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CDC Funding: A Partisan Divide

Date: October 9, 2024

In recent years, calls to defund or significantly reduce the budget of the Centers for Disease Control and Prevention (CDC) have gained traction among certain Republican factions, especially in the wake of the COVID-19 pandemic. Prominent voices within Congress, aligned with former President Donald Trump, have intensified these efforts, advocating for a rethinking of the CDC’s role and funding in public health. The July 23, 2024, House Energy and Commerce Health Subcommittee hearing with the CDC Center Directors illustrated the partisan divide, with Republicans doubling down on their concerns that the agency overstepped its bounds during the pandemic and is rife with inefficiencies, and committee Democrats, led by Ranking Member Frank Pallone, defending the role of the agency in responding to global health emergencies. He blasted Republicans for reporting out a partisan Labor-HHS Appropriations bill that reduces the CDC budget by $1.8 billion.

The following details the arguments for and against maintaining and increasing the budget for the CDC.

Republican Arguments for Defunding the CDC

Government Overreach

Many Republicans have argued that the CDC overstepped its authority during the COVID-19 pandemic when the agency enforced policies such as mask mandates and lockdowns. They assert that these decisions should be left to individuals or local governments rather than dictated by federal agencies.

Sen. Rand Paul (R-KY) has made calls for defunding the CDC due to its overreach during the pandemic. He has criticized the agency for infringing on individual freedoms through mandates on masks and vaccines, suggesting that such decisions should not come from a federal entity.

During the July 23, 2024, House Energy and Commerce Committee hearing, Chair Cathy McMorris Rodgers (R-WA) expressed serious concerns over the CDC’s actions during the pandemic. McMorris Rodgers questioned the agency’s authority to impose mandates restricting personal freedoms, echoing the broader Republican argument against what they see as federal overreach in health policy.

Rep. Marjorie Taylor Greene (R-GA) has taken her opposition to the CDC further by introducing legislation in 2021 to defund the agency, citing violations of constitutional rights during the pandemic. She maintains this stance, calling for dismantling the CDC to prevent future government overreach.

Inefficiency and Bureaucracy

Several Republicans have argued that the CDC has become inefficient, suggesting that reducing the agency’s budget would force the agency to focus on its core mission rather than expand into what they view as politically charged areas, like gain of function research.

Rep. Jim Jordan (R-OH) has prioritized advocating for reducing the size of federal agencies, including the CDC, citing inefficiency. He criticized the CDC during the COVID-19 response, suggesting in 2023 that its bloated bureaucracy prevented the agency from functioning effectively and that budget cuts going forward would help streamline its operations.

Sen. Ted Cruz (R-TX) echoed similar concerns, arguing that unchecked funding leads to inefficiency within large federal agencies like the CDC. In early 2023, Cruz called for greater oversight and budget reductions, noting the CDC’s inconsistent messaging during the pandemic as evidence of poor management.

Economic and Social Impact

Many Republicans contend that the CDC’s recommendations during the pandemic, such as business closures and stay-at-home orders, caused unnecessary economic harm. They argue that defunding the CDC would prevent similar policies from being implemented in the future.

In 2023, Sen. Cruz continued to push for budget reductions in the CDC, claiming that the agency’s pandemic policies contributed to significant economic damage, particularly for small businesses. He argued that budget cuts would reduce the CDC’s ability to impose economically harmful measures in the future.

Sen. Paul has similarly highlighted the negative economic impact of the CDC’s pandemic restrictions. In 2023, he renewed calls for defunding the agency, suggesting that this would prevent the CDC from causing similar disruptions in future health emergencies.

Democratic Arguments for Maintaining or Increasing CDC Funding

In contrast, some Democrats argue that defunding the CDC would severely weaken the country’s ability to respond to health emergencies. They contend that the agency’s funding should be maintained or increased to ensure the U.S. remains prepared for future health crises.

Public Health Protection

Democrats consistently argue that the CDC plays a crucial role in protecting public health, particularly in managing pandemics and responding to bioterrorism threats. They contend that defunding the agency would leave the U.S. vulnerable to future health crises.

Sen. Patty Murray (D-WA) has consistently advocated increasing the CDC’s budget. In 2023, she argued that cutting the agency’s funding would leave the country unprepared for future public health emergencies, putting lives at risk.

Research and Innovation

Democrats emphasize that the CDC is a leader in public health research, including vaccine development and disease surveillance. They argue that defunding the agency would stifle innovation and slow the development of treatments for infectious and chronic diseases.

Rep. Rosa DeLauro (D-CT), Ranking Member of the House Appropriations Committee, has consistently highlighted the CDC’s critical role in public health research. In 2023, she argued that reducing the CDC’s budget would halt progress on key research initiatives essential for preventing future outbreaks.

