(WASHINGTON, D.C.) – U.S. Senator Tom Coburn, M.D. (R-Okla.), Ranking Member of the Homeland Security and Government Affairs Committee, released the following statement regarding the White House cyber intrusions reported Tuesday:

“I’m deeply concerned about the reported attacks on White House networks.

“We’ve worked very closely with the administration to improve our nation’s cybersecurity. This year, Chairman Tom Carper and I came together to craft legislation, the Federal Information Security Modernization Act (S. 2521) to help secure federal networks from these sorts of attacks. We included the White House in our negotiations, to make sure we got it right.

“So I’m disappointed that the White House decided not to notify Congress of the breach, even as its officials debated with my staff the need for agencies to tell Congress when they’ve been hacked.

“I have pressed the administration to share details about what has happened and how the attack succeeded. I have yet to receive satisfactory answers. Let us seize this opportunity to work together to protect against this very serious threat to our national security and economy.”

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WASHINGTON –According to a recent report by the Government Accountability Office (GAO), the Department of Defense (DOD) spent tens of millions of dollars in unnecessary returns of surplus vehicles from Afghanistan to the United States during a one year period. Today, a bipartisan group of Senators on the Committee on Homeland Security and Governmental Affairs highlighted the report findings.

The report, Afghanistan Equipment Drawdown: Progress Made, but Improved Controls in Decision Making Could Reduce Risk of Unnecessary Expenditures (GAO-14-768), found that during a one-year period, the United States Army and Marine Corps returned more than 1,000 military surplus vehicles from Afghanistan to the United States, even though the vehicles were not determined to be needed and therefore should not have been returned. The cost of returning a vehicle to the U.S. is upwards of $100,000 per vehicle - for a total cost as high as $100 million in unnecessary shipments during the period of time examined by GAO. The vehicles in question were no longer needed by the military. The report found that if the Army and Marine Corp had followed Department of Defense proper rules and procedures, the services would have either transferred the surplus vehicles to appropriate overseas allies or scrapped the vehicles in Afghanistan, saving a significant amount of money in logistical and shipping costs.

Senator Carper, Chairman of the Committee on Homeland Security and Governmental Affairs:“This report is a troubling reminder that the Department of Defense has more work do in managing taxpayer dollars. The Government Accountability Office underscores that the DOD can and should do a much better job in preventing unnecessary costs by taking some common sense steps in managing its surplus military vehicles. We simply cannot afford this type of waste and ineffectiveness. Given the tremendous fiscal challenges our government faces, we have an obligation to look in every nook and cranny of our budgets for savings. I believe this is an area where simple yet effective improvements can be made to achieve better results for less money.”

Dr. Coburn, Ranking Member of the Committee on Homeland Security and Governmental Affairs:“Until DOD leadership gets serious about financial management and fundamentally changes the way the Department manages its business and holds itself accountable, Americans will continue to see DOD waste scarce taxpayer dollars. Despite the Department’s assurances that it is making progress and working hard to be better stewards of taxpayer dollars, we see examples like this time and again. Especially in this budgetary environment, actions matter more than empty promises.”

Senator McCaskill, Chairman of the Subcommittee on Financial and Contracting Oversight: “At a time when we’re turning over every rock to find savings for taxpayers—and while we’re engaged in a national conversation about the use of military equipment at home—this kind of waste is unacceptable. I expect military leaders to take these findings seriously and do better.”

Senator Tester, Chairman of the Subcommittee on Efficiency and Effectiveness of Federal Programs and the Federal Workforce: “This issue deserves the highest level of attention and oversight,” Tester said. “While I understand the Defense Department is operating under intense time and budget pressures, we must use common-sense when it comes to spending taxpayer dollars – especially when Americans have already paid a steep price for this conflict.”

(WASHINGTON, D.C.) – A recent Washington Post article identified employee turnover and poor morale as challenges at the Department of Homeland Security that will prevent DHS from achieving its mission of securing the nation. Senator Tom Coburn (R-OK) reiterated his confidence in Homeland Security Secretary Jeh Johnson and urged patience in allowing the Secretary time to change the culture within the Department. 

“Few members of Congress have raised more questions about the Department and its programs than I have,” commented Dr. Coburn, ranking member of the Senate Homeland Security and Governmental Affairs Committee. “But I have the utmost confidence in Secretary Jeh Johnson’s ability to lead and reform the Department. You cannot fix problems that have developed over many years overnight, and the Secretary deserves our patience as he works to change the culture at DHS.”

“Over the past year, we have seen positive steps at DHS, including efforts to strengthen management and coordination among the Department’s many components and offices. We have also seen Sec. Jeh Johnson take decisive actions to fix problems and curb waste within DHS, such as abusive overtime practices. Some of those decisions may be unpopular but they are the right thing to do,” Dr. Coburn continued. 

One of the challenges identified in the Washington Post report was vacancies in key leadership positions within DHS. Led by the Senate Homeland Security and Governmental Affairs Committee, the Senate has confirmed 9 key DHS nominations since Sec. Johnson’s confirmation. “With very few exceptions, our committee has supported the President’s nominations for DHS with broad, bipartisan support. We are working hard to give Secretary Johnson the senior leadership team he needs. Changing the culture within a bureaucracy is always a challenge and to do it successfully requires real and committed leadership which I believe Jeh Johnson is providing. Congress needs to play its part through oversight to assist the Secretary to identify areas that need improvements and pass bills to give him the authority to make the necessary changes, such as reducing unnecessary duplication or adding measurable outcomes and performance goals.”

Washington, DC – The U.S. Senate last week passed a bipartisan bill to expedite the consolidation of federal data centers that could save up to $3 billion in taxpayer dollars. The bill sets hard deadlines and requires federal agencies that have yet to act on consolidation initiatives to conduct inventories and implement consolidation strategies. In addition, the law would require the Government Accountability Office (GAO) to verify agency data center inventories, and would direct the Office of Management and Budget (OMB) to routinely report to Congress on cost savings realized to date.

The Federal Data Center Consolidation Act was introduced by U.S. Senators Michael Bennet (D-CO), Tom Coburn (R-OK), and Kelly Ayotte (R-NH) in October 2013. Senate Homeland Security and Government Affairs Chairman Tom Carper (D-DE) joined the effort and helped usher the bill through the committee last November.

“This bill represents a smarter, more efficient way to operate government and save taxpayer dollars. It will also reduce the federal government’s energy consumption across the country,” Bennet said. “OMB set ambitious but achievable goals that federal agencies are not on track to meet. We’re proposing to hold them accountable in these efforts.”

“The Federal Data Center Consolidation Act builds upon OMB’s efforts to reduce duplication in federal data centers. GAO has described this legislation as ‘essential’ to ensuring agencies make adequate progress in consolidating their data center inventories and saving taxpayers money,” Dr. Coburn said. “The bill is a crucial component in our efforts to reform the way the federal government acquires and manages IT.”

“The Administration’s Federal Data Center Consolidation Initiative is an ambitious challenge that is worth meeting. While evidence shows a major shift in the way the federal government thinks about and pursues IT management in its operations, it’s clear that some agencies have more work to do,” Chairman Carper said. “We need to salute the success stories and push those agencies that have fallen short to work harder. This measure is part of a larger effort to improve our federal government’s IT management and will help agencies focus their efforts on consolidation, better manage their inventories, and ensure that the Administration’s Consolidation Initiative is seen through to its conclusion. I want to thank Senators Coburn, Bennet, and Ayotte for their work on this important issue.”

“With over $17 trillion in debt, there’s no excuse to continue to spend millions on wasteful and unnecessary federal data centers – some of which are utilizing only a fraction of their capacity,” said Ayotte. “I’m pleased that the Senate passed our bipartisan bill, which will save taxpayer dollars by speeding up consolidation and increasing the efficiency of data centers across government.”

A number of studies have shown a relatively low utilization rate of the current IT infrastructure, resulting in an enormous amount of wasted space and energy – and unnecessary costs. In 2010, the Office of Management and Budget (OMB) instructed federal agencies to develop consolidation plans under the administration’s Federal Data Center Consolidation Initiative (FDCCI), which could save up to $3 billion by 2015, according to the GAO, with additional savings beyond that date. However, the GAO also found that a number of agencies have been slow to implement these plans – or, in some cases, to even inventory the total number of data centers they currently manage.

The GAO has publicly endorsed the legislation, saying it is vital to ensure that agencies close down unnecessary data centers by the target deadline. The senators have worked closely with OMB and GAO to ensure that this bill will help strengthen the initiative and achieve meaningful savings.

The bill is also supported by the Professional Services Council and the Information Technology Industry Council.

The lawmakers previously filed the bill as an amendment to the Energy Savings and Industrial Competitiveness Act of 2013 and to the FY 2014 National Defense Authorization Act.

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(WASHINGTON, D.C.) – Today, U.S. Senators Tom Coburn (R-OK) and Mazie Hirono (D-HI) introduced S.2852, the State Regulatory Representation Clarification Act of 2014 which would clarify Congressional intent that the Board of the Federal Deposit Insurance Corporation (FDIC) should include at least one individual who has worked as a state bank regulator.

“Washington does not always know best, and it is important that Congress reaffirms and clarifies its intent that the FDIC will benefit from the view of those with firsthand experience regulating the banking industry at the state level,” Dr. Coburn said. “Our financial regulatory framework needs multiple perspectives, and the state bank regulatory perspective is a critical ingredient in that mix.”

“Hawaii families and businesses face unique circumstances and rely on local banks and credit unions that understand those circumstances to help them buy new homes or get a loan to start a new business,” said Hirono. "In fact, seven of the twelve banks in Hawaii are state chartered, accounting for 84 percent of the small business loans made in the state. It is important that people who understand the  perspective of community banks and how they serve different communities are represented on the FDIC board.”

We know the consequences of an assumption that all good ideas come from Washington. State banking regulators bring an essential point of view to local credit markets and the role of banks in communities throughout the country.

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(WASHINGTON, D.C.) – Reducing Crop Insurance subsidies for America’s wealthy farmers could save hundreds of millions annually for taxpayers, according to a new report from the Government Accountability Office (GAO). GAO’s report examined the effects of reducing the federal subsidy for crop insurance revenue policies, and found possible savings of nearly $2 billion per year with little effect on farmers’ total production cost per acre.

“This report provides us a blueprint on how to save hundreds of millions of dollars with little impact on our farm industry.” Dr. Coburn said. “The Federal Government needs to get out of the business of subsidizing the wealthiest farmers.”

GAO’s report notes that the cost to the federal government of the crop insurance program increased from an average of $3.4 billion per year from 2003 through 2007 to an average of $8.4 billion per year from 2008 through 2012, peaking at $14.1 billion in 2012, a new record. During this time period, the rate of premium subsidies provided by the federal government increased from 37 percent to 63 percent and the amount of acreage covered by the program increased dramatically, all while the farm industry was bringing in record profits.

The GAO report also found median farm household income was significantly higher than median income for all U.S. households in 2012. While the median income for all U.S. households was $51,017, households associated with farms specializing in cash grains such as corn or soybeans had a median household income of about $82,300 and farms specializing in a few choice crops (rice, tobacco, cotton, and peanuts) netted a median income of $101,400. Success does not need a government subsidy.

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WASHINGTON, D.C. — Today the Oklahoma delegation criticized the Obama Administration for failing to approve a one-year extension of Oklahoma’s Elementary and Secondary Education (ESEA) Flexibility:

"The Obama Administration doesn't like when Oklahomans buck big government regulations, and today the Administration responded by penalizing our children with failing to grant the one-year extension of the ESEA flexibility," said Sen. Jim Inhofe."Oklahomans want education reform that sets standards created and certified by Oklahoma's institutions, community leaders, and parents. Instead of supporting these values, the Obama Administration has chosen to make it more expensive and difficult to achieve the state's education goals that, once met, will exceed the requirements set by the U.S. Department of Education. As seen with ObamaCare taxes or the Endangered Species Act rulings, today's decision continues the trend of this Administration punishing Oklahoma for making decisions that represent the goals and interests of its constituents." 

“Greater state and local control over education funding is vital to the success of Oklahoma's students,” said Sen. Tom Coburn. “The experiment in federal micro-management of our nation's schools has proven to be a failure. This is what makes the Secretary's decision to revoke Oklahoma's ESEA flexibility so disappointing. As Oklahoma takes concrete steps to ensure our students are prepared for their future careers, the Department should give our schools the flexibility they need to succeed.”

“The revocation of Oklahoma’s NCLB waiver—just as students begin a new school year—demonstrates this Administration’s unwillingness to allow states the time to establish state-specific, high academic standards,” said Rep. James Lankford. “The Administration granted an education funding waiver if Oklahoma would accept Common Core or if our state would establish college-ready standards. In May, our state chose to reject the Common Core standards and began writing our own. Because of that decision, the Administration has chosen to revoke what little flexibility and clarity Oklahoma educators were allowed by the federal government to help our students and teachers succeed amid a one-size-fits-all federal approach to education policy. The actions of the Administration today increase bureaucracy and decrease time to focus on academic standards.  

“This is a glaring example of why the federal government should not dictate local education policy. In July of last year, the U.S. House passed an Elementary and Secondary Education Act (ESEA) reauthorization to protect local schools from new federal red tape and to provide school districts the flexibility to identify, recruit and retain the best teachers possible. Centralized, federally mandated curricula, inside-the-Beltway education funding priorities and impossible federal standards are not the answers to improve education in our nation.”

“Our state stood firm against further federal intrusion into the education of our children by rejecting the Common Core curriculum and determining that local educational leaders could best develop the appropriate curriculum for Oklahoma students,” said Rep. Jim Bridenstine. “Instead of applauding this constitutional decision and leadership, the Obama Administration decided today to reject the requested one year extension of flexibility previously granted to Oklahoma under ESEA. This politically motivated decision is the perfect example of how the unconstitutional federalization of education has effectively taken away the power reserved for the states and the people by our founders. It's time to abolish the federal Department of Education and return power to the states consistent with the 10th Amendment.”

“I'm very frustrated by this decision not just as an Oklahoma Representative but also as a parent with children in public school,” said Rep. Markwayne Mullin. “Like many Oklahoma families, my family depends on public education, and this irresponsible action promises to weaken our state's ability to provide our youth with the education they need to be successful.” 

"Oklahoma's educators deserve maximum flexibility in order to provide our students with the tools to succeed,” said Rep. Frank Lucas. “Today's decision reflects just how out of touch the Obama Administration is when it comes to the needs of Oklahoma's students, and I urge the President to reconsider extending this critical education measure."

"Although the waiver was not granted, I hope that the Department of Education works with the state to ensure a smooth transition,” said Rep. Tom Cole. “Changing the standards for a school year that has already begun is untenable and will not only be rushed but will likely be difficult to implement. I am disappointed that the Administration would cause such an unfair strain on the system in Oklahoma."

On Aug. 25, the Oklahoma Delegation sent a letter to the Secretary of the U.S. Department of Education Arne Duncan requesting the agency to consider a one-year extension of Oklahoma’s Elementary and Secondary Education Act (ESEA) Flexibility. The extension would allow for Oklahoma to continue developing elementary and secondary education standards in conjunction with institutions of higher education in order to meet and exceed the U.S. Department of Education’s requirements. 

The Delegation wrote, “On behalf of the State, we request that Oklahoma be afforded this one-year extension of the ESEA Flexibility in order to allow state leaders and educators the opportunity to focus on the development and implementation of Oklahoma college- and career- ready standards, as well as other State education reforms necessary to continue supporting the Principles of ESEA Flexibility.”

You can read the full text of the letter by clicking here. 

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WASHINGTON – Today, a bipartisan group of 12 lawmakers from the U.S. Senate and U.S. House of Representatives highlighted a new Government Accountability Office (GAO) report entitled, “Medicare Program Integrity: Increased Oversight and Guidance Could Improve Effectiveness and Efficiency of Postpayment Claims Reviews.”  The report, which was undertaken following a bipartisan and bicameral request to GAO, found that the Centers for Medicare & Medicaid Services (CMS) should take additional steps to improve sufficient oversight and guidance to ensure contractor compliance with CMS regulations and to prevent claim review duplication during the auditing of Medicare providers and suppliers.

CMS utilizes four types of contractors (Medicare administrative contractors, error rate contractors, recovery auditors and anti-fraud contractors) to conduct postpayment reviews of Medicare claims in an effort to control and reduce improper payments.  Each contractor has a unique role in combating improper payments. However, the lack of CMS guidance and clear requirements has resulted in duplicative work by various contractors and a lack of consistency in the communications between the contractors conducting audits and the providers/suppliers being audited. 

The provider community has raised numerous concerns about the consistency and accuracy of the audit process over the past few years and this report is the first effort to determine what steps could be taken to improve the process.  The information in this report can now be used by Congress and CMS to help make improvements and ensure more consistent oversight of both the contractors and audit process.

Key findings from the GAO report follow and a full copy of the report can be found HERE:

• CMS’s Current Duplication Reduction Efforts are Insufficient: CMS established the Recovery Audit Data Warehouse to track recovery audit activities thereby preventing duplication of reviews.  However, the database was not designed to provide information on all possible duplication, and its data are not reliable because other postpayment contractors did not consistently enter information about their reviews. CMS has not provided sufficient oversight of these data or issued complete guidance to contractors on avoiding duplicative claims reviews.

• Communication Between Recovery Auditors and Providers is Flawed:CMS requires auditors to include certain content in correspondence with providers, but requirements are not always clear and vary across contractor types.  Contractors vary in their compliance with their requirements. CMS’s oversight of correspondence varies across contractors, which decreases assurance that contractors consistently comply with requirements. In the correspondence reviewed, GAO found high compliance rates for some requirements, but low compliance rates for requirements about communicating providers’ rights, which could affect providers’ ability to exercise their rights. 

• Current CMS Coordination Strategies Should be Improved: CMS has strategies to coordinate contractors’ activities; however, these strategies have not led to consistent requirements across contractor types or full coordination between contractors.

CMS concurred with the findings of the report and plans to improve CMS oversight and guidance as a result.

The report was requested by Sen. Ron Wyden (D-Oregon), Finance Committee Chairman; Sen. Orrin Hatch (R-Utah), Finance Committee Ranking Member; Sen. Tom Carper (D-Delaware), Homeland Security and Governmental Affairs Committee  (HSGAC) Chairman;  Sen. Tom Coburn (R-Oklahoma), HSGAC Ranking Member; Sen. Chuck Grassley (R-Iowa), Judiciary Committee Ranking Member; Sen. Claire McCaskill (D-Missouri), HSGAC Subcommittee on Contracting Oversight Chairwoman; Sen. Bob Corker (R-Tennessee); Rep. Fred Upton (R-Michigan), Energy and Commerce Committee Chairman; Rep. Henry A. Waxman (D- California), Energy and Commerce Committee Ranking Member; Rep. Charles Boustany, M.D. (R-Louisiana), Ways and Means Subcommittee on Oversight Chairman; Rep. John Lewis (D-Georgia), Ways and Means Subcommittee on Oversight Ranking Member; and Rep. Dianna DeGette (D-Colorado), Energy and Commerce Subcommittee on Oversight and Investigations Ranking Member.

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A billionaire’s fantasy island, Emmy award winning producers, Goldman Sachs, Broadway music from Hollywood, Starbucks, and even dolphins benefited from a tax credit intended to help struggling communities and lower income Americans seeking new opportunities. 

“Banking on the Poor,” a new report released today by Senator Tom Coburn (R-OK) reveals the federal New Markets Tax Credit program is benefitting big banks and private investors that are claiming more than $1 billion of the credit annually. 

The program was created to spur new markets, but is instead subsidizing the same old companies and corporations in little need of taxpayer assistance, like Wall Street banks and fast-food chains and luxury hotels.  It is also providing financing for unnecessary and silly projects such as a sculpture in the desert, a vintage car museum, and doggie days cares. In at least one case, a project supported with a New Markets Tax Credit is threatening to bankrupt an entire town and eliminate jobs, including the entire police department.

“The New Market Tax Credit is a reverse Robin Hood scheme paid for with the taxes collected from working Americans to provide pay outs to big banks and corporations in the hope that those it took the money from might benefit,” stated Senator Coburn.  “When government picks winners and losers, the losers usually end up being taxpayers.  Washington should reduce federal taxes on working Americans and all business owners who create jobs by eliminating tax earmarks, loopholes, and giveaways like the New Markets Tax Credit.” 

