Increased Subsidies:  The bill would increase subsidies for health coverage, offered as refundable tax credits payable directly to insurance companies.  Specifically, H.R. 4872 raises premium subsidy levels for those with incomes between 133-150 percent of the federal poverty level, and those between 250-400 percent.   Individuals with incomes between 300-400 percent of the poverty level would be forced to pay 9.5 percent of their adjusted gross income on health insurance, instead of 9.8 percent in the Senate bill.  The federal share of cost-sharing would also be increased for individuals with income of between 133-250 percent of FPL.

The bill would also revise the income definitions in the Senate bill, using "modified adjusted gross income" instead of "modified gross income" for purposes of determining subsidy eligibility, and permitting states an income disregard of 5 percent of income with respect to determining Medicaid eligibility.  However, the bill also includes an additional adjustment and trigger mechanism after 2018 to slow the growth of the premium subsidy levels.  The Congressional Budget Office has stated that "over time, the spending on exchange subsidies would therefore fall back toward the level under H.R. 3590 by itself."

Individual Mandate:  Modifies the penalty for not having health insurance from $750 or 2 percent of income to $695 or 2.5 percent of income.  This provision would raise $2 billion more in revenue relative to the Senate bill.

Increased Employer Mandate:  The bill would increase the penalty for businesses that do not offer health insurance and have at least one employee receiving a subsidy in the exchange from $750 per full time employee to $2,000 per full time employee.  The first 30 workers are disregarded in calculating the penalty.  The bill would strike the small business exemption carve-out for the construction industry.  This provision raises $25 billion more relative to the Senate bill.

Implementation Funding:  The bill would provide $1 billion in new mandatory spending in a "Health Insurance Reform Implementation Fund" created within the Department of Health and Human Services.

Medicare Part D "Doughnut Hole":  H.R. 4872 would provide a $250 rebate for 2010 for any Medicare beneficiary who enters the prescription drug coverage gap.  The bill also postpones the start of the prescription drug "discount" program created in the Senate bill by six months, until January 1, 2011.  The bill would start a process of closing the "doughnut hole" beginning in 2011; however, that gap will not be filled until 2020-outside the ten-year budget window.  Some Members may be concerned that this delay is a budgetary gimmick to mask the true cost of this new entitlement.

Medicare Advantage Cuts:  The bill cuts Medicare Advantage, phasing in a new system of blended benchmarks.  Benchmarks would be phased in beginning in 2012, and are based on overall levels of Medicare spending, with low-cost areas receiving up to 115 percent of traditional Medicare spending and high-cost areas receiving 95 percent of traditional Medicare spending.  Benchmarks are phased in over longer periods in areas currently receiving MA rebates. The bill would also establish a new mechanism to increase payments to "high-quality" MA plans, even though traditional Medicare does not base its payments on quality measures.  H.R. 4872 would require MA plans to spend at least 85 percent of their premium costs on medical claims, and directs rebates from plans not meeting that threshold into a management account at CMS.

Other Medicare Cuts:  The bill would begin reductions in Medicare disproportionate share hospital (DSH) payments in 2014, rather than 2015 in the Senate bill, but lessens the overall impact of DSH reductions by $3 billion through 2019.  The bill also accelerates and expands changes in the Senate bill regarding the presumed increase in utilization rates for imaging services, resulting in an additional $1.2 billion in savings.

Physician Self-Referral:  H.R. 4872 would extend from August 1, 2010, to December 31, 2010, the implementation of a ban on new physician-owned hospitals included in the Senate bill and adds a limited exception to growth caps on existing physician-owned facilities for those hospitals that treat the largest number of Medicaid patients in their county.

Medicaid Funding:  The bill amends the Senate legislation to "fix" the "Cornhusker Kickback," so that all states would have 100 percent of their Medicaid expansion costs paid in 2014 through 2016, 95 percent in 2017, 94 percent in 2018, 93 percent in 2019, and 90 percent in 2020 and future years.  Members may be concerned that these provisions leave states responsible for tens of billions in unfunded liabilities through 2019-sums that will only grow in the years outside of the budget window.

The bill provides for a five-year transition period in 2014-2018 for "expansion states" that have already broadened their Medicaid programs to include the populations (namely, childless adults) covered under the Senate bill.

H.R. 4872 would provide an increase in Medicaid reimbursement levels to the prevailing Medicare rates in each Medicare fee schedule area, fully funded by the federal government-but only for years 2013 and 2014.  Members may be concerned that this "cliff" in the years following 2014 is a budgetary gimmick to mask the bill's true cost.  The bill would also further reduce Medicaid disproportionate share hospital (DSH) payments beyond those included in the Senate bill, and establishes a payment methodology whereby the largest DSH reductions would be imposed on the states with the largest reduction in the number of uninsured individuals.  The bill provides special language increasing DSH allotments for Tennessee, which may concern Members that it is a special deal designed to win the votes of Tennessee Members.

Fraud and Abuse:  The bill would re-define "community mental health centers" within Medicare, and repeals a section of the Medicare statute related to Medicare prepayment medical review.  H.R. 4872 authorizes the disclosure of information regarding seriously delinquent tax debts to the Centers for Medicare and Medicaid Services (CMS), and requires CMS to consider such information in reviewing provider enrollment applications and reimbursing Medicare providers.  The bill includes a total of $250 million in new funding for the Health Care Fraud and Abuse Control Fund, and links future increases in funding for the Medicaid Integrity Program to consumer price inflation.  The bill also provides for a 90-day period of enhanced oversight of the initial claims of durable medical equipment (DME) providers in cases deemed a significant risk of fraud.

Tax Increases

Decrease in high-cost plans excise tax:  The bill would delay the effective date of the high-cost plans tax from 2013 to 2018, raise the thresholds for what qualifies as a high-cost plan to $10,200 for singles and $27,500 for families.  The bill would include a carve-out for multiemployer plans that generally cover unionized firms that allows single employees to qualify for higher the family threshold. 

New Medicare HI tax on investment income:  The bill would impose a 3.8 percent tax, transferred to the Medicare Trust Fund, on investment income for singles earning over $200,000 and families earning over $250,000.  The bill would exempt active income from certain business ownership stakes and expenses and distributions from retirement plans.  These thresholds are not indexed for inflation, so an ever increasing number of Americans would become subject to these investment and wage taxes over time. 

Flexible Spending Accounts:  The bill would delay the effective date of the $2,500 cap on flexible spending accounts from 2011 to 2013. 

Increased Tax on Pharmaceutical Industry:  The bill would delay the effective date of the pharmaceutical tax one year to 2011, increases the annual fee within the budget window to $4.2 billion in 2018, and increases the per-year fee in perpetuity to $2.8 billion.

Increased Tax on Medical Device Manufacturers:  The bill would change the annual fee with a set dollar amount to an excise tax on medical device sales at 2.9 percent of the price of the device, delayed until 2013.

Increased Fees on Health Insurers:  H.R. 4872 would delay the effective date on the net premiums for the insurance company tax from 2010 to 2014, provide an exclusion for certain non-profit insurers and voluntary employees' beneficiary associations, and increase the annual fee to $14.3 billion in 2018, increasing thereafter annually based on premium growth.

Delay of Elimination of Deductible Part D Subsidy:  The bill would end the deduction for the Medicare Part D subsidy two years later-in 2013. 

Eliminates Credit for "Black Liquor":  The bill would prevent a byproduct from paper production known as "black liquor" from qualifying for the cellulosic biofuels tax credit. 

Title II - Education and Health

Federal Pell Grants:  The bill would provide mandatory funding to increase the maximum Pell Grant to $5,500 in 2010 with progressive increases up to $5,975 by 2017.  Beginning in 2013, Pell Grant increases would be indexed to inflation using the Consumer Price Index.  CBO estimates this provision would cost $22.6 billion over 10 years.

College Access Challenge Grant Program:  The bill would provide mandatory funding in the amount of $750 million over five years for the College Access Challenge Grant Program which promotes partnerships between federal, state, and local governments and philanthropic organizations through grants that are intended to increase the number of low-income students who are prepared to enter and succeed in postsecondary education.

Historically Black Colleges and Universities:  The bill would provide mandatory funding in the amount of $2.55 billion for Historically Black Colleges and Universities through the end of Fiscal Year 2019.

Termination of Federal Family Education Loan Appropriations:  The bill would ensure that no funds expended after June 2010 to support new lending activity in the Federal Family Education Loan program and shift all new loans to the federally-run Direct Loan program. 

