The 21st Century Cures Act聽set for a House vote Wednesday聽is one of the most-lobbied health care bills in recent history, with nearly three lobbyists working for its passage or defeat for every member on Capitol Hill.
More than 1,455 lobbyists representing 400 companies, universities and other organizations聽pushed聽for or against an earlier聽House version of a Cures bill this congressional cycle, according to federal disclosure forms compiled by the Center for Responsive Politics. A compromise version was released over the holiday weekend.
The latest version of the bill would boost funding for the National Institutes of Health by $4.8 billion over ten years, including funding for enhanced brain, cancer and precision medicine research. The NIH鈥檚 2017 discretionary budget is $30.3 billion. It would grant an additional $1 billion to address the opioid crisis. The bill would also speed up the drug and device approval process at the Food and Drug Administration by pushing different evidence standards.
Other than major appropriations bills, a transportation spending bill and an energy infrastructure funding bill, the Cures Act garnered more lobbying activity than any of the more than 11,000 bills proposed in the 114th Congress, an analysis of the CRP data shows. It鈥檚 also the second-most lobbied health care bill since 2011, following only聽the Medicare Access and CHIP Reauthorization Act of 2015, which,聽among other things, overhauled Medicare payments to health providers.
Putting a price tag on the lobbying is difficult because spending reports don鈥檛 break down spending by specific measures. The reports show that interested groups spent as much as half a billion dollars from 2015 through the second quarter of 2016 on all lobbying disclosures that included the 21st聽Century Cures Act.
鈥淚n a bill of this importance and consequence, a lot of groups have a lot of interest in every line in that bill, and they鈥檙e going to put as much pressure as they can on legislators 鈥 and maybe some executive branch people as well 鈥 to get favorable language in that bill to support their interests,鈥 said former Rep.聽Lee Hamilton, who founded the Indiana University Center on Representative Government after spending more than three decades in the House of Representatives. 鈥淭he more intense the lobbying, the more money is at stake.鈥
Senate Majority Leader Mitch McConnell identified the legislation as a priority after a 2016 election that has cast doubt on the future of the Affordable Care Act. Republican President-elect Donald Trump has vowed to eliminate 鈥渞ed tape鈥 at the FDA but hasn鈥檛 specifically commented on the Cures Act.
鈥淎bsolutely this has gained a lot of attention on K Street,鈥 said Tim LaPira, a political science professor at James Madison University. Every Congress, he said, a few dozen bills spark a 鈥渇eeding frenzy.鈥
Even so, the bill hasn鈥檛 spurred as much lobbying as the Affordable Care Act in 2009, which brought out more than 1,200 organizations, according to CRP data.
The Pharmaceutical Researchers and Manufacturers of America, or PhRMA, the main trade group for brand-name drugmakers, applauded the House bill鈥檚 passage. The group鈥檚 lobbying reports naming the bill accounted for $24.7 million in spending by the group, which spent $30.3 million overall.
Its spokeswoman Allyson Funk said in a statement the trade group 鈥渁ppreciate[s] Congress鈥 continued interest in improving biomedical innovation and accelerating new treatments for patients.鈥
Several nonprofit patient advocacy and research groups have opposed the bill, citing concerns about endangering patients with simplified drug and device approvals.
Beyond the pharmaceutical industry, the bill鈥檚 supporters include universities, medical schools and groups representing them, as well as patient groups funded by drug and device companies, said Diana Zuckerman of the nonprofit National Center for Health Research, which has not lobbied the bill but has launched a to convince Congress to 鈥渇ix鈥 it.
鈥淚t really is a David and Goliath issue of where the money is,鈥 Zuckerman said.
AbbVie, the maker of Humira, a drug used to treat arthritis, ulcerative colitis and Crohn鈥檚 disease, reported $7.7 million in lobbying expenditures in disclosures listing the bill as an issue. The company鈥檚 total lobbying was $9.5 million this cycle.
Hospitals and medical schools, which , supported the bill because the NIH funding could propel grants to medical and research institutions, Zuckerman said.
Johns Hopkins Medicine called enhanced biomedical research funding 鈥渓ong overdue.鈥 Spokeswoman Jania Matthews said in an email that the bill would also 鈥減rovide new tools at the FDA to accelerate the approval of new therapies and medical devices.鈥
The U.S. Chamber of Commerce generally supports the bill and reported $87.1 million in expenditures in聽 disclosure reports that cited the Cures Act, with overall spending of $136.5 million through the second quarter of 2016.
The U.S. Oil and Gas Association, with lobbying expenditures of $293,000, lists the Cures Act as a legislative issue. Funding for the bill would partly come from selling crude oil from the U.S. Government鈥檚 Strategic Petroleum Reserve.
money from selling oil would go toward NIH funding 鈥渂ecause just as energy reserves are a national resource designed to protect and serve our citizens, so too is an investment in health innovation and research.鈥
The U.S. Oil and Gas Association declined to comment.
Additional lobbyists may be working on the bill under the radar. LaPira explained that lax lobbying disclosure requirements mean that some lobbyists may not disclose work on the bill, H.R. 6. That鈥檚 what he saw when the Affordable Care Act was passed, too.
鈥淭he clerk鈥檚 office is supposed to list the bill number if they know it, but nobody ever checks,鈥 he said. 鈥淭hat鈥檚 another sort of trick of the trade: to hide in plain sight.鈥
The bill is considered a swan song for sponsor Rep. Fred Upton, whose tenure as chair of the Energy and Commerce Committee is nearing an end, said Paul Heldman, an analyst at Heldman Simpson Partners LLC, a research firm that provides health policy analysis to investors. The Michigan Republican garnered broad support from devicemakers, drug manufacturers, researchers and patient advocacy groups. He鈥檚 more than half a million campaign dollars from pharmaceutical and health product groups in the last two election cycles.
The committee聽has received at least 36 letters of support. But in October, 13 groups, including the Center for American Progress, AFL-CIO and Public Citizen, urged members in a 聽not to rush passage of the bill without first amending it to include drug price controls.
Before the election, it was unclear whether opposition from think tanks close to the Obama administration and Hillary Clinton would impede passage.
鈥淚t may still be an important issue, but I think less likely given the outcome of the election,鈥 Heldman said.
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