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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 I come to this issue not only as a senator, but as a doctor who has practiced medicine in a hospital for the uninsured and underinsured for

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over 25 years. We're seeing 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, particularly for the 62%

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of Americans getting their insurance from a small business. And even those with insurance often have large deductibles before coverage truly kicks in. And so a family delays care or faces significant financial strain or puts it on the credit card and somehow they're

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never able to pay off that credit card balance. We owe it to our fellow Americans to help. And let's put aside feckless partisan politics, do our job, pass and pass legislation to make Americans lives better. We are doing that today. The bills we are voting on

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will help families access affordable quality healthcare. The patients deserve price tags act championed by senators Marshall and Hickinlooper will make pricing information more easily available empowering patients to compare prices and to pick the highest quality affordable option for care. So a mother,

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say for example, Lafayette, Louisiana, has a child with an ear ache, pulls out her phone and says, "Search urgent care center near me. Which one has the best price?" And then she could go to that one. She could go to that one and save her the money that can be quite

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substantial because we've made this information available. The bill also gives employers access to their data, allowing them to develop innovative plan designs, driving down cost and benefiting employees. The legislation is so important and something I've been touting as part of my money and value

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for patients or the MVP agenda to lower cost for health insurance for families. The expedited access to biosimilars act by Senator Paul increases market competition, lowers drug prices, and increases access to more life-saving treatments by eliminating costly and

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redundant clinical study requirements. The manager's ament manager's amendment includes a policy from Senator Moody to eliminate government government red tape that slows down FDA's review of biosimilars. The insulin act sponsored

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by senators Collins and Shaheen caps how much patients pay for insulin preserving access for the 40 million Americans with diabetes. And the National Plan for Epsiles act led by Senator Schmidt and Clolobachar will help the 3.4 4 million Americans living with epsil epilepsy

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improving research, diagnosis, care and treatment. The title 8 nursing workforce reauthorization act from senators Collins and Mkeley and the empower for health act title seven from senators Marcowsky and Reed strengthens the

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health care workforce addressing shortages that limit families access to care especially in rural areas. The Safe Drugs Act championed by senators Banks and Heinrich and the Clear Labels Act from Senators Rick Scott and Gillibrand include common sense policies to help

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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 a problem occurs. The Making Families Food Safer Act from Senator

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Tubberville gives food safety regulators the ability to better respond to food born investigations. Quite topical given the recent cycllospora outbreak. Many of these bills were raised as priorities by members of this committee, but also by

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other senators at our member day hearings in March where off-committee senators could come and present their priorities. Today's markup shows the success we can have when we work together on shared priorities. In that spirit, we're also marking up Senator Sanders Childhood Diabetes Reduction

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Act. This bill increases transparency for families around ultrarocessed food and restricts targeting of junk food ads towards kids. I don't think it's a perfect bill, but it's a starting bill for bipartisan changes we need to make to how food is regulated and allows us

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to have a productive markup today. I'll continue to work on other initiatives in this space, including the need for a national uniform standard for food regulations than rather rather than a patchwork of widely different state laws. And I appreciate the ranking members bipartisan engagement. Lastly,

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lastly, but most importantly, I acknowledge the unbelievable amount of staff work in this markup. In some cases, members of my staff have worked on a piece of legislation for

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over six months. These member priorities would not be moving forward without their expertise, commitment, and sacrifice. So I publicly thank Kristen Chatinsky, I always have to work at that last name. Katherine

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Handler, Matthew Thomas, Romney Grealo, Dominic Travis, Carolyn Benson, and Liz Bilick for their work in this smart. >> Thank you, Senator Marshall. I appreciate my colleagues efforts on these bills, advancing a proatient, pro-

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family and proworker agenda. I look forward to supporting them. With that, I recognize Senator Sanders. >> Mr. Chairman, thank you very much. And I want to applaud the staff on our side as well for their hard work uh and tell you that I intend to be supporting all of the bills that are before us this

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morning. But I do want to say in response to something that you did say that at the end of the day as a nation, we're going to have to ask ourselves one very simple question with regard to healthcare. Is healthc care a human right or is it

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not? And I would suggest, Mr. Chairman, that the overwhelming majority of the American people understand that healthcare is a human right. Whether you're rich, whether you're poor, young or old, people have a right to get the health care that they need. And I hope

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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,

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woman, and child. And by the way, despite the fact that 85 million Americans are underinsured or underinsured today, as the chairman well knows, we are spending close to double what other nations are spending on

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healthcare. And the issue that we are ultimately going to have to deal with is the function of healthcare to make the insurance companies and the drug companies phenomenally rich or do we provide quality care to all people as a human right? Mr. Chairman, uh let me

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focus my remarks now uh on one of the pieces of legislation uh that you met that you mentioned uh piece that I introduced called the Childhood Diabetes Reduction Act. This legislation will require the FDA to put strong warning

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labels on ultrarocessed foods that are high in sugar, salt, and saturated fats. Importantly, it would also ban junk food ads targeted their children, similar to what Congress did to the tobacco industry nearly 30 years ago.