Federal Consolidated Loans:  The bill would give temporary authority for certain borrowers who are still in school to consolidate their loans into a Direct consolidation loan.  The goal of this provision is to ensure students have one servicer of their loans which could be split between the FFEL and Direct Loan program after the transition.  CBO predicts that this provision will cost $40 billion.

Contracts, Mandatory Funds:  The bill would provide mandatory funds and require the Secretary of Education to award contracts to non-profit loan servicing agencies.  Each eligible agency would be given a maximum of 100,000 student loans to service initially. Specifically, the bill provides $50 million for the Department of Education to provide technical assistance to institutions of higher education so they can switch from FFEL to DL. 

Agreements with State Owned Banks:  H.R. 4872 would allow banks that are guaranteed by a state, owned by a state, under the control of a board of directors that includes the Governor, and originates or holds loans under the FFEL program prior to July 1, 2009 to continue to provide federally guaranteed loans to students who are residents of that state or are attending an institution of higher education in that state.  Members may be concerned that the only bank that currently meets this definition is the Bank of North Dakota.

Income Based Repayment:  Beginning on July 1, 2014, the bill would expand the existing income-based repayment program which limits the percentage of an individual's income that goes to student loan repayment, as well as the length of time they have to pay off the loan.  The provision would decrease the limit on loan payments from 15 percent to 10 percent of individual income and forgive loans after 20 years rather than 25 years.  CBO estimates this provision would cost $1.5 billion over ten years.

Insurance Reforms:  The bill applies to all "grandfathered" health plans provisions in the Senate bill regarding excessive waiting periods before becoming eligible for employer-based insurance, lifetime limits on benefits, rescissions, and coverage of dependents, and clarifies that only non-married dependents may remain on their parents' insurance policies until turning 26.  These provisions would raise premiums.

Community Health Centers:  The bill amends the Senate legislation to increase mandatory funding for community health centers by $2.5 billion.  Members may be concerned that neither the reconciliation bill nor the Senate-passed measure include any prohibition on community health centers using these federal funds to offer elective abortion.

Cost and Other Concerns

According to the Congressional Budget Office (CBO), the reconciliation bill, when combined with the Senate bill, would spend a total of $940 billion on coverage expansions.  However, this figure excludes other non-coverage spending: $93.9 billion in related mandatory health spending in the Senate bill, $50.3 billion in mandatory health spending in the reconciliation bill, $41.6 billion in mandatory education spending in the reconciliation bill, and at least $70 billion in discretionary spending included in the Senate bill, bringing the total cost in the bill's first 10 years to $1.2 trillion.  Despite Democrats claims that the bill would reduce the deficit, CBO said in a letter to House Budget Committee Ranking Member Paul Ryan that with the $208 billion to patch the Sustainable Growth Rate (SGR) to prevent reduction in Medicare physician payments, the legislation would result in a $59 billion deficit.  This cost is hidden because it was included in the earlier Democrat bill, but was dropped to provide a better cost estimate.  It is expected to move separately and would bring the true cost of the takeover to $1.4 trillion.  Moreover, Republican staff on the Senate Budget Committee estimate that the total spending in the Senate bill's first 10 years of full implementation (fiscal years 2014-2023) would total $2.4 trillion. 

To pay for the additional spending on subsidies and education spending, the reconciliation bill would raise taxes by an additional $50 billion, and reduces Medicare spending by $60.5 billion.  The reconciliation bill and the Senate bill impose Medicare Advantage cuts totaling $202.3 billion.  Tax increases include $25 billion in additional revenue from the employer mandate, $23.6 billion from removing "black liquor" from the cellulosic biofuels tax credit, $123.4 billion from the new Medicare taxes on investment income-all offset by a $119 billion reduction in revenue from the "Cadillac tax" delay. 

The bill also includes $67 billion in savings from the abolition of the FFEL program, which is channeled into $41 billion in new education spending and $19 billion in new health care mandatory spending.  H.R. 4872 also includes a reconciliation provision to alter federal student loan programs by eliminating the Federal Family Education Loan program and shifting all student loans to a government-run and taxpayer financed system under the Direct Loan program.  While this legislation has nothing to do with the government takeover of health care, the provision is scored as a deficit reduction of $19.4 billion because it moves student lending money into the hands of the federal government.  That money is then used as an offset against the $1 trillion cost of the legislation.  However, CBO has also noted that current budget scoring rules do not include the cost to the government stemming from the risk that the cash flows may be less than the amount projected (that is, that defaults could be higher than projected).  Due to this market risk assessment, CBO reported that it could actually cost taxpayers billions more than Democrats have acknowledged.

Combined with the Senate bill, the legislation includes $569.5 billion in tax increases, of which $48.9 billion in new tax increases are included in the reconciliation bill alone.  The bill includes 12 new tax increases in the bill that violate President Obama's pledge that, "Under my plan, no family making less than $250,000 a year will see any form of tax increase."  In addition, 46 percent of the individual mandate tax would be paid by families making less than $66,150 annually.

BACKGROUND AND EXECUTIVE SUMMARY of the senate bill

Buried within the contents of the more than 2,000 page bill-as well as the separate 383-page manager's amendment, and a 276 page Indian Health Care reauthorization that would be enacted by reference-are details that would see a massive federal takeover of the health care system in America, including the following:

• A new regime of government-run exchanges that would cause as many as 10 million Americans to lose their current employer-sponsored coverage-thus breaking the central promise of then-Senator Obama's presidential campaign;
• An increase in total national health spending, as well as an increase in premiums that could total $2,100 per year-a far cry from then-Senator Obama's promise to lower costs for families by $2,500 annually;
• Stifling insurance regulations that would raise premiums and encourage employers to drop coverage;
• Trillions of dollars in new federal spending that would exacerbate the deficit and imperil the nation's long-term fiscal solvency;
• A board of unelected bureaucrats being empowered to re-write Medicare statutes in a way that could well lead to government rationing of health care;
• Federal funding of insurance policies that cover elective abortion-and an unprecedented federally managed plan that would cover elective abortion procedures;
• Tens of billions in unfunded mandates in the form of a massive Medicaid expansion that would compel all states-except Nebraska-to dedicate more scarce taxpayer resources to fund government-run health coverage in their states-or alternatively to drop Medicaid entirely;
• Taxes on all Americans-individuals who purchase insurance, individuals who do not purchase insurance, and small and large businesses alike-that would kill jobs and raise premiums; and
• Cuts to Medicare Advantage plans that would result in higher premiums and dropped coverage for more than 10 million seniors.

Summary of Key Provisions

Creation of Exchange:  The bill requires States to create their own Health Benefit Exchanges.  Uninsured individuals would be eligible to purchase an Exchange plan, as would those whose existing employer coverage is deemed "insufficient" by the federal government.  Employees with an "unaffordable" offer of group coverage would be able to take the value of their employer's contribution in the form of a tax-free voucher to shop for plans on the Exchange.  The bill allows states to open Exchanges to all employers beginning in 2017, further expanding the scope and reach of the government-run Exchanges. 

Benefit Standards:  The bill establishes a process for the Secretary of Health and Human Services to impose benefit standards for all plans.  Plans in the Exchange would fall into several tiers: bronze (covering 60 percent of anticipated expenses), silver (70 percent), gold (80 percent), and platinum (90 percent).  A young adult plan offering streamlined benefits would also be available, but only to individuals under aged 30.  Employer plans-including those with Health Savings Accounts-could impose maximum deductibles of $2,000 for an individual or $4,000 for a family.  These onerous standards would hinder the introduction of innovative models to improve enrollees' health and wellness-and by insulating individuals from the cost of health services with restrictive cost-sharing, could raise health care costs. 

"Low-Income" Subsidies:  The bill provides subsidies only through the Exchange, again putting private health plans at a disadvantage.  Individuals with access to employer-sponsored insurance whose group premium costs exceed 9.8 percent of modified gross income would be eligible for subsidies.  Some may note that the newly defined "modified gross income" (as opposed to adjusted gross income) excludes deductions for items like contributions to Individual Retirement Accounts (IRAs) or Health Savings Accounts (HSAs), thus imposing an effective tax on savings.

Premium subsidies provided would be determined on a sliding scale.  Individuals with incomes above 133 percent of the Federal Poverty Level (FPL, $29,327 for a family of four in 2009) and thus ineligible for the Medicaid expansion would be able to receive subsidies, which would phase out entirely for individuals with incomes at 400 percent FPL ($88,200 for a family of four), who would be expected to pay 9.8 percent of their income.  Many may also note that, because the definition of FPL for a couple is not twice the size of the poverty level for a single person, the bill creates a marriage penalty-meaning that married couples may lose hundreds, even thousands, of dollars in health insurance subsidies.

