Late objections cast doubt on cures bill

Objections from both sides of the aisle are stirring doubts about a bipartisan medical cures bill that is slated to hit the House floor on Friday.

The 21st Century Cures Act was reported out of committee in May on a 51-0 vote. Supporters of the bill hoped the unanimous endorsement would lead to an overwhelming vote in the House, but they are running into last-minute opposition on the eve of the vote.

{mosads}The bill includes $8.75 billion over five years in new funding for medical research at the National Institutes of Health (NIH).

That spending is drawing fire from conservatives because it is mandatory, meaning it is not revisited each year through the appropriations process. Some Republicans oppose adding another spending program to the books and are upset that the move would bust budget caps put in place in 2011.

“After Medicare Part D, we ended up with ObamaCare, which is a huge increase in spending, and now we’re wanting to have this,” said Rep. John Fleming (R-La.), a physician who works on health issues in the conservative House Freedom Caucus. “Look what’s happening in Greece and Puerto Rico.”

Meanwhile, some Democrats are railing against a late addition to the bill that includes Hyde Amendment language further restricting the use federal funds for abortion services.

“I cannot stand by while these provisions are slipped into an otherwise excellent bill through underhanded maneuvers that run contrary to our democratic process,” Rep. Jackie Speier (D-Calif.) said Thursday, claiming the language was added “in the dead of night.”

Speier, who was one of the original co-sponsors, pulled her support from the bill on Thursday.  A spokesman said that at least five other Democrats are planning to oppose the bill, adding, “I think there’s some momentum.”

Reps. Louise Slaughter (D-N.Y.) and Rosa DeLauro (D-Conn.) also spoke out against the abortion language in the bill.

“Why in the world would you put in an abortion rider on a thing for medical research?” Slaughter asked during floor debate.

Still, the bill has 230 co-sponsors in the House, more than a majority. House Energy and Commerce Committee Chairman Fred Upton (R-Mich.), the bill’s main Republican champion, said Wednesday that he still hopes to get 300 votes in favor.

The bill’s top Democratic supporters, meanwhile, expressed confidence that there would be broad support in their party for the bill on final passage despite the abortion flap.

“There are always going to be some people that are against, but I think it’ll be very few,” Rep. Frank Pallone (D-N.J.) said, adding that the party “is going to work hard to get rid of the riders.”

A Democratic aide said that the hope is a vote on an amendment to strip out the abortion language will help bring Democrats into the fold for the final vote.

“I think most people like me realized that these riders would have applied anyways,” Rep. Diana DeGette (D-Colo.) said of the abortion provisions. “They’re going to vote for the Lee amendment to strip them out, to send that message, and then they’ll vote for final passage.”

The Lee Amendment, sponsored by Rep. Barbara Lee (D-Calif.), would eliminate any abortion-related restrictions in the bill.

On the Republican side, proponents of the bill have been working to tamp down support for an amendment from Rep. Dave Brat (R-Va.) that would change the funding in the bill from mandatory to discretionary. Democrats warn that if the amendment passes Friday, support from their side will crumble because the NIH funding would be far less certain.  

Upton has also pushed back on conservative objections.  

When the conservative group Heritage Action urged members to oppose the bill on Tuesday, Republicans on the Energy and Commerce Committee replied that the move was “surprisingly short-sighted.”

Asked about Heritage Action on Wednesday, Upton told The Hill, “Remember, they opposed the [sustainable growth rate] doc fix too.” That Medicare reform bill went on to pass the House overwhelmingly in March, despite Heritage Action’s opposition.

Behind the scenes, House Budget Committee Chairman Tom Price (R-Ga.) has also objected to the funds being mandatory. 

“We have a basic disagreement, that’s just the way it’s going to stay,” Upton said of Price. 

Price supports Brat’s amendment but did not lend his name to it, not wanting to escalate the disagreement with Upton. 

One aide to a conservative member said Brat’s amendment would fail, giving cover to some conservatives who end up supporting the final bill. 

“It will have significant support but it won’t have a majority of the House,” said Rep. Kevin Yoder (R-Kan.), a conservative who supports the bill.

Brat spoke out against the bill in the Republican conference meeting on Wednesday, saying if the NIH is really such a priority, then it shouldn’t be hard for the Appropriations Committee to increase its funding through the normal process.

“It’s always easy up here to vote yes, yes, yes, yes, you know, ‘learn to govern’ and all these kind of phrases,” he said. “The piece that’s missing is the damage we’re doing to the kids.”

Even Rep. Tom Cole (R-Okla.), a GOP leadership ally, raised concerns about the mandatory spending at a Rules Committee hearing Wednesday.

He said that while the funds only last for five years, the pressure on Congress would be too great not to renew them in the future. 

“I don’t really believe we’ll stop doing this in five years,” he said at a Rules Committee hearing. “I have a real hard time believing that.”

Speaker John Boehner (R-Ohio) has sought to counter conservative concerns. 

Boehner’s office touted the bill in a statement this week, noting that it fully pays for the spending it contains and is projected by the Congressional Budget Office to reduce the deficit by more than $500 million. 

“The bill not only paves the way for a new era of medical innovation, it does so by drawing on several conservative reforms that are good for taxpayers, and good for our economy,” the Speaker’s statement said. 

And like Yoder, some conservatives, including Reps. Andy Harris (R-Md.) and Matt Salmon (R-Ariz.), are in favor of the bill, arguing NIH spending is a smart investment. 

Yoder wrote a letter to his colleagues this week urging support. 

“As conservatives, we should be advocating for federal investment in research now in order to bend the cost curve down the road,” he wrote.