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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

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diabetes. over 10% of our population. Diabetes is not only a serious illness unto itself, but is a contributing factor to heart disease, stroke, amputations, blindness, and kidney failure. And the cost the cost of

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treating that disease is staggering. According to the American Diabetes Association, the total cost of diabetes in the US is over $400 billion a year to treat diabetes. $400 billion a year. It's an extraordinary amount of money.

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And when we talk about the type 2 diabetes epidemic and the huge increase in new cases, we must also talk about the epidemic of obesity in America. about about 90% of people with type two diabetes are overweight or obese. These

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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

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tripled since the 1970s? Tripled since the 1970s. And it's 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

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complicated. For decades, Congress and the FDA have allowed large corporations to make huge profits by enticing children and adults to consume ultrarocessed food and beverages loaded up with sugar, salt, and saturated fat. We can begin to turn that around today

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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.

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Shockingly, according to a study published in the British Medical Journal in 2022, ultrarocessed foods make up an incredible 73% of our nation's food supply. Bottom line, much of the food that we as Americans are now consuming

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are making us unhealthy and are contributing to the fact that our life expectancy is significantly lower than many other wealthy countries. Uh, none of this is happening by accident. The food and beverage industry is spending over 11 billion a year on advertising,

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pushing these unhealthy products onto the American consumer. 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

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to the RDE Center for Food Policy and Obesity, children and teens view about 4,000 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 it rad in

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over 11 billion in profits. Not one of their ads will tell you that 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

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discussed by scientists and doctors for decades, the question then 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? And the answer is not much. So, uh, Mr.

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Chairman, uh, under the bill that we are now considering, the FDA would be required to put a warning label on sugary drinks that says Food and Drug Administration warning drinking beverages with added sugar can contribute to obesity, type 2 diabetes,

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and tooth decay. Not recommended for children. Similar warning labels we put on foods that are high in salt and saturated fats. This is not a radical idea. Chile implemented a similar law. Israel, Mexico, Peru also have similar

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laws. So, Mr. President, the time is now for us to do three things. To put strong labels on the products to protect our kids and to make sure that TV advertising does not hook kids on unhealthy foods.

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>> Thank you, Senator Sanders. will now begin consideration of today's bill. For the awareness of all senators and staff, we intend to vote on amendments as they are raised, but will hold the vote on final passage of both bills until the end of the session. We will keep members and staff updated on the timing of the

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vote on final passage. I'll ask colleagues to limit remarks to two minutes when discussing either of the bills or offering an amendment as there are a lot of amendments to process. As a reminder, when discussing an amendment, please identify which amendment you're discussing by its name and number. We

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were going to do the um price tags bill first, but Senator Marshall has had to leave and so we're going to hold that until he returns. We'll begin now with consideration of S1414, the expedited access to biosimilars act. I thank Senator Paul for his work on

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this legislation to improve access to affordable biosimilar medications. I thank Senator Moody who champion championed legislation incorporated into this bill via the managers amendment. At our April hearing on the biosimilar and generic drug market, we heard how

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biosimilars lack regulatory certainty and have exorbitant development cost. In [snorts] the 15 years since the biosimilar regulatory framework was created, we've learned a lot about how to ensure they are safe and work for patients, but laws have not kept up. This bill addresses these problems by

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reducing data required under law that in many cases is unnecessary and it aligns with the FDA's common practice to provide clearer rules for biosimilar developers. It establishes a clear consistent process for when FDA needs to require additional studies. It also

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eliminates a redundant requirement that multiple FDA offices review each biosimilar before approved. I'm glad to see this legislation progress through committee. I encourage colleagues to support. We have a manager's amendment to S1414. I move to adopt the manager's

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amendment in the nature of a substitute and to have it considered original text for the purpose of further amendments. All in favor say I. I. Opposed? No. The eyes have it. The motion is agreed to. Do any members wish to speak on the bill? Senator Paul. Prescription drug

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pre uh spending is mainly concentrated on biologic drugs like hormone therapy, cancer treatments, and monoconal 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

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blanket requirement for comparative efficacy trials in biosimilar development which are often unnecessary. These trials are like stage three trials that attempt to gauge whether biosimilar and the reference biologic are equally effective. But a review of over 600

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studies published in the journal pharmaceuticals found that no biosimilar with proven analytical similarity has ever failed a comparative efficacy study. The average cost of biosimilar development is 100 to 300 million and comparative efficacy studies generally

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cost 20 to 30 million. Removing these unnecessary studies as they have already done in uh Europe and in England would reduce uh development costs by 10%. Additionally, the studies can also take up to three years to complete and biosimilar development can take up to

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nine years. Delaying treatments for the sake of conducting unnecessary studies harms the very people we intend to help. The FDA has realized that these burdensome nature of these studies and in its recent guidance, the agency waved comparative efficacy studies for

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therapeutic proteins like monoconal antibodies. We've worked with the FDA on this bill because when a biosimilar is proven to be safe and effective, there's 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 the

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time of biosimilar development. Does anyone else wish to speak? The officer raises his hand, but I'm thinking that no, he's just checking his earpiece. [laughter] We'll now begin consideration of S4189, the Insulin Act of 2026. I thank