Preventing Future Crises

Democrats argue that investing in the CDC now will help prevent costly public health crises in the future. They contend that cutting its budget would increase the likelihood of more frequent and severe outbreaks.

Sen. Elizabeth Warren (D-MA) has long argued that public health funding is critical for crisis prevention. In 2023, she warned that defunding the CDC would undermine the country’s ability to detect and respond to emerging health threats.

Economic and Social Stability

Democrats argue that a well-funded CDC protects public health and supports economic stability. By preventing widespread disease outbreaks, the CDC helps avoid the economic disruption seen during the COVID-19 pandemic.

Ranking Member Frank Pallone (D-NJ) of the House Energy and Commerce Committee has stressed the economic benefits of a robust public health infrastructure. He has pointed out that the CDC’s work in preventing diseases and managing outbreaks keeps people in the workforce and reduces health care costs. He has consistently supported increased funding for the CDC, warning that cuts would put public health and the economy at risk.

Conclusion

The debate over CDC funding reflects deep partisan divisions. On one side, Republicans like Sen. Paul and Rep. Taylor Greene argue that the CDC has overreached, is inefficient, and should have its budget reduced or eliminated.

On the other side, Democrats like Sen. Murray, Rep. DeLauro, and Rep. Pallone argue that the CDC is essential for public health protection, research, and crisis prevention. They warn that defunding the agency would leave the country unprepared for future health emergencies, threatening public safety and national security.

Further partisan disagreement over CDC funding is likely to continue into the lame duck session and efforts to fund the government in FY 2025.

Meet Alexandra Costa: Recent Graduate with a Passion for Making a Difference

Date: October 8, 2024

We caught up with our Associate, Alexandra Costa, to learn more about her and how she plans to use her experience in political communications and government affairs to advance the interests of clients at Chamber Hill Strategies.

What sparked your interest in health care policy, and how did you decide to pursue a career in this field?

My mother and friends work as nurses in nursing homes and hospitals. They share with me the struggles they have providing the best care possible for their patients. After learning more about the difficulties many patients accessing health care services, I wanted to learn why the health care system is the way it is and how to make it better.

Tell us about your experiences working in political communications. How have these experiences prepared you for work at Chamber Hill Strategies?

My experiences with political communications began when I was a student at Saint Anselm College in New Hampshire, home of the famed New Hampshire Institute of Politics. There, I worked for CNN and helped with political events for candidates on both sides of the aisle, including former President Donald Trump and Rep. Dean Phillips (D-MN). I also worked with the communications team to produce the college’s blog on political events.

These experiences sharpened my writing skills and taught me how to prepare quality work even when faced with tight deadlines. In the fast-moving world of politics and policy, clients need to be able to count on receiving accurate and timely updates.

You’ve also worked in government affairs at the state and local level. What did you learn from this experience that will be relevant to your work at Chamber Hill Strategies?

My time working for a government relations firm focused on state and local issues was my first step into government affairs. Regardless of which type of government your focus is, many of the required skills are the same. I learned how to properly cover legislative hearings and how to translate “inside baseball” political jargon into meaningful insights for clients.

What drew you to Chamber Hill Strategies, and how do you see your role fitting into the firm’s broader mission?

A colleague told me about Chamber Hill Strategies and knew I would learn and benefit from being under the strong leadership of Jennifer Bell. Along with its health care focus, I was attracted to the firm because of its firm belief in bipartisan representation. I see my role as assisting the team in advancing the interests of our clients and keeping them informed about what is going on in the world of health care law and regulation.

What are you most excited about learning or accomplishing as you start your career in Washington at Chamber Hill Strategies?

I am excited to learn from my colleagues here at Chamber Hill Strategies and to make various connections in Washington. Additionally, I hope to learn more about policies that expand health care to rural communities.

How do you plan to approach learning from and collaborating with more experienced colleagues and clients in the health care policy space?

I love learning from others and am eager to learn about health care policy. Chamber Hill Strategies provides an excellent place for me to grow given the experience this team has working in health care policy in both government and the private sector. I am also excited to learn more about our clients and the specific ways that Chamber Hill Strategies works to ensure their voice is heard in Washington. I hope to learn from their mentorship and guidance throughout my time in Washington.

Outside of health care policy, what personal interests or activities are you passionate about? How do those influence your approach to your work?

I grew up as a competitive figure skater and then became a coach when I retired from competing. Growing up in competitive sports helped me develop a strong work ethic, strong determination, and taught me how to face constructive criticism from peers. These are all traits that I will bring to my work at Chamber Hill Strategies.

Looking ahead, where do you see yourself in five years, and what key milestones are you hoping to achieve at Chamber Hill Strategies?

In five years, I hope to obtain a master’s degree specializing in health care policy. As I pursue this goal, I want to embrace every opportunity here at Chamber Hill Strategies and in Washington to learn about the intricacies of health care policy.

