Blog - Articles Tagged 'Health'

This caught my eye, from Congress Daily ($):

>House Appropriations Chairman David Obey set off a firestorm recently by including report language for the House economic stimulus package that implied that $1 billion to fund research to compare the effectiveness of medical treatments would keep patients from more-expensive medications and procedures — and even staffers who crafted the bill language are fuming over the report.
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>"The trouble is not with the legislative language, which was carefully crafted with all relevant committees in both chambers to be neutral on cost and coverage issues. It is the draft report language that has raised concerns," one House Democratic aide said. “Many people who are committed to advancing [comparative-effectiveness research] would like to see it changed to better reflect the intent of the actual legislative language before this process is over.”

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>According to Obey’s report language, “By knowing what works best and presenting this information more broadly to patients and healthcare professionals, those items, procedures, and interventions that are most effective to prevent, control, and treat health conditions will be utilized, while those that are found to be less effective and in some cases, more expensive, will no longer be prescribed.”

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>Opponents and even some proponents of comparative effectiveness research fear government use of the outcomes of certain research will affect patient access to treatments when the results are used for coverage determinations.
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>"[The stimulus bill] basically could lead to singling out one particular drug for a formulary," Rep. Jo Ann Emerson, R-Mo., said. Emerson introduced comparative-effectiveness research legislation in the previous Congress but does not support the stimulus language.
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>The report language further aggravated those who are typically against any comparative-effectiveness research that could be applied to coverage, including pharmaceutical and biologic drugmakers, as well as some health policy experts.

Here’s a link to download the full report text, and here’s the full bill text (comparative-effectiveness research language occurring on pages 158-60).

Though committee reports, like this one, don’t actually carry the weight of law, they are used by the executive departments and courts as authoritative resources for understanding the purpose and meaning of legislation. Obey’s report language could have a strong impact on how the legislation is carried out by the Department of Health and Human Services.

With somewhat less support than last year, the House has once again approved the Family Smoking Prevention and Tobacco Control Act (H.R. 1256) which would put tobacco products under regulation from the Food and Drug Administration, but would not allow the agency to ban the products altogether. In the previous session of Congress, the House passed the bill by an overwhelming vote of 325-102; despite an expanded Democratic majority in the House, today’s vote was 298-112.

Twenty-one representatives did not vote today either way and support from Republicans dropped off from 96 “aye” votes last session to only 70 today. According to the OpenCongress Wiki, the bill would provide the FDA the legal authority to do the following:

• Prevent tobacco advertising that targets children
• Prevent the sale of tobacco products to minors
• Help smokers overcome their addiction
• Identify and reduce the toxic constituents of tobacco products and tobacco smoke for those who continue to be exposed to them
• Regulate claims about reduced risk tobacco products
• Prevent the tobacco industry from misleading the public about the dangers of smoking.
  
  

This would include establishing stronger warning labels on tobacco products, more stringent regulations of the advertising and sales of tobacco products, the gradual reduction and removal of hazardous ingredients from cigarettes, and new standards for tobacco products labeled “reduced risk” or “low tar.”

One of the most controversial provisions is the Special Rules for Cigarettes section, which bans all flavored tobacco except menthol:

Beginning 3 months after the date of enactment of the Family Smoking Prevention and Tobacco Control Act, a cigarette or any of its component parts (including the tobacco, filter, or paper) shall not contain, as a constituent (including a smoke constituent) or additive, an artificial or natural flavor (other than tobacco or menthol) or an herb or spice, including strawberry, grape, orange, clove, cinnamon, pineapple, vanilla, coconut, licorice, cocoa, chocolate, cherry, or coffee, that is a characterizing flavor of the tobacco product or tobacco smoke. Nothing in this subparagraph shall be construed to limit the Secretary’s authority to take action under this section or other sections of this Act applicable to menthol or any artificial or natural flavor, herb, or spice not specified in this subparagraph.

