Before I get into the featured issues, I want to invite everybody to our Capitol Hill briefing on FDA Reform ([link removed]) next Wednesday at noon in Room 188 of the Senate Russell Building. Tim Andrews (TPA’s Executive Director) will be moderating with an all-star lineup featuring Ross Marchand (TPA), Daren Bakst (Heritage Foundation), Guy Bentley (Reason), and Angela Erickson (Pacific Legal Foundation). The FDA regulates many things that impact our daily lives, including medicines, tobacco products (a distinction that bizarrely includes tobacco-less vaping products), and yes, pet food. The panel will be a good opportunity to hear from experts about key issues facing the FDA, and how the agency could do better. We will also be releasing a new report, Reforming the FDA: Saving Money, Saving Lives. Please feel free to RSVP to me directly if you would like to attend.


A Not-So-Happy Fiscal New Year


The end of the fiscal year is on Monday, September 30th. And, of course, that means the new fiscal year is October 1st. The silence by both parties about passing spending bills or addressing the deficit and debt is deafening. It’s as if neither party cares about the fiscal future of the country. I am disappointed, but certainly not surprised. Republicans and Democrats agreed to a budget deal in late July that increased spending levels across the board and, to add insult to injury, lawmakers and the White House agreed to suspend the debt ceiling altogether until July 31, 2021. This reckless move gives the federal government the green light to request and approve as many wasteful programs as possible over the next two years, without bearing any fiscal responsibility whatsoever. This irresponsible buck-passing will embolden the Pentagon to continue its wasteful, unnecessary F-35 program, and keep federal subsidies flowing to large, successful agri-businesses.



There is no excuse for ignoring the deficit. Members of Congress often claim that they don’t know where to cut spending. Well, we have two resources to help: the Heritage Foundation’s “Blueprint for Balance ([link removed]) ” lists $10.8 trillion in potential savings over the next decade and Sen. James Lankford’s (R-Ok.) annual “Federal Fumbles ([link removed]) ” report outlines $4.7 trillion in potential savings over the next decade. Sen. Joni Ernst (R-Iowa) offered legislation this week that would stop the end-of-year spending spree by government agencies. You can find a useful overview ([link removed]) of the bill on her Senate webpage: “Senator Ernst’s bill, the End-of-Year Fiscal Responsibility Act ([link removed])
, would limit an agency’s spending in the last two months of the year to no more than the average it spent per month during the first ten months of the year. Last year alone, federal agencies spent $53 billion in taxpayer money during the final week of the fiscal year, on everything from lobster tail and crab to a foosball table. ([link removed]) ”


Hospice Care Reform


Hospice care may be one of the most important healthcare services available to Americans. Patients and their families are at the most difficult times in their lives, but hospices continue to deliver excellent care and ensure comfortable end-of-life care. But hospices reasonably worry about regulatory uncertainty and labyrinth Medicare payment policies that have placed significant limits on growth and investments. By increasing transparency and streamlining rules, policymakers can make sure that end-of-life patients continue to get the care they deserve and save taxpayers money.


Before the 1980s, hospices relied almost exclusively on volunteers and donations and the system was unlikely to scale nationwide. The Medicare benefit (enacted in 1983) relieved those fears, and saved taxpayers billions of dollars by shifting resources to institutions that charged a fraction of what intensive-care units charge the government. But as soon as federal agencies got involved in hospice care, providers were forced to answer to the government rather than their patients.


Unlike Medicare, the Department of Veterans Affairs (VA) covers concurrent care and spends less overall on expensive end-of-life care as a result. A 2018 Health Affairs study examining different funding models and spending outcomes found that VA cancer patients “are less likely to receive excessive end-of-life interventions than those treated through Medicare.” Medicare patients may prefer less-costly ways to approach the end of their lives, but many are reluctant to enter hospice care because of the perceived “slamming the door” to any and all treatment. MedPAC notes that, as a result, less than half of eligible Medicare beneficiaries make the decision to cut off treatment and embrace hospice care. This terrible choice is a costly one, leading to a worse quality of life for terminally ill patients and around $9,000 in additional costs on taxpayers during the last year of life. A 2019 study by the National Hospice and Palliative Care Organization found that, in the last two weeks of life
alone, traditional care costs over $7,000 more than hospice care. Strict, illogical payment rules are just one aspect of the federal government’s failing approach toward hospice care. The IMPACT Act of 2014 mandates federal hospice inspections every three years, extensive data reporting, and required surveying of deceased patients’ family members. This sounds all well and good, but there’s little evidence that these costly measures improve outcomes.


