chair Cassidy: Do any members wish to offer amendments? We will now begin with consideration of s. 3794, the safe drugs act of 2026. I thank senator banks for his diligent work on this legislation and leadership to keep patients safe. Compounding pharmacies play a critically important role in our health care system.
▶ 1:02:40Chair Cassidy: They help patients who cannot take oral pills and those who are allergic to certain ingredients access to medication that they need. They also step in to help when supplied distractions supplied distr disruptions occ. At the same time, we see company drugs marketed as fda approved medications. This misleads patients who are looking for affordable options when the brand drug may be too extensive.
▶ 1:03:08Chair Cassidy: Adverse events can have adverse events can h occur with compound drugs but states and fda do not consistently learn about these adverse events when they happen. Fda has stepped in to address some of these problems, but sometimes states and fda are not always sure who is first when a situation arises.
▶ 1:03:26Chair Cassidy: This bill takes common sense approach begin addressing the challenges of compounding, which by the way I have great respect for competitors, which will intern better support the compounding pharmacies that are doing good work in communities around the country. There is more to address in the bill but we have to start someplace. I encourage colleagues to support the legislation. We have a managers amendment.
▶ 1:03:53Chair Cassidy: I move to adopt the manager's amendment in the nature of substitute and have it considered original text for purpose of the amendments. All in favor, please say aye. All opposed, say nay. The ayes have it.
▶ 1:04:10Sen. Banks: Thank you, Mr. chair . My safe drugs act puts in place reasonable safety guardrails for compounding pharmacies. The compounding industry has grown a lot over the last few years because of the telehealth industry, but there are still gaps in the law that some companies are exploiting. We all represent compounding pharmacists and value the work they do, Mr. chairman, as you said.
▶ 1:04:36Sen. Banks: Our constituents obviously rely on them, but investigate of journalists have exposed terrible conditions and dangerous products at some compounding facilities. Patients need to be better protected, and that is what this bill does by making all compounding pharmacies report serious adverse events that label their products and also requires some compounding pharmacies that do significant business across state lines to report how much they are compounding. This is a bipartisan compromise.
▶ 1:05:03Sen. Banks: I want to thank the pharmacy associations and drug safety organizations are working with me on this as well as you, Mr. chairman. We had to exclude several issues and leave them unresolved for now, but we will continue working on them. I appreciate everyone's support. With that, I yield back.
▶ 1:05:21Chair Cassidy: Does anyone else wish to speak? For the abutment or asking to speak? >> amendment.
▶ 1:05:29Chair Cassidy: Seeing no others, do any members wish to offer an amendment?
▶ 1:05:34Sen. Houston: Thank you, Mr. chairman. I offer up amendment one. The reason is because compass americans have to see a doctor every time they want a prescription.many of those prescriptions could be efficiently offered by allowing those drugs to become over-the-counter.
▶ 1:05:59Sen. Houston: I amendment creates an expedited approval pathway for these products and allows sponsors to get early informal fda feedback before filing, and direct fda to weigh the full public health benefit of over-the-counter drugs.
▶ 1:06:13Sen. Houston: Every time we spend a dollar on over-the-counter drug -- every dollar spent on an over-the-counter drug saves the system $7.33 and delivers savings at the convenience for patients and should be a priority for this committee. It helps reduce the cost of people getting access to health care. The current prescription otc switch process at the fda is working. Sponsors need to have more predict ability, less friction.
▶ 1:06:43Sen. Houston: You wanting to happen in the world, create less friction. It is more likely to happen. It is more likely to be efficient. This will improve health care and improve access. I am not asking for a vote today, Mr. chairman, but I look forward to continuing to work on this. And I offered to withdraw my amendment. Thank you.
▶ 1:07:06Chair Cassidy: Thank you, senator husted, for his work. I think this is a wise piece of legislation. Over-the-counter products are a critical piece of this puzzle. I will note benadryl, prilosec, and others have previously been prescription only, and now we just go to the counter and get them.
▶ 1:07:25Chair Cassidy: Fda has created a new category, acnu, that would allow drugs that are otherwise prescription to be accessed otc by using standardized safety tools to ensure the drug is appropriate for the patient. But they just have not approved any and the reforms we authorized are still being implement it. I agree we should look at all options to improve access to safe and affordable medications. Next year, the prescription user fee program is being authorized.
▶ 1:07:56Chair Cassidy: That is the time to consider this policy. I appreciate senator husted's withdrawing the amendment so we can continue this process. Let us now move to s. 494, the national plan for apps national plan for a epilepsy act.
▶ 1:08:13Chair Cassidy: I think senator schmitt and senator carper gosar for their leadership in this important bipartisan the decision which brings federal agencies an epileptic community together to identify gaps and improve diagnosis, treatment, care. The legislation create a clear path to deliver better outcomes for people living with epilepsy and their families. I urge colleagues to support. There is a managers amendment. I move to adopt the manager's amendment in the nature of substitute and have it considered original text for purpose of further amendments.