The New York Times had a great piece on this provision last year, explaining that menthol, the most popular cigarette choice of African-American smokers, was protected in the bill to win support from big campaign donors like Altria Group. Since the bill would put new limits on cigarette advertising, it will likely help Altria’s Marlboro brand stay on top of the industry because smaller brands would have fewer advertising opportunities.

President Obama was a co-sponsor of the bill when he was in the Senate and is hoping the Senate will pass the bill so he can sign it into law.

Getting the bill through the Senate, however, may be difficult. The two senators from the highest tobacco producing state, North Carolina, strongly oppose the bill. Sen. Richard Burr [R, NC] is threatening a filibuster and may be backed up by Sen. Kay Hagan [D, NC]. They are pushing a separate bill, the Federal Tobacco Act of 2009, that would set up a separate agencies to oversee tobacco. The Burr-Hagan agency would be empowered to restrict some advertising and require ingredients to be listed on packs, but they would not have the power to ban products or restrict certain ingredients.

I always love showing off our bill text comparison tool, which displays changes to bills as they go through the legislative process in crossed-out red for striken text and green for text that has been added. The Huffington Post’s reporting that the GOP stripped flue pandemic preparedness money from the stimulus (H.R. 1 ) gives me a perfect opportunity to do so.

Taking a quick look at the Senate amendment (2) version that was pushed by Sen. Susan Collins [R, ME], Sen. Ben Nelson [D, NE] and other moderates makes it clear that funds for preparing and responding to a potential flu pandemics was included in the base bill, but removed subsequently by the amendment. Click the link above, click “show changes,” and do a page find search for “influenza.” Here’s a screen shot:

The two food safety bills in Congress – H.R. 875 and H.R. 759 – are very unpopular. Both bills, people say, would put small organic farms and CSAs out of business by forcing them to jump through the same set of hoops as big agribusiness companies like Monsanto.

Both bill pages on OpenCongress show the level of opposition, which is significantly stronger for H.R. 875. The section-by-section bill text comments left by users are especially helpful for understanding the perceived problems with the legislation. Scroll over the text on that page and click “comments” where there is a speech bubble in the right-hand column to view the analysis.

But apparently neither of those bills will be used as the framework for Congress’ attempt at improving food safety. The House Energy and Commerce Committee just released a discussion draft of a new bill, the Food Safety Enhancement Act of 2009, that, with the blessings of Rep. Henry Waxman [D, CA-30], will be the one that moves forward in Congress. It’s based largely off the unpopular (but less so) H.R. 759.

The official committee announcement, bill summary and discussion draft can be gotten here. Below is the initial summary from the food politics blog La Vida Locavore:

* Gives the FDA mandatory recall authority.

* Requires all food producers to register with the FDA & pay a registration fee of $1000. It applies to both US and foreign producers and will fund the FDA’s activities.

* Requires companies to prepare food safety plans. The FDA can audit them and can specify minimum requirements.

* The FDA is required to issue food safety regulations for production and harvesting of fruits and vegetables. This worries me A LOT. The California Leafy Greens Marketing Agreement provided “safety” guidelines for leafy greens that were absolutely idiotic and harmful. That is what we DON’T want to see happen here. However, that part will be hammered out by the FDA, not by Congress. It’s just something to pay attention to for the future.

* Inspections: High risk facilities must be inspected every 6-18 mos. Lower risk facilities can be inspected every 18 mos to 3 years. Warehouses must be inspected every 3-4 years.

* Traceability:

FDA would be required to issue regulations that require food producers, manufacturers, processors, transporter, or holders to maintain the full pedigree of the origin and previous distribution history of the food and to link that history with the subsequent distribution history of the food; and to establish an interoperable record to ensure fast and efficient traceback (current law permits facilities to hold a record in any format – paper or electronic – making efficient tracing of foods difficult for FDA). Prior to issuing such regulations, FDA would be required to conduct a feasibility study, public meetings, and a pilot project.

Farms that sell directly to consumers or restaurants are exempted from this provision.

* The bill does NOT include: A requirement that companies test for pathogens and report positive results to the FDA. THIS SHOULD BE ADDED to the bill, if we’re going to have a strong and effective bill

This post by Isabelle Cutting, OpenCongress Research Assistant.