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Senators Collins as well as her co-leads, Senators Shaheen, Kennedy, and Waro for their leadership on this piece of legislation. I appreciate their efforts to help make life-saving insulin more of more affordable. Uh, I recognize that this legislation may need more

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refinement and may encounter policy and procedural hurdles beyond this committee. I am pleased that we were able to advance it to the next stage of the legislative process. We have a manager's amendment to S4189. I move to adopt the manager's amendment in the nature of a substitute and have it

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considered original text for the purpose of further amendments. All in favor, please say I. I. All oppose say nay. The eyes have it. The motion is agreed to. Do any members wish to speak on the bill? Senator Collins. >> Thank you, Mr. Chairman. First, I want

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to thank Senator Shaheen for our longstanding partnership on this bill as co-chairs of the Senate Diabetes Caucus, which I founded in 1997 to increase research funding and promote

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better health care for people with diabetes. I also want to thank Senators Kennedy and Waro for their contributions. Beginning in 2015, I chaired eight hearings on prescription drug prices

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when I chaired the Senate Aging Committee. We heard countless stories from Americans who are struggling to afford the medicine they needed. and the unaffordable cost of insulin was featured prominently at almost every

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single hearing. The bill we're marking up today is the culmination of these efforts. While recent decisions by manufacturers to cut their list prices on insulin is encouraging, there is

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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%

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of people with diabetes have rationed or skipped insulin doses due to the cost. One of my constituents, Beck Hoskins, from Chelsea, Maine, skipped doses of insulin when she was unable to afford it

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and ended up in the emergency room. The Insulin Act would help people like Beck afford the insulin that they need to survive. The bill not only caps out-ofpocket costs for patients but addresses perverse incentives in the

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market and the lack of bio similar competition that contributes to high list price for insulin. Although uh the bill has some other issues in it that I'd like to go through

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including uh citizen petitions which are largely backed by brand name manufacturers who were behind 86% of them which is why FDI denied more than nine out of 10 of them. I am mindful of

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the chairman's uh request that we keep our uh remarks brief. So I would like to end by thanking our committee co-sponsors on this of this bill, Senators Marowski, Tubberville, Banks, Baldwin, Kaine, Blund, Rochester,

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Hickinlooper, and also Brooks. I want to also thank all the patient groups that have endorsed our bill. Thank you, >> Senator Senator Paul. Um, I respect the intentions and motives of those who would like to see lower

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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 in the Soviet Union was a guy goes into the store and he says, "Are

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you the store that doesn't have eggs?" And the guy says, "No, no, no. We're this that's across the street. We're the store that doesn't have toilet paper." because they were so used to having shortages of things. You want people to have stuff. You want people to have the basics of life. You want them to have food. So, you know, do we have a right

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to food and health care as the ranking member would say? Well, you know, you can say that then you can set prices, but it doesn't work. What happens in capitalism is you have a freely fluctuating price. Now, are pharmaceuticals freely fluctuating prices? No. Most of it's uh interrupted

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by an intermediary. the government in over half of the cases is the intermediary and then insurance companies are the uh intermediaries and others obstructing the real true price. The only real true price of drugs in our country applies to about 3 or 4% of people that have absolutely no

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insurance. Not something I'm recommending, but they're the only people who really care. Almost all the prices are already set throughout the system. So, while I think this is well-intentioned, I think the history of price controls is not a good one, and I will oppose it. Senator Baldwin

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>> amendments. Um, >> does anybody else wish to speak on the bill? >> Okay. >> Do any members wish to offer an amendment? >> Mr. Chairman, >> Senator Baldwin, >> I I want to start by expressing how excited I am to have the uh insulin act

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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's why I introduced my amendment Baldwin

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Collins number one. Uh this bipartisan amendment uh would uh restore a pilot program for uninsured patients to access insulin for $35 a month and a resource center to help patients afford and

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access affordable insulin. Both of these policies were in the original text of the insulin act but unfortunately are not in the managers amendment before us today. So I ask for the support of all of my colleagues on this amendment to

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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. And Mr. Chairman, I ask for a

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vote on uh my amendment Baldwin 1 to S4189. >> Okay. Um I commend Senators Collins and Shaheen for their tireless work advocating on those who need insulin to survive and partly perhaps largely

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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 creating new duplicative grant programs that exacerbate the problems in our health care system that drive

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healthcare cost. Community health centers already provide deeply discounted insulin to patients regardless of insurance status or ability to pay. community health centers and many others received billions in both mandatory and

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discretionary funding to support mir by participating in the 340B program. Any 340B provider is getting insulin for pennies on the dollar. These savings are supposed to be passed on to the uninsured or low-income

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patients to pay for insulin and other treatments on a sliding fee scale. There are real transparency and oversight concerns that prevent 340B from translating to better access and lower costs for patients. So rather than holding covered entities accountable to

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ensure that existing resources are being used as Congress intended, this amendment amendment creates another source of funding and enables diversion further diversion of 340B revenue away from that which Congress originally

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intended. I will note that the Trump administration strongly opposes this provision. I acknowledge that members on both sides of the aisle may support the amendment and I share the goal having practice medicine in a hospital for the uninsured and the uninsured um to have affordable insulin, but I'll

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say the hospital where I practiced used 340B the way it was supposed to be used and actually gave the medicine for free to those who came in. And I would say that this amendment is giving cover for 340B entities which is not using the

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program the way that we intended it to. They're using as a money grab. Now I can urge my colleagues to oppose this amendment. Um and allow others to speak or make my motion. >> Could I Mr. Chairman? >> Senator Senator Sanders.