▶ 1:08:45Chair Cassidy: All in favor, say aye. The motion is agreed to. Do any members wish to speak to the bill? Senator hassan.
▶ 1:08:54Sen. Hassan: I want to thank senator schmitt and klobuchar and those on the bill. As someone who has family motors live with epilepsy, it is important we make more progress on this disease. It is treatable and can be debilitating. I think it is time for a really concerted strategic effort to improve treatment and better lives. Thanks.
▶ 1:09:22Chair Cassidy: Anyone else? We shall now move to s. 18474. I think senator -- thank senator collins for the work. It addresses nursing staffing shortages especially in rural areas, and I urge colleagues to support. We have a managers amendment.
▶ 1:09:49Chair Cassidy: I move to adopt the manager's amendment in the nature of substitute and have it considered original text for purpose of further amendments. All in favor, say aye. Opposed nay. ,the motion is agreed to. Do any of you wish to speak? Senator collins.
▶ 1:10:02Sen. Collins: Thank you, Mr. chairman. Maine continues to face a serious shortage of nurses, particularly in our rural communities, where hospitals struggle to recruit and retain staff. This shortage is driven by a severe shortage of nursing faculty.
▶ 1:10:28Sen. Collins: Our bill would help strengthen the nursing workforce by reauthorizing critical programs that support nursing education, expanding access to critical training, and helps schools prepare more students for careers in nursing. His programs are essential to addressing the workforce shortage facing hospitals in rural areas across our country.
▶ 1:10:54Sen. Collins: I have a letter of support for this bill from the nursing community coalition, which represents 65 nursing groups. I ask all of my colleagues to support this legislation. And I am yielding back the remainder of my time, even though I want to talk more. [laughter]
▶ 1:11:14Chair Cassidy: On average, you are still over time.
▶ 1:11:18Sen. Collins: Oh.
▶ 1:11:21Chair Cassidy: Does anyone else wish to speak? Senator blunt rochester.
▶ 1:11:26Sen. Blunt Rochester: Thank you, Mr. chairman, and thank you to the ranking member for this bipartisan markup, and to senators merkley and collins for your important work on the underlying bill. I also want to acknowledge michael leads -- my co-leads on work in this space for their support of the national nursing workforce interact.
▶ 1:11:52Chair Cassidy: Just a second, senator blunt rochester. I think you are going to your bill. Correct?
▶ 1:11:59Sen. Blunt Rochester: Yes.
▶ 1:12:03Chair Cassidy: This anyone wish to speak on the bill we are currently on?
▶ 1:12:09Sen. Blunt Rochester: I would like to call up blunt rochester amendment one. And again, looking at the clock. Ok.
▶ 1:12:17Chair Cassidy: Got.
▶ 1:12:19Sen. Blunt Rochester: Ready?
▶ 1:12:22Chair Cassidy: Yes, ma'am.
▶ 1:12:24Sen. Blunt Rochester: Thank you to the senators for their support on the national nursing workforce interact. On which my amendments are based. I will say this, we all know nursing is the largest health care profession in our country, and it touches everyone from birth with nursing midwives to palliative care. The work we are trying to do to strengthen our nursing workforce is important.
▶ 1:12:55Sen. Blunt Rochester: When nurses feel distressed patients file. Shortages show up in care for delayed treatment to coast us with all departments to longer hospital stays to worse outcomes, and there was an economic toll as well. Burnout related to turnover alone cost and estimated $9 billion a year. So we appreciate the support of our amendment, my amendment creates a three-year pilot program to support state nursing workforce centers and establish a formal relationship with hrsa.
▶ 1:13:28Sen. Blunt Rochester: There are 46 states currently that have centers and they help states understand whether they have the right nurses in the right places doing the right things and also helps with workforce planning. My amendment also -- again, this is bipartisan. It is bicameral. It is endorsed by over two dozen organizations from nurses to hospitals to aarp.
▶ 1:13:53Sen. Blunt Rochester: And I also want to thank all of the members and staff who helped us, particularly senator sanders' staff and senator cassidy's staff for your help and support on this. I am within my time, and I am so proud. On behalf of nurses, that support our verses. And I yield back.
▶ 1:14:12Chair Cassidy: Thank you.
▶ 1:14:14Sen. Blunt Rochester: And I asked for a yes vote from my colleagues.
▶ 1:14:17Chair Cassidy: You almost stuck the landing and shriveled at the end. We can do it as a voice.
▶ 1:14:22Chair Cassidy: Senator marshall.
▶ 1:14:26Sen. Marshall: I would like to speak in favor of them. Have I ever mention my wife is a nurse? You know, nurses make or break health care. Nurses stand in the gap. If you are a newly-diagnosed diabetic and you cannot get into the nutritionist, the nurse is standing in the gap. A patient in a mental health crisis. You cannot get them into the specialist. The nurses stand in the gap. The nurses are the boots on the ground that make a difference.