The New Markets Tax Credit program was expected to steer private financing into low-income communities to help create jobs.  Yet, virtually every neighborhood, from Beverly Hills to the Hamptons, could qualify for the program. “As a result of the definition of qualified low-income communities, virtually all of the country’s census tracts [neighborhoods and communities] are potentially eligible for the NMTC,” according to the nonpartisan Congressional Research Service.[i]

While some of the projects are well intended, like health clinics, it is still difficult to measure if these tax expenditures are truly helping those seeking a hand up or simply subsidizing banks, corporations, and others companies that are already succeeding. 

The program duplicates over 100 other federal economic development efforts. There are at least 23 community development tax expenditures costing taxpayers over $10 billion annually and 80 overlapping discretionary programs costing $6.5 billion annually, 28 of which are specifically designed to spur growth in new markets.  Because of this redundancy, many projects and corporations are double dipping on taxpayers—receiving multiple federal subsidies through other grant programs and tax giveaways.  Furthermore, it is unclear which of these best meets the overlapping goals, or if any of them spur more economic growth than policies encouraging private investments that do not spend taxpayer money.

A separate Government Accountability Office report issued today, also critical of the New Markets Tax Credit program, revealing:

• The fees charged by the CDEs reduced the amount of assistance provided to low-income community projects by $619 million (7.1 percent) from 2011 to 2012;
• A majority of NMTC-financed projects utilize more than one source of public funding, despite the purpose of the tax credit being to leverage private investment;
• Nearly two-thirds (62 percent) of New Markets projects received other public funding from 2010 to 2012; and
• New Markets investors are able to claim the tax credit on the equity provided by the other public sources.

(WASHINGTON, D.C.) – Less than seven percent of the spending information reported to USASpending.gov is accurate. More than $600 billion in spending is completely missing, according to a new report by the Government Accountability Office.

In 2006, Dr. Coburn, along with then-Senator Barack Obama, introduced the Federal Funding Accountability and Transparency Act (FFATA), which was signed into law by President Bush.  The law required the creation of a single website to track all federal spending. In order to address the inconsistency of the information on USAspending.gov, Senators Coburn, Portman, Warner, and Carper passed the DATA Act, a bill originally introduced by Congressman Issa that improves the reporting required under FFATA and requires the posting of even more granular information. 

“The administration set a goal of 100% accuracy by the end of 2011,” Dr. Coburn said, “Three years later the federal government cannot even break a 10% accuracy rate. This complete failure in spending transparency hurts our ability to assess the pros and cons of how Washington spends tax dollars. It is disappointing that the federal bureaucracy is so vast and unaccountable that the Administration cannot enact the president’s signature accomplishment as a senator requiring the government to disclose how and where it spends money. Without transparency there can be no accountability,”

“We live in a world in which information drives decisions and, given the budget constraints that our government faces, we need reliable information on how and where our money is being spent. By increasing the availability, accuracy, and usefulness of federal spending information, we enhance government transparency, improve accountability, and reduce wasteful government spending,” Chairman Carper said. “This latest GAO report underscores the federal government’s ongoing challenges when it comes to showing the American people how their tax dollars are being used, at what cost, and with what result. That’s why efforts like the DATA Act are so important. The bipartisan DATA Act takes an important first step towards the establishment of government-wide financial data standards, which will significantly improve the ability of policy makers and the public to analyze how federal tax dollars are being spent. But as with any legislation, Congress’ job does not end when the President signs the bill. Fortunately, this report will help guide us in our efforts as we work with the Administration to ensure that the DATA Act is properly implemented. I urge the Administration to follow through with GAO’s recommendations and I will continue to collaborate with my colleagues in Congress as we work toward a more transparent and responsive government.” 

"At a time when the government is running trillion-dollar deficits on top of a record $16 trillion debt, Washington should be doing all it can to track how taxpayer dollars are spent,” Portman stated. “This report is more evidence that we need the transparency and visibility that comes with the DATA Act now more than ever so we can identify and eliminate wasteful spending.”

“It is completely unacceptable that the federal government continues to struggle to report even the most basic information on how taxpayer resources are spent. Congress cannot conduct effective oversight if spending information is unreliable, and taxpayers are rightly frustrated when information isn’t accurate or easily accessible,” Warner said. “This is exactly why I authored and Congress enacted the Digital Accountability and Transparency Act earlier this year, which will modernize the way federal financial data is collected and reported.”

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(WASHINGTON, D.C.) – Bipartisan legislation that would increase public transparency around financial settlements reached by federal enforcement agencies, The Truth in Settlements Act, is one step closer to become a reality. Originally introduced by U.S. Senators Tom Coburn, M.D. (R-OK) and Elizabeth Warren (D-MA), the bill passed the Senate Homeland Security & Governmental Affairs Committee today.

"Taxpayers deserve to know the settlement details corporations arrange with the government, and the best place for Congress to start is with policies that enhance transparency," Dr. Coburn said. "Since agencies are not currently required to disclose the financial structure of government settlements, too often the true value of those settlements is not known because often companies are allowed to deduct part of the payment. Our bill gives taxpayers the transparency tools they need to access real information and numbers regarding enforcement settlements." 

“When government agencies reach settlements with companies that break the law, they should disclose the key terms of those deals to the public," said Senator Warren. "Today’s vote moves us one step closer to increased transparency and stronger accountability around government settlements. This bill will help shut down backroom deal-making and ensure that Congress, citizens and watchdog groups can hold regulatory agencies accountable for stronger and more effective enforcement to the law." 

When federal agencies settle cases, they often tout the dollar amount obtained from the offender, but in many cases that amount is misleading because of tax deductions and other "credits" built into the settlement that reduce the settlement's true value. Worse, sometimes agreements are deemed confidential, with key details or even the fact of a settlement hidden from the public. The Truth in Settlements Act will require more accessible and detailed disclosures about these agreements to allow the public to hold regulators accountable for the true value of these deals.

Under the Truth in Settlements Act, any agency that issues a written public statement that references the amount to be paid under a settlement will be required to include explanations of how those payments are categorized for tax purposes and whether those payments may be offset by "credits" for particular conduct. Companies that settle with enforcement agencies will be required to disclose in their Securities and Exchange Commission (SEC) filings whether they have deducted any or all of the dollar amounts of their settlements from their taxes; and federal agencies will be required to post basic information about settlements and provide copies of those agreements on their websites.

(WASHINGTON, D.C.) – Today, U.S. Senators Tom Coburn, M.D. (R-OK) and Tom Carper (D-DE) introduced S. 2651, the Department of Homeland Security Office of Inspector General Mandates Revision Act of 2014, which would eliminate excessive, unread and outdated reports mandated by federal law.  

“Congress mandates hundreds of reports that often waste valuable time and resources on unnecessary and outdated products that no one reads.   S. 2651 attempts to relieve this burden for the Department of Homeland Security’s Office of Inspector General.  This legislation will provide flexibility for the office to perform more important audits vital to its oversight function and mission of preventing waste, fraud, and abuse,” Dr. Coburn said.  “These outdated reports are largely busy work that does not result in any real changes.  This bill eliminates these wasteful reporting requirements that cost taxpayers a total of $7.8 million last year, and do little to help the Department of Homeland Security better protect our nation.  Instead of mandating reports, Congress should mandate results and conduct real oversight to make sure agencies are operating efficiently.”   

“In an agency as large and important as the Department of Homeland Security, the Office of the Inspector General is a critical ally,” said Chairman Carper. “It is our duty in Congress to conduct fruitful oversight and ensure that the role and functionality of the Inspector General is fully supported. This measure is an important step that will eliminate certain wasteful reports that often restate information already provided by federal agencies, as well as enhance the Inspector General’s ability to deter waste, fraud and abuse within the Department. It will also enable the Department’s Inspector General and Congress to spend more time working together to recommend ways for the Department to carry out its critical responsibilities in the most effective and efficient ways possible.”

See a summary of the legislation here.

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(WASHINGTON, D.C.) – Today, Homeland Security & Government Affairs Committee Ranking Member Tom Coburn (R-OK), Finance Committee Ranking Member Orrin Hatch (R-UT), Ways and Means Committee Chairman Dave Camp (R-MI), and Oversight Subcommittee Chairman Charles Boustany Jr., M.D. (R-LA) released the preliminary results of a Government Accountability Office (GAO) undercover examination of enrollment controls in the ObamaCare health care exchanges. 
 
As part of a “secret shopper” investigation, GAO created 18 fictitious identities to apply for premium subsidies through the federal Exchange by telephone, online and in-person.  With only one exception, GAO was able to get premium tax credits and health insurance with fake information through telephone and online applications.  The results of their investigation are as follows:
 
11 out of 12 Fake Applications Approved: Out of 12 applications with fake information for the Federal exchanges, 11 were approved.  The total amount of these credits was $2,500 per month or $30,000 per year and is currently being paid out for insurance policies for these fictitious individuals.
 
Applications with Fake Documents of Citizenship and Income Approved: Investigators provided fake documents, such as Social Security Numbers and proof of income and citizenship, which proved to be no barrier to getting taxpayer-funded credits.  Additionally, investigators found that federal contractors made no effort to authenticate documents applicants provided.
 
In-Person Assisters Nowhere to be Found: GAO made six in-person attempts to sign up for federal subsidies.  GAO was unable to obtain assistance in five of those attempts for a range of reasons including one navigator stating assistance was not available because HealthCare.gov was down and another declining to provide assistance.  These assisters have received tens of millions of dollars in federal grants to provide services to applicants.

Ranking Member Tom Coburn: “GAO’s early results of its audit ofHealthcare.gov are astounding.  Fictitious people have used fictitious documents to gain tens of thousands of dollars in real subsidies.  Yet, before subsidies were paid in January, the former secretary ‘certified’ the proper controls were in place to prevent these kinds of improper payments.  Given GAO’s evidence and the OIG’s findings earlier this month, we have seen consistent problems in how HHS has implemented Healthcare.gov.  Far from fictitious, this kind of incompetence and gross mismanagement is unacceptable and deeply troubling.  At a time when we’re facing a $17 trillion debt, it is imperative that HHS take the necessary steps to address the problems identified in GAO’s report.”

Finance Committee Ranking Member Orrin Hatch: “Ironically, the GAO has found Obamacare is working really well – for those who don’t exist.  When the Administration deemed the conversation about Obamacare over after reaching enrollment targets, they were dead wrong.  These appalling findings not only question the validity of their numbers but show this poorly drafted law’s massive vulnerabilities to rampant waste and fraud.  From the outset, I have raised the alarm on the enormous fraud and abuse implications of this ill-conceived law.  Now the question is: Will this Administration finally own up to the taxpayer funded sinkhole this law has turned into and protect American families and taxpayers moving forward?”
 
House Ways and Means Committee Chairman Camp: “We are seeing a trend with ObamaCare information systems: under every rock, there is incompetence, waste, and the potential for fraud. Last month, we found that the Administration was unable to verify income or eligibility for insurance subsidies.  Now, we learn that in many cases, the Exchange is unable to screen out fake identities or documents.  This law is already hitting Americans where it hurts the most – their pocketbooks.  Now, this Administration is forcing the American taxpayer to foot the bill for ObamaCare’s waste and fraud.”
 
House Oversight Subcommittee Chairman Boustany: “ObamaCare is a mess.  Its broken structure invites waste, fraud, and abuse that will cost the American taxpayer millions in subsidies to individuals whose eligibility the Administration won’t bother to verify.  No wonder hard-working Americans are fed up with a government that spends too much on broken programs that aren’t doing the job they’re intended to.  We can and must do better.”
  
Background: According to GAO, nationally over 2.6 million application inconsistencies have been found for people who have selected health plans in the Exchange.

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WASHINGTON - Today, Homeland Security and Governmental Affairs Committee Chairman Tom Carper (D-Del.) lauded the Senate confirmation of Shaun Donovan as the Director of the Office of Management and Budget (OMB). The Senate confirmed Secretary Donovan by a vote of 75 to 22.

Chairman Carper released the following statement after Secretary Donovan’s confirmation:

“The Director of the Office of Management and Budget (OMB) is a critical position in putting our nation on a responsible, sustainable fiscal path,” said Chairman Carper. “Shaun Donovan has proven himself to be a leader who will be a strong voice for fiscal responsibility and for effective government management. As Secretary of the Department of Housing and Urban Development over the past five years, Secretary Donovan has a maintained a proven track record of cutting through red tape and finding ways for agencies to work more effectively together. As Director of OMB, I know he will continue to foster interagency coordination and be a leader of integrity and intelligence as he spearheads the agency’s critical mission. While his predecessor Sylvia Mathews Burwell left big shoes to fill, I believe he is up to the task. I appreciate Secretary Donovan’s willingness to serve the people of this country in this critical capacity and I look forward to working with him in his new role.”

Chairman Carper spoke on the Senate floor in support of Secretary Donovan’s nomination earlier today. To read a copy of his remarks, as prepared for delivery, click here.

In June, the Senate Homeland Security and Governmental Affairs Committee held the nomination hearing on Secretary Donovan’s nomination.

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Amendment # 3459 - to exclude National Park System land from the payments in lieu of taxes program. Additional information here.

Amendment # 3460 - to change the price of the senior lifetime interagency parks pass from $10 to $80. Additional information here.

Amendment # 3461 - to provide that amounts in the Federal Land Disposal Account shall be used for Federal budget deficit reduction and to address the maintenance backlog on Federal land. Additional information here.

Amendment # 3462 - to provide proper due process for veterans to prevent them from being unfairly deprived of their Second Amendment Rights. Additional information here.

Amendment # 3466 - to authorize funds from the Land and Water Conservation Fund to be used to address deferred maintenance backlog issues on Federal lands. Additional information here.

(WASHINGTON, D.C.) – U.S. Senator Tom Coburn, M.D. (R-OK) commented today on the reports released by the Department of Health and Human Services (HHS) Inspector General (IG) regarding the lack of safeguards to prevent improper subsidies under Obamacare.

“The reports released today highlight that the federal government lacks necessary safeguards to prevent taxpayers from providing improper subsidies to illegal immigrants, individuals who are incarcerated, or individuals whose income is too high to qualify for a subsidy,” Dr. Coburn said.  “The Obama Administration has failed to keep its promise that effective controls were in place to prevent waste and fraud in Obamacare payments.  These reports show a trend of broken promises in Obamacare’s botched implementation.”  

HHS IG reports summary:

HHS IG released two reports today on inconsistencies within applications for health insurance on a state or federal exchange.  An inconsistency occurs when the information reported by an applicant cannot be verified, and can result in ineligible individuals (such as illegal immigrants, individuals who are incarcerated, or individuals whose income too high to receive Obamacare subsidies) receiving taxpayer subsidies under Obamacare.  The most common inconsistencies reported from the Federal and State marketplaces were inconsistencies related to income and citizenship.

These reports, mandated by the Consolidated Appropriations Act, 2014, are the first two in a series of reports the IG plans to conduct on HHS’ activities to verify the eligibility of health care applications within federal and state exchanges.

IG Findings:

“The Federal marketplace was generally incapable of resolving most inconsistencies. Without the ability to resolve inconsistencies in an applicant’s eligibility data, the marketplace cannot ensure that an applicant meets each of the eligibility requirements for enrollment in a QHP [qualified health plan] and when applicable, eligibility for insurance affordability programs.”

Federal Marketplace:

• 89 percent of inconsistencies were unresolved (2.6 million out of 2.9 million inconsistencies) because the system was not fully operational
• Most of these inconsistencies related to citizenship, national status, lawful presence, income, and employer-sponsored minimum essential coverage
• The Federal marketplace was capable of resolving inconsistencies with Social Security numbers, non-employer minimum essential coverage, incarceration status, and whether the applicant is an Indian. However, even though CMS’ system to process these types of inconsistencies was operational, it only resolved less than 1 percent of these inconsistencies.

State Marketplaces:

Out of the 15 states that did not use the Federal marketplace:

• Massachusetts, Nevada, Oregon, and Vermont reported they were unable to resolve inconsistencies
• California reported it resolved some inconsistencies but lacked the resources to resolve all of them
• Hawaii, Minnesota, and Colorado relied on their state Medicaid offices to resolve inconsistencies (Hawaii and Minnesota reported that all applicants apply for Medicaid before applying for a QHP)
• The seven remaining state marketplaces (Connecticut, D.C., Kentucky, Maryland, New York, Rhode Island, and Washington) reported they resolved the inconsistencies. However, the IG’s second report which included a review of Connecticut’s exchange found, despite reporting it resolved inconsistencies, “The Connecticut marketplace determined applicants to be eligible for insurance affordability programs when they were not eligible.”

Dr. Coburn’s Previous Work on this Issue:

Senators Hatch, McConnell and Coburn sent a letter urging HHS IG to carefully examine reports that the government may be paying incorrect Obamacare subsidies. Find more information here: http://www.coburn.senate.gov/public/index.cfm/pressreleases?ContentRecord_id=02255264-0ece-44d2-b187-502a71c7b3e2 

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(WASHINGTON, D.C.) – U.S. Senator and doctor Tom Coburn, M.D. (R-OK), today released his new oversight report “Friendly Fire: Death, Delay, and Dismay at the VA.”  The report is based on a year-long investigation of VA hospitals around the nation that chronicled the inappropriate conduct and incompetence within the VA that led to well-documented deaths and delays.  The report also exposes the inept congressional and agency oversight that allowed rampant misconduct to grow unchecked.

“This report shows the problems at the VA are worse than anyone imagined.  The scope of the VA’s incompetence – and Congress’ indifferent oversight – is breathtaking and disturbing.  This investigation found the problems at the VA are far deeper than just scheduling.  Over the past decade, more than 1,000 veterans may have died as a result of the VA’s misconduct and the VA has paid out nearly $1 billion to veterans and their families for its medical malpractice.  As is typical with any bureaucracy, the excuse for not being able to meet goals is a lack of resources.  But this is not the case at the VA where spending has increased rapidly in recent years,” Dr. Coburn said.

“The Administration and Congress have failed to ensure our nation is living up to the promises we have made to our veterans,” Dr. Coburn added.  “As a physician who has personally cared for hundreds of Oklahoma veterans, this is intolerable.  As a senator, I’m determined to address the structural challenges of the Department of Veterans Affairs so we can end this national disgrace and improve quality and access to health care for our veterans.  But make no mistake.  Whatever bill Congress passes cannot ignore the findings of this report.  While it is good that Congress feels a sense of urgency we are at this point because Congress has ignored or glossed over too many similar warnings in the past.  Our sense of urgency should come from the scope of the problem, not our proximity to an election.”

Key findings in the report include:

A CULTURE OF MANIPULATION PERMEATES THE DEPARTMENT.

• The cover up of waiting lists for doctor’s appointments at the VA is just the tip of the iceberg, reflecting a perverse culture within the department where veterans are not always the priority and data and employees are manipulated to maintain an appearance that all is well.
• Bad employees are rewarded with bonuses and paid leave while whistleblowers, health care providers, and even veterans and their families are subjected to bullying, sexual harassment, abuse, and neglect.  For example, female patients received unnecessary pelvic and breast exams from a sex offender, a noose was left on the desk of a minority employee by a co-worker, and a nurse who murdered a veteran harassed the family of the deceased to get them to admit guilt for the death.
• The care at more centers is getting worse and some VA health care providers have lost their medical licenses, and the VA is hiding this information from patients. 
• Delays exist for more than just doctors’ appointments—disability claims, construction, urgent care, and registries are also slow or behind schedule.
• Despite a nursing shortage, many VA nurses spend their days conducting union activities to advocate for better conditions for themselves rather than veterans.

VA MADE WAITING LISTS WORSE.

• As waiting lines were growing, the VA expanded eligibility in 2009 to those who already had insurance without any service related injuries, making the delays longer.
• Despite having the authority to do so, the VA was reluctant to let vets off the waiting lists by freeing them go to doctors outside of its system while sitting on hundreds of millions of dollars intended for health care that went unspent year to year.
• VA doctors are seeing far fewer patients than private doctors and some even leave work early.

VA EMPLOYEES BEHAVE AS IF THEY ARE ABOVE THE LAW.

• Criminal activity at the department is pervasive, including drug dealing, theft, and even murder.  A VA police chief even conspired to kidnap, rape and murder women and children.
• Many VA doctors and staff are overpaid and underworked, some are paid not to work and more and more employees are not even showing up for work.

THE VA WASTES AND MISMANAGES BILLIONS OF DOLLARS.

• The report identifies $20 billion in waste and mismanagement that could have been better spent providing health care to veterans.
• The federal government has paid out $845 million for VA medical malpractice since 2001.
• Most VA construction projects are over budget and behind schedule, inflating costs by billions of dollars.