How Congress May Regulate the Use of Artificial Intelligence in Health Care

Date: October 2, 2024

Artificial intelligence (AI) is transforming health care, offering ways to improve diagnostics, optimize treatment plans, and enhance patient outcomes. However, its rapid growth raises issues around privacy, safety, bias, and ethics, all of which require regulation. While current frameworks offer some level of oversight, Congress and the Administration have begun exploring new ways to regulate AI, especially in health care.

Key Areas of Focus for Congressional Regulation

Data Privacy and Security

AI systems require massive amounts of health care data to function effectively. Current laws, such as the Health Insurance Portability and Accountability Act (HIPAA), oversee the protection and sharing of medical data. However, HIPAA was not designed with AI in mind. New frameworks may be needed to manage the complexities AI introduces, like the integration of non-traditional data sources and real-time analytics.

Congress has not passed specific legislation focused on AI data privacy in health care, but there are relevant discussions. Senate Majority Leader Chuck Schumer (D-NY) has taken a leading role in shaping U.S. policy around the use of AI through the formation of bipartisan AI task forces focused on crafting comprehensive legislation to address the rapid advancements in AI, including its implications for health care. Schumer has expressed concern over the risks associated with AI in health care, particularly regarding patient data privacy, potential algorithmic bias in diagnostic tools, and the need for transparency in AI-driven decision-making. His approach seeks to balance the promise of AI in improving health outcomes with the need for safeguards to protect patients and ensure equitable access to these advancements.

The House Energy and Commerce Committee, chaired by Rep. Cathy McMorris Rodgers (R-WA), held several hearings focusing on AI in health care. The hearings are part of the Committee’s broader effort to understand and shape the role of emerging technologies in the health sector. The discussions centered on the potential benefits AI could bring to patient care, including improved diagnostic accuracy, faster drug development, and enhanced health care access, particularly in rural and underserved areas. (https://www.maceradrinks.com/) The hearings also delved into the risks and challenges associated with integrating AI into health care systems. Key concerns discussed included the need for stringent data privacy protections, preventing algorithmic bias that could lead to health care disparities, and ensuring AI tools are transparent and explainable to both patients and providers.

Safety and Accountability

Ensuring AI-driven medical technologies are safe is critical. The Food and Drug Administration (FDA) regulates medical devices, including certain AI systems. However, AI presents unique challenges due to its evolving nature, where algorithms may change after initial approval. Current regulations do not always account for this, and Congress may need to create new frameworks to ensure continuous monitoring.

One such framework may be legislation such as the Artificial Intelligence for the Armed Forces Act which would encourage the use of AI while ensuring safety standards. While this bill focuses more on defense than health care, Congress could use similar principles to shape legislation addressing health care-specific AI, requiring continuous monitoring and real-time updates to safety regulations.

An additional approach could be The Advancing American AI Act, which passed the Senate in 2021. This bill calls for creating government standards for AI across sectors, including health care. Standardization could lead to the development of a more uniform way to evaluate the safety of AI systems in medical settings.

Bias and Fairness

AI in health care can perpetuate biases if it is trained on skewed or incomplete data. This is particularly concerning when AI tools are used to diagnose or make treatment decisions, potentially exacerbating disparities in care for marginalized populations.

On September 24, 2024, Senator Ed Markey (D-MA) introduced legislation to address bias in the use of AI. The Artificial Intelligence Civil Rights Act would prohibit developers from offering or using algorithms that discriminate based on characteristics like race or gender. Additionally, the FDA has acknowledged the issue of bias in AI, proposing guidelines that developers must follow to ensure their algorithms are trained on diverse datasets. Congress may push for legislation that mandates transparency in developing AI health care tools to minimize biases.

Ethical Standards and Human Oversight

AI optimizes many aspects of health care, but ethical concerns remain, especially when AI is involved in patient care decisions. AI is already assisting health care professionals in diagnosing diseases, planning treatments, predicting outcomes, and managing population health. Congress may consider regulations requiring human oversight in critical health care decisions to prevent AI from being the sole decision-maker. Additionally, the need for ethical guidelines to prevent AI from prioritizing efficiency over patient well-being is essential.

While there is no AI-specific health care legislation addressing ethics, the Biden Administration’s AI Bill of Rights emphasizes the need for meaningful human oversight of AI decisions and proposes guidelines to ensure AI technologies are used ethically. This could lead to future regulations that enforce human oversight in health care AI applications.

Current Legislative Efforts

Though Congress has yet to pass comprehensive AI health care-specific legislation, several bills touch on important aspects of AI regulation. One key bill is the National AI Initiative Act of 2020 which would establish a national AI strategy. While not enacted, the bill lays the groundwork for further sector-specific regulations, including health care. The AI in Government Act of 2020 also would seek to improve AI use across federal agencies and could influence how AI is implemented in federally funded health care programs.