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>> Thank you. >> Mr. Chairman, I strongly support capping the out-of- pocket cost for insulin at $35. for Americans. The underlying legislation, as we know, uh does that for Americans who have insurance. Uh but it does not do that for the uninsured.

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And that is what this amendment uh addresses. Uh as I think we all know, several years ago, as part of the inflation reduction act, we were able to make sure that people on Medicare Medicare do not pay more than $35. We also had success in substantially

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lowering the cost of asthma and OCD inhalers. Bottom line, we are making success having success in making uh insulin available to those who need it. This is an important amendment. Let's support it. >> Mr. Chairman, >> Senator Collins.

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>> Mr. Chairman, I support this amendment and pleased to be the principal co-sponsor. The original bill that we reintroduced in this Congress had this provision in it in an attempt to move

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the bill along. Uh we agreed to take it out and decide it at the committee level. But I think it's important that we not leave this population, the most vulnerable population behind. Thank you.

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>> Does anyone else wish to speak? I now make a motion to table the amendment. I shall be voting to table. The clerk should call the role. >> Senator Paul I. >> Senator [snorts] Collins. >> No. >> Senator Marowski.

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>> Senator Marshall. >> Senator Scott. >> Senator Holley. >> Senator Tuberville. >> Senator Banks. Hi. >> Senator Heid. Hi. >> Senator Moody. Senator Armstrong.

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>> Senator Sanders, >> no. >> Senator Murray, >> no. By proxy. >> Senator Baldwin, >> no. >> Senator Murphy, >> all by proxy. >> Senator Kaine, >> by proxy. >> Senator Hassan, >> Senator Hickinlooper, >> Senator Marky,

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>> all by proxy. >> Senator Kim, >> no. By proxy, >> Senator Blunt Rochester, >> Senator Olserbrooks, >> all by proxy. Chairman Cassidy. >> Chairman Cassidy is a yes and notes that Senator Scott is yes by proxy >> and Moody is a yes. I thought we were

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voting on the amendment. I apologize. >> On the on the amendment. >> Yes. >> I thought I thought we were voting on something else. So I'll change my vote. I apologize. >> And so you change it to >> yes a yes. And Armstrong is a yes by proxy and Marcowski is not voting.

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>> Okay. I have 10 eyes 12 nazs. The motion is not agreed to. >> Is not tabled. >> It is tabled. >> The motion is not table. Correct.

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>> It's not tabled. >> I now move I now move to vote on adopting the amendment. The clerk shall call the role. I shall be voting no. >> Senator Paul. >> No. >> Senator Collins. >> I. >> Senator Mowski.

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>> Not voting. >> Senator Marshall. Hi >> Senator Scott, >> Senator Hall. >> No. By proxy, >> Senator Holly, >> Senator Treil, >> Senator Banks

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>> for the amendment. >> Adoption of the amendment. >> Adoption of the amendment. >> That's not for the bill. It's for the adoption of amendment. >> Senator Houston. >> No. >> Senator Moody. >> Senator Armstrong. >> No. By proxy. Senator Sanders. >> Hi.

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>> Senator Murray. >> I by proxying. >> Senator Baldwin. >> Hi. >> Senator Murphy. >> I by proxying. Senator >> Kaine. >> I by proxying. >> Senator Hassan. Do >> you have these? >> Senator Hickinlooper. >> Senator Marky. >> I by proxy. >> Senator Kim. >> I by proxy.

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>> Senator Blunt Rochester. >> Senator Olserbrooks. >> I by proxy. >> Chairman Cassidy. Um. >> Okay. >> And Senator Cassidy is a no. I have 12 eyes, 10 nazs.

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>> The uh the amendment is adopted. We will now begin with consideration of S 2355, the Patients Deserve Price Tags Act. I thank Senator Marshall and his colleague, Senator Hickinlooper, for their efforts on this legislation aimed

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at increasing transparency in healthcare cost. [clears throat] This bill has undergone extensive bipartisan negotiations over I think six months. Stakeholder engagement, multiple rounds of technical feedback from the administration from from I think three

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to four agencies. I'm proud of the process this legislation has gone through and the bipartisan staff work that has gone along with it. It is an example of the important work we can achieve in improving the US health care system when we work together in a bipartisan fashion. We have a manager's

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amendment to S2355. I move to adopt the manager's 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 I. I. All oppose say nay. The eyes have it. The motion is

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agreed to. Do any members wish to speak on the bill? >> Yeah, Mr. Chairman. >> Senator Marshall. >> Yeah. Well, thank you, Mr. chairman and and ranking member Sanders as as well and to my colleagues, Senator Hickin Luber and and all your teams who've worked so hard on this bill. 500

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comments we've went through from HHS, Department of Labor, Treasury, 80 red lines. But look, patients deserve price tags, not surprise billing. Once and for all will force transparency and competition in into health care.