THE SENATE VETERANS AFFAIRS COMMITTEE HAS BEEN AWOL WHEN IT COMES TO KEEPING PROMISES MADE TO VETERANS.

• The Senate Veterans Affairs Committee largely ignored the warnings about delays and dysfunction at the VA for decades, abdicating its oversight responsibilities and choosing to make new promises to veterans rather than making sure those promises already made were being kept.
• This report details how Congress was repeatedly alerted and warned of the problems plaguing the VA over decades.
• The Senate Veterans Affairs Committee has only held two oversight hearings the last four years, and was even profiled in Wastebook 2012 for being among the committees in Congress holding the fewest number of hearings.

Click here to read the entire report or here for a summary.  

The top 10 most outrageous VA behaviors are here.

The top 10 VA boondoggles are here. 

###

Dr. Coburn asked CRS to look into funding gimmicks used to hide federal spending increases in the appropriations bill.  The full report can be found here.

Additional information can be found here and here. 

WASHINGTON – Several senators are pressing Defense Department leaders to end the practice known as “plugging.”  “Plugging” is the use of false numbers in financial ledgers that forces balances and effectively masks accounting errors and control deficiencies.

Senators Chuck Grassley, Tom Coburn, Tom Carper and Ron Johnson wrote Defense Department Comptroller Robert Hale and Inspector General Jon Rymer urging the Defense officials to take “strong corrective action to end the long-standing, wide-spread use of ‘plug’ figures, which continue to reflect a major shortcoming in DoD financial management.”

“Of great concern to us is the fact that the use of ‘plugs’ appears to be growing. For example, the fiscal year 2008 value of DoD ‘plugs’ used in the fund balance with Treasury was $5.3 billion, but in the short space of five years, it rose to $9.6 billion in 2013. That is an increase of $4.3 billion or 80%.  However, these are just net ‘plug’ figures used to balance the statements and may be just the tip of the iceberg.  When gross amounts – positive and negative ‘plugs’ -- are tallied up, it is estimated that the dollar value of all DoD “plugs” would be much higher,” the senators wrote.

The members concluded, “The DoD ‘plugging’ problem is long-standing and deep-seated in the Defense Department’s accounting culture. Such dependence on ‘plugging’ is indicative of a dysfunctional finance and accounting system. It is symptomatic of the root causes that leave the Department’s accounting books in an un-auditable condition and lead to well-deserved criticism that the Department is not a good steward of the taxpayers’ money. ‘Plugging’ should never be granted a safe haven in the DoD OIG’s own financial statements.”

Here is the text of the letter.  A signed copy of the letter can be seen by clicking here.

June 12, 2014

Transmitted Electronically

The Honorable Robert F. Hale
Under Secretary (Comptroller) and Chief Financial Officer
Office of the Under Secretary of Defense (Comptroller)
United States Department of Defense
1100 Defense Pentagon
Washington, DC 20301-1100

Mr. Jon T. Rymer
Inspector General
Department of Defense
4800 Mark Center Drive
Alexandria, VA 22350-1500

Dear Comptroller Hale and Inspector General Rymer:

The Department of Defense (DoD) has taken encouraging steps to strengthen financial management.  Department-wide improvements will allow more timely, reliable, accurate, and useful information for operational and financial decision making. However, as we surely all agree, we must all work together in order to overcome continuing and pervasive financial management problems that affect the Department’s ability to control costs, anticipate future expenditures, measure performance,  prevent and detect fraud, waste, and abuse, and above all, to provide an accurate and complete accounting of how the money is spent. 

We are writing to you today to urge you to take strong corrective action to end the long-standing, wide-spread use of “plug” figures, which continue to reflect a major shortcoming in DoD financial management.

“Plugs,” also known as reconciling amounts, are unsupported adjustments to an accounting record or general ledger. They are false numbers used to force balances and have the effect of masking accounting and control deficiencies. While not strictly prohibited by law, their use is considered unacceptable and improper by regulation and accepted accounting practices and audit standards.^[1]

The use of “plug” figures throughout the Department  recently received in-depth exposure in the second part of a three-part series of articles by Scot J. Paltrow of the Reuters News Service entitled “Unaccountable: The High Cost of the Pentagon’s Bad Bookkeeping.”^[2]

Of great concern to us is the fact that the use of “plugs” appears to be growing. For example, the fiscal year 2008 value of DoD “plugs” used in the fund balance with Treasury was $5.3 billion, but in the short space of five years, it rose to $9.6 billion in 2013. That is an increase of $4.3 billion or 80%.^[3]However, these are just net “plug” figures used to balance the statements and may be just the tip of the iceberg. When gross amounts – positive and negative “plugs” -- are tallied up, it is estimated that the dollar value of all DoD “plugs” would be much higher.^[4] A recent DoD Office of the Inspector General report on the Army and other related reports indicate that DoD plugs could easily run into hundreds of billions of dollars.^[5]

Surprisingly, even the DoD Office of the Inspector General’s (OIG) own financial statement for FY 2012, which failed to earn a clean opinion, contained “unsupported adjustments” of more than $200 million, according to the independent auditor. These “plugged” entries were similarly used to “force” the general ledger into agreement with the budget execution and cash management reports to the Treasury Department. ^[6] We believe the OIG should be setting an example of excellence in accounting for the entire department to follow by producing credible and reliable financial statements, which would not include the use of “plugs.”

After the last Paltrow article in Reuters was published, Senator Grassley asked the DoD OIG what it had done or was planning to do to root out, expose, and address “plugging” abuses. The OIG replied by stating: “We have been reporting about the problem of unreliable data, unsupported journal vouchers and plugging for many years.” ^[7]To back-up this assertion, a list of 35 OIG audit reports going back to March 1994 was provided.  While these 35 reports identified plugging issues, the remedies proposed by the OIG were, for the most part, not fully implemented. The audit reports essentially told the military services and agencies involved to create new policies and procedures to do what they are already supposed to be doing. ^[8]  Despite all these reports, the problem of plugging within the Department is still wide-spread. The Department still needs to fix the problem. The DOD responses do not provide a high-level of confidence that the gravity of this problem is truly understood and accepted and that a solution will come any time soon.

The DoD “plugging” problem is long-standing and deep-seated in the Defense Department’s accounting culture. Such dependence on “plugging” is indicative of a dysfunctional finance and accounting system. It is symptomatic of the root causes that leave the Department’s accounting books in an un-auditable condition and lead to well-deserved criticism that the Department is not a good steward of the taxpayers’ money. “Plugging” should never be granted a safe haven in the DoD OIG’s own financial statements.

We believe that the DoD OIG must play a constructive role in helping the Department to fix its broken accounting system and to meet mandated audit readiness deadlines.

In order to play a leadership role in financial management reform, the DoD OIG should start by ending the use of plugging in its own financial statements.

We also urge the DOD Comptroller and IG to end the wide-spread use of plugging throughout the Department.  We request that you provide our offices with a plan that includes a specific timetable to accomplish this important goal. Your careful consideration of this proposal would be appreciated.

Sincerely,

Charles E. Grassley                                                     
Ranking Member                                                         
Committee on the Judiciary                                

Tom Coburn, M.D.                                                     
Ranking Member                                                         
Committee on Homeland Security and Governmental Affairs  

Thomas R. Carper                                                       
Chairman                                                                     
Committee on Homeland Security and Governmental Affairs

Ron Johnson
Ranking Member
Subcommittee on Financial and Contracting Oversight
Committee on Homeland Security and Governmental Affairs

^[1]DoD Financial Management Regulation 7000.14R, Volume 4, Chapter 2, Accounting for Cash and Fund Balances with Treasury, Section 020102.B1 (Dec. 2009) as cited in CRS American Law Division Memo to Senator Grassley, 2/12/14; ``Federal Financial Management Improvement Act of 1996,''  (section 803.a.); OMB Circular A-136 Revised, “Financial Reporting Requirements,” (October 21, 2013, pages 31-33); Statement of Federal Financial Accounting Concept 5, ( pgs. 1-2): and DoD FMR, volume 6A, chapter 2, prescribes JV-related supporting documentation and approval requirements implementing Federal law and OMB requirements;
^[2] How the Pentagon’s Payroll Quagmire Traps America’s Soldiers, 7/2/13, Reuters.com;  Behind the Pentagon’s Doctored Ledgers, A Running Tally of Epic Waste, 11/18/13, Reuters.com; and Why the Pentagon’s Many Campaigns to Clean Up Its Accounts Are Failing, 12/23/13, Reuters.com
^[3] GAO email, 11/14/13; and DoD Agency Financial Report for FY 2013, p.82;
^[4] GAO email to Senator Grassley’s office, 4/4/14;
^[5] DoD OIG Report No. 2012-096, 5/31/12; Oversight Review of Audit Reporting by the DoD OIG, prepared by the Staff of Senator Chuck Grassley, 9/7/10, p. 25;
^[6] DoD OIG, Financial Statement Audit, FY 2012, Independent Auditor’s Report, pp. 32-34 and 72;
^[7] Emails from office of Senator Chuck Grassley to DoD OIG, 11/21/13 and 12/18/13, and DoD OIG email response, 12/17/13;
^[8] Reports 98-192, 8/25/98 and  2001-177, 8/31/2001;

Dr. Coburn released the following letter on his hold of the nominations of Richard Engler and Manuel Ehrlich to be members of the U.S. Chemical Safety and Hazard Investigation Board, because of the Board’s refusal to cooperate with an investigation by its inspector general.

Washington, D.C. ­– U.S. Senators John McCain (R-AZ), Tom Coburn (R-OK), Richard Burr (R-NC), and Jeff Flake (R-AZ) will hold a press conference to introduce the Veterans Choice Act TOMORROW, June 3, 2014 at 1:45 p.m. ET. The Veterans Choice Act addresses the most pressing issues raised by the scandal at the U.S. Department of Veterans Affairs by providing veterans with greater flexibility and choice in health care providers and increasing accountability and transparency at the VA.

TUESDAY, JUNE 2, 2014

WHO:    

U.S. Senator John McCain (R-AZ)

U.S. Senator Tom Coburn (R-OK)

U.S. Senator Richard Burr (R-NC)

U.S. Senator Jeff Flake (R-AZ)

WHAT: Press Conference introducing the Veterans Choice Act

WHEN: Tuesday, June 3rd – 1:45 p.m. ET

WHERE: Senate Radio/Television Gallery

S-325 – U.S. Capitol Building

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Dr. Coburn, along with 34 other Members of Congress, today sent a letter to the Congressional Leaders asking them to pledge their support for the continued ban on earmarks. The 2011 decision to end earmarks ensured that legislative priorities were focused on making decisions based on what is best for the nation as a whole, instead of on the individual needs of lobbyists and politicians.

The full text of the letter is below:

More than three years ago, members of Congress in both chambers from both parties stood together to impose a moratorium on the practice of congressional earmarking.

The American people celebrated this bipartisan leadership.  But, recently, we have noted that members on both sides of the aisle are calling for a return to earmarking.  We believe this would be unwise and would further damage Congress’ reputation and ability to tackle the nation’s challenges.

We recognize there are a wide range of views on this subject in our caucuses but we believe it is important to reaffirm our support for this policy.  Congress has ample flexibility to exercise its power of the purse and represent the interests of our constituents without using earmarks.  For instance, the appropriations process under regular order and our oversight authority gives members ample opportunity to set priorities and vet decisions with their elected peers.

We therefore urge you to pledge your continued support for the earmark moratorium and do everything in your power to work together to address the nation’s highest priorities without the unhelpful distraction of earmarks.

Senators Coburn, Enzi and Burr today sent letters to the Departments of Labor, Education, Veterans Affairs, and Defense asking for comprehensive data on the metrics and strategies used to oversee and guide and the agencies’ health care workforce training programs.  In April 2014, the senators also sent a letter to HHS asking for similar information.   

A 2013 GAO report found the federal government administers 91 different health care workforce programs, with total obligations of $14.2 billion in FY2012.

Fannie Mae and Freddie Mac’s recent weak profit reports coinciding with ominous stress tests are a stark reminder that the American taxpayers continue to be exposed to billions of dollars in risk from the government-backed duopoly.  I supported S. 1217 passage out of the Banking Committee today as an important first step to move the risk of our nation’s housing market off the backs of the taxpayers and onto a firm bedrock of a private capital driven, competitive, and diverse housing finance system.

I would be the first to support a proposal that completely removes the government from the housing market, but those desires must be matched with an honest declaration that such a reform will end the 30 year fixed rate mortgage.  In a body that cannot get rid of tax breaks for race horses, predicating housing finance reform on the abolition of the cornerstone of the U.S. housing market does nothing but keep the taxpayers on the hook for $5 trillion worth of Fannie Mae and Freddie Mac securities and guarantees – an ironic exercise of self-defeat.

Further, S. 1217 does not create a government guarantee on mortgage backed securities.  That guarantee has always existed since Fannie Mae was spun out of the federal government as a budget gimmick in 1968.  Rather, S. 1217 turns the previous implicit government guarantee into an explicit one and outlines that it can only be triggered after a massive amount of private capital losses that would provide more than enough protection to withstand another 2008-type crisis. 

While this bill still needs improvements prior to becoming law, especially reigning in the authority provided to the executive branch under unusual and exigent circumstances, it is past time that Congress stop making excuses and move forward with this long overdue reform.

(WASHINGTON, D.C.) – U.S. Senator Tom Coburn, M.D. (R-OK) released the following statement today following revelations that sequestration resulted in only one layoff, according to the Government Accountability Office (GAO).  As GAO writes on page 51 of this report, “DOJ officials reported that one DOJ component—the U.S. Parole Commission—implemented a reduction in force of one employee to achieve partial savings required by sequestration in fiscal year 2013.”

“Despite relentless warnings about the dire consequences of sequestration’s budget cuts, it appears sequestration resulted in only one layoff.  While that’s good news for federal employees and other workers, it is devastating to the credibility of Washington politicians and administration officials who spent months – and millions of dollars – engaging in a coordinated multi-agency cabinet-level public relations campaign to scare the American people.  Taxpayers expect us to root our predictions in fact, not ideology and spin.  The facts seem to say the experts underestimated sequestration’s impact by between 99,999 and 1,599,999 jobs, according to two frequently-cited estimates by Goldman Sachs and the Congressional Budget Office,” Dr. Coburn said.

“Today, I’m sending a letter to the Office of Management and Budget with the hope of soliciting a fact-based explanation for the American people.  The American people deserve to know the truth, especially if it suggests politicians’ favorite programs can endure far more in budget cuts than sequestration imposed,” Dr. Coburn added.

The full text of the letter is below:

Dear Director Burwell,

I appreciate your leadership as the director of the Office of Management and Budget (OMB).  Your office has an important role in protecting and stewarding taxpayers’ resources.  Over the last three years, one of OMB’s most important responsibilities has been the implementation of sequestration, as mandated by the Budget Control Act of 2011.  Not only did OMB issue guidance on how departments should plan for the budgetary reductions, OMB also had some discretion in identifying which programs were subject to sequestration reductions.

The Budget Control Act is the law of the land until FY 2021, so it is essential to have a complete understanding of how agencies manage their workforces and operations in this constrained fiscal environment. 

Under OMB’s guidance, federal departments and agencies responded to sequestration in a variety of ways, as noted in a recent report by the Government Accountability Office (GAO).   Nearly every agency studied by GAO limited employee training and travel.  Most agencies used leftover funds from previous fiscal years to offset some of the mandated reductions.  NASA slowed down development of the program that will allow the U.S. to stop relying on Russia for trips to the International Space Station.  At the same time, NASA--like most agencies--did not furlough any employees.  Similarly, the National Science Foundation reduced the number of new research awards, but did not furlough any employees.  Almost no agencies directly reduced the number of staff.  Only one agency--the U.S. Parole Commission--implemented a reduction in force of one employee “to achieve partial savings,” according to GAO.  

To aid the understanding of the impact of sequestration on the federal workforce, please provide the following information by June 6, 2014:

1.         Broken out by fiscal year, please provide the number of permanent, federal civilian employees for the last five years?  Please include a breakdown by agency, position title, and pay scale. 

2.         Please provide a list of all departments or agencies that have implemented a reduction in force due to sequestration.  Please list any impacted positions, by fiscal year, position title and pay scale.

3.         Please provide electronic copies of any memoranda, guidance, or other documentation circulated by OMB advising federal agencies how to manage their federal workforces in response to sequestration. 

4.         What are the legal obstacles, if any, that hinder the executive agencies from making further reductions in workforce levels as they work to increase efficiency?

5.         What is OMB’s timeline for implementing GAO’s recommendation that OMB publish the criteria used to determine the exemption status of program, projects, and activities?

I know we share the goal of ensuring federal resources are used as effectively as possible, and I look forward to working with your office to address these questions. 

Sincerely,

Tom A. Coburn 

###

(WASHINGTON, D.C.) –  U.S. Senators and doctors Tom Coburn, M.D. (R-OK), John Barrasso, M.D. (R-WY), John Boozman, O.D. (R-AR), and Rand Paul, M.D. (R-KY) today introduced S. 2278, the Safeguarding Care of Patients Everywhere Act, to eliminate a provision from the Patient Protection and Affordable Care Act that allows the Secretary of HHS to prohibit health insurers from working with medical providers who don’t meet Secretary-established criteria for quality. A House version of the bill, authored by Representative Gingrey (R-GA), was introduced last year.

“A political appointee now has full discretion to determine what constitutes as ‘quality’ care, despite what is actually best for an individual patient,” said Dr. Coburn. “Allowing an unelected bureaucrat to have unilateral power to interfere with the physician-patient relationship is unprecedented.”

“This section of Obamacare highlights the law’s disregard for the sanctity of the doctor-patient relationship,” said Gingrey. “It is critical that Congress act to stop President Obama’s “one-size-fits-all” health policies that put HHS bureaucrats – unbound by the Hippocratic Oath – in charge of patient diagnoses and treatment procedures.”

Currently, the Secretary could decide to make certain policies part of a one-size-fits-all quality evaluation and these decisions may not be subject to review by state insurance commissioners, medical licensing boards, or professional societies. These decisions could essentially force providers out of practice, exacerbating the huge physician shortage our nation is already facing, and the harm will fall on the very patients the provision intended to help. This could result in patients losing their doctors and freedom to choose the treatments they need. The SCOPE Act amends this provision so that the Secretary of HHS does not have the ability to prohibit medical providers from conducting lawful business.

###

(WASHINGTON, D.C.) – U.S. Senators Tom Coburn, M.D. (R-OK) and Mark Udall (D-CO) today began circulating a bipartisan letter in support of the moratorium on congressional earmarking. The senators are urging members in the House and Senate to sign. The text of the letter is below:

More than three years ago, members of Congress in both chambers from both parties stood together to impose a moratorium on the practice of congressional earmarking.

The American people celebrated this bipartisan leadership.  But, recently, we have noted that members on both sides of the aisle are calling for a return to earmarking.  We believe this would be unwise and would further damage Congress’ reputation and ability to tackle the nation’s challenges.

We recognize there are a wide range of views on this subject in our caucuses but we believe it is important to reaffirm our support for this policy.  Congress has ample flexibility to exercise its power of the purse and represent the interests of our constituents without using earmarks.  For instance, the appropriations process under regular order and our oversight authority gives members ample opportunity to set priorities and vet decisions with their elected peers.

We therefore urge you to pledge your continued support for the earmark moratorium and do everything in your power to work together to address the nation’s highest priorities without the unhelpful distraction of earmarks.

###

The vast majority of Americans do not want earmarks and Members of Congress need to take this threat seriously. The number of signatures this letter has represents how seriously Members are taking the threat. Here is a list of the Members who have signed on:

Senators McCain, Enzi, Coats, Flake, Toomey, Johanns, Grassley, Graham, Thune, Sessions, Ron Johnson, Ayotte, Paul, Burr, Cornyn, Cruz, Fischer, Vitter, McCaskill, Scott, Rubio, Corker, Barrasso, Risch, and Lee

Representatives Lankford (OK-05), Hensarling (TX-05), Duncan (SC-03), Pompeo (KS-04), DesJarlais (TN-04), Gosar (AZ-04), Ron DeSantis (FL-06) and Cooper (TN-05)

The Council for Citizens Against Government Waste supports our letter and have sent a letter urging Members of Congress to sign on. See the article here.

Taxpayers for Common Sense sent this letter urging Senators to support the earmark moratorium. 

(WASHINGTON, D.C.) – Senators Tom Coburn (R-OK) and Chris Coons (D-DE) today introduced S. 2240, the Medicare Choices Empowerment and Protection Act, a bill to encourage Medicare beneficiaries to create advance directives. This will allow individuals to provide clear guidance to their medical providers and family members about their health care decisions should they become incapable of speaking for themselves.