The bill further provides for cost-sharing subsidies, such that individuals with incomes under 100 percent FPL would have two-thirds of their cost-sharing covered for a platinum level plan, while individuals with incomes at 400 percent FPL would have one-third of their cost-sharing covered for a silver plan.  These rich benefit packages, in addition to raising subsidy costs for the federal government, would insulate plan participants from the effects of higher health spending, resulting in an increase in overall health costs-exactly the opposite of the bill's purported purpose.

"Fannie Med" Co-Operatives and National Plan:  The bill as amended requires the Office of Personnel Management (OPM) to "offer at least two multi-State qualified plans through each Exchange in each State."  The bill requires that at least one insurance plan option offered be a non-profit entity.

The bill establishes a Consumer Operated and Oriented Plan (CO-OP) program to provide grants or loans for the establishment of non-profit insurance cooperatives to be offered through the Exchange, but does not require states to establish such cooperatives.  The bill authorizes $6 billion in appropriations for start-up loans or grants to help meet state solvency requirements. 

Many may be concerned that both the OPM federally sanctioned plans and cooperatives funded through federal start-up grants would in time require ongoing federal subsidies, and that a "Fannie Med" co-op would do for health care what Fannie Mae and Freddie Mac have done for the housing sector.  Some may also note that former OPM Director Linda Springer has publicly expressed concern that her former office lacks the capacity to oversee such a project in the manner that it currently oversees the Federal Employee Health Benefits Program (FEHBP).

Medicaid Expansion:  The bill would expand Medicaid to all individuals with incomes under 133 percent of the federal poverty level ($29,327 for a family of four).  Under the bill, the expansion of Medicaid to more than 10 million individuals would be fully paid for by the federal government only through 2016-thus imposing billions in unfunded mandates on 49 states. 

However, as part of the "compromise" negotiated by Leader Reid, one State-Nebraska, home of Sen. Ben Nelson-would have 100 percent of its Medicaid costs paid in perpetuity.  Given public comments by Senate HELP Committee Chairman Tom Harkin (D-IA) that such a precedent could eventually lead to the federal government paying 100 percent of all Medicaid costs for all states.

Federal Funding of Abortion Coverage:  The bill specifically permits taxpayer subsidies to flow to private health plans that include abortion, but creates an accounting scheme designed to designate private dollars as abortion dollars and public dollars as non-abortion dollars.  Specifically, the provisions claim to segregate public funds from abortion coverage and would allegedly prevent funds used on abortion from being considered when determining whether plans meet federal actuarial standards.  However, the accounting scheme has likewise been rejected by pro-life organizations, which recognize it as a clear departure from long-standing federal policy against funding plans covering abortion (e.g., Federal Employee Health Benefits Program, Medicaid, SCHIP, etc.). 

Unlike government-run programs like Medicare and Medicaid, which can specifically prohibit coverage of a particular service, funds provided to a third-party insurance company to subsidize an individual's coverage would by definition make that individual's "supplemental" abortion coverage more affordable.  Therefore many Members may believe that the only way to prevent federal funds from subsidizing abortion coverage is to prevent plans whose beneficiaries receive federal subsidies from covering abortions. 

The bill would require plans to follow "generally accepted accounting requirements" while establishing the regime.  The bill also allows States to "prohibit abortion coverage in qualified health plans" offered in their State's Exchange.  However, these provisions would still result in federal funds flowing to plans that cover elective abortions-and would not prohibit citizens in States which have opted-out of elective abortion coverage in their own Exchange seeing their federal funds flow to plans that cover elective abortion in other States.  To that end, even pro-life Democrats like Rep. Bart Stupak (D-MI) have criticized the bill language as unacceptable, and a far cry from the standards established in the Stupak amendment-which extended the current law Hyde Amendment prohibitions on federal funding for abortion coverage-that passed on a strong bipartisan vote in the House.

Further, the "Fannie Mae" model administered through OPM created by the manager's amendment contains zero prohibition on coverage of elective abortion-an unprecedented federal sanctioning of plans that cover elective abortions.  To that end, many may note that insurance plans within the FEHBP-which Members of Congress themselves utilize-have been prohibited from offering abortion coverage since 1995, and federal employees have expressed strong satisfaction with their choice of plan options.

Medicare Payment Board:  The bill would create a new Independent Medicare Advisory Board established to make recommendations about the future growth of Medicare spending.  The appointed bureaucrats would be required to submit recommendations to Congress to keep Medicare spending below targeted levels-and such recommendations would be legally binding absent legislative action by Congress. 

Particularly given the controversy surrounding the recent recommendations by the US Preventive Services Task Force with respect to mammogram coverage, many may be concerned that the Medicare Board contemplated by the legislation could result in additional coverage decisions being made by unelected bureaucrats largely or exclusively on cost grounds.  Moreover, many may be concerned that in time this provision could closely resemble a concept advocated by former Senator Tom Daschle-a board of unelected bureaucrats making health care decisions for all health plans nationwide, including decisions about which therapies and treatments the federal government will cover.  In his book Critical, Daschle wrote that, "We won't be able to make a significant dent in health-care spending without getting into the nitty-gritty of which treatments are the most clinically valuable and cost-effective."

Funneling Patients into Government Care

Federal Insurance Restrictions:  The bill imposes new regulations on all health insurance offerings, with only limited exceptions.  The bill imposes price controls on insurance offerings, requiring insurers with a ratio of total medical expenses to overall costs (i.e. a medical loss ratio), of less than 80 percent in the individual and small group market, or 85 percent in the large group market, to offer rebates to beneficiaries.  Some Members may be concerned that government-imposed price controls, by requiring plans to pay out most of their premiums in medical claims, would give carriers a strong disincentive not to improve the health of their enrollees through prevention and wellness initiatives-as doing so would reduce the percentage of spending paid on actual claims below the bureaucrat-acceptable limits.  The bill would also "require health plans...to submit a justification for any premium increase" in advance, and permit Exchanges to reject bids by insurance companies with "excessive" (term undefined) price increases-thus permitting bureaucrats to exercise arbitrary controls over health insurance companies.

Existing policies could remain in effect-but only so long as an individual does not move, change jobs, or experience any other material change in life status.  Contrary to President Obama's repeated promises that "You will not have to change [health insurance] plans," CBO found that "relatively few non-group policies would remain grandfathered by 2016"-meaning millions of individuals would lose their current individual health insurance plans as a result of Democrats' government takeover of health care.

Mandates on Employers; "Fair Share" Penalties:  The bill imposes a series of mandates related to  employers offering health insurance coverage.  Specifically, the bill taxes large employer plans (i.e. with more than 50 workers) that impose long "waiting periods" of over 30 days on coverage eligibility up to $600 per full-time employee.  The bill also taxes large employers who do not offer coverage, or who offer coverage that results in employees obtaining subsidies because that coverage costs more than 9.8 percent of modified gross income, to pay taxes.  The penalty in the first instance is $750 per employee, and in the second instance constitutes $3,000 per employee receiving subsidies, or $750 per worker, whichever is less.

Members may be concerned that the "fair share" penalties would most adversely affect those workers whom health "reform" is intended to help.  For instance, the taxes would discourage employers from hiring married individuals or parents raising children-as such individuals would be more likely to qualify for subsidies, thus triggering penalties.  In particular, single parents would be much more likely to qualify for insurance subsidies based upon their income, making it much less likely that such workers would be hired.  The liberal Center for Budget and Policy Priorities also previously noted that the provisions "likely would have discriminatory racial effects on hiring and firing.  Because minorities are much more likely to have low family incomes than non-minorities, a larger share of prospective minority workers would likely be harmed."

Individual Mandate:  The bill places a tax on individuals who do not purchase "minimum essential coverage," as defined by the bureaucratic standards in the bill.  The tax would constitute 2 percent of adjusted gross income, up to the amount of the national average premium for bronze plans offered through the Exchange.  The tax would not apply to non-resident aliens, those exempted on religious grounds, individuals for whom coverage is "unaffordable" (i.e. costing more than 8 percent of modified gross income), and those with short (i.e. fewer than three month) gaps in coverage.  "Acceptable coverage" includes qualified Exchange plans, "grandfathered" individual and group health plans, Medicare and Medicaid plans, and military and veterans' benefits.  But the bill omits protections for military health plans that were included in the House bill.  Specifically, the Senate language does not appear to give the Department of Veterans' Affairs (VA) health care system specific protection from interference by other government agencies administering the various authorities contained in the massive bill, as it pertains to "minimum essential coverage."  The final bill would leave it up to a bureaucrat at the Department of the Treasury to determine whether TRICARE meets the minimum standards under the Democrats' individual health insurance mandate.