Behind the fairly long shadow cast by growing interest around immigration and continued interest in firearms legislation, here are a handful of bills that have been heating up this week for voters and viewers on OpenCongress. This analysis is based on information from the OpenCongress Battle Royale, which gives an overhead view of what bills, senators, representatives and issues are popular in Congress.

1. HR 1791 – Stopping Trained in America Ph.D.s from leaving the Economy act of 2009 or the STAPLE Act

This bill would offer foreign nationals with a Ph.D. from a U.S. university in a STEM (science, technology, engineering, or mathematics) related field a greater chance at obtaining permanent residency and exempt them from the current numerical caps on H1-B visas.

The angle in which Rep. Jeff Flake [R, AZ-6], the bill’s sponsor, has framed the provision of H-1B visas is not, however, removed from controversy. S. 887, sponsored by Sen. Richard Durbin [D, IL] and Sen. Charles Grassley [R, IA], for example, focuses on limiting the provision of such visas in order to promote and ensure the hiring American workers over their foreign counterparts.

Currently only 65,000 H-1B visas, a category of immigrant visas reserved for highly skilled workers, are available with an additional 20,000 set aside for applicants with a master’s degree or higher from an American institution of higher education. This number was reduced from the previous quota of 195,000 in 2004 making the H1-B visa market a highly competitive arena. Applications this fiscal year, however, have been down from previous cycles. Nevertheless, both proponents and critics to the H1-B visa expansion argue that early figures of such visa applications (which are accepted starting April 1st) do not adequately reflect the appropriateness of the current cap.

2. H.R. 2629 – Coercion is Not Health Care Act

Also gaining interest among voters in light of Congress’s recent work on reforming the U.S. health care system is a somewhat antagonistic bill proposed by Rep. Ron Paul [R, TX-14] in late May. The bill seeks to remove the Federal government’s influence on the decision to purchase or maintain health insurance. It follows from the argument that government interference leads to more expensive health insurance, a financial burden that could motivate insurance providers to turn to “cash-only” options and make it difficult for those relying on government-mandated insurance to find health care. The message of the bill thus is that Congress should reverse the trend of bureaucratized and politicized health insurance and put Americans the decision-making positions of health care.

Along the same vein of argument and introduced on the same day (but not yet viewed as much by the public) Representative Paul also proposed H.R. 2630, the Protect Patients and Physicians Privacy Act.

3. H.R. 2631 – Affordable Gas Price Act

In response to gas prices being on the rise again, this bill, introduced by Rep. Ron Paul [R, TX-14], seeks to reduce the cost of gas as well as the government’s level of involvement in mitigating energy prices. Arguing that Federal fuel taxes are a major contributor to the cost of gasoline, the bill proposes to suspend such taxes whenever average gas prices exceed $3.00 per gallon. It also would repeal the current federal suspension on offshore drilling and encourage oil exploration in Alaska’s Arctic National Wildlife Refuge.

4. HR 875 – Food Safety Modernization Act

The Food Safety Modernization Act of 2009 has also snagged viewers by simultaneously touching on issues such as GMO’s, organic farming, federalism, and that the sponsor of the bill, Rep. Rosa DeLauro [D, CT-3], is the wife of a political strategist tied to Mosanto. The bill seeks to enhance food safety by introducing new administrative bodies and tasks to monitor more closely the production, transportation, and sale of food in the country. The bill would broadly do this by increasing surveillance and inspection capabilities and encouraging data collection and research on food-borne illnesses.

Proponents of the bill interpret it fairly literally by framing it as having the potential to minimize the hazards of foodborne illness. They focus on the bill’s administrative restructuring, namely the standardized safety requirements for domestic and imported foods, the establishment of the Food Safety Administration, and the FDA’s change of name to the Federal Drug and Device Administration.

Critics, recently with a more prominent voice, frame the bill around its farther reaching implications for localized control among agents ranging from organic farmers to state authorities. See Section 202 for registration requirements, which could prove to be debilitating bureaucratic hurdles for some small farmers.