“Advance directives are a valuable, voluntary tool that offers patients the ability to protect patients’ future health care preferences or to specify someone to act on their behalf. This bill would encourage their adoption by Medicare beneficiaries and is intended to start a discussion about how best to move this policy forward. We welcome constructive comments from stakeholders to improve this plan and to better encourage the voluntary adoption of advance directives by Medicare beneficiaries that can be accessible in real-time by their physicians and hospitals.”

"Every American deserves the opportunity to live his or her final days with dignity," Senator Coons said. "Too many Americans leave their end-of-life care to chance or to the preferences of distraught family members. This bill will help more Americans ensure they are the ones making the choices about their end-of-life care, reducing confusion and empowering more Americans to spend their final days and hours on their own terms. I am proud to work with Dr. Coburn on this bipartisan legislation and intend to work with all of my colleagues to see it become law."

Under the Medicare Choices Empowerment and Protection Act, Medicare beneficiaries would be able to voluntarily create and register an advance directive with CMS at any time.  Advance directives would be created through and maintained by outside organizations certified by CMS, and could be terminated at any time by the beneficiary. An advance directive would include any written statement that outlines the kind of treatment and care a beneficiary wants or does not want under certain conditions, and can include identification of a health care proxy.

To address concerns about confidentiality, the Medicare Choices Empowerment and Protection Act requires both CMS and outside groups maintaining advance directives to hold the highest standards for privacy and security protection as well as system functionality. CMS would only keep track of the certified organization through which a beneficiary has created an advance directive and would not keep a database of these documents. Beneficiaries would also receive a small, one-time incentive for registering an advance directive.

Additional information here.

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(WASHINGTON, D.C.) – U.S. Senator Tom Coburn, M.D. (R-OK) released the following statement today regarding the Government Accountability Office’s (GAO) fourth annual report detailing unnecessary duplication in the federal government.  This year’s report identified 26 areas of duplication that could save taxpayers $45 billion over five years.  See summary and report card for more information.

“Over the past four years, GAO’s duplication reports have identified a mother lode of potential savings – at least $200 billion annually.  Sadly, Congress has done very little digging.  We’ve achieved a small fraction of the savings GAO has revealed,” Dr. Coburn said.

“Turning this ready-made list of cuts into savings is one of the best ways Congress can regain the trust and confidence of the American people.  No American – regardless of party or ideology – wants to see their tax dollars fund unnecessary duplication and bloat, particularly when real incomes have flat-lined and our economy is being dragged down by a $17 trillion debt.

“A handful of members have taken up this cause including Representatives Paul Ryan, Jim Bridenstine, James Lankford, Virginia Foxx and Senator Tim Scott, but they need more support.  Congress could also pass two bipartisan bills based on GAO’s recommendations.  The Taxpayers Right to Know Act would require federal agencies to provide taxpayers with an annual report card for each of its programs and disclose overlap and performance measures.  The Let Me Google That For You Act would eliminate the National Technical Information Service (NTIS) that sells free government reports that are available online to other federal agencies and the public at a loss.

“At the end of the day, there are no short-cuts around the hard work of oversight and identifying and eliminating waste.  Congress, particularly the appropriations committees, has no excuse to not achieve these savings when GAO has already done much of Congress’ work for it,” Dr. Coburn said.

GAO began issuing these reports after Dr. Coburn attached an amendment to the debt limit increase in 2010.  The amendment was approved by a vote of 94 to 0. 

GAO’s previous three reports identified 162 areas of government duplication and cost savings.  To address these areas of concern, GAO recommended 380 specific actions to be taken by Congress and the administration to help reduce duplication, fragmentation, and overlap.  For additional background on GAO’s previous reports click here.

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(WASHINGTON, D.C.) – U.S. Senators Tom Coburn (R-OK) and Claire McCaskill (D-MO) and U.S. Representatives Jim Bridenstine (R-OK) and Henry Cuellar (D-TX) today introduced the Let Me Google That For You Act, a bill to eliminate an outdated agency that has lost more than $1 million trying to sell government reports that are available for free online. With a money-losing profit model only the government could design, the National Technical Information Service (NTIS) sells free government reports to other federal agencies and the public – at a loss.

“This is the ‘let me google that for you’ office of the federal government,” said Dr. Coburn.  “Nearly all of the reports being sold are already available for free on other government websites, including my own.  NTIS is selling at least six of the oversight reports issued by my office, such as the annual Wastebook which details outrageous Washington spending and mismanagement.  Ironically, the latest edition of Wastebook—which lists NTIS as one of the most wasteful government offices—is not available for sale yet by NTIS.  I have sent a letter to the Department of Commerce today requesting the office stop charging for the reports that I issue to taxpayers at no cost that highlight government waste, like the NTIS.”

“This agency has clearly outlived its usefulness,” said McCaskill, Chairman of the Senate Subcommittee on Financial & Contracting Oversight. “I find it staggering that the agency is selling government reports both to the public and to other federal agencies that are widely available for free and easy to find with a simple Google search—and the agency is still losing money. I think Americans would gain a little more confidence that their tax dollars are being spent wisely if we ended this display of waste and inefficiency. This is a government office performing a function that the advent of the Internet has made outdated, and it’s past time we eliminate it.”

“Only the Federal Government would attempt to sell what you can get for free, make no money, then subsidize the failure,” said Congressman Bridenstine. “I am proud to stand with Dr. Coburn in eliminating this office.”

“Voters send us to Washington to write effective legislation and make sure the federal government is operating in a responsible manner,” said Congressman Cuellar. “That a government agency is selling free reports to another part of the government and the general public is a prime example of federal overreach and inefficiency.  The Let Me Google That For You Act is an excellent step towards streamlining the way the government works and keeping Washington accountable.”

Last year, the Government Accountability Office highlighted NTIS’ operations, in its annual duplication report, finding, “Of the reports added to NTIS’s repository during fiscal years 1990 through 2011 … approximately 74 percent were readily available from other public sources.” Meanwhile, from 1995 to 2000, the office sold only 8 percent of the 2.5 million reports in its repertoire.  NTIS has lost on average at least $1.3 million over the last 11 year, running a deficit on its document production for nearly a decade.

Eliminating the office should be a top priority for Congress as it looks for commonsense and bipartisan ways to reduce federal spending, increase government efficiency, and act upon one of the GAO’s recommendations to eliminate unnecessary duplication. 

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(WASHINGTON, D.C.) – U.S. Senators and doctors Tom Coburn, M.D. (R-OK) and John Barrasso, M.D. (R-WY) today released a new report entitled, “Prognosis: Outlook Not So Good” chronicling the scope of Obamacare’s failures and challenges.  The report also details what the senators and doctors got right and wrong about predictions they made in three previous oversight reports.  

“For millions of Americans, Obamacare itself has become a pre-existing condition that has limited their access to quality, affordable health care.  As we warned in our previous reports, Obamacare is fundamentally flawed.  The law strengthens the hand of government and weakens the hand of doctors and patients.  Obamacare is cutting choices, not costs, and costs will likely continue to rise,” Dr. Coburn said.

“As doctors, we know that Americans should be in charge of their own healthcare decisions - not Washington.  Over the past four years, we’ve highlighted the negative side effects of the healthcare law for patients, providers and taxpayers,” said Barrasso.  “Our new report confirms again exactly how Americans across the country are losing their insurance plan, watching their costs increase, and paying higher taxes.  It’s time to repeal this law and replace it with step by step reform that focuses on care instead of coverage.”

The report shows Coburn and Barrasso correctly predicted, among other things, that:

• millions of Americans would lose their health insurance plans
• the “employer mandate” would lower incomes and result in hundreds of thousands of jobs being lost
• the law’s new mandates would increase health costs for individuals and families

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(WASHINGTON, D.C.) – U.S. Senators and doctors Tom Coburn, M.D. (R-OK) and John Barrasso, M.D. (R-WY) today released a new report entitled, “Prognosis: Outlook Not So Good” chronicling the scope of Obamacare’s failures and challenges.  The report also details what the senators and doctors got right and wrong about predictions they made in three previous oversight reports.  

“For millions of Americans, Obamacare itself has become a pre-existing condition that has limited their access to quality, affordable health care.  As we warned in our previous reports, Obamacare is fundamentally flawed.  The law strengthens the hand of government and weakens the hand of doctors and patients.  Obamacare is cutting choices, not costs, and costs will likely continue to rise,” Dr. Coburn said.

“As doctors, we know that Americans should be in charge of their own healthcare decisions - not Washington.  Over the past four years, we’ve highlighted the negative side effects of the healthcare law for patients, providers and taxpayers,” said Barrasso.  “Our new report confirms again exactly how Americans across the country are losing their insurance plan, watching their costs increase, and paying higher taxes.  It’s time to repeal this law and replace it with step by step reform that focuses on care instead of coverage.”

The report shows Coburn and Barrasso correctly predicted, among other things, that:

• millions of Americans would lose their health insurance plans
• the “employer mandate” would lower incomes and result in hundreds of thousands of jobs being lost
• the law’s new mandates would increase health costs for individuals and families

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Dr. Coburn and Senator Burr sent a letter to Minister Ambrose asking Health Canada to stop the production of an addictive non-abuse deterrent opioid that is banned in the U.S. Due to the proximity of our nations drugs can easily cross the border, legally and illegally.  By coordinating our regulatory approaches to this prescription medication the public health in both nations can improve while ensuring patients have access to the medicines they need. 

Washington—Senators Dianne Feinstein (D-Calif.), Tom Coburn (R-Okla.), Amy Klobuchar (D-Minn.) and Jeff Flake (R-Ariz.) today introduced the Patent Fee Integrity Act, a bill to protect and secure patent user fees paid by U.S. inventors and businesses and stabilize funding for the Patent and Trademark Office. 

            The bill protects the current user-fee system by placing those fees in a separate fund to prevent them from being raided for other purposes. Text of the legislation is available here. 

            The bill also includes provisions to ensure accountability for the PTO, requiring annual operations and spending plans be sent to Congress, as well as an annual independent financial audit. 

            “In 1990, Congress made the PTO a self-funded agency, but those funds are frequently plundered for other uses,” said Senator Feinstein. “Since then, more than $1.1 billion in user fees have been diverted. When fees paid by inventors are used for general purposes, they amount to a tax on innovation. Today’s bill prevents that from happening. If we fail to support the PTO and reduce delays in the patent process, we are contributing to a decline in American ingenuity, and that is something we should all work hard to avoid.” 

            “Keeping the funds at the Patent and Trademark Office is one the best ways Congress can take action on a jobs program,” said Dr. Coburn. “Instead of letting politicians in Congress raid PTO’s funds to pay for parochial pet projects, lawmakers should ensure that funds raised by patent fees stay at the PTO. Doing so will help shore up the PTO’s finances and alleviate the backlog of hundreds of thousands of potentially job-creating patent applications that are due a review.” 

            “Businesses deserve to know that the fees they pay will be used as intended and help improve the patent process—not diverted for unrelated purposes,” said Senator Klobuchar. “This bipartisan bill will help ensure the Patent and Trademark Office has the resources it needs to continue supporting innovative companies that are fueling growth and job creation in our economy.” 

            “I have long tried to ensure the Patent and Trademark Office is able to keep the fees it collects from U.S. inventors and businesses,” said Senator Flake. “The PTO needs these fees to ensure the timely and thorough review of patent applications. Delays in patent approvals stifles innovation and growth of businesses, and so Congress ought to do everything it can to ensure the PTO has adequate resources.” 

Background 

            For much of its history, funding for the Patent and Trademark Office was supported by taxpayer dollars. Then, in 1990, Congress established a 69 percent user fee “surcharge” to eliminate taxpayer funding.

            However, those funds are often used for other purposes. In 1992, $8.1 million in user fees were diverted. The amount diverted to non-patent issues increased steadily, rising to a high of $209 million in 2011. Since 1990, more than $1.1 billion in patent user fees have been diverted. 

            During those years, the length of time to secure a patent rose, from 18 months in 1991 to 35 months in 2010.

            The bill has wide support from the patent user community and has been endorsed by numerous large and small corporations and patent organizations.

Amendment #2828 - To authorize to be appropriated to carry out the Child Care and Development Block Grant Act of 1990, $14,400,000,000 for the period consisting of fiscal years 2015 through 2020. Additional information here. 

Amendment #2829 - To require the evaluation and consolidation of duplicative early learning and child care programs, as identified by the 2012 Government Accountability Office report entitled “Opportunities to Reduce Duplication, Overlap and Fragmentation, Achieve Savings, and Enhance Revenue.” Additional information here. 

Amendment #2830 - To eliminate child care subsidies for millionaires. Additional information here. 

Amendment #2831 – To eliminate provisions for a toll-free Web site and hotline. Additional information here. 

Amendment #2832 – To eliminate child care subsidies for high-income individuals. Additional information here.

(WASHINGTON, D.C.) – U.S. Senators Tom Coburn, M.D. (R-OK) and Mark Udall (D-CO) today applauded the Senate’s unanimous passage of H.R. 2019, a bill that eliminates taxpayer financed political party conventions.  The bill redirects the savings to provide for a 10-year pediatric research program to be administered by the National Institutes of Health.

 “The party is over for Washington politicians,” Dr. Coburn said.  “Hardworking taxpayers will no longer have to fund summertime party junkets for the political class.  I want to thank Leaders Reid and McConnell for their support of this measure and for agreeing to pay for new spending for pediatric medical research by eliminating spending for political conventions.  Reid’s decision, in particular, sets an important precedent – and reverses past resistance – by paying for new spending by reducing spending elsewhere.  Historically, Washington has considered that principle to be unusual.  But in the real world it’s called common sense and living within your means.  We need more of that in Washington. I look forward to the President quickly signing this bill into law so this egregious practice can end once and for all.” 

“I have long fought to end public subsidies for national political party conventions, which have become nothing more than elaborate parties. I am proud Congress finally heeded my call and passed this bipartisan proposal,” Udall said. “This common-sense idea will  help save millions of dollars — and the president should sign it into law without delay.”

Coburn and Udall have worked together to prohibit the use of Presidential Election Campaign Funds (PECF) for political party nominating conventions, including introducing legislation last year and in the previous session of Congress.

Dr. Coburn previously listed taxpayer-funded conventions as the number one most wasteful item in his 2011 Wastebook.

In June of 2012, Dr. Coburn’s amendment to S. 3240, the Agriculture Reform, Food, and Jobs Act of 2012, passed the Senate 95-4.  However, the measure was never signed into law. 

In early 2013, Dr. Coburn introduced a bill to eliminate the use of public funds for political party conventions, cosponsored by Sen. Udall.

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Amendment #2758:   Requires the VA to publish information on the provision of health care, including delays in care and outcomes of medical services. Additional information here.

Amendment #2759: To strike section 301, relating to the expansion of eligibility for VA coverage to those currently not eligible. Additional information here.

Amendment #2760: To allow veterans to go to the health care provider of their choice. Additional information here.

Amendment #2761: To require the VA to carry out a pilot program to provide health care and services to individuals through non-VA entities to ensure more timely care with better outcomes for veterans currently experiencing excessive delays in accessing care. Additional information here.

Amendment  #2762: To limit the implementation of new programs and expansion of existing programs until the VA meets certain metrics, including reduced wait times and increased quality of medical care for our national heroes. Additional information here.

Additional Information on the bill and the VA:

Additional information on the Veterans Omnibus here.

Congressional micro-mismanagement harming veterans here. 

Veterans suffering at VA facilities here.

VA mismanagement and waste here.

Waiting times and delays for veterans care here.

Dr. Coburn released the following letter on his hold regarding S. 653, the Near East and South Central Asia Religious Freedom Act of 2013. 

February 25, 2014

The Honorable Mitch McConnell

Senate Minority Leader

United States Senate

Washington, D.C.

Dear Senator McConnell:

I am requesting I be consulted before the Senate enters into any unanimous consent agreements or time limitations regarding S. 657, the Foreign Prison Conditions Improvement Act of 2013.

While I support the intent of this legislation, I believe if Congress decides to spend American taxpayer dollars on prisons, those taxpayer dollars should be spent on improving our own correctional facilities.  Furthermore, there does not appear to by any Constitutional role for Congress to spend American taxpayer dollars on improving conditions at foreign prisons, nor would this proposed expenditure enhance our own national security, or assist foreign nations in enhancing their own law enforcement capabilities. 

Also, the Congressional Budget Office (CBO) estimates that enacting this bill will increase discretionary spending by $695 million over five years, and I want to ensure there is a clear offset for this additional cost.  I remained concerned that we continue to fund new programs, particularly foreign aid programs, without prioritizing our spending.  We could easily find $695 million in current spending on low-priority or under-performing initiatives to offset this cost. 

The U.S. national debt is $17 trillion, and despite pledges to control spending, Washington instead adds billions to the national debt every day.  Congress must start making tough choices and stop jeopardizing the future standard of living of our children by borrowing from future generations.                                                                              

Sincerely,                               

Tom A. Coburn, M.D.

United States Senator

Dr. Coburn sent a letter to Inspector General Scott Dahl of the U.S. Department of Labor expressing his concerns regarding the wasteful spending practices within the Department.  

Dr. Coburn, along with Senators McConnell and Alexander, today sent a letter to the FDA asking them to respond to questions regarding safeguards accompanied with the production of a powerful hydrocodone product. A response from the FDA can be found here. 

Additional information on the Veterans Omnibus here.

Congressional micro-mismanagement harming veterans here. 

Veterans suffering at VA facilities here.

VA mismanagement and waste here.

Waiting times and delays for veterans care here.

(WASHINGTON, D.C.) – U.S. Senator Tom Coburn, M.D. (R-OK), ranking member of the Homeland Security and Governmental Affairs Committee, today released a new report: “The Federal Government’s Track Record on Cybersecurity and Critical Infrastructure.”  The report details serious vulnerabilities in the government’s efforts to protect its own civilian computers and networks, and the critical, sensitive information they contain.  The report notes that “Since 2006, the federal government has spent at least $65 billion on securing its computers and networks, according to an estimate by the Congressional Research Service.”

 “Weaknesses in the federal government’s own cybersecurity have put at risk the electrical grid, our financial markets, our emergency response systems and our citizens’ personal information,” Dr. Coburn said.  “While politicians like to propose complex new regulations, massive new programs, and billions in new spending to improve cybersecurity, there are very basic – and critically important – precautions that could protect our infrastructure and our citizens’ private information that we simply aren’t doing.” 

The report compiles problems identified in over 40 audits, investigations and reviews by agency Inspectors General, the Government Accountability Office and others.  In many cases, simple fixes like using stronger passwords, and applying patches and updates in a timely manner, would fix critical vulnerabilities.

“More than a decade ago, Congress passed a law making the White House responsible for securing agency systems.  It’s still not happening,” Dr. Coburn added. “They need to step up to the job, and Congress needs to hold the White House and its agencies accountable.” 

The report highlights numerous government cyber failures, including: 

-          Last February, hackers broke into the U.S. Emergency Alert System and broadcast warnings of zombie attacks to several U.S. cities.

-          Internal Revenue Service computers were been found to have literally thousands of serious vulnerabilities because critical software patches have not been installed.

-          In 2012, the Securities and Exchange Commission mishandled and potentially exposed critically sensitive information, including diagrams of how to hack into trading exchanges. 

To read the full report, click here.

CRS Memo on FISMA spending here. 

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Dr. Coburn sent a letter to Steven Bunnell, general counsel for Department of Homeland Security, asking for the agency to provide unredacted versions of previously requested documents. 

WASHINGTON – Today, U.S. Senators Richard Burr (R-N.C.), Tom Coburn, M.D. (R-Okla.), and Orrin Hatch (R-Utah) unveiled the Patient Choice, Affordability, Responsibility, and Empowerment (CARE) Act - a legislative plan that repeals Obamacare and then replaces it with common-sense, patient-centered reforms that reduce health care costs and increase access to affordable, high-quality care.  In contrast with Obamacare and its government centered mandates and regulations, the Senators’ proposal empowers the American people to make the best health care choices for themselves and their families.

Following today’s release of the plan, the three Senators will work with their Senate colleagues and experts across the health care community to further refine and improve upon the proposal, with the goal of building consensus and introducing legislation.