For individuals with incomes of under $100,000, the cost of complying with the mandate would be under $2,000-raising questions of how effective the mandate would be, as paying the tax would in many cases cost less than purchasing an insurance policy.  As then-Senator Barack Obama pointed out in a February 2008 debate, in Massachusetts, the one State with an individual mandate, "there are people who are paying fines and still can't afford [health insurance], so now they're worse off than they were.  They don't have health insurance and they're paying a fine."

Medicare Advantage:  The bill would phase in a system of Medicare Advantage (MA) competitive bidding over a three-year period beginning in 2012.  The bill also imposes an arbitrary adjustment on MA payment benchmarks as part of the competitive bidding process.  Many may note that despite its title, traditional Medicare would not be required to compete head-to-head against private health plans in MA "competitive bidding"-thus giving government-run Medicare an advantage.  The Congressional Budget Office has stated that these provisions would collectively cut $120 billion from Medicare Advantage, and would result in millions of seniors losing access to their current plans, and/or having the extra benefits-reduced cost-sharing, dental and vision coverage, etc.-that MA plans provide curtailed or eliminated entirely.

The bill also gives the Secretary blanket authority to reject "any or every bid by an MA organization," as well as any bid by a carrier offering private Part D Medicare prescription drug coverage, giving federal bureaucrats the power to eliminate the MA program entirely-by rejecting all plan bids for nothing more than the arbitrary reason that an Administration wishes to force the 10 million beneficiaries enrolled in MA back into traditional, government-run Medicare against their will.

Tax Increases

Government-Forced Insurance Penalties:  Offsetting payments to finance the government takeover of health care would include taxes on individuals not complying with the mandate to purchase coverage, as well as taxes by businesses associated with the "fair share" penalties, as outlined above.  The mandates would raise $15 billion and $28 billion respectively over ten years.

"Cadillac" Tax on High-Cost Plans:  The bill imposes a 40 percent excise tax on the excess cost of employer-sponsored plans above threshold amounts.  In 2013, the threshold amounts would be $8,500 for an individual policy and $23,000 for a family policy.  Individuals in certain "high-risk professions" would be subject to a higher threshold, and the 17 states with the highest costs (as determined by the average employer-sponsored insurance premium) would see the threshold amounts phased in during the years 2013-2015.  In future years the threshold amount would be raised for inflation at the rate of general price inflation (i.e. Consumer Price Index) plus one percent-which based on past trends would imply that the "Cadillac" tax would hit more plans over time.  According to the Joint Committee on Taxation, the provisions would raise $148.9 billion over ten years.

While some Members may support reforming the current tax treatment of health insurance, many may oppose the bill's model of raising taxes to finance a government takeover of health care.  Many may also note that the bill applies a standard 40 percent tax on all plans regardless of the purchaser's income-potentially subjecting millions of low-income and middle-class families with employer-sponsored coverage to tax rates exceeding the highest marginal rate under current law.

Higher Payroll Taxes:  The bill imposes a 0.9 percent increase in Medicare payroll taxes on individuals with incomes over $200,000 and families with incomes over $250,000, raising $86.8 billion over ten years.  The tax is NOT indexed for inflation, meaning it would affect many more taxpayers over time.  In addition to being administratively burdensome-as individual employers would have to base tax withholding in part on the salary of an employee's spouse-many may be concerned about the precedent set for diverting Medicare payroll taxes in a way that finances a $2.5 trillion new entitlement scheme for younger Americans.

Taxes on Health Plans:  The bill prohibits the reimbursement of over-the-counter pharmaceuticals from Health Savings Accounts (HSAs), Medical Savings Accounts, Flexible Spending Arrangements (FSAs), and Health Reimbursement Arrangements (HRAs), and increases the penalties for non-qualified HSA withdrawals from 10 percent to 20 percent, effective in 2011.  Because these savings vehicles are tax-preferred, adopting these provisions would raise taxes by $6.3 billion over ten years, according to the Joint Committee on Taxation.

The bill would place a cap on FSA contributions, beginning in 2012; contributions could only total $2,500 per year, subject to annual adjustments linked to the growth in general (not medical) inflation. Members may be concerned that these provisions would first raise taxes by $13.3 billion, and second-by imposing additional restrictions on health savings vehicles popular with tens of millions of Americans-undermine the promise that "If you like your current coverage, you can keep it."  At least 8 million individuals hold insurance policies eligible for HSAs, and millions more participate in FSAs.  All these individuals would be subject to additional coverage restrictions-and tax increases-under this provision.

The bill raises the threshold to itemize health expenses from 7.5 percent to 10 percent of adjusted gross income, beginning in 2013; seniors over age 65 would receive a four-year extension of the 7.5 percent income threshold for four additional years (i.e. until 2017).  This provision would raise taxes by $15.2 billion.  The bill also repeals the current-law tax deductibility of subsidies provided to companies offering prescription drug coverage to retirees, raising taxes by $5.4 billion.  Many may be concerned that this provision would lead to companies dropping their current coverage as a result. 

Taxes on Health Products:  The bill would impose several health-related excise taxes: a $2.3 billion tax on drug makers (raises $22.2 billion over ten years), an annual fee on medical device makers rising to $3 billion (raises $19.2 billion), and a tax on insurance companies that rises to $10 billion annually in  beginning in 2011, raising taxes by $59.6 billion.  Many may echo the concerns of the Congressional Budget Office, and other independent experts, who have confirmed that these taxes would be passed on to consumers in the form of higher prices-and ultimately higher premiums.

Taxes on Insurance Industry Executives:  The bill would cap the deductibility of insurance industry executive salaries at $500,000 beginning in 2013, raising $600 million.  Many may question why the insurance industry-alone among health care industries, or indeed all industries-warrants such treatment, and whether or not this provision constitutes an attempt to extract political retribution on a particular industry out of favor with Democrats.

COST AND OTHER CONCERNS

Cost:  According to the Congressional Budget Office's Hpreliminary scoreH of H.R. 3590, the legislation would spend nearly $1 trillion over its first ten years.  More specifically, CBO estimates that the bill would spend $871 billion to finance coverage expansions-$395 billion for the Medicaid expansions, $436 billion for "low-income" subsidies, and $40 billion for small business tax credits.  The spending on coverage expansions does not even include additional federal spending included in the legislation-including a new reinsurance program for retirees, $10 billion in mandatory spending on community health centers, closing the Medicare Part D "doughnut hole," and a $13 billion trust fund for public health-that totals $95.5 billion.  When combined with the cost of the coverage expansions, total spending under the bill actually approaches $1 trillion.

In its score, CBO notes that "under the legislation, federal outlays for health care would increase during the 2010-2019 period, as would the federal budgetary commitment to health care"-by a total of $200 billion over that ten year period.  Many may be concerned that spending at least $1 trillion to finance a government takeover of health care would not only not help the growth in health costs, but-by creating massive and unsustainable new entitlements-would also make the federal budget situation much worse.

Savings would come from reductions within the Medicare program, of which the biggest are cuts to Medicare Advantage plans (net cut of $119.9 billion), reductions in adjustments to certain market-basket updates for hospitals and other providers (total of $147 billion), skilled nursing facility payment reductions (total of $23.9 billion), various reductions to home health providers (total of $39.4 billion), and reduction in imaging payments ($3 billion).  A further $35.7 billion in savings would come from reducing subsidies (i.e. means-testing) to Medicare Part D prescription drug plans for the first time, and from freezing the current annual adjustment to the Part B means test at its current level (i.e. $85,000 for a single retiree and $170,000 for a couple) until 2019.  A further $28.2 billion in savings is projected from the automatic reductions in Medicare spending expected to be triggered by the Independent Medicare Advisory Board during the years 2015-2019.

CBO has also HconfirmedH that the legislation as introduced would raise health care premiums for struggling middle-class families, resulting in non-group premium increases of $300 per year for individuals and $2,100 for families.  While the Obama campaign HpromisedH that its plan would reduce premiums by $2,500 per year for families, CBO confirmed that premiums would still continue to rise-and for millions, premiums would rise higher than under current law.