Find more discussion on Congress’s role in food safety here.

5. S. 773 – Cybersecurity Act of 2009

In congruence with the theme of cybersecurity in the news earlier this week, viewers showed interest in the Cybersecurity Act of 2009. This bill signals enhanced government interest and involvement in all things combining security and “cyber” (for which it provides a definition in Section 23).

Along with an advisory panel, the bill would develop a national licensing, certification, and re-certification program for cybersecurity professionals and bring cybersecurity wholly under the government’s scope by declaring it unlawful to provide cybersecurity services without participating in such a program.

Unsurprisingly, the bill’s circulation has aroused the always-contentious debate between personal freedom and security. This bill would indeed allow for the limit or shutdown of Internet traffic to and from Federal government agency systems on the grounds of a “cybersecurity emergency” or the interests of national security. It does not yet, however, discuss how the need such an emergency would be determined of how long affected Internet access would be limited but keep checking up on Congress’s action regarding the bill here.

By some bizarre turn of events, House Republicans are expected today to vote almost unanimously against a bill to fund the ongoing wars in Iraq and Afghanistan. Their opposition to the bill, coupled with the House progressives’ opposition to funding the wars in general, has thrown passage of the bill, and funding for U.S. troops overseas, in doubt.

You may remember that former Republican presidential candidate John McCain used then-Senator Barack Obama’s vote against a war-funding bill that did not contain a withdrawal timeline as evidence that he did not support the troops. McCain made the claim several times during the presidential debates, even though Obama had voted in favor of a different war-funding that did include a withdrawal timeline. It was clear then to those paying attention then and it’s clear now: voting against a war-funding bill doesn’t necessarily mean that you are a troop abandoner. It usually means that there is some other element in the bill, besides the actual money for the troops, that you oppose. Either you think the bill will still pass without your vote, or you can force the bill to be rewritten to incorporate the changes you are demanding.

That’s the case with House Republicans today. The Hill reports:

For years, Republicans portrayed the bills funding the wars in Iraq and Afghanistan as matters of national security and accused Democrats who voted against them of voting against the troops. […]

But Republicans say this year is different. Democrats have included a $5 billion increase for the International Monetary Fund (IMF) to help aid nations affected by the global financial crisis. Republicans say that is reason enough to vote against the entire $106 billion spending bill and are certain voters will understand.

There’s something else Republicans also oppose in the bill, and they’re using it to turn the whole thing on its head, saying that a vote against the bill is a vote for the troops. CQ reports:

[House Minority Leader John Boehner (R-OH)], who expressed concern that the bill does not block the possible release of controversial detainee photos, said “a no vote is the way to go” for anyone “serious about protecting our troops.”

Boehner here is referring to the Lieberman-Graham amendment, which was added to the bill by the Senate, but ultimately taken out in the conference committee negotiations under pressure from progressives and civil libertarians. The amendment would have blocked the public disclosed of any photograph “taken between September 11, 2001 and January 22, 2009 relating to the treatment of individuals engaged, captured, or detained after September 11, 2001, by the Armed Forces of the United States in operations outside of the United States,” even if the Freedom of Information Act required that they be disclosed. Salon’s Glenn Greenwald has more background on the amendment, including President Obama’s position on it.

I should point out that there are two other non-war related provisions in the bill that are playing into all of this – $7.7 billion in flu preparedness money (Republicans stripped $1 billion in flu money from the supplemental, calling it extraneous pork) and “cash for clunkers.” Congress Daily notes that cash for clunkers, an auto-market stimulus proposal attached to the bill in order to bring a few straggling midwestern Democrats and Republicans on board, might get stripped out by the Senate:

If the House passes the measure, it will go to the Senate, where Republicans may try to strike a provision from the supplemental that would provide $1 billion for the first year of a program that would give drivers a voucher for up to $4,500 to buy or lease a fuel-efficient car if they trade in a less-efficient vehicle.