 “The American people have found out what is in Obamacare— broken promises in the form of increased health care costs, costly mandates, and government bureaucracy.  They don’t like it and don’t want to keep it,” said Burr.  “Our nation’s health care system was unsustainable before Obamacare, and the President’s health care plan made things worse.  That’s why the Patient CARE proposal repeals Obamacare and focuses on targeted reforms that will lower costs and expand access to quality care. We can lower costs and expand access to quality coverage and care by empowering individuals and their families to make their own health care decisions, rather than empowering the government to make those decisions for them.”

“For millions of Americans, Obamacare itself has become a preexisting condition that has caused them to lose their insurance, their doctors and their choices. Congress has a responsibility to not only repeal this misguided law but replace it with a plan that will provide better care at a lower cost, and will help preserve programs like Medicaid instead of driving them closer to bankruptcy,” said Dr. Coburn. “It is unfortunate the Senate Majority Leader blocked a vote on an alternative in 2009.  But it’s critical we chart another path forward.  Our health care system wasn’t working well before Obamacare and it is worse after Obamacare.  Americans deserve a real alternative, and a way out.   I’m pleased to take this important step with my colleagues.”   

“Forcing too many Americans out of the insurance they have, away from the doctor they trust and, for some, out of the job they need, Obamacare is a disaster.  With our plan, we’ve shown once again that by empowering Americans – not Washington – with the right tools and information, they will make the best informed health care decisions for themselves,” said Hatch. “After first repealing the President’s health law, we take aim at the chief concerns of the American people - greater economic security by driving down costs and expanding access to high-quality care through increased insurance market competition and reforms.  What we’ve put forward is sustainable and achievable – and without the tax hikes, mandates, and budget-busting spending that have made Obamacare so unpopular with the American people.” 

The Patient CARE Act provides a legislative roadmap to fully repeal the President’s health care law, known as Obamacare, and replace the law with common-sense measures that would:

• Establish sustainable, patient-centered reforms:
  • Adopt common-sense consumer protections;
  • Create a new protection to help Americans with pre-existing conditions;
  • Empower small business and individuals with purchasing power;
  • Empower states with more tools to help provide coverage while reducing costs; and
  • Expand and strengthen consumer directed health care.
• Modernize Medicaid to provide better coverage and care to patients:
• Transition to capped allotment to provide states with predictable funding and flexibility; and
• Reauthorize Health Opportunity Accounts to empower Medicaid patients.
• Reduce unnecessary defensive medicine practices and rein in frivolous lawsuits.
• Medical Malpractice reforms.
• Increase health care price transparency to empower consumers and patients.
• Requiring basic health care transparency to inform and empower patients.
• Reduce distortions in the tax code that drive up health care costs:
• Capping the exclusion of an employee’s employer-provided health coverage.

A detailed summary of the proposal can be found here. 

A side-by-side comparison to Obamacare can be found here.

Frequently asked questions on the proposal can be found here.

Illustrative examples of how patients –who are harmed by Obamacare— are helped under the proposal can be found here.

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Dr. Coburn and five other Senators wrote a letter to HHS Secretary Kathleen Sebelius. The letter, dated Tuesday, Jan. 21, 2014, follows-up prior correspondence the Senators had with the Secretary on the same issue: the Department’s ongoing and misleading suggestion that certain Medicare benefits are “free” due to Obamacare.  

Dr. Coburn highlights expenditures in the Omnibus Appropriations bill.  Additional information can be found here. 

(WASHINGTON, D.C.) – Today, Senate Homeland Security and Governmental Affairs Committee Chairman Tom Carper, (D-Del), Ranking Member Tom Coburn, M.D. (R-OK), and House Chairman of the Committee on Energy and Commerce Fred Upton (R-Mich) highlighted a new Government Accountability Office (GAO) report entitled, “IT Dashboard: Agencies Are Managing Investment Risk, but Related Ratings Need to Be More Accurate and Available,” which found that while agencies have made progress at addressing problems with “high risk” IT investments,  reporting guidance discrepancies and lack of timely updates remain problems for the Office of Management and Budget (OMB), which manages the Dashboard.  The report also found that agency risk ratings are not always consistent with their supporting data.  For fiscal year 2014, 27 federal agencies have submitted plans to spend about $82 billion on IT investments.  Of that, $38.7 billion will be spent on “major” IT investments, $37.6 billion on “non-major” IT investments, and $5.5 billion on classified DOD IT investments.

 "When it comes to analyzing the billions of taxpayer dollars the federal government is spending on information technology, the 'IT Dashboard' is a window where there once was a wall," said Chairman Carper. "This tool holds great potential and can help both Congress and the public better understand how scarce taxpayer dollars are spent on information technology projects. However, in order to realize its full potential, agencies must continue to take steps to improve their own organization of IT investments and how they report those investments to the Dashboard. As this report shows, agencies’ efforts are getting better, but are still not perfect. That's why I urge the Administration and agencies’ Chief Information Officers to quickly make good on their promise to improve the 'IT Dashboard' and implement the recommendations suggested by the Government Accountability Office in their report.”

 “The federal government spends billions of taxpayer funds on IT projects every year, and taxpayers have a right to know how effectively those dollars are spent,” Ranking Member Coburn said. “The IT Dashboard is an important tool that enhances transparency on IT projects, and GAO has outlined a number of steps OMB should immediately take to improve the Dashboard.  Notably, GAO pointed out that vague language in OMB’s reporting guidance allows agencies to reclassify IT investments as non-IT investments. As a result, for example, the Department of Energy decided, and OMB agreed, that supercomputers no longer count as IT projects, and has removed them from reporting on the IT Dashboard. This, combined with GAO’s findings that OMB failed to update the public Dashboard for 15 of the past 24 months, means taxpayers are left in the dark on the progress of multimillion dollar projects.  GAO also found that less than half of the IT investments ratings they reviewed were fully consistent with investment risk.  These findings illustrate how OMB is risking accurate transparency with their current IT Dashboard practices, and I will continue to work with OMB and the Committee on enhancing real transparency that gives taxpayers the tools they need to hold the government accountable.” 

"Constant scrutiny of federal spending is critical to reducing taxpayer waste. GAO has helpfully showed the value of the IT Dashboard and identified improvements in its series of reviews of this important tool,” Chairman Upton said.  “Unfortunately, this report shows that past advice has not been heeded, and has identified 'a troubling trend toward decreased transparency and accountability.' This report should be a wake-up call to OMB to make every effort to reverse this trend. Our oversight will continue as we monitor the operations of the agencies we oversee, such as the Department of Energy, whose questionable activity related to the Dashboard is highlighted in this report."

The IT Dashboard is a public website launched by OMB in June 2009 to improve transparency and oversight of “major” federal IT investments.  The Dashboard “displays federal agencies’ cost, schedule, and performance data for over 700 major IT investments at 27 federal agencies, accounting for $38.7 billion of those agencies’ planned $82 billion budget for fiscal year 2014.”

 The Dashboard uses a color-coded rating system to display agencies’ performance for three OMB-defined criteria: cost, schedule, and CIO evaluation.  Cost and schedule ratings are based on a mostly objective reading of data agencies submit to OMB.  For instance, a project that is 30 percent over budget or 30 percent past schedule is automatically rated “red” (high or moderately high risk).  

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WASHINGTON, D.C.—U.S. Senators John Thune (R-S.D.), Lamar Alexander (R-Tenn.), Richard Burr (R-N.C.), Tom Coburn (R-Okla.), Mike Enzi (R-Wyo.) and Pat Roberts (R-Kan.) today expressed concern over a Department of Health and Human Services (HHS) Inspector General (IG) report finding insufficient oversight by the Centers for Medicare & Medicaid Services (CMS) of the $32.7 billion electronic health record (EHR) meaningful use incentive program. The IG found that few, if any, protections have been put in place at CMS or with government contractors to detect or prevent fraud from occurring in the EHR program, and suggested that CMS is still using the outdated practices that were used to review and audit paper health records.

“Today’s HHS Inspector General’s report confirms the concerns we expressed last spring about the need for adequate oversight of the electronic health record program to prevent waste and fraud,” said Thune, Chairman of the Senate Republican Conference. “I support the use of electronic health record systems as a way to improve health care, but CMS must ensure that the system is not manipulated in a way that allows for overbilling. As the administration continues to implement the next stages of the meaningful use program, CMS must do more to ensure that the technology it approves better protects taxpayer dollars.”

“Encouraging the use of electronic health care records by doctors, hospitals and other health care providers is about improving care for patients,” said Alexander, the senior Republican on the Senate Health Committee. “The Centers for Medicare and Medicaid Services should be doing everything it can to prevent and stop the fraud and abuse that undermine this crucial innovation in the health care industry and put Medicare at risk of overpaying for care.”

“Today’s HHS IG’s report highlighting insufficient practices to protect electronic health records is deeply concerning,” said Burr, the senior Republican on the Senate Veterans’ Affairs Committee. “It is particularly troubling that the issues raised today are not new, but echo those highlighted by my colleagues and I last year. Today’s report is another example of the Administration falling short when it comes to implementation of IT initiatives and only increases my concerns regarding the security of consumer’s information under the Affordable Care Act. When it comes to protecting patient’s information, the Administration’s actions continue to speak louder than their promises. Billions of taxpayer dollars are being spent to advance health information technology under the HITECH Act and the Administration should ensure that the American people’s investment is sound and their information secure.”

“The Inspector General's office has offered an important warning that CMS is failing to adequately oversee the program integrity of its electronic health records program,” said Dr. Coburn, the senior Republican on the Senate Homeland Security and Governmental Affairs Committee. “Taxpayers fund the federal incentive payments that help to drive providers' adoption of EHRs, which contain sensitive personal information. CMS has a fundamental responsibility to do a better job of policing and enforcing basic security requirements. I look forward to working with my colleagues who penned the REBOOT report in continuing oversight as needed to ensure CMS takes the necessary precautions to protect taxpayers and patients.”

“Reducing the opportunities for fraud and removing the incentives for overbilling are vital to improving confidence in electronic health record programs,” said Enzi, a senior member of the Senate Health Committee. “The serious issues identified by the Inspector General need to be addressed to protect patient information, improve data security, and reduce waste. I join my colleagues in calling for changes to this program that will put privacy and safety of one's personal information first.”

“It’s unfortunate that another report is being released citing pitfalls in the implementation of electronic health records,” said Roberts, the senior Republican on the Senate Rules Committee. “Even more unfortunate is the fact that my colleagues and I have been pointing out these problematic concerns to the Administration for over a year and as this report details little to no response has occurred. Electronic health records are important for the future of our health system, however their implementation must be done in a thorough and conscientious way that ensures all providers are included and leads to the reduction of waste or fraud and not its increase. I will continue to push for an interoperable health IT system but it must protect patient privacy and it must include safeguards against waste, fraud, and abuse.”

In April of 2013, the group of Republican senators released a white paper, “REBOOT: Re-examining the Strategies Needed to Successfully Adopt Health IT,” outlining concerns with current federal health information technology policy, including increased health care costs, lack of momentum toward interoperability, potential waste and abuse, patient privacy, and long-term sustainability. 

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WASHINGTON- Today, Senate Homeland Security and Governmental Affairs Committee Chairman Tom Carper (D-Del.) and Ranking Member Tom Coburn (R-Okla.) commended the Centers for Medicare and Medicaid Services (CMS) for moving forward on key proposals to curb the fraudulent diversion of prescription drugs from the Medicare program. The announcement follows a hearing the Committee held in June that highlighted the need for stronger oversight of the Medicare prescription drugs program.  

“I welcome the steps that the Centers for Medicare and Medicaid Services (CMS) is taking to curb the fraudulent diversion of drugs from Medicare,” said Chairman Carper. “For years, Medicare has lost millions of dollars due to fraudulent prescriptions for painkillers and other drugs. This fraudulent activity is not only a financial drain on a vital federal program, but it is also harmful to those struggling with prescription drug abuse. These commonsense reforms will help provide CMS with the tools and authority needed to actively combat this type of waste and fraud while protecting Medicare beneficiaries and strengthening the Medicare program.”

“I applaud Medicare officials for adopting policies that will enable program integrity experts to review and act on abusive and harmful prescribing of powerful drugs and controlled substances,” said Dr. Coburn. “The vast majority of physicians are professionals who want to help patients. Yet, where there is proof of abuse or fraud, CMS should take necessary actions to protect patients and taxpayers. Moving forward, it will be important for Medicare officials to implement this policy in a manner that is data-driven, thoughtful, and helps educate the provider community.”

The new proposal allows CMS to more quickly identify suspect Medicare prescriptions and actively prevent providers from charging the Medicare program for unnecessary medications. For example, CMS will be able to remove providers whose licenses to prescribe prescription painkillers or other controlled substance have been revoked by state regulators.  In addition to providing enhanced enforcement capabilities, these reforms will fix a loophole in the Medicare Part D program that allows providers to prescribe medications, even if they are not approved Medicare providers.

During the June 2013 hearing, testimony by CMS, the Health and Human Services Office of Inspector General and others showed that CMS’s oversight of the Part D program lacked effective controls to prevent waste and fraud. Witnesses testified that CMS should use its existing authority to enhance its oversight procedures to protect the Medicare Prescription Drug Program and save taxpayer dollars, and work with Congress on other steps that may require new legislative authority. Many of the reforms suggested by the witnesses are reflected in CMS’s new proposal.

The proposal by CMS is open for comments, and is scheduled for final adoption in January of 2015.

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Amendment #2606 - To end unemployment payments to jobless millionaires and billionaires. Additional information here. 

Amendment #2607 - To ensure that individuals do not simultaneously receive unemployment compensation and disability insurance benefits.  Additional information here. 

WASHINGTON - Today, Senate Homeland Security and Governmental Affairs Committee Chairman Tom Carper (D-Del.), Ranking Member Tom Coburn (R-Okla.), Senate Financial and Contracting Oversight Subcommittee Chairman Claire McCaskill (D-Mo.) and Senator Susan Collins (R-Maine) highlighted a new Government Accountability Office (GAO) report that details some of the problems and lessons learned from the General Service Administration’s transition process for Networx telecommunications contracts for over 150 agencies from the legacy FTS2001 contracts. 

“The rocky transition to the Networx contracts was, unfortunately, a lesson in lost opportunities,” said Chairman Carper. “As this report shows, dozens of agencies missed out on hundreds of millions of dollars in savings under the new contracts, and instead accrued tens of millions in increased costs in contract management. Given that we are trying to do more with fewer resources in every part of the government, it is essential that programs like Networx reach their full potential and garner all possible savings. One of my core values is if it isn’t perfect, make it better, and I believe that the General Services Administration must look at these lessons learned and perfect its process so the transition to the next suite of telecommunications contracts does not veer off -course as the Networx transition did.”

“GSA’s failure to successfully transition its telecommunications services to Networx is the latest in a long line of contracting problems.  Too often we’ve seen poor planning, unnecessary duplication, and inadequate management at GSA,” Dr. Coburn said.  “Even worse, as the report shows, it cost taxpayers $329 million more than if GSA had adequately transitioned to Networx on schedule.  Such mismanagement and waste is simply unacceptable, especially at a time of increasing debts and limited resources.  GAO has made a number of recommendations to GSA, including that GSA establish better transition plans with detailed time frames to get this program back on track. GSA should implement these recommendations and take immediate steps to prevent future delays and wasteful and unnecessary spending. I look forward to working with the committee to conduct oversight of this, and other efforts by GSA to improve efficiency, and save taxpayer dollars.”

The transition from FTS2001 to Networx took almost three years longer than planned, and GSA estimates that the delay increased the transition cost by over $66 million.   Further, GAO estimates that if the transition had occurred on time agencies could have saved over $328.7 million by moving to lower-cost services on the Networx contracts.  GAO found that the delays by agencies in transitioning to Networx were attributable to a number of factors, including weak project planning and a complex acquisition process characterized by duplicative contracts and a large number of service options.  Additionally, GSA reported that these issues were compounded by a decline in contracting and technical expertise in the agencies.

The General Services Administration (GSA) negotiated the Networx contracts in 2007 to provide a range of telecommunications services to federal agencies, including internet and wireless services.  These contracts will expire in 2017 and GSA is in the planning stage for the next generation of contracts to replace Networx, which will be known as NS2020.  However, GAO reports that there is a high risk that GSA will not meet its goal of awarding the next set of contracts in 2017, and that GSA expects to extend the Networx contracts for at least three years. 

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Yesterday the Office of Inspector General (OIG) at the U.S. Department of Health and Human Services (OIG) said that overseeing health insurance exchanges under the Patient Protection and Affordable Care Act (“Obamacare”) is the biggest challenge that HHS faces in 2014.  The OIG made the announcement in their updated annual report of the ten “top management & performance challenges” the Department faces in the year ahead. 

Each year the OIG outlines the key “continuing vulnerabilities” HHS faces in efforts to reduce waste, fraud, and abuse and ensure program integrity. The OIG said that overseeing health exchanges under Obamacare was the top performance challenge because the creation of the exchanges added “a substantial new dimension to the Department's program landscape.”  Exchanges must meet  a “complex set of program requirements” which have to be successfully implemented for the first time in federal policy—regardless of whether or not the exchange is federally-facilitated or state-run.

The report amplified HHS Secretary Kathleen Sebelius’s recent focus on the contractors who are implementing the health care law. The Secretary made news recently when she announced she asked the OIG to examine the role of contractors in the failed October launch of the health website.

Contractors have played, and will continue to play, a “vital role in building, maintaining, and fixing the systems” that underpin the health care exchanges, the OIG report explained. But the report suggested that it is ultimately the Department—not contractors alone—which is responsible, since contractors are performing tasks prescribed by the Administration.  “The Department must ensure, to the greatest extent possible, that the Government obtains specified products and services from its various contractors on time and within budget” the report said pointedly.

Many observers, including Jeff Zients, who was brought in to assist with coordinating the rollout of the health law, have suggested that one factor in the creation of the website problems was the fact that no single individual was totally in charge of all the individual pieces of a complex implementation.  The OIG report lent credence to this conclusion, saying the management headache was increased by “the large number of contracts and the need to coordinate work across multiple contractors.”  The report listed challenges associated with successful contract administration elsewhere it its top ten list.

While the functionality of the health website has notably improved compared to the initially rocky rollout of HealthCare.gov—a rollout that damaged voters’ perception of the President’s credibility and trustworthiness on his signature domestic initiative—the OIG report provided little solace for federal health officials who think the worst may be over.  The OIG said HHS still faces “significant, well-publicized challenges in ensuring that healthcare.gov operates successfully” for consumers. As weeks of media coverage has highlighted, the problems run deep. As the report explains, the challenges  include “both the front-facing consumer functions, as well as the back-end administrative and financial management functions.”

Congressional critics find the report confirms their warnings of further “glitches” with the health law’s rollout.  Republicans have been critical of the Administration’s waffling on how they would verify individual consumers’ eligibility or of HHS’s efforts to share massive amounts of data with other federal agencies—two areas the report stressed the need for continued careful oversight. 

But even supporters of the health law are likely to worry about additional challenges, as the tasks outlined for the Department are rather daunting. On top of making the website work, OIG offered a laundry list of items Secretary Sebelius and her leadership must focus on in weeks and months ahead.  The OIG said HHS must keep its eye on overseeing “eligibility systems, payment accuracy, contractor oversight, and data security and consumer protection.” 

If those tasks were not intimidating enough, the report also warned federal officials who likely already behind schedule that coordination between federal and state programs, private health plans, and an array of federal contractors is “necessary to achieve program objectives and poses an additional challenge.” The Department must still work to “ensure that healthcare.gov verifies consumers' personal information; accurately determines eligibility for Marketplace insurance, tax credits, and cost-sharing subsidies; operates effectively and easily for consumers; and transmits complete, accurate, and timely information to insurers regarding enrollees,” the report said. 

Fixing the data sharing may be a tall order, since even very recently there have been problems with the website successfully transmitting 834 forms to insurers and Medicaid enrollment data to states.  This is why “vigilant monitoring and testing of the Marketplaces and rapid mitigation of identified vulnerabilities are essential” to preventing further problems, the report explained.

Some early reports of consumer enrollment suggest that fewer young consumers may have enrolled in plans compared to prior projections, though HHS has yet to release any detailed data. Echoing a worry of many health policy experts outside the Administration, the report underscored younger, healthy Americans have to enroll in Obamacare for the policy experiment to succeed.  “Sufficient enrollment, deemed as including enrollment of relatively healthy individuals, is essential for producing a stable and effective insurance market,” the report noted.

One issue the report focused on has received less media attention to date, but will be increasingly important in the weeks ahead: payment accuracy. A dizzying array of new and complex federal payments—advance premium tax credits, cost-sharing subsidies, and premium stabilization payments—must be made to a range of entities. These payments involve “complex calculations and offsets, adjustments, and reconciliations, which pose challenges for making accurate payments,” the report cautioned. The OIG said it was imperative HHS “work closely with insurers to ensure that information is timely, complete, and accurate” and also “develop error rates to measure the integrity of program payments.”