▶ 1:14:58Sen. Marshall: And, senator collins is right. The challenge is we don't have enough educators. And we literally talking to my community colleges, tech colleges, we have twice the number of qualified applicants as we can take into the system. They can stand in the gap and quickly change the delivery of health care meeting patients where they are. Want to thank all my colleagues for promoting nurses.
▶ 1:15:29Sen. Marshall: We just can't have too many of them. Ai is not going to replace them, by the way. Thank you, Mr. chairman.
▶ 1:15:35Chair Cassidy: I appreciate senator blunt rochester's goal to improve data collection. This amendment uses existing funding to support public-private partnerships operating nursing workforce centers. The amendment addresses deficiencies in gathering information about the nursing workforce and improves capacity. For that reason I support the amendment. I moved to vote on adopting the amendment in the interest of time.
▶ 1:16:04Chair Cassidy: I would ask that all who are in favor say aye, if someone wishes to vote no, they can be recorded no, even to a voice vote. All in favor, please say aye. Opposed, say, nay. The amendment is adopted. We will now begin -- does anyone else wish to offer an amendment? Senator blunt rochester?
▶ 1:16:31Sen. Blunt Rochester: I would also like to call up won amendment one.
▶ 1:16:38Chair Cassidy: Ok.
▶ 1:16:40Sen. Blunt Rochester: Senator murkowski was unable to be here this morning, but she knows how important titling programs are. And that more needs to be done to address our nursing workforce shortages. Low compensation and inadequate pay.
▶ 1:16:58Sen. Blunt Rochester: Not to mention burnout and heavy workloads, push nurses away from teaching, making faculty roles, as senator marshall mentioned, less attractive than chronic -- clinical drives which pay significantly more. According to the american association of college of nursing U.S. nursing schools turn away 92,000 -- 92,672 qualified applicants from the nursing programs. The primary reason cited was faculty shortages.
▶ 1:17:31Sen. Blunt Rochester: Every vacant seat means fewer nursing students can be trained. Worsening the nationwide shortage. That is why senator murkowski and senator durbin worked together to introduce the nursing faculty shortage reduction act, which the murkowski amendment is based on. This demonstration program is designed to address the critical shortage of qualified nursing educators in the united states by providing grants to schools, to supplement faculty salaries.
▶ 1:17:59Sen. Blunt Rochester: This covers the gap between clinical nursing and nursing pay, ensuring we have sufficient nurses to teach our next generation. That, I encourage my colleagues to support this amendment and ask for a vote.
▶ 1:18:12Chair Cassidy: Is a voice vote ok?
▶ 1:18:15Sen. Blunt Rochester: Then we will ask for a voice vote in the interest of time.
▶ 1:18:19Chair Cassidy: I think senator murkowski. I think senator murkowski for a strong support of the nursing workforce. This mmn provides financial support to offset pay gap between clinical nursing practice and teaching the next generation of nurses. The amendment exposes problems in how universities recruit and retain faculty, from key professions like nursing. I also want to acknowledge senator murkowski' is good faith efforts to work to improve the legislation.
▶ 1:18:47Chair Cassidy: The amendment we are considering today is a substantial improvement over what was offered at the last markup. I appreciate senator murkowski's work on this issue and will support the issue. Does anybody else wish to speak to the amendment? I now vote -- moved to vote, we will have a voice vote, but if anybody wishes to be recorded as a nay we shall do so. All in favor, please say aye. All opposed, say, nay.
▶ 1:19:19Chair Cassidy: By proxy I have armstrong as an know, and that is it. We will now go to the mpower for health act. I think senators murkowski and read for their work. This legislation authorizes the workforce programs under title vii, strengthening the health care pipeline that helps improve training and retention of health workers. Especially in underserved areas. I urge colleagues to support.
▶ 1:19:51Chair Cassidy: I moved to adopt the manager's amendment and have a considered original text for the purpose of further amendments. All in favor, please say aye. The motion is agreed to. Do any members wish to speak to the bill? Senator collins.
▶ 1:20:08Sen. Collins: Mr. chairman, I just want to point out the empower for health care act improves the act which senator kaine and I have introduced. It would reauthorize the geriatrics workforce enhancement program and geriatrics academic career awards program. These programs operate in 37 states, including maine.
▶ 1:20:38Sen. Collins: Maine's population is the oldest state by median age in the country. Yet there is a very significant short fall of health care providers who specialize in geriatrics.
▶ 1:20:52Sen. Collins: Reauthorizing these programs will help ensure that older americans will be cared for by a health care workforce specifically trained to meet their unique and complex health care needs. I appreciate the work that senator kaine and I have done on this bill. The act also includes the bio preparedness workforce pilot program reauthorization act.
▶ 1:21:21Sen. Collins: A bill that I worked on with senator baldwin. Thank you, Mr. chairman.
▶ 1:21:25Chair Cassidy: Does anyone else wish to speak? Do any members wish to offer an amendment check him senator blunt rochester.