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Could you imagine going to the grocery store, standing in front of the of the meat locker, and and you're a you're living credit card to credit card, you're on social security, and you can't know what the price is between beef and chicken and and pork. Could you imagine

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that? Can you imagine checking out and then still not knowing what the price was and maybe three months later someone tells you what the price is? Healthcare is the only business in the world that's allowed this to go on. You know, this um has been a really a

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15-year journey for me to to work on this concept. And then eight years uh we've been working on it. Staff is working on it, making this bill better, better, and and better. It's not perfect, but it's going to close so many loopholes. It's going to force healthc care providers to show you the price tag

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up front, not an estimate. It's going to show you the price upfront. You know, think about this. You you need an MRI of your knee. In one place it might be $300, another place it might be $3,000 and it's the same uh care given at both

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places. A hip replacement might cost $15,000 one location and $80,000 in another. When when families have five $7,000 deductible, price tags matter. So again, I just can't say enough how hard our staff has worked on this and and

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certainly just appreciate Senator Hickinlooper's efforts as well and then all of our co-sponsors for uh bringing this across the finish line today. Thank you so much. >> Thank you, Senator Marshall, and also thank you for staying within two minutes. I've had a light gavvel to this date, Senator Collins, but I shall start

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trying to enforce the two-minute rule. Uh starting, of course, with Hickin Looper. [laughter] Thank you, Mr. Chair, uh, and Ranking Member Sanders. Um, for months, we've been working alongside Senator Marshall and his staff, uh, Chairman Cassidy,

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Ranking Member Sanders to push forward this Patients Deserve Price Tags Act. Uh, in 2025, Americans spent $5.7 trillion on health care. In the last 25 years, healthc care inflation has risen by 121%. That's 40% more than the cost

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of living's gone up too frequently. There's no way of knowing what you need to pay for medical care, what what the cost is. Patients often while sick or or in severe pain have the added mental anguish that comes from a totally dark opaque system. The Journal of American

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Medical Association has estimated that about 25% of our health care spend is on administrative processes, pricing failures, waste inefficiency. I mean, even assuming 10% of that is is legitimate uh administrative costs, it

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it provides the opportunity for hundreds of billions of dollars of savings. The the gaming and confusion in our health care system drives people crazy and we can put a stop to it. The lack of transparency in our health care system is the proverbial elephant in the room. It's almost unique among other services

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and goods that Americans pay for every day. No single company in this system is a monopoly. But without transparency, health care is an aggregated monopoly. This makes it almost impossible for people to make financially sound decisions about their healthcare. It

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hurts the 180 million Americans whose health insurance are sponsored by their employers who they also don't have access to critical information. Even our nation's largest employers won't be able to see what they're paying for. 180 million Americans have amazing

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purchasing power. Let's be clear. Preliminary non uh partisan economic consulting firms estimate 75 billion dollars in additional tax revenue savings and reduction of costs would be dramatically more than that. And we need to ensure that Americans can seek

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medical care without the risk of being bankrupt. I will yield, but only after I thank Colin Goldfish and Romney Crepado, Lily Ryan, Max Seltzer, uh, patients rights advocate, uh, our own staffer Hannah Burner for all their time and effort to get this bill in tip-top

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shape. Uh, we know that there's a better future for healthcare and sunlight is the best disinfectant. >> Amen. >> Thank you. >> Back, >> Senator Paul, >> I commend the authors for their intentions on this. I think that it mistakes the problem for being transparency and the problem is actually the prices are fixed. So if you're on

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Medicare, that's about half the people in the country, 40 45% of people on Medicare and we tell you what the price is and we make the hospital publish it everywhere. Does your price change? No, it's fixed. If you're on Medicaid and we force the hospital to publish the prices and all these things and we push it out

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there, is that going to change the price of Medicaid? No, the price is fixed. If we force the hospitals to put the price of your insured care out there and they do all the work and it's labeled everywhere, will the price of your insured care change? No, it's all it's all fixed. There's only a very small

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amount of this market that cares about this and these people don't have insurance. Once again, that's the true marketplace. I'm not saying it's a great thing, but in the true marketplace, people care. There are apps and there are people beginning to ask that. I know at our local hospital, if you'll pay immediately towards either deductible or

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if you don't have insurance, you get a 25% discount. So, I think people are aware of these problems, but I don't want people to think that this fixes the problem. When you mandate transparency on prices that are fixed doesn't change the situation. The goal and what we need

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to try to strive to is where we have more patients that are in the situation where p where prices are fluctuating where prices are fixed. Transparency won't help. Would anyone else wish to speak? Okay. We will now move on to the S4974

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um make the making America's food safer act. I thank Senator Tubberville for his work to advance food safety given the Food and Drug Administration the tools to better inspect food facilities and to respond to food born illnesses is

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essential for Americans to have access to safe foods. This bill also gives FDA the ability to destroy unsafe food at ports of entry. We have numerous examples of unsafe products, including radioactive seafood and illegal ecigarettes, entering the market without