Under Senate rules, Senators may strike provisions of a conference report that were not in the bill passed by either chamber. Senate Republicans could raise a point of order on the floor to strike the language, which would take 60 votes to waive.

Senate Budget ranking member Judd Gregg said last week the “cash for clunkers” provision of the bill could be subject to the rule, but his office would not confirm that he would raise a point of order against the provision.

The House vote on the supplemental has officially been postponed for the day, meaning that Democratic leaders think they don’t have the votes to pass it. Lots going on here; we’ll keep you updated.

UPDATE: Obama has already stated that he intends to block the release of detainee torture photos, even if the Graham-Lieberman amendment isn’t passed into law. The Hill today is reporting that Obama is considering the use of an executive order to block the photos from being made public. No word on whether Obama Administration’s restated commitment to barring the release of the photos will be enough to convince House Republicans to vote for the supplemental.

While I’m on the subject, here’s a CQ piece on how there is no proof that the release of detainee photos actually leads to more military deaths.

And here’s another piece from CQ on why some Texas Democrats, not coming from the progressive angle of defunding the wars, might vote against the supplemental:

Texas Democrats threatened to withhold their votes for a $105.9 billion war-funding measure Tuesday, as the legislation sped toward consideration on the House floor and party leaders worked to quash the insurrection.

“The great majority of the Texas delegation are against the supplemental until we get some relief,” Rep. Ruben Hinojosa said.

The revolt centers on a dispute over how funds from the economic stimulus law (PL 111-5) are spent on public schools in the state. And it comes at a time when the Texans’ votes could be critical for adopting the conference report on the supplemental spending bill (HR 2346 — H Rept 111-151).

The Texans say they are upset that the state legislature and governor diverted money intended for schools —particularly schools that serve low-income students — to the state’s “rainy day” fund.

UPDATE 2: The supplemental conference report went back to the floor at around 5 pm and it has now officially been passed (6:40 pm).

For now, here are the vote details. Five Republicans voted for the bill and 32 Democrats voted against it.

(This post by Isabelle Cutting, OpenCongress Research Assistant)

In January, Rep. Henry Waxman [D, CA-30] replaced the more moderate Rep. John Dingell [D, MI-15] as the Chairman for the Energy and Commerce Committee by a secret vote of 137-122 held amongst House Democrats.

The motivation was to have a progressive at the helm of the committee that would hold jurisdiction over some of the most important legislation that would be coming up in the 111th Congress. Indeed, as Chairman, Rep. Waxman has been the leading force behind bills such as the recently enacted, Family Smoking Prevention and Tobacco Control Act and the up and coming American Clean Energy and Security Act of 2009. He has also co-sponsored the Food Safety Enhancement Act of 2009, which as of yesterday has again seen action in Congress.

Now that Waxman is in charge of pushing these latter two pieces of legislation (both are expected to be voted upon in June and August respectively), he’s meeting opposition from rural, moderate Democrats – likely the same crowd that voted against him taking over the committee in January.

The Food Safety bill, nevertheless, passed through its final committee action yesterday, June 17th. It comes as a response to the recent food crises and is a product of what Rep. Frank Pallone identifies as 11 years of proposed food safety bills.

The bill broadly calls for greater FDA regulatory powers over the national food supply and food providers. Such extensions of authority include quarantine, recall, and search without a warrant capabilities. This legislation also seeks to establish a national food tracing system requiring any and all producers, manufacturers, processors, transporters, and holders must maintain the full pedigree of the origin and distribution history of their food. Other potentially debilitating hurdles presented by this bill are the registration requirements such as a $500 fee.

Waxman’s Food Safety bill is built largely off of the previously proposed Food and Drug Administration Globalization Act of 2009, but focuses solely on food, while the other would also seek to address drug and cosmetic safety. It is also an “enhancement” to previously proposed food safety bills as it seeks to up tracing and record keeping requirements, punishments to relevant violations, and extends Federal jurisdiction over any violation of the bill to an extraterritorial scope.