▶ 1:21:33Sen. Blunt Rochester: Thank you, chairman cassidy, and ranking member sanders. Thank you to senators reid and murkowski for their work on the underlying bill. Thank you to my colleagues who have worked with us on this legislation. I have been working on this bill since we were in the house, and it stemmed from what we saw during the pandemic. Just the impact on our nurses.
▶ 1:22:00Sen. Blunt Rochester: So, to be able to see us move forward with this is a great day for nurses in this country. My amendment is a commonsense fix that would give them the clear authority to establish a federal nursing focused research center. Something they are currently prohibited from doing. This would ensure consistent federal data collection on the nursing workforce. Data which will help policymakers and health care leaders create strategies for alleviating the nursing workforce shortage.
▶ 1:22:32Sen. Blunt Rochester: As I said before, we have bipartisan support and support from others across our country. Again, the nurse supply and demand in the united states has always moved in cycles, but have not been able to see the changes coming, and what we want to do with this amendment is fix that. Thank you so much for the support of my colleagues. And, again, we salute our nurses in this country. Thank you, and I yield back.
▶ 1:23:01Chair Cassidy: Does anyone wish to speak on the amendment? I think senator blunt rochester's goal of improving data clutching. The amendment helps states report data on health workforce programs, including nursing workforce programs and better data helps policy workers make informed decisions about recruitment and retention of nurses and other health care providers. I urge colleagues to support the amendment. I move now to adopt the amendment.
▶ 1:23:31Chair Cassidy: By voice vote. All of those in favor, please say, aye. Those that wish to be recorded as nay? The amendment is adopted. Now we have any more amendments on this bill? Ok.
▶ 1:23:56Chair Cassidy: Let's move to the rural obstetrics readiness act. I think senators collins and hassan for their leadership on this legislation. Bill aims to help rural practitioners prepare for and manage stature come urgency's.
▶ 1:24:14Chair Cassidy: This legislation further facilitates access to care for mothers residing in rural communities by supporting the improved delivery of emergency obstetric services during pregnancy, labor, liberty, or the postpartum period in areas without dedicated units. We have a manager's amendment. I moved to adopt the nature of a substitute considered original text for the purpose of further amendments. All in favor, please say aye. Those opposed, say, nay. The motion is agreed to.
▶ 1:24:44Chair Cassidy: Do any members wish to speak on the bill? Surprise, surprise. Hasson does.
▶ 1:24:52Sen. Hassan: I want to thank you. Not only for this markup, but for the work your teams helped us do on senate bill 380. I want to thank senator collins is well for her leadership.
▶ 1:25:07Sen. Hassan: Across our country we are seeing maternal health care deserts as more role hospitals -- rural hospitals are struggling to keep their delivery units bill would provide support to help ensure that small hospitals, especially those without labor and delivery units or specialists, have the training they need to respond to an emergency such as labor and delivery.
▶ 1:25:30Sen. Hassan: I appreciate the communities work on this bill and while we were not able to include the purchase of equipment has an allowable activity under today's agreement I look forward to working with the committee in the future to add that critical use of funds. This is the kind of equipment that some of our hospitals simply cannot afford to purchase at this time. I urge my colleagues today to support this legislation.
▶ 1:25:52Chair Cassidy: Anyone else?
▶ 1:25:54Sen. Collins: Thank you, Mr. chairman. Let me salute senator hassan for her leadership on this bipartisan legislation. Our bill will help prepare rural health care facilities that do not have a designated labor and delivery unit to respond to obstetric emergencies.
▶ 1:26:17Sen. Collins: Nationwide more than 2 million women live in a county without a provider offering obstetric care. In maine about half of our hospitals do not have dedicated labor and delivery units. We are trying to recruit senator marshall to come to maine to help with that. Rural mainers have to drive more than 45 minutes to the nearest birthing hospital on average.
▶ 1:26:50Sen. Collins: The bill we are marking up today will ensure that rural hospitals will be better-prepared to handle women experiencing an emergency with her pregnancy. Even if that hospital does not have dedicated labor and delivery staff. The training opportunities created by this bill are sorely needed.
▶ 1:27:14Sen. Collins: It seems like every month we learn of another rural hospital in maine that is giving up its obstetrics unit because of a lack of providers. I ask all of our colleagues to support passage of this legislation. Thank you.
▶ 1:27:31Chair Cassidy: Senator husted.
▶ 1:27:34Sen. Husted: Thank you, Mr. chairman. This bill is necessary for a variety of reasons, but one of the challenges we have in america is with declining birth rates. In general since 2000 we have had an 11% reduction in this country in births, and in many states it is higher than 25%.
▶ 1:27:56Sen. Husted: And it is acute in rural areas because there are fewer people having babies, and the economics and challenges these hospitals are having our legitimate concerns, so I just commend sponsors for bringing this legislation forward. Thank you.