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the ability to seize and destroy. I also thank Senator Marshall for his work on ingredient safety. Ensuring that what what goes into our food is safe is also important to improve our own health and I look forward to working with him on this in the future. We have a manager's

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amendment to S4974. I move to adopt the manager's amendment in the nature of a substitute and have it considered original text for the purpose of the amendments. All those in favor, please say I. I. All oppose say nay. The eyes have it. The motion is agreed to. Do any members wish to speak

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on the bill? >> Thank you, Mr. Chairman. >> Senator Tubberville. >> Uh, first I'd like to thank Senator Kaine on this. Uh, this is this is really important, especially those that have ports. You know, it's a common sense target approach. It modernizes our

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food safety system. It removes outdated statutory restrictions, allowing the FDA to leverage accredited third-party certificants programs data from both domestic and foreign facilities to prioritize inspections to help our supply chain.

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The bill 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. And finally, it grants the HHS secretary authority to order the destruction of

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unsafe food imports that present a significant public health concern, preventing dangerous illegal products from simply turning around and re-entering supply chains while preserving full due process rights for owners. This is a bipartisan step

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forward for public health supply chain efficiencies and American farmers. Basically, what this does is when it when bad food comes into our ports and it's turned around by our food inspectors, it goes right back out into the waters and goes to another port and

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hopefully they get by with uh with murder, so to speak. So, we want to be able to destroy this food and not allow it into our country. So, I urge my colleagues to support this bill. Um, I want to thank Senator Tubberville

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for roping me into working with him on this one. Um, I I very much appreciate this bill. I have a unique perspective that I share with Hickinlooper. In the history of the United States, only 30 people have been mayors, governors, and US senators. And the reason that number

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is so small is that being mayor will kill you. Um but but this one part of this bill that's really good is the data sharing between state, local and federal health agencies with respect to this particular issue of food safety because

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there's a lot of data that exists in silos and when it doesn't get shared then we can't do what we need to do to keep people safe. And so I really appreciate the portion of this that during tough times and when there are challenges the data can be shared between the agencies at the local, state

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and federal level. I appreciate my colleague for bringing this forward and glad to support it. >> Anyone else wish to speak? >> Um, okay. We shall now go to uh do any members wish to offer an amendment? Senator Baldwin.

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>> Uh, Mr. Chairman, I would like to speak briefly to my amendment Baldwin 1 to S4974. I will offer and withdraw and not ask for a vote on this. This contains um this amendment contains the codifying

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useful regulatory definitions or kurd act. The kurd act is a bipartisan bill with my colleague from Wisconsin, Senator Johnson, that would establish a definition of natural cheese for dairy

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processors and provide consumer clarity. While I will not be offering the bipartisan Kurd Act amendment today, I want to thank uh the chairman and ranking member for committing to work with me and with Senator Johnson to find

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a path forward for this legislation. Thank you. >> Thank you, Senator Baldwin. I thanks for offering the amendment. It's important that food labeling is accurate and does not mislead. I believe that the FDA currently has the regulatory ability to make the changes in this amendment and

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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 in other legislative vehicles later this year. Are there any other amendments? >> I'll be back.

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Seeing no other amendments. Did you uh let's move on. Uh we'll now consider S3788, the Clear Abels Act. Clear Labels Act. I thank Senator Rick Scott and his co-lead Senator Gillibrand for this their work on this legislation. I

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acknowledge Senators Tubberville, Moody, and Armstrong who are co-sponsors for their contributions. As chair of the aging committee, Senator Rick Scott has brought increased attention to the vulnerabilities of our global supply chain. Congress must help address these challenges. Customs and Border

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Protection already requiresarmacies to provide drug country of origin information to patients. But pharmacies don't have this information, so they can't comply. This bill addresses that gap by requiring drug manufacturers to provide information about API suppliers

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and other key steps in the supply chain so that pharmacies know where the products they provide to patients come from. Having this information provided through a drug label will also help fill gaps in FDA's information. Right now FDA knows how much API gets imported every

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year and it knows which suppliers a drug manufacturer 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

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S3788. I move to adopt the manager's amendment in the nature of a substitute and have it considered original text for the purpose of further amendments. All in favor say I. I. Oppose say nay. The eyes have it. The motion is agreed to. Do any members wish to speak on the

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bill? Senator Hassan. >> Well, thank you, uh, Mr. Chair. I share the goal of this legislation to increase the Food and Drug Administration's in insight into our prescription drug supply chain. However, I do have concerns about the national security implications if we require companies to

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list publicly the exact location of each manufacturing facility that we rely on for life-saving medications. So, I hope this committee will work to address those national security concerns. I think that's something we can do um after this bill is reported out today,

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but I just wanted to raise the concern. Thank you. >> Thank you, Senator Paul. >> I think labeling requirements are a cost which would increase the cost of drugs and not necessarily change things. Most people are sort of directed where they're going to buy their drugs. Listing and having people list that it

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came from China, I don't think changes anything. I think it's also important to know that there's a lot that comes from China and there's a lot that comes from India and the pharmaceutical chain sort of shifts. The the supply chain shifts every time it shifts. If next year you find it's a little bit cheaper to get it