In terms of overall spending on health care costs, many may note that the independent actuaries at the Centers for Medicare and Medicaid Services found that H.R. 3590 would raise total national health spending by more than $200 billion between 2010-2019.  Many may cite this data point to question the effectiveness of Democrats' health "reform," given that the legislation was originally intended to reduce costs, not raise them.

Tax Increases:  Offsetting payments include $15 billion in taxes on individuals not complying with the mandate to purchase coverage, $149 billion from the "Cadillac tax" on high-premium insurance plans, $28 billion in payments by businesses associated with the employer "free rider" penalty, and $65 billion in associated other revenue interactions. 

The Joint Committee on Taxation notes that other bill provisions would increase federal revenues over and above the $257 billion in tax increases noted above.  JCT found that the increase in the Medicare payroll tax would raise $86.8 billion, corporate reporting would raise $17.1 billion, the worldwide interest implementation delay would raise $26.1 billion, the treaty withholding provisions would raise $7.5 billion, and the codification of the economic substance doctrine would raise $5.7 billion.  Taxes on Health Savings Accounts (HSAs) and other similar savings vehicles would raise $19.6 billion, while provisions relating to retiree drug subsidies would raise taxes by $5.4 billion.  Raising the threshold to itemize health expenses from 7.5 percent to 10 percent of adjusted gross income would generate $15.2 billion in revenue, limiting the deductibility of insurance industry executive salaries would raise $600 million, and a 10 percent tax on indoor tanning services would raise $2.7 billion.

The excise tax on medical devices would raise taxes by $19.2 billion.  Similar excise taxes on insurance companies and drug manufacturers would raise $59.6 billion and $22.2 billion respectively.  Finally, the tax on health benefits used to finance the Comparative Effectiveness Research Trust Fund would raise $2.6 billion over ten years.

Out-Year Spending:  The score indicates that of the $871 billion in spending for coverage expansions under the specifications examined by CBO, only $17 billion-or less than two percent-of such spending would occur during the first four years following implementation (i.e. 2010-2013).  Moreover, the bill in its final year would spend a total of nearly $200 billion to finance coverage expansions.  In other words, the Democrat bill spends so much, it needs many of its tax increases to take effect immediately to finance spending beginning in 2014-and even then cannot come into proper balance without relying on budgetary gimmicks.

Budgetary Gimmicks:  While the CBO score claims H.R. 3590 as amended would reduce the deficit by $132 billion in its first ten years, Democrats achieved that "deficit-neutral" solely by excluding the cost of reforming the Sustainable Growth Rate (SGR) mechanism for Medicare physician payments-the total cost of which stands at $285 billion over ten years, according to CBO-from this bill, and including it instead in separate legislation (H.R. 3961; S. 1776) that is not paid for.  While Members may support reform of the SGR mechanism paid for in a fiscally responsible manner, many may view any legislation that presumes a more than 21 percent cut in Medicare payments to physicians in 2010 as an inherent gimmick designed solely to hide the apparent cost of health "reform."

The bill also relies on $72 billion in revenue from a new program for long-term care services.  As the long-term care program requires individuals to contribute five years' worth of premiums before becoming eligible for benefits, the program would find its revenue over the first ten years diverted to finance other spending in Democrats' health care "reform."  However, even Democrats, such as Senate Budget Committee Chairman Kent Conrad (D-ND), have called the program a "Ponzi scheme," and non-partisan actuaries at the Centers for Medicare and Medicaid Services found that the program faces "a significant risk of failure."  Therefore, many may find any legislation that relies upon such a program to maintain "deficit-neutrality" fiscally irresponsible and not credible.

Background:  H.R. 1612 builds on an existing program established in the Public Lands Corps Act of 1993 (P.L. 103-82).  The program provides youth service opportunities to carry out repair and restoration projects in national parks.  The program has employed thousands of young people to repair and restore national parks.   Funding for the programs are derived from the collection of a 20 percent Recreational Fee Demonstration Program, initiated in 1997.  The program is currently authorized at $12 million annually for conservation projects by Department of the Interior land management agencies and the U.S. Forest Service.  Until Fiscal Year 2009, no money had been appropriated for the program.  The National Park Service has thus utilized its authority to use fee revenues for backlog maintenance work to finance projects.

Possible Concerns:  Members may be concerned that as national unemployment stands at 9.7 percent, this legislation would spend millions of dollars to expand a national parks program.  According to Natural Resources Ranking Member Doc Hastings (R-WA), "We are also deeply concerned that the recent CBO scoring of this bill estimates that implementing the legislation would cost $120 million over the 2010-2014 period-a huge increase over current spending levels and the President's requested amount."

Members may be concerned that this is an explicit admission that the final Democrat health care bill does not protect these plans. Additionally, Members may be concerned that during the 111th Congress, the House has passed hundreds of bills which have not been taken up for by the Senate. There is little reason to believe this legislation would be an exception to that rule.

Background:  Since 2002 and 2005, respectively, the National Oceanic and Atmospheric Administration (NOAA) Bay-Watershed Education and Training (B-WET) and Environmental Literacy Grant programs have advanced ocean, atmospheric, and environmental literacy in the U.S.  NOAA's B-WET program provides regionally-focused funding through competitive grants to projects which promote "meaningful watershed educational experiences," in which schoolchildren are involved in hands-on investigative or project-oriented learning experiences. There are currently six NOAA B-WET offices: Chesapeake Bay, California, Hawaii, Gulf Coast, New England, and Northwest. Over the program's history, more than $40 million has been used to fund more than 530 B-WET projects across the country.

NOAA's ELG program focuses on creating an environmentally literate public that uses a comprehensive understanding of the role of the oceans, coasts and atmosphere to guide responsible social, environmental, and economic decision-making.  Since 2005, 59 competitive awards totaling $25.8 million have been granted through the ELG program, enabling NOAA to partner with a variety of educational and nonprofit organizations.

Both programs were established through the congressional appropriations process, although neither program has been formally codified in law.

According to additional views from Subcommittee Ranking Member Tom McClintock, 200 billion gallons of water have been diverted from the San Joaquin Valley, where communities and farms are desperate for water, in order to protect the Delta Smelt. H.R. 4252 does nothing to restore the water to the San Joaquin Valley, water which could restore thousands of jobs to the area. Due to the man-made drought in the San Joaquin Valley, unemployment is rampant. Rep. McClintock detailed the dire situation in the San Joaquin Valley by stating, "It is overwhelming for many people to see, much less endure, such conditions. Recent food handouts in Mendota and nearby Firebaugh drew lines more than a half-mile long. Dozens of people recently camped out or arrived in the middle of the night to line up for a handful of short-term jobs. People wait for hours outside grocery stores, not to buy food but to accept produce that's thrown out because it is too old to sell." Some members believe that this bill, while a good step to clean the water supply in the Rialto-Colton Basin, is once again, another situation where the Democrat majority favoring one part of California over another because of "partisan intransigence."

Carol W. LaGrasse, president of the Property Rights Foundation of America, testified before the Committee on Natural Resources, in opposition to the bill on January 21, 2010. Her concerns center around the problems associated with the National Park Service interfering with established legal access to private property should the area be deemed worthy of inclusion in the National Park System. She cited a similar situation in the Adirondack State Park.

Subcommittee Ranking Member Rob Bishop offered an amendment to the bill that would instruct the Secretary of the Interior to determine the effects of National Park Service designation on a variety of recreational, commercial, and energy concerns in the Hudson River Valley. Furthermore, the amendment would instruct the Secretary to determine any authorities that will compel or permit the Secretary to influence local land use decisions or place restrictions on non-federal land. The amendment was adopted by a roll call vote of 35-0.

The Alpine Lakes Wilderness was originally designated by Congress in 1976. It sits 45 minutes east of downtown Seattle. The proposed wilderness additions, which total approximately 22,000 acres, are low elevation lands that provide important habitat for wildlife during times of the year when high elevation lands are covered by snow. Elk, deer, cougars, and bobcats all live in the mountain valleys that comprise the wilderness additions proposed by H.R. 1769. The bill would also designate 27.4 miles of the Middle Fork Snoqualmie River and the entire Pratt River as wild and scenic rivers. In 1990, the U.S. Forest Service recommended these rivers for designation because of their outstanding recreation, fisheries, wildlife, and ecological values. The Pratt River is a major tributary of the Middle Fork Snoqualmie River, and both rivers are a source of clean water for the fisheries of the Snohomish River system.