Conclusion

AI holds tremendous promise for improving health care but also brings new risks requiring legislation and regulatory oversight. While Congress has yet to enact specific legislation targeting AI in health care, discussions are underway. The focus on data privacy, safety, bias, and ethical standards will likely guide future action. By balancing innovation with patient protection, Congress can shape a health care system where AI enhances care while safeguarding rights and well-being.

Week Ahead: Last Week, Best Week?

Date: September 23, 2024

Congress returns just in time to consider a bipartisan agreement to keep the government funded through December. On the other side of Pennsylvania Avenue, Ukrainian President Volodymyr Zelenskyy is coming to meet with President Biden and Vice President Harris about the state of the war against Russia. Let’s see what this consequential week holds. Welcome to the Week Ahead!

The Administration

Yet Another Obamacare Challenge

The Department of Health and Human Services (HHS) has requested the Supreme Court review a court decision that partially blocked enforcement of the Affordable Care Act (ACA) mandate for employers to cover certain preventive health services at no-cost. At issue in this challenge is the ruling by the 5th Circuit Court of Appeals that members of the U.S. Preventative Services Task Force (USPSTF)were not properly appointed under the U.S. Constitution’s appointments clause (governing the appointment of Executive Branch officials). The ACA requires that private insurers cover at no cost services that the USPSTF has rated either “A” or “B” (meaning the panel finds that the services have a substantial or moderate net health benefit.)

Will the Supreme Court take up this challenge, and if they do, how will the new Administration respond?  We will also be watching to see to what extent fights about the ACA impact the election, especially with Republican Vice Presidential candidate J.D. Vance’s recent reopening the issue on the campaign trail.

FTC Sues PBMs

In other health care legal news, the Federal Trade Commission (FTC) announced legal action against the three largest pharmacy benefits managers (PBMs), arguing that these entities have engaged in anticompetitive practices designed to increase profits from insulin.

The Biden Administration has made addressing concerns about anti-competitive economic practices a top priority, and the FTC has been a leader in those efforts. The agency has faced both internal and external criticism for being too political, but Lina Khan, the agency’s chair, has won bipartisan praise from at least one Republican – J.D. Vance. This means regardless of who wins the White House in November, Chair Khan will have at least the potential for an ally in either Administration.

The Senate

Rare Pediatric Disease Priority Review Voucher Program Gets HELP Vote

The Senate Health Education, Labor, and Pensions Committee will hold a markup on September 26. This markup includes health care legislation such as S. 4583, which would reauthorize the Rare Pediatric Disease Priority Review Voucher Program through September 30, 2024. A similar version of this bill passed out of the House Energy and Commerce Committee in May and both bills have bipartisan support.

Legislation to reauthorize the Rare Pediatric Disease Priority Review Voucher Program has garnered bipartisan support in both chambers. However, it has also faced criticism based on concerns that not enough oversight is being done to ensure it is meeting its goal of incentivizing the development of rare pediatric disease treatments. We will be watching to see what the Senate HELP Committee will do in regards to legislation to reauthorize this program.

Health Care Hearings

September 24: Senate Health, Education, Labor and Pensions Committee hearing on Novo Nordisk’s pricing of diabetes and obesity medication

September 24: Senate Finance Committee hearing on women’s reproductive health care

September 25: Senate Homeland Security and Governmental Affairs Committee business meeting, including re: S.4667, the Risk Research Review Act

September 26: Senate Environment and Public Works Superfund, Waste Management, and Regulatory Oversight Subcommittee hearing on the public health impacts of PFAS exposure

September 26: Senate Health, Education, Labor, and Pensions Committee executive session to consider legislation

The House

More Health Care Bills on the Docket

Just like last week, the House has several health care bills on its schedule for floor action the week of September 23. This list of bills includes legislation related to pediatric drug development (H.R. 3433) and Medicaid coverage for U.S. service members (H.R. 8108) that just passed out of Energy and Commerce on September 18.

Notably absent from the list: Legislation to extend COVID-era telehealth flexibilities, such as the Telehealth Modernization Act (H.R.7623), which also passed out of the Energy and Commerce Committee on September 18. As a reminder, those flexibilities are set to expire at the end of the year. We will be watching for action on this when Congress returns in November.

Healthcare Hearings

September 25: House Veterans’ Affairs Committee hearing on supporting the Veteran caregiver community

September 26: House Oversight and Accountability Health Care and Financial Services Subcommittee hearing on recent Biden Administration action related to Medicare Part D

There You Have It

Election season is in full swing, with early voting already underway in three states! Are you registered to vote? If not, get registered here. Make it a great week!