▶ 1:28:12Chair Cassidy: Does anyone else wish to speak? We will now consider the childhood diabetes reduction act. I thank senator sanders for his work on this legislation. Providing transparency to consumers about the food they eat is important to giving them the tools to make their own health decisions. I have long called on the nih to increase focus on nutrition and obesity, including in my 2024 nih modernization white paper.
▶ 1:28:42Chair Cassidy: Louisiana, the pennington center is doing cutting-edge work to improve our understanding of how nutrition affects health. The nih provisions of the bill strengthens research on food and dietary patterns and the relationship between diet and chronic disease. I'm glad we are able to come to a bipartisan agreement on these issues. While other areas of the bill raised policy and jurisdictional concerns, in the spirit of bipartisanship I will support it to advance a priority of the ranking member. We have a managers amend and.
▶ 1:29:13Chair Cassidy: I moved to adopt the manager's amendment and the nature of a substitute and have a considered original text for the purpose of further amendments. All in favor, please say aye. Opposed, say, nay. The motion is agreed to. Do any members wish to speak to the bill? Senator sanders.
▶ 1:29:28Sen. Sanders: Thank you, Mr. chairman. I will not repeat what I said at the beginning of the markup. I think everybody understands we have a her lynda's diabetes crisis in this country. And that is related to the crisis we have with obesity. Maybe there are a lot of factors involved as to why.
▶ 1:29:50Sen. Sanders: Certainly one of them is that the food industry produces a lot of junk food targeted to our kids, resulting in many of our children being overweight, laying the groundwork for diabetes. What we do here is two things. We require a warning label on sugary drinks that says "food and drug administration warning, drinking beverages with added sugar can contribute to obesity and tooth decay.
▶ 1:30:20Sen. Sanders: Not recommended for children. Not a radical idea. It is being done by countries all over the world. Secondly, we ban junk food advertising targeted to kids. Also not a radical idea. But done throughout the world. Thank you, Mr. chairman.
▶ 1:30:36Chair Cassidy: Senator paul. Anybody else wish to speak to the amend meant? Senator collins?
▶ 1:30:43Sen. Collins: Thank you, Mr. chairman. While I appreciate the intent of the ranking member to reduce the incidence of diabetes, particularly for our nation's children, I'm concerned that his bill will not truly combat diabetes. That is why the diabetes advocacy groups have not taken a position on this bill.
▶ 1:31:09Sen. Collins: But it will have the unintended consequence of making food more expensive for americans. In addition, I have had many conversations with school nutrition directors who have expressed concerns that when we start getting into mandates that you can have full fat milk in schools or chocolate milk or strawberry milk.
▶ 1:31:40Sen. Collins: That it leads to food waste and it deprives children of the opportunity to have calcium that they need. I think this bill would end up labeling foods like yogurts, cheeses, potatoes, smoothies, and other products as somehow being detrimental to health, and therefore will set the effort back.
▶ 1:32:07Sen. Collins: In order to truly tackle the long-term challenges with appropriate child nutrition have long supported programs at the cdc and nih that seek to tackle the issue of obesity in youth, as well as this study of altar processed foods, which I support. Therefore, I will oppose this bill.
▶ 1:32:29Sen. Sanders: Mr. chairman, if I may?
▶ 1:32:32Chair Cassidy: Senator sanders.
▶ 1:32:34Sen. Sanders: Let me be clear. The definition of altar processed food in this bill exclude products that meet the fda's definition of healthy, which must include a key food group recommended by the dietary guidelines. This includes dairy, vegetables, fruits, whole grains, and proteins. This legislation does not require warning labels on dairy products, like natural cheese, warm milk.
▶ 1:33:02Sen. Sanders: We are willing to continue to working with officers to improve this definition, but that is the simple reality of what is in this bill.
▶ 1:33:11Chair Cassidy: Senator marshall.
▶ 1:33:14Sen. Marshall: Thank you, Mr. chairman. Desperate times call for desperate measures. This childhood obesity epidemic is for real. I was trying to look up the numbers. I could not find them off the top of my head but america is on the seafood diet. Seafood and eat it. I would like to do less when it comes to regulatory process, but I'm going to support senator sanders' bill here.
▶ 1:33:45Sen. Marshall: It is not perfect. But sometimes we have to do something. And this is the most significant something I can see. Senator sanders mentions we spend four times more than other countries, but one of the reasons is we are sick. We have a very sick country and it starts with this childhood epidemic that we have, and sugary drinks are a big part of the calorie intake. I think this is a great -- it is a good first step and we have more work to do.
▶ 1:34:16Sen. Marshall: We have to take care of the grass loopholes and several other things that are not quite ready for prime time, but I think this is a step in the right direction and we are going to support senator sanders' bill. On cue.
▶ 1:34:28Chair Cassidy: Would anybody else like to make a comment before we go to amendments? Do any members wish to offer an amendment? Senator paul.