H.R. 4395 would expand the boundary of Gettysburg National Military Park in Pennsylvania to include the train station at which President Abraham Lincoln arrived to deliver the Gettysburg Address. The railway station, built just four years before the battle, is now owned by the Borough of Gettysburg and operated by the National Trust for Historic Gettysburg. The building is listed on the National Register of Historic Places. The National Park Service would acquire the train station property from the Borough. H.R. 4395 authorizes the Secretary of the Interior to purchase the property from a willing seller only after all other efforts to acquire the land without cost to the government have been exhausted. It is expected that local community partners including the Gettysburg Convention and Visitors Bureau will provide staffing for the site while the National Park Service will be limited to covering utility costs.

The bill would also expand the boundaries to include 45 acres in Cumberland Township where the owner has expressed a willingness to sell to the National Park Service. This parcel is adjacent to the current park boundary, along the southern base of Big Round Top and part of the Battlefield Historic District. It was the site of cavalry skirmishes associated with the Battle of Gettysburg.

The Jenkins Act of 1949 regulates shipments of tobacco products through common carriers, such as the U.S. Postal Service and private shipping companies, directly to consumers. The law requires tobacco sellers that ship tobacco products directly to consumers to file monthly reports with the tax collection agency in each state in which it does business. Several major private shipping companies, such as UPS, DSL, and FedEx, do not ship tobacco products. Most consumer tobacco shipments are sent via the U.S. Postal Service.

The sale of illegal cigarettes and smokeless tobacco products reduces federal, state, and local government revenues. Additionally, according to the bill's sponsor, Hezbollah, Hamas, al Qaeda, and other terrorist organizations have profited from trafficking in illegal cigarettes and counterfeit cigarette tax stamps. The sale of illegal cigarettes and smokeless tobacco over the Internet, and through mail, fax, or phone orders, also makes it cheaper and easier for children to obtain tobacco products. The number of Internet vendors in the U.S. and in foreign countries that sell cigarettes and smokeless tobacco to buyers in the U.S. increased from only about 40 in 2000 to more than 500 in 2005.

Public Law 111-68, Legislative Branch Appropriations Act of 2010 contains section 101 (a), which states:

"Notwithstanding any other provision of law, any amounts appropriated under this Act for `House of Representatives-Salaries and Expenses-Members' Representational Allowances' shall be available only for fiscal year 2010. Any amount remaining after all payments are made under such allowances for fiscal year 2010 shall be deposited in the Treasury and used for deficit reduction (or, if there is no Federal budget deficit after all such payments have been made, for reducing the Federal debt, in such manner as the Secretary of the Treasury considers appropriate)."

According to the Congressional Research Service (CRS), each Legislative Branch Appropriations bill since 1995 has contained a similar control over left over MRA funds.  H.R. 4825 would permanently place the provision into law.

Additionally, there are intermingled federal and State lands within units of the National Forest System in Florida that are of comparable quantity and quality and of approximately equal value.  Interchanging these lands would be in the public interest by facilitating more efficient public land management.

The FAA is an agency within the Department of Transportation that oversees and regulates the nation's aviation system. The Airport and Airway Trust Fund (AATF), created by the Airport and Airway Revenue Act of 1970, provides funding for the nation's aviation system through several aviation excise taxes. Funding currently comes from collections related to passenger tickets, air cargo excise taxes, passenger flight segments, and aviation fuels, among other sources. The current funding mechanisms for the FAA were set forth by the Vision 100-Century of Aviation Reauthorization Act, which became law in 2003. Vision 100 expired at the end of FY 2007, and the FAA has since been funded by a series of temporary authorizations. Both the House (H.R. 915) and the Senate (S. 1451) have introduced a long-term FAA extension. H.R. 915 passed the House on May 21, 2009, by a vote of 277-136. The Senate has yet to act on either S. 1451 or the House passed extension.

HTF Background: On March 17, 2010, the Senate passed the HIRE Act (H.R. 2847) by a vote of 68-29, and sent the measure, including the surface transportation extension to the president's desk. H.R. 4853 would execute an agreement made between the Chairmen of the applicable House and Senate committees without having had to modify the HIRE Act and thus return the bill to the House for yet another vote.

According to additional views from Subcommittee Ranking Member Tom McClintock, 200 billion gallons of water have been diverted from the San Joaquin Valley, where communities and farms are desperate for water, in order to protect the Delta Smelt. H.R. 4252 does nothing to restore the water to the San Joaquin Valley, water which could restore thousands of jobs to the area. Due to the man-made drought in the San Joaquin Valley, unemployment is rampant. Rep. McClintock detailed the dire situation in the San Joaquin Valley by stating, "It is overwhelming for many people to see, much less endure, such conditions. Recent food handouts in Mendota and nearby Firebaugh drew lines more than a half-mile long. Dozens of people recently camped out or arrived in the middle of the night to line up for a handful of short-term jobs. People wait for hours outside grocery stores, not to buy food but to accept produce that's thrown out because it is too old to sell." Some members believe that this bill, while a good step to clean the water supply in the Rialto-Colton Basin, is once again, another situation where the Democrat majority favoring one part of California over another because of "partisan intransigence."

Carol W. LaGrasse, president of the Property Rights Foundation of America, testified before the Committee on Natural Resources, in opposition to the bill on January 21, 2010. Her concerns center around the problems associated with the National Park Service interfering with established legal access to private property should the area be deemed worthy of inclusion in the National Park System. She cited a similar situation in the Adirondack State Park.

Subcommittee Ranking Member Rob Bishop offered an amendment to the bill that would instruct the Secretary of the Interior to determine the effects of National Park Service designation on a variety of recreational, commercial, and energy concerns in the Hudson River Valley. Furthermore, the amendment would instruct the Secretary to determine any authorities that will compel or permit the Secretary to influence local land use decisions or place restrictions on non-federal land. The amendment was adopted by a roll call vote of 35-0.

The Alpine Lakes Wilderness was originally designated by Congress in 1976. It sits 45 minutes east of downtown Seattle. The proposed wilderness additions, which total approximately 22,000 acres, are low elevation lands that provide important habitat for wildlife during times of the year when high elevation lands are covered by snow. Elk, deer, cougars, and bobcats all live in the mountain valleys that comprise the wilderness additions proposed by H.R. 1769. The bill would also designate 27.4 miles of the Middle Fork Snoqualmie River and the entire Pratt River as wild and scenic rivers. In 1990, the U.S. Forest Service recommended these rivers for designation because of their outstanding recreation, fisheries, wildlife, and ecological values. The Pratt River is a major tributary of the Middle Fork Snoqualmie River, and both rivers are a source of clean water for the fisheries of the Snohomish River system.

H.R. 4395 would expand the boundary of Gettysburg National Military Park in Pennsylvania to include the train station at which President Abraham Lincoln arrived to deliver the Gettysburg Address. The railway station, built just four years before the battle, is now owned by the Borough of Gettysburg and operated by the National Trust for Historic Gettysburg. The building is listed on the National Register of Historic Places. The National Park Service would acquire the train station property from the Borough. H.R. 4395 authorizes the Secretary of the Interior to purchase the property from a willing seller only after all other efforts to acquire the land without cost to the government have been exhausted. It is expected that local community partners including the Gettysburg Convention and Visitors Bureau will provide staffing for the site while the National Park Service will be limited to covering utility costs.

The bill would also expand the boundaries to include 45 acres in Cumberland Township where the owner has expressed a willingness to sell to the National Park Service. This parcel is adjacent to the current park boundary, along the southern base of Big Round Top and part of the Battlefield Historic District. It was the site of cavalry skirmishes associated with the Battle of Gettysburg.

According to a CRS report, an adequate level of dissolved oxygen is necessary to support most forms of aquatic life.  While very low levels of dissolved oxygen (hypoxia) can be natural, especially in deep ocean basins and fjords, hypoxia in coastal waters is mostly the result of human activities that have modified landscapes or increased nutrients entering these waters. Hypoxic areas are more widespread during the summer, when algal blooms stimulated by spring runoff decompose to diminish oxygen.  Such hypoxic areas may drive out or kill animal life, and usually dissipate by winter.  In many places where hypoxia has occurred previously, it is now more severe and longer lasting; in others where hypoxia did not exist historically, it now does, and these areas are becoming more prevalent.