Waxman opened Wednesday’s full House Energy and Commerce committee session by applauding the notable bipartisan consensus behind the bill and support given by consumer and public interest groups. However major agricultural and agribusiness organizations have voiced strong opposition to several provisions in the bill. On June 15th, 20 such groups sent the House Energy a letter outlining their concerns:

As drafted, this legislation would give the Food and Drug Administration broad new powers to regulate the entire spectrum of the agricultural and food system — from production agriculture to the final retail establishment — in many cases without appropriate thresholds or accountability.

Some of their concerns were met as the House Energy and Commerce Committee approved an amendment to exempt livestock and poultry farms from much of the expanded FDA authority, namely the on-farm inspections, quarantine capabilities, and creating a new tracing system. Such provisions would indeed be redundant as the USDA already has the power to quarantine animals upon a state’s request and has an identification and tracing system already in place. These same provisions, however, remain in effect for the grain side of diversified livestock and grain operations.

Lingering concerns relate to the FDA’s authority to suspend a facility’s registration, the facility-specific product-safety standards, user fees, and standards for raw commodities.

Although dominant, discourse surrounding this bill is not all critical. Here is Jill Richardson’s take on it at La Vid Locavore along with a positive note from the Consumers Union.

The bill is expected to be voted on by the House in August and its companion bill, S.1269, was introduced in the Senate on Tuesday. Find the most recent markup of H.R.2759 here.

Also owing to Rep. Waxman is the American Clean Energy And Security Act of 2009, which appears to be hung up over concerns from farm-state Democrats and conservative Blue Dog Democrats. This bill is also expected to be on the House floor in the near future, but key issues still need to be resolved.

HAI reports:

Peterson met yesterday afternoon with the bill’s chief architect, Congressman Henry Waxman (D-California) and electric utility officials to try to iron out an agreement on changes to the bill.

One sticking point is the distribution of pollution allowances, which companies would buy and sell to meet a cap on greenhouse gas emissions. According to Peterson, rural electric cooperatives and other Midwestern electric utilities would not receive enough allowances compared with utilities in coastal states.

The bill as presently written would give pollution allowances to local electric distribution companies, with half based on their emissions and half based on their electricity sales. Rural electric cooperatives argue that the formula is unfair to coal-fired utilities that have relatively high emissions per unit of energy.

In anticipation of this here are some sites of discussion on the Waxman-Markey Bill:

• Related to issues in the bill, the select committee on Energy Independence and Global Warming held a hearing this morning entitled “Global Warming’s Growing Concerns: Impacts on Agriculture and Forestry”.

• Progression of comments on Open Left by Chris Bowers here and here

• Optimistic words from Waxman, himself on Politico

• Not so optimistic words from rural farm-states Democrats on Yglesias and FT

• Speculations from Steve Kirsch at the Huffington Post

The Washington Post has some shocking numbers on the insider, big-money fight against a public health insurance option:

The nation’s largest insurers, hospitals and medical groups have hired more than 350 former government staff members and retired members of Congress in hopes of influencing their old bosses and colleagues, according to an analysis of lobbying disclosures and other records.

The tactic is so widespread that three of every four major health-care firms have at least one former insider on their lobbying payrolls, according to The Washington Post’s analysis.

Nearly half of the insiders previously worked for the key committees and lawmakers, including Sens. Max Baucus (D-Mont.) and Charles E. Grassley (R-Iowa), debating whether to adopt a public insurance option opposed by major industry groups. At least 10 others have been members of Congress, such as former House majority leaders Richard K. Armey (R-Tex.) and Richard A. Gephardt (D-Mo.), both of whom represent a New Jersey pharmaceutical firm.

The hirings are part of a record-breaking influence campaign by the health-care industry, which is spending more than $1.4 million a day on lobbying in the current fight, according to disclosure records. And even in a city where lobbying is a part of life, the scale of the effort has drawn attention. For example, the Pharmaceutical Research and Manufacturers of America (PhRMA) doubled its spending to nearly $7 million in the first quarter of 2009, followed by Pfizer, with more than $6 million.