▶ 1:34:38Sen. Paul: I applaud the attention -- intentions of those who are concerned about childhood obesity and diabetes. It absolutely is a problem. Sort of an ironic problem that the problem in a capitalist society is too much food, but that is a problem we have, and too much of the wrong foot. I don't know that labeling will do anything. They share the desperation, but there is something we can do. We subsidize the wrong food. We give people food stamps.
▶ 1:35:08Sen. Paul: A significant percentage of our country gets food stamps and the number one item on food stamps is coca-cola, pepsi, soft drink. Number four on the list is bagged snacks. Number 11 is candy. Believe it or not you cannot just get an individual candy bar, you can get a bag of candy on food stamps. Cookies are on the top 20 list. Dingdong's, twinkies. If we were really serious about this we would not subsidize bad food. My amendment would not change the amount. We would still have the same amount of food stamp money.
▶ 1:35:38Sen. Paul: Not one person would get less money that had money for healthy food. I amendment would simply say that there would be a formulary and candy would not be on the formulary anymore. Sugary soda will not be on the formulary anymore. This is not unprecedented. The wic program does this. We looked at using the wic program, but we did not think it was expansive enough.
▶ 1:36:06Sen. Paul: Anyway, food stamps, there would still be thousands of items people could buy. Inevitably it would be shifted. I think it can be a part of a bipartisan issue. It hasn't been so far, but I hope both sides of the aisle would consider this. This has real teeth in it. Doesn't produce food stamps. All it does is say the unhealthy foods that have been referred to sofar would not be paid for by the taxpayer.
▶ 1:36:30Chair Cassidy: Senator sanders.
▶ 1:36:32Sen. Sanders: I do understand where senator paul is coming from, but I disagree with him. Obviously our goal is to encourage the folks in our country to eat better, and that is why we are having these warning labels. Because I suspect that many parents may not know how much sugar there is in the various products kids eat.
▶ 1:36:57Sen. Sanders: The problem with senator paul's amendment is, you know, you've got a low income kid, he is with his friends, and suddenly we are saying to that kid, because you are on poor and on food stamps you cannot do what your other friends are doing. We are stigmatizing these kids. The goal, of course, is to get people on food stamps, and every american to try to eat better, to educate people about what is in the foods they eat.
▶ 1:37:25Sen. Sanders: But I think this is stigmatizing low income folks who are on food stamps, so I would oppose this amendment. >> both arguments are good arguments and I have grappled with this. I tend to be on senator sanders' side of this, I'm going to go with senator marshall. Desperate times mean we push this further. Senator sanders has been advocating and I view that step as consistent with the legislation I want to support.
▶ 1:37:53Chair Cassidy: Anyone else wish to comment on the amendment? >> really quickly, so, I agree with both the senators, and it is a tough call. It is absolutely a tough call on what to do here, but I am proud of what else we have done after we have tried to reward good behavior with food stamps. We have tried to double up.
▶ 1:38:16Chair Cassidy: If you are making good healthy choices working with grocery stores, and trying to reward good behavior, eventually we need to figure out a way to incorporate senator paul's goal here as well. But I am concerned that it would -- I don't think we would have the votes to get the big bill, senator sanders' bill across the finish line. So, I am truly torn on what to do here. Thank you.
▶ 1:38:42Chair Cassidy: Anyone else wish to speak to this? This amendment would add a policy to the bill that falls outside of our committee's jurisdiction. Either way, I agree with the concept and I agree, desperate times call for desperate measures. I spoke to this in the ad committee when I was in the house. Before proceeding with this amendment we need to proceed with the tag committee to receive feedback.
▶ 1:39:12Chair Cassidy: I will be supporting a motion to table this policy, although I agree with paul. But nonetheless, for jurisdictional issues I will make a motion to table the amendment. The clerk shall call the roll. >> one more thing I forgot. I believe states have the ability to do this already. Thank you.
▶ 1:39:30Chair Cassidy: The clerk shall call the roll. >> senator paul. Senator collins.
▶ 1:39:39Chair Cassidy: No is to oppose tabling, yes is to table, on the paul amendment. Murkowski is not voting. >> senator marshall. Senator scott. Senator hawley. Senator tuberville. Senator banks. Senator husted.
▶ 1:40:01Chair Cassidy: Can I interrupt for a second? Banks is -- I'm sorry, to prevail is a no by proxy. And tim scott is a yes by proxy. >> senator moody. Senator armstrong.
▶ 1:40:18Chair Cassidy: Yes by proxy. >> senator sanders.
▶ 1:40:23Sen. Sanders: Yes. >> senator murray. Senator baldwin.
▶ 1:40:28Sen. Sanders: Aye by proxy. >> senator murphy. Senator kaine. Senator hassan. Senator hickenlooper. Senator markey. Senator kim. Senator kim? Senator blunt rochester. Senator alsobrooks. Chair cassidy.
▶ 1:40:56Chair Cassidy: Yes. >> I have 16 ayes, 6 nays.
