21st Century Cures Bill

Floor Speech

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Mr. President, I thank the Senator from Massachusetts for calling us together on the floor to discuss this important bill, the 21st Century Cures Act. It is a bill I followed closely because I started off introducing the American Cures Act.

My goal in medical research was inspired by Dr. Francis Collins at the NIH. He just told me point blank: If you want to increase the output of medical research, find cures for diseases and help innocent people, increase the spending at the NIH by 5 percent real growth a year for 10 years, and I will light up the scoreboard.

That is what I set out to do. That is what the American Cures Act set out to do, including the Centers for Disease Control and the Department of Defense medical research. As is usually the case in Congress, it is no surprise when someone sees an idea and thinks they can do it a little differently and a little better so, in the House of Representatives, Congressman Fred Upton and Congresswoman Diana DeGette introduced the 21st Century Cures Act.

Theirs was a different approach. I guess it reflected a difference in philosophy. What we see today is what has happened to an originally good idea as it worked its way through the House of Representatives over a long period of time. The simple concept of increasing medical research spending at NIH by 5 percent a year has now become a very complicated formula.

Frankly, it is one I have very mixed feelings over. I look at it and think: It would have been so simple for us to make a national commitment on a bipartisan basis to increase NIH funding by 5 percent a year and to do it over 10 years. I know we would see the difference.

Just to put things in perspective so we understand them, there are certain diseases now which are costing us dearly: Alzheimer's. We know about that, don't we. There is hardly a family in America who does not have someone in their family or a friend who has been stricken by Alzheimer's. Think of this for a moment. An American is diagnosed with the Alzheimer's disease once every 67 seconds--once every 67 seconds.

Twenty percent--twenty percent of all the money we spend on Medicare in America is spent for Alzheimer's and dementia--one out of five dollars--but you add to that, one out of three dollars in Medicare is spent on diabetes, so between diabetes and Alzheimer's, over half of our Medicare budget is going to those patients.

When we talk about the need to develop new drugs to intervene and, with God's blessing, to cure some of these diseases, we are talking about not only alleviating human suffering, we are talking about the very real cost of government and health care--the very real cost that we bear as individuals, as families, as businesses, as a government, and as taxpayers.

In this bill are some positive things, this 21st Century Cures bill. I do want to highlight them because they are worthy; the fact that we are now going to commit ourselves to deal with issues such as opioids. The opioid-heroin epidemic in America is real, and we are not investing in what we need to treat it and deal with it. We need to have substance abuse treatment--much, much more than we have today.

One out of six or eight people who are currently addicted are receiving treatment. We need to do dramatically better. This bill puts money into that. It also includes language, including some parts I offered as an amendment, that will deal with mental illness. Mental illness and substance abuse treatment are basically on the same track in terms of helping people. This bill addresses that. I am glad it does. I think that is very positive.

What is disappointing about this bill--there are several things. First, the money we are spending in this bill largely comes from one source, prevention--health care prevention funding in the Affordable Care Act. How important is that? Do you know how that money is being spent? We have something called the 317 vaccination program. What it says is, if you come from one of the poorest families in America, we will pay for our children to be vaccinated so they don't have to worry about the diseases that can change the life or even take the life of an infant.

The 317 vaccine program, half of the money comes from the prevention funds we are raiding for medical research. Does that make sense; that we are going to take money away from prevention and vaccination to invest in new drugs to treat diseases? We can prevent these diseases in the first place with adequate vaccinations.

It is a warped sense of justice in America that we would eliminate the health care prevention funds to pay for health care research funds.

It is a zero sum as far as I am concerned. It is not just a matter of vaccinations. When you look at other things: 43 percent of the money that is spent on diabetes in America--prevention of diabetes in America--is through the prevention fund in the Affordable Care Act.

That figure tells us that if we can invest on getting people to change their lifestyles, sometimes very slightly, or to take certain drugs, they can avoid the onset of diabetes. So we are cutting the prevention funds for diabetes in order to pay for more research for cures for diabetes. Does that make sense?

Let me ask you about this: tobacco. A lot of my career in Congress has been focused on tobacco, the No. 1 avoidable cause of death in America today. Tobacco cessation programs pay off many times over. They are paid for by the prevention funds we are now raiding for medical research. We are taking away the funds to prevent tobacco addiction, and we are going to put more investment in trying to find cures for lung disease. There is something wrong with this thinking--completely wrong with this thinking.

At the outset, I would say going to the prevention programs to pay for research programs is not clear thinking on the part of the people that are putting this together. We are told: Well, you better do it because the Republicans will take control of the White House and Congress next year and they are going to wipe out all of the prevention funds. They want to do away with the Affordable Care Act. We will pay a heavy price for that. We are starting to make that payment today.

The second thing I want to say is, I am totally underwhelmed by the amount of money in this bill. When you take a look at the amount of money that is being spent here, it has dramatically changed as we have debated this bill. Originally, this was a $9.3 billion program for medical research, pretty hefty. Over a 5-year-period of time, this would have had a dramatic impact in a short period of time.

Well, that changed. It is about half of that now. It is spread over 10 years. So the amount of money actually going to the National Institutes of Health any given year is interesting--$400 million, $500 million--but it does not match what was originally promised in the 21st Century Cures Act. Of course, the question is, if this money is put in out of prevention funding, will it be additive? Will it be more? Let me close by saying this. I know there are many who have strong feelings about this bill. I think it is a step in the right direction, but as Senator Warren has told us, it is at a hefty cost when it comes to some of the favors included in this bill for people who have friends in high places when it comes to the Congress.

Here is what I can tell you with certainty. We have been able, for 2 successive years in the appropriations process, to do something important and historic. Let me tip a hat to my colleague from Missouri, Senator Roy Blunt, a Republican, who took up this cause in the Appropriations Committee and provided 5-percent real growth in spending for the National Institutes of Health last year and would do it again this year if the Republican leadership would allow us to bring his appropriations bill to the floor.

We know we can make substantial new investments in NIH medical research. We have a bipartisan will to achieve it. We have the Appropriations Committee ready to act. Instead, what I am afraid of is this bill, which is a modest investment in medical research, will be the end of the conversation for many Members of Congress.

When the time comes months from now, whether this passes or not--it probably will pass--but when the time comes months from now for us to debate medical research, many will say: Oh, we already checked that box. We have already done that with the 21st Century Cures bill.

This bill is a pale imitation of the original bill. It is only a fraction of the funding which the Appropriations Committee has already put in to enhance medical research at the NIH. It overpromises and underdelivers. Some of the aspects of it--the troubling aspects--are off-label drugs and special favors for the contributors when it comes to medical treatment are out of place here.

If we did not learn any lesson in this last election about draining the swamp, well, shame on us because the American people told us do it differently--do it openly. Bring in transparency and honesty in this effort. When it comes to medical research, we should expect nothing less.

I yield the floor.

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