The largest hypoxic area affecting the United States is in the northern Gulf of Mexico near the mouth of the Mississippi River, but there are others as well.  Most U.S. coastal estuaries and many developed near shore areas suffer from varying degrees of hypoxia, causing various environmental damages.  Research has been conducted to better identify the human activities that affect the intensity and duration of, as well as the area affected by, hypoxic events, and to begin formulating control strategies.

In 1997, Congress directed the U.S. Geological Survey to give priority attention to hypoxia in the FY 1999 budget (through the FY1998 Department of the Interior appropriations).  Near the end of the 105^th Congress, provisions of the Harmful Algal Bloom and Hypoxia Research and Control Act of 1998 were incorporated into the Coast Guard Authorization Act of 1998.  The Coast Guard Authorization Act authorized appropriations through NOAA to conduct research, monitoring, education, and management activities for the prevention, reduction, and control of hypoxia, harmful algal blooms, Pfiesteria, and other aquatic toxins.  In 2004, Title I of P.L. 108-456, the Harmful Algal Bloom and Hypoxia Amendments Act of 2004, expanded this authority and reauthorized appropriations through FY 2008.

According to a CRS report, an adequate level of dissolved oxygen is necessary to support most forms of aquatic life.  While very low levels of dissolved oxygen (hypoxia) can be natural, especially in deep ocean basins and fjords, hypoxia in coastal waters is mostly the result of human activities that have modified landscapes or increased nutrients entering these waters. Hypoxic areas are more widespread during the summer, when algal blooms stimulated by spring runoff decompose to diminish oxygen.  Such hypoxic areas may drive out or kill animal life, and usually dissipate by winter.  In many places where hypoxia has occurred previously, it is now more severe and longer lasting; in others where hypoxia did not exist historically, it now does, and these areas are becoming more prevalent.

The largest hypoxic area affecting the United States is in the northern Gulf of Mexico near the mouth of the Mississippi River, but there are others as well.  Most U.S. coastal estuaries and many developed near shore areas suffer from varying degrees of hypoxia, causing various environmental damages.  Research has been conducted to better identify the human activities that affect the intensity and duration of, as well as the area affected by, hypoxic events, and to begin formulating control strategies.

In 1997, Congress directed the U.S. Geological Survey to give priority attention to hypoxia in the FY 1999 budget (through the FY1998 Department of the Interior appropriations).  Near the end of the 105^th Congress, provisions of the Harmful Algal Bloom and Hypoxia Research and Control Act of 1998 were incorporated into the Coast Guard Authorization Act of 1998.  The Coast Guard Authorization Act authorized appropriations through NOAA to conduct research, monitoring, education, and management activities for the prevention, reduction, and control of hypoxia, harmful algal blooms, Pfiesteria, and other aquatic toxins.  In 2004, Title I of P.L. 108-456, the Harmful Algal Bloom and Hypoxia Amendments Act of 2004, expanded this authority and reauthorized appropriations through FY 2008.

In June 2008, the Judicial Conference of the U.S. transmitted to the Speaker of the House a Certificate indicating that "consideration of the impeachment of Judge Porteous may be warranted."  After an extensive investigation and a series of hearings the Judiciary Committee voted to refer four articles of impeachment to the House for its consideration.  The articles involve the following conduct:

(1)   A curatorship kickback scheme the judge had with two attorneys;

(2)   The judge's inappropriate handling of a federal case involving both material misrepresentations he made during a recusal hearing, and his soliciting and accepting money from an attorney involved in the case, while he had the matter under advisement;

(3)   The judge's corrupt relationship with two bail bondsman and his actions taken both as a State and federal judge to assist them in their business;

(4)   The judge's numerous false and misleading statements and other violations of orders of the bankruptcy court in connection with his 2001 bankruptcy filing; and

(5)   The judge's false statements to both the FBI and the Senate during his nomination and confirmation process which led him to obtain his judgeship under false pretenses.

The Constitution divides war powers between Congress and the president.  Congress has the power to declare war and raise and support the armed forces, while the president is commander in chief. 

This legislation invokes an arguably unconstitutional provision of the 1973 War Powers Resolution (P.L. 93-148) to direct an immediate withdrawal of U.S. troops from Afghanistan.  The War Powers Resolution requires the president to notify Congress within 48 hours of committing forces to military action and forbids forces from remaining for more than 60 days, with a further 30 day withdrawal period, without an authorization of the use of military force or a declaration of war.  The 1973 law was passed by two-thirds of Congress, overriding a presidential veto.

Under the terms of that act, if the president commits U.S. troops to foreign hostilities without a declaration of war or statutory authorization, he must withdraw them within a period of 60 to 90 days unless Congress authorizes a longer deployment.  A concurrent withdrawal resolution, not requiring the president's signature, can be introduced at any time and must be referred to a committee, which has 15 days to report the measure.  It then becomes pending floor business to be voted up or down within three days.

However, under current law, a withdrawal resolution cannot be considered if Congress has enacted a declaration of war or an authorization for the use of military force.  Congress enacted a use-of-force resolution for Afghanistan in 2001, although the sponsor claims that does not preclude a withdrawal resolution from being used.

Every president since Richard Nixon has argued that the war powers law is unconstitutional because it interferes with the president's prerogatives as commander in chief.  This argument was supported by the Supreme Court's decision in a 1983 immigration case that Congress cannot, by disapproval resolutions, alter the rights and duties of persons outside the Congress because that constitutes lawmaking requiring presidential participation.

Congress has used the withdrawal provisions of the War Powers Resolution three times.  In 1993, the House adopted a resolution directing the president to remove troops from Somalia by March 31, 1994.  In 1998 and 1999, the House rejected resolutions directing U.S. troop withdrawals from Bosnia-Herzegovina and the Yugoslavia, respectively.

In June 2008, the Judicial Conference of the U.S. transmitted to the Speaker of the House a Certificate indicating that "consideration of the impeachment of Judge Porteous may be warranted."  After an extensive investigation and a series of hearings the Judiciary Committee voted to refer four articles of impeachment to the House for its consideration.  The articles involve the following conduct:

(1)   A curatorship kickback scheme the judge had with two attorneys;

(2)   The judge's inappropriate handling of a federal case involving both material misrepresentations he made during a recusal hearing, and his soliciting and accepting money from an attorney involved in the case, while he had the matter under advisement;

(3)   The judge's corrupt relationship with two bail bondsman and his actions taken both as a State and federal judge to assist them in their business;

(4)   The judge's numerous false and misleading statements and other violations of orders of the bankruptcy court in connection with his 2001 bankruptcy filing; and

(5)   The judge's false statements to both the FBI and the Senate during his nomination and confirmation process which led him to obtain his judgeship under false pretenses.

Government Job Creation Programs:   On February 13, 2009, the House passed H.R. 1, the American Recovery and Reinvestment Act of 2009, also known as the Democrats' "stimulus" bill.  According to CBO's re-estimate, the bill contained $862 billion in new spending and tax provisions and required the U.S. to increase its interest payments on borrowed money by $347 billion over ten years, raising the bill's total cost to $1.1 trillion.  Democrats' said the stimulus would create between three and four million new jobs.  In January, 2009, the Obama Administration claimed that unemployment would not surpass 8 percent if the stimulus was passed.  However, the stimulus bill failed to meet its objective and unemployment is now 9.7 percent and the unemployment level has increased by more than 3 million jobs since February.

Some Members may be concerned that the $1,000 tax credit for hiring and retaining employees resembles the Jimmy Carter tax credit of the late 1970's, which did little to curb long-term unemployment.  In 1977, the Carter Administration signed the New Jobs Tax Credit (NJTC), one of four programs of the 1977 economic stimulus package, into law.  The NJCT provided federal wage subsidies for two years, from 1977-1978, to companies that hired new workers.  During the two years of the program, one-in-three new jobs received the tax credit at an estimated cost of $4 billion annually.  Despite the high number of credit recipients, the actual impact of the NJCT has been the topic of contentious debate.  During that period the unemployment rate dropped by 1.5 percent.  However, the decline in unemployment was short-lived and the NJTC ultimately failed to curb unemployment in the long run.  Two years later, in 1979, the unemployment rate began to increase rapidly (perhaps as a result of the loss of federally subsidized jobs).  Emil Sunley, the Deputy Assistant Secretary for Tax Analysis at the Carter Administration's Treasury Department said in 1980 that, "The impact of the credit on jobs was slight."  Likewise, Howard Gleckman of the Urban-Brookings Tax Policy Center said of a similar subsidy proposed last year, "tax credits for hiring new workers promise to be an administrative nightmare and won't create many new jobs."