▶ 1:41:08Chair Cassidy: The amendment is table. Do we have another amendment? Senator husted? Simple houston thank you, Mr. chairman. I share the concerns about health of children in this country and what they are eating. I also care about the cost of food. And I do not want the cost of compliance with this bill to fallen working families.
▶ 1:41:35Chair Cassidy: Furthermore, I understand we need to understand what altar process means in this bill. It is not a term of art with a settled boundary, it is a list of ingredients that show up on the foods that most families by, and anna ford. As they try to make ends meet. My admin is simple.
▶ 1:41:56Chair Cassidy: Requires that before the bill goes into effect it is confirmed that it will not raise the cost of food for families, and I will ask for a recorded vote, and I encourage my colleagues to vote, yes.
▶ 1:42:09Chair Cassidy: Do any members wish to speak on the amendment? Senator sanders.
▶ 1:42:13Sen. Sanders: This amendment, unfortunately, is a poison pill. It is intended to further delay warning labels on altar processed food. We have been talking about labels year after year after year. We understand what this is now. It is inadequate. The time is now to do it. For more than 30 years the food and beverage industry has been required to put nutritional labeling on their products. These labels are totally inadequate. I think most of us know that.
▶ 1:42:45Sen. Sanders: Putting warning labels on ultra-processed foods will not lead to higher overall grocery prices. We have seen that in other countries around the world. There are a lot of reasons why food prices are going up. But it ain't labels. Thank you, Mr. chairman.
▶ 1:43:08Chair Cassidy: I thanked senator husted for offering this amendment. I agree with his concerns that the risk of making food prices more expensive for consumers, but I will oppose this amendment, but while I do so I commit to working with the senator to ensure this policy in the underlying bill does not harm consumers as we continue to diligence the bill. I shall now make a motion to table the amendment and ask for unanimous consent to voice vote the motion to table. Any objection? Ok.
▶ 1:43:38Chair Cassidy: So, a voice vote, please. All in favor to table? An aye is to table the amendment. All in favor? All opposed, say, nay. Collins and hawley are reported as no and senator husted is reported as know and banks is no. I think we see that murkowski is not voting? And murkowski is not voting.
▶ 1:44:09Chair Cassidy: Ok. Are there any other amendments to offer? Ok. In the interest of time, without objection, we are going to batch vote on final passage for some of the bills. Batch number one. We will now move to final passage of the following bills as amended, and move that they be favorably reported.
▶ 1:44:38Chair Cassidy: By the way, none of these have amendments. This would be the expedited access to bio similars act. We are voting on the bills we have already considered. I'm sorry. As amended. So, we are going to do the expedited access to biosimilars, the national plan for epilepsy act, and this would be for final passage.
▶ 1:45:09Chair Cassidy: If there is no objection we shall batch. The clerk shall call the roll. I shall be voting, yes. >> senator paul.
▶ 1:45:17Chair Cassidy: Yes by proxy. >> senator collins. Senator marshall. Senator scott.
▶ 1:45:25Chair Cassidy: Yes by proxy. >> senator hawley. Senator tuberville.
▶ 1:45:30Chair Cassidy: Yes by proxy. >> senator banks. Senator husted. Senator moody. Senator armstrong.
▶ 1:45:38Chair Cassidy: Yes by proxy. >> senator sanders. Senator. Senator baldwin. Senator murphy. Senator kaine. Senator hassan. Senator hickenlooper. Senator markey. Senator kim. Senator blunt rochester. Senator alsobrooks. Chairman cassidy.
▶ 1:46:02Chair Cassidy: Aye. >> 22 ayes, 0 nays.
▶ 1:46:10Chair Cassidy: We will now move to final passage of the following bills and move that they be favorably reported. Patients deserve price tags act. The clear labels act. The empower for health act. The title eight nursing workforce reauthorization act of 2025.
▶ 1:46:40Chair Cassidy: The rural obstetrics readiness act. For the clerk calls the roll I would like to say, it has been a long morning, but when people say that congress is not functioning well, this committee had a long morning because we were functioning well and we have taken stuff from people who are off committee and on khamenei and in a considered way brought things that make our country's life better. I think you all for participating.
▶ 1:47:06Chair Cassidy: [applause] so, the clerk shall call the roll. I shall be voting coming yes. >> senator paul. Senator marshall. Senator scott.
▶ 1:47:23Chair Cassidy: Yes by proxy. >> senator hawley. Senator tuberville.
▶ 1:47:28Chair Cassidy: Yes by proxy. >> senator banks. Senator husted. Senator armstrong.
▶ 1:47:35Chair Cassidy: Yes by proxy. >> senator sanders. Senator murray. Senator baldwin.
▶ 1:47:41Sen. Sanders: Aye by proxy. >> senator hassan. Senator hickenlooper. Senator markey. Senator kim. Senator blunt rochester. Senator alsobrooks. Chairman cassidy.
▶ 1:47:56Chair Cassidy: Yes. >> 21 ayse, 1 nay.