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from uh Vietnam than China. You got to change your label again. I just don't think it changes the end end uh choices that much on this. And so I'd be I'd be wary of adding more requirements that don't in the end probably shift what kind of decisions people make because

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most people are directed by these decisions by the insurance they already have. >> Does anyone else wish to speak? >> Mr. Chairman, >> Senator Collins. >> Mr. Chairman, mindful of the chairman's admonition, I would request unanimous

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consent to put my comments in the record. Um it is it is given. [laughter] Um do any members wish to offer amendments? Okay. We'll now begin with consideration of S3794,

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the Safe Drugs Act of 2026. I thank Senator Banks for his diligent work on this legislation and leadership to keep patients safe. Compoundingarmacies play a critically important role in our health care system. They help patients who cannot take oral pills and those who

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are allergic to certain ingredients access the medication that they need. They also step in to help when supply disruptions create drug shortages. At the same time, we've seen examples of compounded drugs marketed as FDA approved medications. This misleads

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patients who are looking for affordable options when the brand drug may be too expensive. And by the way, just like any medication, adverse events can occur with compounded drugs. But states and FDA don't consistently learn about these adverse events when they happen. FDA has

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stepped in to address some of these problems. But sometimes states and FDA are not always sure who's first when a situation arises. This bill takes common sense approaches to begin addressing the challenges of compounding, which by the

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way have great respect for compounders, which will in turn better support the compounding pharmacies that are doing good work in communities around the country. There is more to be done beyond the topics addressed in this bill, but it's a we got to start someplace. It's a good first step. I encourage colleagues

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to support the legislation. We have a manager's amendment to S3794. I move to adopt the manager's amendment in the nature of a substitute and have it considered original text for the purpose of further amendments. All in favor, please say I. I. Oppose say nay.

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The eyes have it. The motion is agreed to. Do any members wish to speak to the bill? Senator Banks. >> Thank you, Mr. Chairman. My safe safe drugs act puts in place reasonable safety guard rails for compoundingies. The compounding industry has grown a lot

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over the last few years because of the teaalth industry, but there are still gaps in the law that some companies are exploiting. We all represent compounding pharmacists and value the work that they do, Mr. Chairman, as you said, and our constituents obviously rely on them, but

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investigative journalists have exposed terrible conditions and dangerous products as some compounding facilities. Patients need to be better protected. And that's what this bill does by making all compoundingies report serious adverse events that label their products

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and also require some compoundingies that do significant business across state lines to report how much they are compounding. This is a bipartisan compromise. I want to thank the pharmacy associations and drug safety organizations for working with me on on

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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. >> Does anyone else wish to speak? >> Senator Hustep, you want to wait for the

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amendment or you have to speak >> for amendment? >> Okay. Uh, seeing no others, uh, do any members wish to offer amendments? Senator Hustad. >> Uh, thank you, Mr. Chairman. Uh, I call up Houston amendment number one to S 3794. And the reason that I'm doing this is

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because countless Americans have to go see a doctor every time they want uh a prescription, but many of those prescriptions could be more efficiently offered by allowing those drugs to become over-thecounter. My amendment

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creates an expedited approval pathway for these products, allows sponsors to get early informal FDA feedback before filing, and directs FDA to weigh the full public health benefit of over-the-counter drugs. Every time we spend a a dollar on an over-the-counter

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drug, that saves uh every dollar spent on an overcounter product saves the health care system $7.33 cents and delivers those savings uh at the convenience for patients and should be a priority for this committee. Helps reduce the cost of people getting access

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to health care. The current uh prescription OTC switch process at the FDA isn't working. uh and sponsors need to be have more predictability and less friction. You want something to happen in the world, create less friction. It's more likely to happen. Uh it's more

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likely to be efficient and this will improve health care and improve uh access and cost. So, uh I'm not asking for a vote today, Mr. Chairman, but I look forward to continuing to work this um work on this delivery for patients and I offer but withdraw my amendment.

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Thank you. Thank Senator Hustev for his work. I think this is actually a wise piece of legislation. Over-the-counter products are a critical piece of this puzzle. I will note that benadryil, tag, pryloc, and a lot of non-steroidals have

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previously been prescription only and now we just go into the counter and get them. Um FDA has created a new category of products called ACNU, pronounced acne, that would allow drugs that are otherwise prescription to be accessed OTC by using standardized safety tools

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to ensure the drug is appropriate for the patient before getting the drug. But they just haven't approved any and the reforms that we authorized last year are still being implemented. I agree that we should look at all options to improve access to safe and affordable medications. Next year, the prescription

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user fee program is being reauthorized. That is the time to consider this policy. I appreciate that Senator Hustad is withdrawing this amendment so that we can continue that process. Let's now move to S494, the National Plan for Epsil epilepsy act. I thank

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Senator Schmidt and his co-lead Senator Clolobachar for their leadership in this important bipartisan legislation which brings federal agencies, researchers, and the epilepsy community together to identify gaps and improve research, diagnosis, care, and treatment. The

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legislation creates a clear path to help deliver better outcomes for people living with epilepsy and their families. I urge colleagues to support it. There is a manager's amendment to S494. I move to adopt in the nature of a substitute and have it considered original text for the purpose of further amendments. All

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in favor say I. I oppose. Nay. The eyes have it. The motion's agreed to. Do any members wish to speak to the bill? >> Mr. Chair, >> Senator Hassan. >> Um, I just want to thank Senator Schmidt and Clolobachar. And I think uh Senators Collins and Kaine are also on this bill.