Surprisingly, the report cautioned that HHS still has to complete the “development and implementation of financial management and payment systems and ensure that payments to insurers, which are scheduled to begin in January 2014, are accurate.” If systems are incomplete at this point and are in fact still being “developed” within a few weeks of going live, bumps and errors may be inevitable.  So the OIG report stresses that federal officials will need to be proactive and nimble to react in such an environment in which “the Department will face continuing challenges as the program evolves over time.”

A number of consumers and privacy groups have worried if fraudsters and crooks can scam the new system, since the OIG is on the record as saying the new program is a ripe target for fraud. “As with other new programs,” the report counseled “the Department must monitor for known fraud, waste, and abuse risks and detect emerging new risks” and “respond quickly and effectively.” Because these exchange’s data systems handle consumers' sensitive personal information, “security of data and systems is paramount” the OIG stressed.

To maximize security, consumers also need to be educated about potential fraud schemes, the report suggested. Scams include a range of gimmicks, the OIG outlined, including “identity thieves posing as legitimate assisters offering to help individuals purchase insurance in exchange for money or personal identifying information; imposters misleading Medicare beneficiaries into falsely believing they need to purchase new insurance; and sham websites that appear to be legitimate.”

Moving forward, the report said the OIG will monitor the implementation and functioning of the exchanges and focus oversight on key risk areas, such as eligibility systems, payment accuracy, information technology security, and contracting. The OIG also announced it will audit program safeguards to prevent the submission of fraudulent or inaccurate information.

# # #

Inspector General: Running Obamacare’s Exchanges Is  The “Top Management Challenge” for HHS In 2014 

Washington, D.C. — Today, Senators Joe Donnelly (D-IN) and Tom Coburn (R-OK) introduced the Preserving Access to Manufactured Housing Act, legislation that would maintain important consumer protections while also protecting the ability of manufactured home customers to buy, sell, and refinance homes.

Donnelly said, “For many Hoosier families, the decision to purchase a home is one of the most significant investments they will make. We should be doing all we can to preserve access to affordable housing, especially when it comes to manufactured housing, which can be the best option for many families. I thank Senator Coburn for joining me in this effort.”

Dr. Coburn said, “This bill will ease onerous federal regulations for consumers and retailers which slow economic growth in the industry.”

Earlier this year, the Consumer Financial Protection Bureau (CFPB) issued guidelines, as required under the Dodd-Frank Wall Street Reform and Consumer Protection Act, to expand the range of loan products that can be considered high-cost mortgages under the Home Ownership and Equity Protection Act (HOEPA). Unfortunately, the CFPB failed to recognize the uniqueness of manufactured home loans compared to the rest of the housing industry.  Set to go into effect in January 2014, these guidelines will likely classify a large percentage of small-balance loans used for the purchase of affordable manufactured housing as high-cost loans.  As a result, there would be increased lender liabilities associated with making and obtaining a HOEPA high-cost mortgage, which could lead to a loss of credit available to those seeking to purchase manufactured housing.  

The primary purpose of the Preserving Access to Manufactured Housing Act is to adjust new HOEPA thresholds so fewer manufactured home loans are classified as high-cost.  Under the new guidelines, if a transaction is for less than $50,000 and the home is considered personal property, then the interest rate on a mortgage cannot exceed Average Prime Offer Rate (APOR) by more than 8.5% or else it is considered ‘high-cost’ and subject to added liability and disclosure.  The bill would change that threshold to APOR + 10% for transactions under $75,000.

Earlier this year, Senator Donnelly discussed this issue with CFPB Director Richard Cordray and recently joined other Senators in sending a letter to Director Cordray requesting a delay of the new rules for manufactured housing until CFPB has had a chance to fully study the issue.

Read the full legislation here.

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On November 29, 2013, Mary Wakefield, the director of the Health Resources and Services Administration at HHS replied to the letter Dr. Coburn (along with Sen. Burr and Enzi) sent her on November 1, 2013. Their original letter followed up on the findings of GAO’s report (GAO-13-806), which the Senators said showed HRSA had failed to provide Congress and the public with timely and meaningful analysis regarding health care provider shortages across our country. As the Senators noted in their letter, they were “gravely troubled by the findings” of the report, and therefore requested a series of documents from HRSA on the matter.  

HRSA Director Wakefield’s letter included responses (see here and here) to a number of specific items the Senators had requested, as well as references to a new HRSA study issued as a result of the Senators’ oversight work. The new study, “Projecting the Supply and Demand for Primary Care Practitioners Through 2020,” was issued by HRSA’s Bureau of Health Professions National Center for Health Workforce Analysis. 

The new study found that the country will be about 20,400 primary carephysicians short by 2020. HRSA’s study cites “aging and population growth” as accounting for 80 percent of the change in demand, but they also say 20 percent of the demand is due to the Patient Protection and Affordable Care Act/Obamacare. So, while Obamacare is not the sole cause of the coming primary care physician shortage, the provisions of the law will exacerbate the shortage.

A methodological limitation of the study noted by some is that “the model assumes continuation of key trends in service utilization, practitioner practice patterns, and practitioner production.” In other words, the study is a straight line projection of current supply and demand for physicians, and does not assume any changes in delivery system innovation, payment, or utilization. This is a notable limitation, since changes in physician practice patterns, payments, and utilizations continue to evolve each year.  Certainly, there will be changes to a number of dynamics impacting physician utilization between now and 2020.

However, while the methodological approach is a limitation of the study’s findings, it is a relatively small limitation and should not be read to negate the study’s findings.  In fact, many observers have argued that this straight line projection of current supply and demand is actually the best way to project physician shortages for 2020, since that date is in the relative near term, just about six years away.  (This approach contrasts with other workforce shortage projection which forecast supply and demand over a longer time horizon and therefore increase the uncertainty of those projections).

Finally, as the study notes, the primary care physician shortages could be worse in some places across the country. “The national averages reported here mask substantial distributional disparities across the United States,” the report warns. Additionally, some underserved localities could see a greater need for various specialties as well.

(Washington, DC) – U.S. Senators Jeanne Shaheen (D-NH) and Tom Coburn (R-OK) introduced bipartisan legislation today to rein in excessive spending on oil paintings of government officials. The bipartisan bill would put a cap on the amount of taxpayer support for the portraits and limit the practice to those officials in the line of succession for the presidency.

“At a time when vital services and programs are facing cuts, we need to be looking at every way we can stop excessive spending practices in Washington,” Shaheen said. “Official portraits should be done in a way that protects taxpayers, as we do in New Hampshire.”

“Hardworking taxpayers shouldn’t foot the bill for lavish official portraits, especially when government officials spend more on paintings of themselves than some Americans make in a year,” Dr. Coburn said. “This bill reins in excessive spending on such portraits and protects taxpayers from funding waste.”

ABC News and The Washington Times have reported that the Obama Administration has spent nearly $400,000 on commissioned portraits of agency directors and Cabinet secretaries over the last two years. According to a 2008 Washington Post study of these contracts, these portraits can cost upwards of $50,000. 

The bipartisan Responsible Use of Taxpayer Dollars for Portraits Act would limit taxpayer support for portraits to $20,000. The bill clarifies that for portraits that cost more than $20,000, other funds may be used. In addition, the legislation would only allow federal funds to be provided for portraits of officials in line for the presidency. 

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In an updated report, the Congressional Research Service (CRS) provided an examination of the identified legislative and other actions taken to repeal, defund, and delay the new health care law Patient’s Choice and Affordable Care Act since the law’s enactment.  The report shows that since the new health care law passed in 2010, Congress has passed 15 bills to repeal or rescind funding for portions of the law, and President Obama’s administration has delayed implementation of 6 provisions of the law, including the small business exchange (SHOP) and the employer mandate.

Read the full report here.

(WASHINGTON, D.C.) – U.S. Senator Tom Coburn, M.D. (R-OK), ranking member of the Senate Homeland Security and Governmental Affairs Committee, released the following statement regarding a new Inspector General report revealing serious gaps in DHS’s own cybersecurity: 

“This report shows major gaps in DHS’s own cybersecurity, including some of the most basic protections that would be obvious to any 13-year-old with a laptop.  DHS doesn’t use strong authentication.  It relies on antiquated software that’s full of holes.  Its components don’t report security incidents when they should.  They don’t keep track of weaknesses when they’re found, and they don’t fix them in time to make a difference.  

“President Obama has called on the private sector to improve its cybersecurity practices to ensure that our nation’s critical infrastructure is not vulnerable to an attack.   DHS and other agencies must be held to at least the same standard.  

“The fact is the federal government’s classified and unclassified networks are dangerously insecure, putting at risk not only U.S. national security, but the nation’s critical infrastructure and vast amounts of our citizens’ personally identifiable information. 

“We spend billions of taxpayer dollars on federal information technology every year.  It is inexcusable to put the safety and security of our nation and its citizens at risk in this manner.” 

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Washington, D.C. – U.S. Senators Barbara Boxer (D-CA) and Tom Coburn (R-OK) praised President Obama for signing their bipartisan legislation, the HOPE Act (HIV Organ Policy Equity Act), which ends the federal ban on research into organ donations from HIV-positive donors to HIV-positive recipients. The bipartisan measure would open a pathway to the eventual transplantation of these organs and could provide life-saving assistance to HIV-positive patients who are at risk of liver and kidney failure. 

The Boxer-Coburn bill passed the Senate in June, and the House version, introduced by Representatives Lois Capps (D-CA) and Andy Harris (R-MD), was passed earlier this month by a voice vote.

“I am proud that President Obama signed our bipartisan legislation into law today,” Senator Boxer said. “Ending this outdated research ban will save lives and give hope to thousands of patients and their families.”

Senator Coburn said, “I applaud the President for signing this important piece of bipartisan legislation into law and am hopeful it produces encouraging results for HIV-positive individuals.”

“After years of work on crafting this legislation, building bipartisan, bicameral consensus, and collaborating with advocates in the HIV and medical communities, I am thrilled to see the President sign the HOPE Act into law today,” Representative Capps said. “This proves that even in a divided Congress, we can come together to pass common sense bills with bipartisan efforts that will help save lives, improve health outcomes, and save taxpayer dollars.”

Representative Harris said, “This legislation gives new hope to all of those waiting for organ transplants. As a physician who has performed anesthesia during organ transplants, I have seen firsthand the life-saving joy that receiving an organ can bring to patients and their families.  I appreciate the bipartisan support this common sense change to an outdated law has received.”

The ban on the donation of organs from HIV-positive donors and related research was enacted as part of the Organ Transplant Amendments Act of 1988, but is now medically outdated. With the advances in antiretroviral therapy, many HIV-positive patients are living longer lives. These patients are now more likely to face chronic conditions such as liver and kidney failure, for which organ transplants are the standard form of care.

There are currently more than 100,000 patients on the active waiting list for organ transplants in the United States and about 50,000 people are added to the list each year – but fewer than 30,000 transplants are performed annually. Tragically, many patients die while waiting for a transplant.

According to a study published in the American Journal of Transplantation, allowing organ transplants from HIV-positive donors to HIV-positive recipients could increase the organ donation pool by 500-600 donors a year and save hundreds of lives. 

The bipartisan Senate bill was co-sponsored by Senators Tammy Baldwin (D-WI), Rand Paul (R-KY), Richard Burr (R-NC), Michael Enzi (R-WY), Elizabeth Warren (D-MA), Mark Kirk (R-IL), Dianne Feinstein (D-CA), Mary Landrieu (D-LA), Brian Schatz (D-HI), Richard Blumenthal (D-CT), Roy Blunt (R-MO), Mark Pryor (D-AR) and Carl Levin (D-MI). 

This legislation also has broad support from the medical community and advocacy groups, including the American Medical Association, American Society of Nephrology, American Society of Transplant Surgeons, American Society of Transplantation, Association of Organ Procurement Organizations, American Academy of HIV Medicine, American Society for the Study of Liver Disease, the Human Rights Campaign, National Minority AIDS Council, HIV Medicine Association, National Coalition for LGBT Health, Infectious Diseases Society of America, Gay and Lesbian Medical Association, United Network for Organ Sharing, The AIDS Institute, amfAR (American Foundation for AIDS Research), Lambda Legal, the Treatment Access Group (TAG), and AIDS United. 

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In Letter to Health & Human Services Secretary Kathleen Sebelius, Lawmakers Write, “Recent events, including the rollout of the health care marketplace exchanges on October 1, have deepened our concerns about the success of CO-OPs and the probability of taxpayers being repaid for the $2 billion that was loaned to these plans.”

WASHINGTON – Today, five Republican lawmakers wrote to Health and Human Services Secretary Kathleen Sebelius and questioned the success of the Consumer Operated and Oriented Plans (CO-OP) loan program – a new ObamaCare program that has issued nearly $2 billion in loans to non-profit health insurance issuers – and whether taxpayer dollars would be repaid on time.  In the letter, spearheaded by Finance Committee Ranking Member Orrin Hatch (R-Utah), the lawmakers cited two Health and Human Services Inspector General (HHS-IG) reports that identified a number of risks within the CO-OP program and requested a status update of the challenges being faced.

“Recent events, including the rollout of the health care marketplace exchanges on October 1, have deepened our concerns about the success of CO-OPs and the probability of taxpayers being repaid for the $2 billion that was loaned to these plans,” wrote the lawmakers.

In addition to Hatch, the letter was signed by Senator Lamar Alexander (R-Tenn.), Ranking Member of the Senate Health, Education, Labor and Pensions (HELP) Committee, Senator Mike Enzi (R-Wyo.), Ranking Member of the HELP Subcommittee on Children and Families, Senator Tom Coburn (R-Okla.), Ranking Member of the Senate Homeland Security and Government Affairs Committee, and Rep. Charles Boustany (R-La.), Chairman of the House Ways and Means Subcommittee on Oversight.

Earlier this year, a number of Republican Senators asked the Government Accountability Office to conduct an independent audit examining the effectiveness of CO-OPs. The members also requested GAO evaluate CO-OPs’ efforts related to covering the uninsured, providing lower-cost plans, and repaying loans from the U.S. Department of Health and Human Services. 

Last year a similar group of Republican Senators and Representatives wrote to Secretary Sebelius regarding the funding and structure of the CO-OP program, however the Administration’s response, received nine months later, lacked details. Since CO-OPs became operational on October 1^st, reports have indicated serious problems with the program. HHS, for example, has already terminated the loan to the Vermont CO-OP. It remains unclear as to whether the group will be able to repay the loan. The lawmakers asked Secretary Sebelius to respond to them by December 6.

Also last year, in an oversight report on ObamaCare, two Republican Senators penned a data-driven critique of the CO-OP program. Examining HHS’s own projections that they expect a third of all health insurance cooperatives to fail to repay their taxpayer-backed loans, the Senators warned the CO-OP program could be another Solyndra, citing the failed energy company that collapsed and failed to repay millions in taxpayer dollars.

The text of the letter to Secretary Sebelius is below and a signed copy can be found HERE:

The Honorable Kathleen Sebelius

Secretary of Health and Human Services

U.S. Department of Health and Human Services

200 Independence Avenue, SW

Washington, DC 20201 

Dear Secretary Sebelius: 

Last year, we wrote to you regarding the Department of Health and Human Services’ (HHS) implementation of the Consumer Operated and Oriented Plans (CO-OP) loan program, which gives loans to help create non-profit health insurance issuers.  Recent events, including the rollout of the health care marketplace exchanges on October 1, have deepened our concerns about the success of CO-OPs and the probability of taxpayers being repaid for the $2 billion that was loaned to these plans. 

The Patient Protection and Affordable Care Act (PPACA) created the CO-OP loan program, which offers funding to non-profit health insurance issuers that offer qualified health plans in the individual and small group markets.[1]  As of January 2, 2013, the Centers for Medicare & Medicaid Services (CMS) had awarded loans totaling $1.98 billion in funding to 24 CO-OPs operating in 24 states.[2]  The loans come in two forms:(1) startup loans, which assist with costs of establishing CO-OPs; and (2) solvency loans, which help CO-OPs meet state insurance solvency and reserve requirements.[3]

When we wrote to you in May 2012, we noted that there was little evidence that the CO-OP program would promote greater competition and lower costs in most state insurance markets, and we questioned whether HHS had significantly underestimated the financial risk that these entities pose to the Federal Treasury.  The responses to our letter from CMS Administrator Marilyn Tavenner—which were delivered on your behalf more than 9 months after we sent our letter—did little to assure us that HHS or CMS was prepared to address these issues. 

Indeed, a recent HHS Inspector General report identified many of the same issues that we discussed in our previous letter, including several immediate challenges: the “tight” 18-24 month window that CO-OPs had from receiving financing to being ready enroll consumers; market uncertainty; and the difficulty of quickly identifying and contracting with the right health care providers and vendors for key services.[4]  Additionally, as of June 2013 – just four months before the October 1 exchange rollout – five of the CO-OPs had not yet been issued insurance licenses by their states.[5] 

The HHS Inspector General issued a second report in July 2013 that raised even greater concerns about the viability of the CO-OP program.[6]  The Inspector General found “little evidence of private monetary support in any of the 16 applications” that the Inspector General reviewed – applications which were all approved for funding.[7]  Perhaps more troubling, the Inspector General found that “11 of 16 CO-OPs reported estimated startup expenditures in their applications that exceeded the total startup funding ultimately provided by CMS.”[8]  The Inspector General concluded that “there is a risk that CO-OPs could exhaust all startup loan funding before they are fully operational or before they earn sufficient operating income to be self-supporting” based on “unforeseen risks (such as limited enrollment) or barriers (such as uncertainty about operations of the State-based or federally facilitated marketplaces or a State’s denial of insurance licensure)”.[9] 

Although it has only been a few weeks since the health care exchange marketplace was launched, some of these fears have already been realized.  In fact, The Washington Post reported that “the [exchange] problems, in particular the malfunctioning federal Web site, are hitting the co-ops hard because they depend on the exchanges for business.”[10]  The Post cited an internal review by Deloitte that uncovered financial problems in the Maryland, New York, and New Jersey CO-OPs.  Moreover, the Post reported that after being denied a license by the state, the Vermont CO-OP had its loan terminated by HHS, and the CO-OP “said it will be unable to repay $4.5 million that had been spent.”[11]  Similarly, the Ohio CO-OP also missed the deadline for getting licensed and its CEO was uncertain about whether the CO-OP would be able to continue to operate.[12] 

These recent reports have further underscored our valid concerns about the nature of the CO-OP program and have illustrated the need for effective management by HHS and CMS, as well as consistent Congressional oversight.  Therefore, in the interest of taxpayers and individuals enrolled in these plans, please provide our offices with the following information: 

1. What steps did HHS take to actively monitor the status of CO-OP awardees’ license applications? 
2. Have all 24 CO-OPs received state insurance licenses?  For any CO-OPs that have not yet been licensed by states in which they operate, when do you expect that they will receive a license?
3. Why did the Ohio CO-OP miss the deadline to receive its state insurance license?
4. When do you anticipate that the CO-OPs will become fully operational?  What is HHS doing to ensure that CO-OP startup funds are not exhausted before they become fully operational? 
5. What has HHS done in response to the Inspector General’s finding that “11 of 16 CO-OPs reported estimated startup expenditures in their applications that exceeded the total startup funding ultimately provided by CMS”?  Specifically, has HHS required these 11 CO-OPs to make any adjustments to their budgets and/or operation plans?
6. For the 11 CO-OPs identified in the previous question, please explain why CMS elected to fund these entities at a lower level than the estimated startup expenditures.
7. Following the problematic launch of the HealthCare.gov website, what steps has HHS taken to ensure that CO-OPs are able to signup new customers using alternative means?
8. Have CO-OPs submitted all required quarterly and semiannual reports and quarterly disbursement requests?  If not, what steps has HHS taken?
9. Under the terms of the CO-OP program, a CO-OP is required to inform CMS one month in advance if it believes that it will be unable to reach any of its milestones.  Identify each CO-OP that has made this notification to CMS.  In each instance, provide the CO-OP’s explanation about why it made the notification and what steps, if any, CMS took in response to the notification.
10. Has HHS delayed or discontinued funding to any co-op as the result of the CO-OP’s failure to meet the operating requirements.
11. The Inspector General’s first July 2013 report indicates that CMS delayed portions of startup loans to five co-ops because they failed to reach milestones on time.  What is the operating status of each of these CO-OPs?
12. What has HHS done to address the financial problems in the Maryland, New York, and New Jersey CO-OPs?  Has HHS made any modifications to the loan terms of these CO-OPs?
13. Please provide all documents related to (1) the Vermont CO-OP’s failure to obtain an insurance license and (2) HHS’s decision to terminate the Vermont CO-OP’s loan.
14. What steps has HHS taken to recover funds from the Vermont CO-OP
15. Out of the $1.98 billion awarded to CO-OPs, what amount does HHS expect to be repaid?  What is the period of time by which HHS expects these funds to be repaid?