Without payment reform and regulatory streamlining, hospice care will prove far more expensive and fragmented than it needs to be. Fortunately, Medicare is piloting a program that would allow recipients to enter hospice care while still receiving treatment for their illnesses. This is a step in the right direction and should be accompanied by additional cost-cutting reforms. The millions of Americans entering the sunset of their lives deserve sensible policies that make hospice care as accessible as possible.


Blogs:


** Monday: Under a President Sanders, UAW-style strikes would be a regular occurrence ([link removed])
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** Tuesday: Taxpayer Watchdog Praises Kennedy in Push for Public C-Band Auction ([link removed])
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** Wednesday: Watchdog Condemns Massachusetts Vaping Ban ([link removed])
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** Thursday: Watchdog Praises Trump Administration for International Postal Victory ([link removed])
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Media:


September 21, 2019: The Sunshine State News (Florida) mentioned TPA in their story, “Dan Webster Wants the Feds to Follow Florida's Lead in Extreme-Weather Situations.”


September 22, 2019: St. Louis Public Radio mentioned TPA in their story, “McCaskill, Blunt at odds on permanent earmark ban.”


September 22, 2019: News Talk 99.5 WRNO (New Orleans, La.) interviewed TPA policy director Ross Marchand on surprise billing issues and healthcare reform.


September 23, 2019: Townhall ran TPA’s op-ed, “Taxpayers and Consumers Need Beware of Costly, 'Green' Trojan Horses.”


September 23, 2019: Newsmax TV interviewed TPA external relations director Grace Morgan about vaping and FDA reform.


September 23, 2019: The News-Graphic (Georgetown, Ky.) ran TPAF senior fellow Johnny Kampis’ op-ed, “As taxpayer-funded Kentucky Wired sputters, reports show record broadband deployments by ISPs.”


September 23, 2019: WSLA (Slidell, La.) interviewed TPA policy director Ross Marchand on surprise billing issues and healthcare reform.


September 24, 2019: Corporate Secretary mentioned TPA in their story, “Senators introduce bill to extend whistleblower protection.”


September 25, 2019: The Guardian quoted TPA in their story, “Juul CEO steps down amid sudden spike in vaping-related illnesses.”


September 25, 2019: The Epoch Times (Washington, D.C.) quoted TPA in their article, “Iowa Republican Joni Ernst Emerging as Senate’s Top Foe of Government Waste.”


September 25, 2019: The Center Square ran TPAF senior fellow Johnny Kampis’ op-ed, “State auditor taking another look at KentuckyWired.”


September 25, 2019: The Appalachian News-Express (Pikeville, Ky.) ran TPAF senior fellow Johnny Kampis’ op-ed, “State auditor taking another look at KentuckyWired.”


September 25, 2019: The Hazard Herald (Hazard, Ky.) ran TPAF senior fellow Johnny Kampis’ op-ed, “State auditor taking another look at KentuckyWired.”


September 25, 2019: KPVI (Pocatello, Id.) ran TPAF senior fellow Johnny Kampis’ op-ed, “State auditor taking another look at KentuckyWired.”


September 25, 2019: The Highland County Press (Hillsboro, Ohio) ran TPA’s op-ed, “Under a President Sanders, strikes would be a regular occurrence.”


September 25, 2019: The Press and Journal (Middletown, Pa.) mentioned TPA in their story, “State Rep. Mehaffie took money from Exelon PAC.”


September 25, 2019: China Global TV Network America interviewed TPA policy director Ross Marchand to discuss the Universal Postal Union and international shipping rates.


September 25, 2019: WMAP (Long Island, NY) interviewed TPA executive director Tim Andrews about New York’s ban on flavored vaping products.


September 26, 2019: Catalyst ran TPA’s op-ed, “FDA Must Allow, Not Thwart, Genetic Testing Revolution.”


September 26, 2019: The Washington Examiner (Washington, D.C.) ran TPA’s op-ed, “You don’t need to block DC traffic to slash pollution.”


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September 26, 2019: WBFF (Fox, Baltimore) interviewed me about a potential private audit of the city of Baltimore.


September 27, 2019: TPA policy director Ross Marchand appeared on “Live and Lansing” (1320 WILS; Lansing, Mi.) to discuss surprise billing issues and healthcare reform.


September 27, 2019: WBSM (Boston, MA) interviewed TPA executive director Tim Andrews about Massachusetts’ ban on vaping products.
September 27, 2019: Inside Sources ran TPA's op-ed "The Real Issue Fueling Hong Kong Protests."

Have a great weekend, and as always, thanks for your continued support.

Best,
David Williams
President
Taxpayers Protection Alliance
1401 K Street, NW
Suite 502
Washington, D.C. xxxxxx
www.protectingtaxpayers.org ([link removed])

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