A number of concerns have been raised with the proposal, including:

Who Qualifies?:  There are administrative questions as to how to measure who receives the tax credit (i.e., what constitutes new or incremental employment) and how it is distributed.  Some have suggested that businesses could easily game the system to receive a benefit without actually increasing employment.  For instance, without proper guidelines and oversight, an employer could fire and hire the small employee as a new worker or split one position into two.  And the program would be administered by the same Administration that has had abandoned its confusing and misleading stimulus methodology of jobs "saved or created."

Not Long-Term, Pro-Growth:  Unlike many of the proposals in the Republican "stimulus" alternative, this sort of jobs tax credit is a temporary wage subsidy and not a true drop in the federal tax burden.  Many Members may believe that long-term tax relief (such as lowering tax rates) is a more effective way to spur long-term economic growth and across-the-board employment.

Seclusion and restraint techniques are used to control students with behavioral problems, and sometimes, students with disabilities.  Seclusion can include being locked in a room alone for hours, and restraint techniques can vary from holding a child in a seat to various positions which may restrict a child's breathing and movement. 

The use of seclusion and restraint techniques, including how such techniques are defined, is primarily regulated at the State level.  Currently, thirty-one States have laws and regulations in place that govern the use of seclusion and restraint techniques in schools.  According to the Committee of Education and Labor Republican staff, the regulations differ greatly State-to-State.  Seven states place some restrictions of the use of restraints, but do not regulate seclusions.[1]  Seventeen States require that staff receive training before being permitted to restrain children.[2]  Thirteen States require schools to obtain consent prior to using foreseeable or non-emergency physical restraints,[3] while nineteen require parents to be notified after restraints have been used.[4]  Two States require annual reporting on the use of restraints.[5]  Eight States prohibit the use of prone restraints or restraints that impede a child's ability to breathe.[6]  Nineteen States have no laws or regulations related to the use of seclusions or restraints in schools.[7]  In addition, school districts may also have their own guidelines governing the use of such practices in the classroom.  In a report released this week by the Department of Education, 15 of the 19 States without laws stated that they intend to have protections in place this year or in the near future.    

During a hearing in 2009, the Government Accountability Office (GAO) testified that:

• Over the last two decades, there have been hundreds of allegations of child abuse made by attorneys, parents, advocacy groups, and the media over the use of seclusion rooms and restraint techniques in public schools.  
• They had confirmed that there have been several cases over the last few years in which children with disabilities, ranging in age from 4 to 14 years old, were abused as a result of the use of seclusion or restraints.  
• They examined 10 cases and determined that a number of them had resulted in the death of the student, which led to a criminal conviction, civil or administrative liability, or a large financial settlement.  
• They discovered that most of the teachers in these situations, including those in which the student died, were not trained in how to properly address discipline problems and were still in the teaching profession even after the incident.  

The report from GAO documented several cases where teachers and aides used tactics to seclude and restrain students with disabilities.  It revealed that in Texas and California alone, a combined 33,095 students were secluded or restrained in the school year leading up to the report's issuance.  During the hearing, local school administrators discussed the need for training in positive behavior interventions to help teachers and school officials avoid the need for seclusions and restraints.

In addition to the GAO report and the recent Department of Education report, other reports have documented cases of injury and death due to improper use of seclusion and restrain techniques.  The Council of Parent Attorneys and Advocates, Inc. (COPAA) published a report in May of 2009 documenting 155 cases where children were subjected to adverse intervention techniques.  Similarly, the National Disability Rights Network (NDRN) issued a report in January of 2010 documenting the inadequacies of State regulations and how incidents have occurred in the absence of federal guidelines.  P&A systems in both Texas and California have published their own studies as well. 

While there are no current federal regulations regarding seclusion and restraint in public and private schools, both terms are defined in the Children's Health Act of 2000.  In a similar vein to H.R. 4247, the Children's Health Act of 2000 grants the Secretary of Health and Human Services the authority to issue guidelines on the safety of children and youth in public and private health facilities.  The Children's Health Act restricts the use of seclusion and restraint in health care facilities that receive federal funds and in non-medical, community-based facilities for children and youth.  The only exceptions to these regulations are those for emergencies, if the individual is putting themselves-or others-in immediate danger, or if other less restrictive methods would be ineffective.

[1] Alaska, Colorado, Hawaii, Michigan, Ohio, Utah, and Virginia.

[2] California, Colorado, Connecticut, Illinois, Iowa , Maine, Maryland, Massachusetts, Nevada, New Hampshire, New Mexico, New York, Oregon, Pennsylvania, Rhode Island, Texas, and Virginia.

[3] Colorado, Delaware, Maryland, Massachusetts, Montana, New Hampshire, New York, North Carolina, Oregon, Pennsylvania, Tennessee, Virginia, and Washington.

[4] California, Colorado, Connecticut, Illinois, Iowa, Maine, Maryland, Massachusetts, Minnesota, Nevada, New Mexico, New York, North Carolina, Oregon, Pennsylvania, Rhode Island, Tennessee, Texas, and Virginia.

[5] California and Connecticut.

[6] Colorado, Connecticut, Iowa, Massachusetts, Pennsylvania, Rhode Island, Tennessee, and Washington.

[7] Arizona, Florida, Georgia, Idaho, Indiana, Kansas, Kentucky, Louisiana, Mississippi, Missouri, Nebraska, New Jersey, North Dakota, Oklahoma, South Carolina, South Dakota, Vermont, Wisconsin, and Wyoming.

The United States is a signatory to the Madrid Protocol, an international treaty that allows a trademark owner to seek registration in any of the countries that have joined the Protocol. 

This means an American trademark owner pays the U.S. Patent and Trademark Office in Alexandria, Virginia, a nominal fee to expedite the necessary paperwork overseas.  This process makes it easier and cheaper for U.S. trademark owners to acquire protection for their intellectual property in other countries.   

The main purpose of S. 2968 is to bring provisions for maintaining extensions of protection under Madrid in conformity with provisions for maintaining registrations.  Maintenance filings with PTO by the trademark owner are necessary to perpetuate protection of the trademark.  

The bill was developed in concert with the U.S. Patent and Trademark Office and relevant trade associations that represent the interests of trademark holders.  There is no known opposition to the bill.

The National Earthquake Hazards Reduction Program

Since the creation of NEHRP in 1977, the program has contributed to the development of earthquake knowledge, seismic building codes, and increased awareness of the threat of earthquakes among public officials and the general public.  The NEHRP legislation directs four federal agencies--NIST, the National Science Foundation (NSF), the United States Geological Survey (USGS), and the Federal Emergency Management Agency (FEMA)-to coordinate efforts according to the agencies' expertise.  The NSF funds basic research to study earthquakes and earthquake engineering; NIST and FEMA support and facilitate the development and implementation of safer earthquake building practices; and the USGS, in addition to supporting research to improve the understanding of earthquakes, also provides critical seismic monitoring through the Advanced National Seismic System (ANSS) and the Global Seismographic Network (GSN).  In addition to its role in building research and development, NIST is also the lead agency for NEHRP, responsible for ensuring coordination, including a coordinated budget and strategic plan.

The National Windstorm Impact Reduction Program (NWIRP)

Congress created NWIRP in 2004, directing NIST, NSF, FEMA, and the National Oceanic and Atmospheric Administration (NOAA) to develop a coordinated R&D agenda to mitigate the impact of windstorms.  In 2006, the National Science and Technology Council (NSTC) identified a number of priorities to achieve the goals of the program, including research to improve knowledge about windstorms and the characteristics of wind, advancing wind-resilient design and construction methods for buildings and other structures, and spurring mitigation action among the public.  However, the program did not receive attention or funding.  Consequently, very little federal attention has been paid to R&D to increase the resiliency of the built environment to windstorms.

National Construction Safety Team Act

The National Construction Safety Team Act (NCSTA) (P.L. 107-231), signed into law on October 1, 2002, authorizes NIST to establish teams to investigate building failures.  The purpose of the Act is to improve the structural integrity of buildings and evacuation and emergency response procedures by investigating building failures and recommending specific improvements to building standards, codes, and practices, as well as evacuation and emergency response procedures.  The Act establishes NIST as the lead federal agency for building failures.

Wildfires at the Wildland-Urban Interface

Fires at the wildland-urban interface are a growing problem as more communities develop around forested land.  For instance, between 2003 and 2007, such fires destroyed over 8,000 structures in California. NIST is developing tools for reducing community losses in wildland-urban interface fires.