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um as somebody who has family members who live with epilepsy, uh it's just critically important that we make more progress on this disease. It is treatable. It can also be truly debilitating. And um I think that it's time for a really concerted strategic

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effort uh to improve treatment and and better lives. Thanks. >> Anyone else? We shall now move to S1874, uh, the Title 8 Nursing Workforce Reauthorization Act of 2025. I thank

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Senators Collins and co-lead Senator Mkeley for their work. This legislation reauthorizes and updates the nursing workforce programs under title 8, which addresses nurse staffing shortages, especially in rural areas, and I urge colleagues to support. We have a manager's amendment. I move to adopt in

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the nature of a substitute and have it considered original text for purposes of further amendments. All in favor, please say I. I oppose. Nay. Eyes have it. Motions agreed to. Do any members wish to speak? Senator Collins.

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>> 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

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a severe a severe shortage of nursing faculty. Our bill would help to strengthen the nursing workforce by reauthorizing critical programs that support nursing education, expand access to clinical

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training, and help schools prepare more students for careers in nursing. These programs are essential to addressing the workforce shortage facing hospitals in rural areas across our country. I have a

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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'm yielding back the

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remainder of my time even though I want to talk further. [laughter] >> On average you're still over time. Uh >> oh. Oh cruel. Do do any does anyone else wish to speak? Senator Blunt Rochester.

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>> Thank you, Mr. Chairman. Uh, and thank you to the ranking member for um this bipartisan markup and to uh senators uh Mkeley and Collins for your important work on the underlying bill. Um, I also want to um acknowledge my co-leads on uh

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work in this space, Senators Tillis, Mkeley, uh, and Kramer for their support of the National Nursing Workforce Center Act. >> Just just a second, Senator um, Blunt Rogers, I think you're going to your bill, correct? >> Yes. And then I have other senator.

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>> It's part of the >> first does anybody else wish to speak on the bill which we're currently considering? >> And do any members wish to offer an amendment? Yeah, I'd like to call up Blunt Rochester amendment one. >> Got it. Okay. >> Thanks. >> And again, I'm looking at the clock.

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Okay. >> Okay. >> Go ahead. >> Can we ready? >> Yes, ma'am. >> All right. Thank you, Sher Cassidy and Ranking Member Sanders. And again, um, thank you to, uh, Senators Tillis, Mkeley, and Kramer for their support on the National Nursing Workforce Center

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Act, um, on which my amendments are based. Um, and I I will say this, um, we all know that nursing is the largest health care profession in our country and it touches everyone from birth with nursing midwives to paliotative care. And so the work that we are trying to do

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to strengthen our nursing workforce is important. When nurses uh feel distressed, patients feel it. And shortages show up in patient care from delayed treatments to closed hospital departments to longer hospital stays to worse outcomes. And there's an economic

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toll as well. Burnout related to turnover alone costs an estimated $9 billion a year. And so we appreciate the support of our amendment. Uh my amendment to title 8 creates a three-year pilot program to support state nursing workforce centers and

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establish a formal relationship with HERSA. There are 46 states currently that have nursing workforce centers and these centers help states understand whether they have the right nurses in the right places doing the right things and also helps with workforce planning.

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Um my amendment uh also again um are this is bipartisan, it's biccameal, it's endorsed by over two dozen organizations from nurses to hospitals to AARP. Um and I also want to thank all of the um

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members and staff who helped us particularly Senator Sanders staff and Senator Cassid's staff for your help and your support on this. and I am within my time and I am so proud on behalf of nurses. Let's support our nurses and I yield back.

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>> Thank you. >> And I ask for a yes vote from my colleagues. >> You almost took the landing then you just trembled at the end. >> But we could do it at we can do it as a voice. >> Mr. Chairman, >> Senator Marsh, >> I would like to speak to the bill and the amendment if if I could in in favor of them. Have I ever mentioned my wife

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as a nurse? >> Yes. >> Good. Um, you know, nurses um make or break health care. Nurses stand in the gap. If you're a newly diagnosed diabetic and you can't get into the nutritionists, the nurses standing in

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the gap. A patient in a mental health crisis, we can't get them into the mental health specialist. The nurses stand in the gap. The nurses are the ones that solve the problems. They're the boots on the ground that make a difference. And Senator Collins is

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absolutely right. The challenge is we don't have enough educators, nurse educators. And you know, we literally talking to my community colleges, tech colleges, we have 2x twice the number of qualified applicants as we can take into the system. Uh they're not going to

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replace doctors, but they can sure, like I said, stand in the gap and quickly change the delivery of health care, meeting patients where they are. And just want to thank all my colleagues for working on promoting nurses. We We just can't have too many of them.