We appreciate your assistance in helping us better understand the current state of the CO-OP program.  Due to the urgency of the reported problems associated with the CO-OPs, we ask that you respond to this letter in a more timely fashion than to our previous letter and provide responses no later than December 6, 2013.

Sincerely,

Coburn offered the following amendments to S. 1197,  the National Defense Authorization Act of 2014.  Conservative estimates conclude that DOD could save over $386 billion in 10 years through reductions in low priority spending.  

Amendment #2155 - Requires DOD to obtain an audit with an unqualified opinion by FY 2018.  More information here. 

Amendment #2156 - Eliminates DOD non-defense spending and transfers duplicative programs to other agencies. More information here. 

Amendment #2157 - Establishes position precedence and qualifications for DOD Undersecretary of Defense for Management. More information here. 

Amendment #2158 - Requires disposal of DOD excess property by public sale or auction. More information here. 

Amendment #2159 - Requires the Department of Defense to use existing authority to implement GAO duplication recommendations. More information here. 

Amendment #2160 - Requires DOD to publish annually online their unclassified unobligated balances by account and an explanation of why they are unobligated. More information here. 

Amendment #2161 - Reduces DOD tuition assistance program and limits to use as a retention tool where the military services have a critical-needs shortage of military personnel. More information here. 

Amendment #2162 - Strikes section 524, which restricts use of DOD tuition assistance funds at for-profit institutions. More information here. 

Amendment #2163 - Prohibits the Department of Defense from employing tax cheats. More information here. 

Amendment #2164 - Withholds funding for acquisition of aircraft and equipment for the Afghan Security Forces until the Secretary of Defense submits a plan to Congress confirming the plan to transfer the C-27A planes to another agency or entity. More information here. 

Amendment #2165 - Withholds funding for acquisition of aircraft until the Secretary of Defense submits a plan to Congress confirming the plan to transfer the Air Force’s C-27J planes to another agency or entity. More information here.

Amendment #2166 - Expresses the Sense of the Senate that the small arms and ammunition used by the United States Army should be superior to the small arms and ammunition used by potential threat nations, foreign allied militaries, and U.S. domestic law enforcement. More information here. 

Amendment #2520 - To require a report on plans for the disposition of the C-27A aircraft. 

(WASHINGTON, D.C.) –U.S. Senator Tom Coburn, M.D. (R-OK) and Congresswoman Barbara Lee (D-CA), along with 38 other lawmakers, sent a letter to President Obama calling on the Administration to announce a doubling of the number of people on treatment through the President’s Emergency Plan for AIDS Relief (PEPFAR) during the Fourth Replenishment of the Global Fund to Fight AIDS, Tuberculosis and Malaria scheduled to take place in Washington, D.C., in December.

“We applaud the Administration’s achievement of increasing the number of people on treatment supported by PEPFAR to 6 million, and the recent announcement of 1 million babies globally born HIV-free thanks to PEPFAR support,” they write.  “To build on this success, we urge you to set a new, bold PEPFAR goal of 12 million people on treatment by the end of fiscal year 2016…. At this critical juncture, scaling up to capitalize on scientific advances, while expanding deployment of proven-effective prevention tools that are already available to us, will not only save millions of lives but will also significantly reduce human suffering, new HIV infections, and healthcare costs in the years to come.”

PEPFAR, a bipartisan program established in 2003, has treated and cared for millions of individuals facing HIV/AIDS, tuberculosis and malaria across the world.

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WASHINGTON, D.C. – Today, U.S. Senators Richard Burr (R-NC), Tom Coburn (R-OK), and Saxby Chambliss (R-GA) reintroduced the Public-Private Employee Retirement Parity Act to address long-term liabilities facing the federal government.  The legislation would end the defined benefit pension portion of the Federal Employee Retirement System (FERS) for new federal government hires starting six months after enactment, leaving fully in place the Thrift Savings Plan with the current match (up to 5%) for both current and future federal workers.  The bill would also apply to Members of Congress. 

“Right now, federal government workers receive far more generous retirement benefits than private sector employees.  The cost to taxpayers of these benefits is unsustainable and we simply cannot afford it,” said Sen. Burr.  “We cannot ask taxpayers to continue to foot the bill for public employee benefits that are far more generous than their own.”

“Generous pension plans for members of Congress have helped turn congressional service into a career rather than a calling,” said Dr. Coburn.   “At the same time, federal workers enjoy a better benefits package and higher overall pay than most taxpayers – even at a time when many Americans are still simply looking for a job.  This status quo is unsustainable and needs to be reformed.”

“With America now $17 trillion in debt, we simply cannot continue to commit to future government spending,” said Sen. Chambliss.  “Americans have demanded their leaders make the necessary changes to our fiscal policies to put our nation on a track to sustain economic growth and real job creation.  The Public-Private Employee Retirement Parity Act is a small change that will have a big impact on our debt and deficit.” 

Currently, federal workers enjoy both a defined benefit pension and a Thrift Savings Plan (equivalent to a 401(k)) with up to a 5% match, paid for by the taxpayers.  The average private sector employee gets a 401(k) with a 3% employer match and no pension.  Federal workers also continue to enjoy federal health care benefits (FEHBP) after they retire, a benefit that is becoming increasingly rare in the private sector. 

The legislation will require the Administration to make the annual report on the on the actuarial status of the federal retirement system publically available online by January 31st each year.  According to the most recent Office of Personnel Management’s Civil Service Retirement and Disability Fund annual report, the FERS system is currently underfunded by $20.1 billion for fiscal year 2012.  In the coming years, as more of the retirement burden falls on the FERS system, the required federal government contributions to FERS will skyrocket, especially in comparison to what federal workers will put into the system.  In 2012, the Federal government contributed about $22.2 billion to FERS. By 2065, those required contributions will rise to $239.5 billion, with the government paying out $415.3 billion in benefits. 

Current federal government employees and retirees would not be impacted by the changes in the Burr-Coburn-Chambliss bill.

Click here to learn more.

###

Fact #1:  Because of Scoring Guidelines, CBO Does Not “Score” Program Integrity Provisions as Saving Money. 

An analyst from the nonpartisan Congressional Research Service has explained that, with regard to program integrity initiatives, at least one of two scorekeeping guidelines apply, depending on whether the program integrity initiatives are funded as discretionary spending or direct spending (i.e., mandatory spending): rule #3 and rule #14.  These rules, from the “Scorekeeping Guidelines” published in the Joint Explanatory Statement of the Committee of Conference on H.R. 2015 (105^th Congress), are used to measure compliance with congressional and statutory budget rules.[1] 

These rules effectively mean that, unless Congress changes the basic nature of the Medicaid and Medicare programs as an entitlement – or changes the scoring rules themselves – CBO is not allowed, for scorekeeping purposes, to assign savings to most program integrity provisions.

Fact #2: Because of Fact #1, CBO Assumes That CMS Uses Its Program Integrity Funding in the Most Efficient and Most Effective Manner.

Despite a wealth of analysis from GAO reports and Inspector General reports showing gaps, failures, and limitations in CMS’s administration of program integrity initiatives, according to conversations with CBO staff, CBO said they assume CMS uses its program integrity funding in the most effective manner.  This assumption is understandable given the restrictions of the scoring conventions CBO must uphold, but it f clearly is a scoring convention that does not necessarily reflect real-world experience and an abundance of data to the contrary. Assessing this assumption critically, one downside of CBO assuming CMS is doing a top job under current law is that this assumption is biased toward the status quo and does not take into account the relevant merits of specific policies. 

Fact #3:  While Scorekeeping Guidelines Prevent CBO From Include Savings In Its Official Score For Scorekeeping Purposes, CBO Does Estimate That Program Integrity Initiatives Provisions Do Save Money.

In its August 1 estimate of the Budget Control Act of 2011, CBO explained that increasing the budget caps (and thus appropriations) to the Health Care Fraud and Abuse Control fund would result in real savings to the program, even though those savings are not scorable under the convention of the budget rules.   CBO said: “If the Congress were to appropriate the maximum amounts eligible for the cap adjustment related to HCFAC, spending for such activities would be about $3 billion above CBO’s baseline. Based on that increase, CBO estimates that benefit outlays for Medicare, Medicaid, and CHIP would fall by about $3.7 billion over the 2012-2021 period. Additional savings would accrue after 2021.” In Table 2 of the same document, CBO shows a $2.9 billion increase in HCFAC funding results in a -$3.7 billion “Non-Scorable Effects on Direct Spending Outlays” – or in other words, $3.7 billion (roughly $800 million net) in real savings for taxpayers that do not count under budget rules.

WASHINGTON – On the heels of a new Treasury Inspector General for Tax Administration (TIGTA) report that found the Internal Revenue Service (IRS) has failed to reduce improper Earned Income Tax Credit (EITC) payments, Finance Committee Ranking Member Orrin Hatch (R-Utah) and Homeland Security and Governmental Affairs Ranking Member Tom Coburn (R-Okla.) today pressed the IRS for additional answers on how the agency will manage ObamaCare’s premium subsidies, complex tax credits designed to defray the cost of purchasing health insurance, based on household income.

In a letter to Principal Deputy Commissioner Daniel Werfel, the Senators questioned whether the IRS was equipped to process the subsidies which are both advanceable and refundable – meaning pay out first and verify later – and asked for details on the policies that are in place to curb improper payments to taxpayers.

“This [TIGTA] audit raises serious concerns about the IRS’s unwillingness or inability to successfully prevent billions of taxpayer dollars being wasted on erroneous tax credit claims.  We are particularly worried about these findings, given the IRS’s role generally as the primary agency administering a range of credits and specifically in overseeing and implementing the premium tax credits under the Patient Protection and Affordable Care Act (PPACA),” wrote the Senators.  “Similar to the EITC, the Affordable Care Act offers refundable tax credits for certain eligible individuals.  However, we believe that a range of provisions in federal law, regulations, and administrative practices actually leave the health care overhaul even more seriously susceptible to fraud or abuse than the EITC program already is.”

The text of the letter to Principal Deputy Commissioner Werfel is below and a signed copy can be found HERE:

Daniel Werfel

Principal Deputy Commissioner

Internal Revenue Service

1111 Constitution Avenue, NW

Washington, D.C. 20230

Dear Principal Deputy Commissioner Werfel: 

Recently, the Treasury Inspector General for Tax Administration (TIGTA) reported that the Internal Revenue Service (IRS) has “made little improvement in reducing the improper payment rate for the Earned Income Tax Credit (EITC) since being required to report estimates of these payments to Congress.”[1] In 2012, the IRS allowed about $13.6 billion in improper EITC payments to tax filers who were ineligible for the credit.  Unfortunately, that means that up to 25 percent of EITC last year payments were improper. 

Back in 2008, TIGTA recommended that IRS come up with alternative methods for identifying and preventing improper payments. However, TIGTA’s recent audit revealed that IRS has not taken any steps to address this recommendation.[2]  In fact, TIGTA found that IRS does not even have a goal for reducing future improper payments, or a plan in place to meet such targets.[3]  The IRS’s failure to take recommended steps to increase program integrity means the program continues to be at risk.  In 2011, up to $16.7 billion in tax credits were issued improperly, and in 2010, the amount was roughly the same—$18.4 billion. 

This audit raises serious concerns about the IRS’s unwillingness or inability to successfully prevent billions of taxpayer dollars being wasted on erroneous tax credit claims.  We are particularly worried about these findings, given the IRS’s role generally as the primary agency administering a range of credits and specifically in overseeing and implementing the premium tax credits under the Patient Protection and Affordable Care Act (PPACA). 

Similar to the EITC, the Affordable Care Act offers refundable tax credits for certain eligible individuals.  However, we believe that a range of provisions in federal law, regulations, and administrative practices actually leave the health care overhaul even more seriously susceptible to fraud or abuse than the EITC program already is. 

First, to try to prevent improper payments for federally-facilitated exchanges, IRS will rely partly on personal attestations of income, and only audit a random sample of applicants who claim that their income decreased more than 10 percent from amounts found in last year’s tax filing starting in 2014.[4] State-based exchanges will not be required to perform this audit until 2015.

Second, because of a change the Obama administration made this past summer, premium credit applicants in state-based exchanges can simply provide a personal attestation that they do not receive qualifying insurance through their employer to receive their premium credits in 2014. No further documentation is required.[5]

Third, a provision in current law actually limits how much the federal government can recover from sending a greater amount of subsidy to consumers than for which they were eligible.[6] In other words, the law currently prevents the recovery of overpayments paid to individuals who turn out not to be eligible for them.   This cap on recovering overpayments will prevent federal officials from pursuing billions of dollars in overpayments. In fact, according to CBO, if that cap on recapturing subsidy overpayments were eliminated, taxpayers would save $43 billion over a decade.[7]

Finally, the concerns lie not just with the EITC, but with other tax requirements as well. A more recent TIGTA report found that even some of the standard income and withholding verification processes at the IRS may be failing to prevent fraudulent tax refunds.[8] As the IRS watchdog explained, “most current year third?party information is not available until well after the tax return filing season begins and tax returns are processed,” and, as a result, a 2012 audit shows that nearly 1.5 million tax returns “were not detected by the IRS as potentially fraudulent despite having the same characteristics as IRS-confirmed identity theft fraudulent tax returns.” 

Overall, taken together, these realities paint a worrisome picture of the fraud that may be anticipated under PPACA. The premium tax credits vulnerability to fraud and abuse is significant because the Congressional Budget Office estimates that the credits cost taxpayers $796 billion over the coming decade.[9]  If these health coverage premium tax credits experience an improper payment rate similar to that of the EITC, about $200 billion taxpayer dollars could be wasted or lost to fraud. Therefore, to better understand how IRS will manage the potential for significant fraud and abuse in applications for PPACA premium tax credits, we respectfully ask for responses to the following questions.

1. What is IRS’s plan to avoid improper payments made to applicants for premium tax credits, and how will IRS recover such improper payments?
2. To what extent is IRS planning to identify or implement alternative compliance methods to avoid or recoup improper premium tax credits, similar to TIGTA’s 2008 recommendation regarding EITC?
3. Given the history of high improper payments for EITC, what assurances can you provide that premium tax credits will not result in the same rate of fraud and abuse?
4. What lessons have you learned from addressing EITC improper payments that could be applied to implementing the ACA?
5. What are IRS’s 2014 targets for premium tax credit improper payments? 

Please provide your response no later than November 25, 2013. 

Sincerely,

HATCH
COBURN

Washington, DC – Senators Michael Bennet (D-CO), Tom Coburn (R-OK), and Kelly Ayotte (R-NH) introduced a bill to help reduce government inefficiency by consolidating the total number of federal data centers, and making those data centers more efficient.  Because federal agencies have been slow to act on consolidation initiatives, the bill sets hard deadlines and requires agencies to conduct inventories and implement consolidation strategies.  Numerous studies have shown a relatively low utilization rate of the current infrastructure, resulting in an enormous amount of wasted space and energy – and incurring unnecessary costs. 

In 2010, the Office of Management and Budget (OMB) instructed federal agencies to develop consolidation plans under the administration’s Federal Data Center Consolidation Initiative (FDCCI), which could save up to $3 billion by 2015, according to the Government Accountability Office (GAO), with additional savings beyond that date. However, GAO also found that a number of agencies have been slow to implement these plans – or, in some cases, to even inventory the total number of data centers they currently manage. Under the FDCCI, the federal government set a goal of shutting down at least 1,200 of the over 3,000 known data centers it owns and operates. 

“At a time when we are facing tough choices to cut spending and lower the deficit, this is a commonsense proposal that will help the federal government save billions in taxpayer dollars while also conserving energy,” Bennet said. “We already know that this plan is a simple way to reduce inefficiency and it ensures that federal agencies are taking action to identify and shut down unnecessary centers.” 

“Across the federal government, duplication, overlap and mismanagement costs taxpayers at least $250 billion every year. The way to solve that problem is one program and one area at a time,” Dr. Coburn said. “I’m proud to join my colleagues in offering legislation that will consolidate duplicative data centers and help save taxpayers up to $3 billion.” 

“With over $17 trillion in debt, there’s no excuse to continue to spend millions on wasteful and unnecessary federal data centers – some of which are utilizing only 5 percent of their capacity,” said Ayotte.  “Our bipartisan legislation is a common sense measure that will save taxpayer dollars by speeding up consolidation and increasing the efficiency of data centers across government.”

The cost just to pay for the electricity to operate federal servers and data centers across the government is about $450 million annually. According to the Department of Energy, data center spaces can consume 100 to 200 times more electricity than a standard office space.  This bipartisan legislation would help support OMB’s government-wide effort to bring down these costs and conserve energy at the same time. 

This bill would require participating federal agencies to submit complete data center inventories and a consolidation strategy, which must include a timeline for implementation and cost-savings estimates.  The legislation includes hard deadlines, and participating agencies must also submit annual updates on their progress for the next five years.  In addition, the law would require the GAO to verify agency data center inventories, and would direct OMB to routinely report to Congress on cost savings realized to date. 

The GAO has publicly endorsed the legislation, saying it is necessary to ensure that agencies close down unnecessary data centers by the target deadline. The senators have worked closely with OMB and GAO to ensure that this legislation will help strengthen the initiative and achieve meaningful savings.

The senators originally filed this legislation as an amendment to the Energy Savings and Industrial Competitiveness Act of 2013 (S.1392).

# # #

(WASHINGTON, D.C.) – Today, Ranking Member of the Senate Homeland Security and Governmental Affairs Committee Tom Coburn, M.D. (R-OK) highlighted two new reports from the Department of Health and Human Services Office of Inspector General that show Medicare paid millions to dead doctors, dead beneficiaries, undocumented workers and illegal aliens.  The reports show Medicare wasted $23 million in care on the deceased in 2011, $25 million on dead doctors between 2009-2011, and $29 million for prescription drugs to more than 4,000 unlawfully present beneficiaries between 2009-2011.  

“Awarding benefits to the deceased is dead wrong,” Dr. Coburn said.  “I am particularly concerned about this latest development because, despite being notified of this problem five years ago, the administration continues to pay dead doctors.  Every individual wrongfully awarded benefits, be it the deceased or undocumented, diverts scarce resources away from those who need it most.  That is why Chairman Carper and I introduced the Improper Payments Agency Cooperation Enhancements Act, which enhances coordination between agencies with anti-fraud and waste mechanisms that will curtail this egregious practice.  Congress should pass this bill without delay. At the same time, the administration must take action to work with all agencies to ensure those who do not qualify for benefits do not receive them.” 

Key findings include: 

Medicare Wrongly Paid $29 Million in Drug Costs for 4,000 People Illegally in U.S.

Under federal law, health care benefits are not allowed to be paid for services provided to unlawfully present beneficiaries.  However, a new report from the Inspector General of the U.S. Department of Health and Human Services finds that the Medicare program wrongly paid drug costs totaling $29 million on behalf of 4,139 unlawfully present individuals.  Medicare program officials have said they will correct the problem, but have not given a timeframe for implementing needed corrective actions, nor have they agreed to recoup monies lost during this year and last year for the same reason. 

Medicare Wrongly Paid $23 Million for Dead Patients in 2011 

Under federal rules, Medicare claims for health care benefits are not supposed to be paid for dead people who were enrolled in Medicare beneficiaries. However, a new report from the Inspector General of the U.S. Department of Health and Human Services finds that the Medicare program wrongly paid $23 million in 2011 for services after a Medicare patient was already dead. These dollars represent a preventable waste of taxpayer dollars and have a harmful effect on an already cash-strapped program cumulative effect year over year. Medicare program officials have said they will correct the problem, but have not given a timeframe for implementing needed corrective actions. Moreover, despite ongoing Congressional oversight and concerns about the program’s integrity, Medicare officials clearly failed to take proactive preventative steps in this area.