▶ 1:48:04Chair Cassidy: So, it passes. These bills pass as a batch. We will now move to final passage of s 3794. I moved to favorably report. The clerk shall call the roll. >> senator paul.
▶ 1:48:26Chair Cassidy: Do I have his proxy here? No by proxy. >> senator collins. Senator murkowski. Senator marshall. Senator scott.
▶ 1:48:39Chair Cassidy: No by proxy. >> senator hawley. Senator tuberville. --
▶ 1:48:48Chair Cassidy: Come back to that. >> senator banks. Senator husted. Senator moody. Senator armstrong.
▶ 1:48:58Chair Cassidy: Yes by proxy, and tim scott is yes by proxy. >> tim scott is yes?
▶ 1:49:06Chair Cassidy: By proxy. >> senator tuberville.
▶ 1:49:10Chair Cassidy: Yes by proxy. >> senator sanders.
▶ 1:49:18Sen. Sanders: Aye. >> senator murray. Senator baldwin. Senator murphy. Senator kaine. Senator hassan. Senator hickenlooper. Senator markey. Senator kim. Senator blunt rochester. Senator alsobrooks. Chairman cassidy?
▶ 1:49:47Chair Cassidy: Aye. I'm sorry, senator paul wishes to be recorded as a yes on this vote. >> iayes, and 4 nays.
▶ 1:50:13Chair Cassidy: Bill is favorably reported. Now we will -- report on passage of 4189. The clerk will call the roll. >> senator paul.
▶ 1:50:27Chair Cassidy: No by proxy. This is the insulin bill. The collins insulin bill. >> senator collins. Senator murkowski.
▶ 1:50:38Chair Cassidy: Not voting. >> senator marshall. Senator scott.
▶ 1:50:43Chair Cassidy: No by proxy. >> senator hawley. Senator tuberville.
▶ 1:50:49Chair Cassidy: Yes by proxy. >> senator husted. Senator moody. Senator armstrong.
▶ 1:50:56Chair Cassidy: No by proxy. >> senator sanders.
▶ 1:51:00Sen. Sanders: Aye. >> senator kaine. Senator hassan. Senator hickenlooper. Senator murphy. Senator kim. Senator blunt rochester. Senator alsobrooks. Chairman cassidy?
▶ 1:51:17Chair Cassidy: No. >> I have 18 ayes, 4 nays.
▶ 1:51:26Chair Cassidy: The bill is favorably reported. I moved to favorably report as amended 5286. >> senator paul. Senator murkowski. Senator marshall. Senator scott. Senator hawley. Senator tuberville.
▶ 1:51:52Chair Cassidy: No by proxy. >> senator banks. Senator husted. Senator moody. --
▶ 1:52:02Chair Cassidy: I'm sorry? >> senator moody is a no? Senator armstrong.
▶ 1:52:09Chair Cassidy: No by proxy. >> senator sanders.
▶ 1:52:13Sen. Sanders: Aye. >> senator murray. Scenario -- senator baldwin. Senator murphy. Senator kaine. Senator hassan. Senator -- senator hickenlooper. Senator markey. Senator kim. Senator blunt rochester. Senator alsobrooks. Chairman cassidy.
▶ 1:52:36Chair Cassidy: Aye. >> I have 12 ayes, 10 nays.
▶ 1:52:46Chair Cassidy: The bill is favorably reported. I moved to authorize staff to make any requiring -- required technical changes. All of those in favor, say, aye. All opposed, say, nay.
▶ 1:53:18Chair Cassidy: No I think senator baldwin has comments. >> chairman, I have comments but I also have a unanimous consent that I be recorded as present for the unblocked votes that I missed due to jacking between commerce committee markup and this.
▶ 1:53:34Chair Cassidy: Granted.
▶ 1:53:38Sen. Baldwin: My comments relate to the childhood diabetes reduction act. I strongly support the legislation's goal for reducing childhood obesity and diabetes, and have long fought for greater investments in diabetes treatment research prevention. I have also fought to ensure that our nation's children have access to healthy food that helps them grow.
▶ 1:54:05Sen. Baldwin: My concern is not with the bill's objective, it is with how it would be implement it. As drafted, the legislation could require many dairy products, including milk, cheese, and yogurt to carry an fda warning label unless the fda chooses to exempt them through its regulatory authority.
▶ 1:54:29Sen. Baldwin: This places tremendous weight on agency discretion rather than providing a clear direction in statute. Unfortunately, fda leadership under republican and democratic administrations have long refused to enforce proper nutritional labeling standards that already exist for dairy products. I oppose this bill today because I think we have more work to do to get this right.
▶ 1:54:59Sen. Baldwin: This legislation must include provisions to support the accurate labeling of dairy products, and I look forward to working with the committee to address these concerns. Thank you, Mr. chairman.
▶ 1:55:10Chair Cassidy: Thank you, senator baldwin. Senator collins? Ok. Good job, everyone. The committee stands adjourned.