Medicare Wrongly Paid $25 Million to Dead Doctors Over 3-Year Period 

Under federal rules, Medicare is not supposed to pay the bills of dead doctors. Yet, a 2008 Congressional hearing that Dr. Coburn participated in revealed Medicare was paying millions of taxpayer dollars for dead doctors. Earlier this year, Dr. Coburn asked the Inspector General of the U.S. Department of Health and Human Services, to see if this was still a problem within Medicare. The Inspector General reviewed Medicare claims and found that Medicare had paid $25 million to dead doctors from 2009 to 2011. Given some the lag time in billing, there may be some circumstances where some of those payments may be legitimate. Yet, even the most conservative approach to eliminating potentially valid claims found Medicare paid at least $8.2 million for dead doctors!  Despite that Medicare officials have told this was a problem five years ago, they still have not given a timeframe for implementing corrective actions. 

Reports available here:

Medicare Payments Made on Behalf of Deceased Beneficiaries in 2011

Medicare Improperly Paid Millions of Dollars for Prescription Drugs Provided to Unlawfully Present Beneficiaries During 2009 Through 2011

Supporting Documents:

HHS Letter to Dr. Coburn 

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(WASHINGTON, D.C.) – U.S. Senator Tom Coburn, M.D. (R-OK) will unveil his new oversight report on the National Park Service entitled, “PARKED! How Congress’ Misplaced Priorities are Trashing Our National Treasures,” at a press conference on Tuesday, October 29, 2013, at 11:30 a.m. EST in Room S-325 of the Capitol. 

 WHAT:  Press conference to unveil new oversight report, “PARKED! How Congress’ Misplaced Priorities are Trashing Our National Treasures”

WHEN: Tuesday, October 29, 2013, at 11:30 a.m. EST

WHERE: Room S-325 of the Capitol

###

(WASHINGTON, D.C.) - Dr. Coburn released the following statement after the Senate voted to fund the federal government through January 15 and raise the debt ceiling through February 7.

“Washington doesn’t need short-term budget and debt limit extensions as much as we need a long-term spending addiction recovery plan.  The American people should do what any responsible parent would do if their adolescent child couldn't handle the responsibility of a credit card.  We should cut up the credit card and live within our means.  With this agreement, the hard decisions we have to make have only been put off for another day, when our fiscal problems will be bigger and more painful to solve.  It’s time to make tough choices now.” 

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This document summarizes elements of the Congressional Budget Office’s 2013 Long-Term Budget Outlook and CBO’s blog post, “Federal Spending on the Government’s Major Health Care Programs Is Projected to Rise Substantially Relative To GDP.”  Content other than headers are quotes.

Health Care Spending Will Continue to Increase the Deficit

• Budget deficits would gradually rise again under current law, CBO projects, mainly because increasing internet costs and growing spending for Social Security and the government’s major health care programs (Medicare, Medicaid, the Children’s Health Insurance Program, and subsidies to be provided through health insurance exchanges).
• The pressures of an aging population, rising health care costs, and an expansion of federal subsidies for health insurance would cause spending for some of the largest federal programs to increase relative to GDP. The aging of the baby-boom generation, together with growth in health care spending per person and an expansion of federal subsidies for health insurance, is expected to steadily boost the government’s spending for Social Security and major health care programs. Barring changes to current law, that additional spending would contribute to rising budget deficits starting in a few years, causing federal debt to swell from a level that is already very high relative to the size of the economy.

 The Current Spending Path Is Unsustainable, Even “Impossible” to Maintain

• By 2023, federal debt held by the public would equal 71 percent of GDP and would be on an upward trajectory. Under a wide range of possible assumptions about some key factors that influence federal spending and revenues, the budget is on an unsustainable path.
• Deficits are sustainable in the long run only if federal debt grows no more rapidly than the economy. But under the extended baseline, interest rates would exceed the growth rate of the economy.
• The growth of health care spending cannot exceed economic growth indefinitely, because if it did, total spending on health care would eventually account for all of the country’s economic output—an impossible outcome.

 Spending on Federal Health Care Programs Will Outpace Economic Growth

• Most of the projected growth in noninterest spending as a share of GDP over the long term is expected to come from the government’s major health care programs: Medicare, Medicaid, the Children’s Health Insurance Program, and subsidies to help people purchase health insurance through the exchanges created under the Affordable Care Act. Under current law, total outlays for those health care programs, net of offsetting receipts, would grow much faster than the economy, increasing from almost 5 percent of GDP now to 8 percent in 2038.
• Although the growth of health care spending has slowed recently, CBO projects that spending per enrollee in federal health care programs will continue to increase at a faster pace than per capita GDP.

 Increased Spending Driven By Aging Seniors, Rising Costs, and Obamacare

• Those projected increases in spending stem from three factors: the aging of the population; rising health care spending per beneficiary; and changes related to the ACA, specifically the introduction of exchange subsidies and the expansion of Medicaid in many states.
• Three factors underlie the projected increase in federal spending for the major health care programs and Social Security as a percentage of GDP: the aging of the U.S. population, “excess cost growth,” and the upcoming expansion of Medicaid eligibility and provision of health insurance subsidies authorized by the ACA.

Federal Entitlement Programs – Including Obamacare – Are Driving Our Spending Problem

• The growth of federal noninterest spending as a share of gross domestic product (GDP) results entirely from projected increases in spending for a few large programs: Social Security, Medicare, Medicaid, and (to a lesser extent) insurance subsidies that will be provided through the health insurance exchanges established under the Affordable Care Act (ACA). The health care programs, which currently account for just over half of total spending for those large programs, are responsible for almost three-quarters of the rise in spending projected for those programs over the next 25 years under the extended baseline.

 Federal Spending A “Challenge” For “State and Local Governments, Businesses, and Households”

• Although spending for health care in the United States has grown more slowly in recent years than it had previously, high and rising levels of such sending continue to pose a challenge not only for the federal government’s two major health insurance programs, Medicare and Medicaid, but also for state and local governments, businesses, and households.

Annual Increase in Health Spending Outpaces Economic Output Per Person Since 1985

• Total national spending on health care services and supplies increased from 4.6 percent of GDP in calendar year 1960 to 9.5 percent in 1985 and to 16.4 percent in 2011, the most recent year for which such data are available. Underlying those trends, health care spending per person has grown faster, on average, than the nation’s economic output per person since 1985, even after the recent slowdown is factored in.
• CBO estimates that growth in health care spending per person (after adjusting for demographic changes) has outpaced growth in GDP per capita by an average of 1.5 percent per year since 1985.

 Obamacare Part of “Sharp Increase” In Number of People Pushing Federal Health Spending Higher

• …Federal spending for health care will be pushed up in the future by a sharp increase in the number of people receiving benefits from government programs……[including] the expansion of federal support for health insurance under the Affordable Care Act (ACA), which will significantly increase the number of people receiving benefits from Medicaid and make other people eligible for subsidies for health insurance purchased through exchanges.
• Over the next 25 years, aging accounts for 35 percent of the programs’ spending growth relative to GDP in CBO’s extended baseline, excess cost growth accounts for 40 percent, and the expansion of federal subsidies accounts for 26 percent.

 Medicare Spending On Track to Nearly Double Over Next 25 Years

• Net federal spending for those programs (that is, spending net of offsetting receipts for Medicare) would grow from an estimated 4.6 percent of GDP in 2013 to 8.0 percent in 2038.

 Future Federal Health Care Spending Could Be Even Worse Than Predicted

• Beyond the coming decade, projecting federal health care spending becomes increasingly difficult because of the considerable uncertainties involved. A wide range of changes could occur—in people’s health, in the sources and extent of their insurance coverage, and in the delivery of medical care—that are almost impossible to predict but that could have a significant effect on federal health care spending. Therefore, CBO followed a fairly formulaic approach for the projections beyond 2023.
• Several [sic] demonstrations are currently under way; which of them—if any—will prove to be successful in slowing spending growth and can be scaled up is uncertain.

Taxpayers Are Increasingly Paying More for Medicare through General Federal Tax Revenue

• The amount of Medicare payroll taxes collected has declined from 63 percent of gross federal spending for Medicare in 2000 to an estimated 35 percent in 2013. During that same period, the share of those benefits financed by beneficiaries’ premiums and other offsetting receipts has grown from 10 percent to an estimated 13 percent, and the share financed by general funds of the government, income taxes on benefits, and the remaining sources of funding for the program has increased from 27 percent to 51 percent.

 Making Medicare Solvent Requires Hard Choices

• Eliminating [Medicare’s solvency gap] would require an immediate and permanent increase in HI payroll taxes from 2.9 percent to 3.9 percent of taxable payroll as currently projected, an immediate and permanent cut in spending on Part A equal to almost one-quarter of current spending, or some combination of tax increases and spending cuts with an overall present value equal to 1.0 percent of projected taxable payroll..

 Medicare’s Insolvency Means Seniors Access to Health Care “Would Almost Certainly Be Reduced”

• Once the HI trust fund was exhausted, it appears that total payments to health plans and providers for services covered under Part A of Medicare would be limited to the amount of revenues subsequently credited to the trust fund. If that occurred, beneficiaries’ access to health care services would almost certainly be reduced.

 Seniors on Medicare Have Increasingly Benefits Greater Relative To Their Contributions

• Over their lifetime, beneficiaries born in the 1940’s would, on average, receive about $160,000 in benefits (net of premiums paid) and pay about $45,000 in payroll taxes (both figures are expressed in 2013 dollars). Those born in the 1950’s would receive, on average, about $205,000  in benefits and pay about $60,000 in payroll taxes, CBO estimates. And those born in the 1960’s would receive, on average, about $270,000 in benefits and pay about $65,000 in payroll taxes.

(WASHINGTON, D.C.) – Today, Homeland Security and Governmental Affairs Committee Ranking Member Tom Coburn, M.D. (R-OK), Chairman Tom Carper (D-DE), Permanent Subcommittee on Investigations Chairman Carl Levin (D-MI) and Permanent Subcommittee on Investigations Ranking Member John McCain (R-AZ), released the findings of a two year investigation into a case study of abuses surrounding the approval process of Social Security Disability benefits.  The report, entitled, “How Some Legal, Medical, and Judicial Professionals Abused Social Security Disability Programs for the Country’s Most Vulnerable: A Case Study of the Conn Law Firm,” details inappropriate conduct and collusion between a law firm, Social Security Law Judges and doctors in approving benefits, while outlining the inept agency oversight which allowed the misconduct to take place for years.

 The investigation was led by Senator Coburn.  The first year of the investigation was conducted by the Permanent Subcommittee on Investigations when Senator Coburn was the Ranking Member there, prior to his becoming the Ranking Member of the full Committee.  The Committee will hold a hearing today featuring the report entitled: “Social Security Disability Benefits:  Did A Group of Judges, Doctors and Lawyers Abuse Programs for the Country’s Most Vulnerable?” on Monday, October 7, 2013, at 3 p.m. EST in room 342 of the Dirksen Senate Office Building in Washington, D.C.  The hearing will be broadcast on CSPAN 3.          

 “This report highlights the very problems Congress needs to focus on but too often ignores.  In just two years, the Social Security Disability Trust Fund could be depleted.  That means millions of disabled Americans will face benefit cuts while every American could see an increase in their payroll taxes.  That is unacceptable.  What is also outrageous, as this report details, is how well-heeled and well-connected lawyers, doctors, and judges have gamed the system for their own benefit.  Every bogus claim made on behalf of someone who is not truly disabled robs taxpayers and denies or delays benefits for someone who is truly disabled.   This is an enormous and urgent problem that should demand our immediate attention,” Ranking Member Coburn said, noting that a previous report on the disability program showed at least more than 25 percent of 300 disability cases reviewed contained errors or poor quality analysis.  

 “This investigative report details some very troubling occurrences within the Social Security disability review office in West Virginia,” Chairman Carper said.  While we don't have any evidence that this is more than an isolated case, one example of inappropriate actions of this nature is one too many. I welcome the opportunity to hold a hearing today examining a number of issues surrounding Social Security’s disability programs, gather facts and attempt to ascertain the truth. In the midst of this very partisan time, one thing that Republicans and Democrats agree on is that we need to make every effort to ensure our federal programs are well run and are as free as possible from abuse or wasteful practices.  Whether it’s Delaware, West Virginia, or anywhere else in our nation, we need to ensure strong oversight in all of our government operations, to ensure both fairness and effectiveness. I am encouraged that the Social Security Administration has already acknowledged many of the issues raised by the investigation, and I understand that it has begun to implement stronger reviews and other solutions. My colleagues and I in Congress will continue to work with the Administration to provide oversight, guidance and resources to ensure that a few bad actors don't take scarce tax payer resources from those who truly deserve them.”

 “Federal disability programs provide critical assistance to the most vulnerable among us,” said Senator Levin, “and we can’t afford for those programs to be undermined by a law firm engaged in improper and collusive conduct that is abusive, longstanding, and intolerable.  The report doesn’t decide whether the benefits awarded to individuals represented by Eric Conn were right or wrong, since there are too many claimants to generalize.  Nor does it apply to the dedicated and honest professionals that keep our disability programs going despite limited resources and back-breaking caseloads.  After all, the investigation was launched after Social Security whistleblowers exposed the wrongdoing.  Our goal is to spotlight the abusive conduct, put an end to it, and recommend measures to prevent similar abuses in the future.”

 “The findings in the report regarding potential fraud in the Social Security Disability Programs are alarming and demand immediate attention by Congress, the Social Security Administration, and – where evidence obtained by the Committee suggests that crimes were committed – the Department of Justice,” said Senator McCain. “These programs are designed to help those who are most in need because of their inability to work. Yet, their susceptibility to being abused, at a cost of billions of taxpayer dollars, threatens both their viability and their continued ability to help those actually in need of the government’s help.”

 Key findings of the report include:

 • Daugherty Awarded More Than $2.5 Billion in Benefits in the Last Years of His Career. Judge Daugherty moved an unusually large number of disability cases through the agency and awarded an unusually high percentage of disability benefits. Over a nearly seven year period, from 2005 to his retirement in mid-2011, Judge Daugherty awarded disability benefits to 8,413 individuals, which translates into about 1,200 cases per year and an estimated total award of federal lifetime benefits exceeding $2.5 billion.

 • Judge Provided “DB Lists” to Conn Law Firm. From at least June 2006 to July 2010, Judge Daugherty telephoned the Conn law firm each month and identified a list of Mr. Conn’s disability claimants to whom the judge planned to award benefits. Judge Daugherty also indicated, for each listed claimant, whether he needed a “physical” or “mental” opinion from a medical professional indicating the claimant was disabled. Over the four year period reviewed, from 2006 to 2010, the monthly list identified between 14 and 52 disability claimants each time for at least 1,823 claimants. Conn Law Firm personnel referred to the monthly list as the “DB List” for David B. Daugherty.

 • Daugherty Relied on Conn’s Doctors to Generate Medical Evidence. After receiving the DB List, Mr. Conn’s office scheduled appointments for the identified claimants with certain doctors favored by the law firm. The Conn law firm provided several of those doctors with physical or mental residual functional capacity (“RFC”) forms in which the medical information was already filled out, and the doctors signed the forms without making any changes. Frequently, these pre-filled forms contained information that conflicted with other information in the claimant’s case file.

 • Identical Medical Evidence Used for Multiple Claimants. A review of the RFC forms found that the Conn law firm supplied certain doctors with 15 pre-filled versions of the physical RFC form and five pre-filled versions of the mental RFC form for hundreds of claimants. In almost all cases, only the names and Social Security numbers on the forms differed. Of the forms reviewed, 97 described the claimants as having the exact same limitations and contained no unique medical or employment information specific to the claimant. Because each individual has different abilities and ailments, and the forms require a complex set of data, finding two RFCs exactly alike should have statistically been an extremely rare occurrence.

 • Key Doctors Had Suspect Credentials. Of the doctors used by the Conn law firm to produce medical opinions for disability claimants, two had their medical license suspended or revoked in another state. Under SSA rules, a doctor with a suspended or revoked license could not be used by the Social Security Administration to review a disability case, but could still examine claimants at the request of a claimant or outside attorney.

 • Judge Daugherty Wrote Questionable Decisions Relying on Mr. Conn’s Doctors. A review of 110 case files for disability claimants listed on the DB Lists found the vast majority to contain highly questionable decisions. In all 110 cases, Judge Daugherty’s decisions justified reversing the agency’s prior denial of disability benefits by relying solely on the medical forms provided by the doctors procured by the Conn law firm. All but two of the 110 cases used the agency’s Medical-Vocational grid guidelines to award benefits.

 • Mr. Conn Obtained Millions in Attorney Fees Paid by SSA. From cases on the DB Lists alone, over the four year period from 2006 to 2010, the Social Security Administration paid Mr. Conn over $4.5 million in attorney fees.10 Social Security records show that, altogether in 2010, Mr. Conn was the third highest paid disability law firm in the country due to its receipt of over $3.9 million in attorney fees from the Social Security Administration. In 2009, Mr. Conn received a total of $3.5 million in attorney fees from the agency.

 • Mr. Conn Paid Doctors Substantial Fees for Evaluations. The doctors used by Mr. Conn to evaluate his claimants were also paid substantial fees. A review of records found that, over the past six years, Mr. Conn paid five doctors almost $2 million to provide disability opinions for his claimants. Mr. Conn contracted with his claimants to repay the fees given to the doctors to perform their medical evaluations.

 • Daugherty Bank Records Show $96,000 in Unexplained Cash Deposits. From 2003 to 2011, Judge Daugherty’s bank records contain regularly occurring cash deposits totaling $69,800, the source of which is unexplained in the judge’s financial disclosure forms. From 2007 to 2011, his daughter’s bank records list similar cash deposits totaling another $26,200. When asked about the $96,000 in cash deposits, Judge Daugherty refused to explain their origin or the source of the funds.

 • SSA Whistleblower Targeted by Huntington Chief Judge Andrus and Eric Conn. Following the public disclosure of Mr. Conn’s relationship with Judge Daugherty, Huntington Chief ALJ Andrus worked with Mr. Conn to discredit and retaliate against an SSA employee suspected of leaking the information.

 • Mr. Conn Destroyed Documents during an Investigation. After talking with SSA OIG investigators, Mr. Conn contracted with a local shredding company to destroy over 26,000 pounds of documents, the equivalent of 2.6 million sheets of paper. Former Conn law firm personnel asserted that he destroyed all hard copies of the DB Lists as well as computer hard drives in his office.

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Supporting Documents: 

Dr. Coburn's Opening Statement

Exhibit Part 1

Exhibit Part 2

Exhibit Part 3

Exhibit Part 4

Exhibit Part 5

Exhibit Part 6

A:  YES. Dr. Coburn has always supported efforts to delay, defund, and repeal Obamacare.  Dr. Coburn offered his free market alternative to Obamacare, the Patient’s Choice Act, but it was blocked by Majority Leader Harry Reid. Dr. Coburn has since conducted extensive oversight on Obamacare (See here, here, here, and here.)  In fact, Dr. Coburn has been involved with amending or destroying certain provisions of Obamacare nine times.   

Q: Does Dr. Coburn support the Continuing Resolution (Including both House and Senate versions as of September 26, 2013)?

A: NO.  Dr. Coburn has never supported continuing resolutions because they are short term budgetary band-aids that continue wasteful spending and duplication. Continuing Resolutions are an irresponsible way to fund the federal government.  Further, this particular Continuing Resolution sets the fiscal year 2014 spending level at $20 billion more than the spending level promised in the Budget Control Act - the 2011 bipartisan agreement to reduce government spending - plus an additional $18 billion in short-term accounting gimmicks.  This bill violates the spending restraint laid out in the Budget Control Act and increases government spending at a time when we are nearly $17 trillion in debt and borrowing 19 cents for every dollar we spend and adding to our debt nearly $26,000 every single second.

Q: Why doesn’t Dr. Coburn support the “Defund Obamacare Campaign” associated with the current CR?

A: Because attaching it to the CR is not achievable or strategically smart.  Dr. Coburn has and will continue to support defunding Obamacare.   The current “Defund Obamacare” campaign, however, is based on a false promise that has been used by special interest groups to bolster political careers instead of focusing on smart strategies that can actually weaken and destroy Obamacare.  By coupling the issue with the CR, these groups are telling the American people that Republicans in Congress can actually defund Obamacare by not voting for the CR or by allowing the government to shut down.  This is simply not true.  Simply put: we cannot defund or replace Obamacare completely until we have a Republican supermajority in the House and Senate that can override a Presidential veto.  Even then, Dr. Coburn questions if we could obtain all 67 votes in the Senate needed to override a veto.   Additionally, the Congressional Research Service (CRS) issued a report which concluded that even if the government were to be shutdown, Obamacare would still live on, not least of because the power to continue its implementation would be given to President Obama.  Again, if a shutdown occurred, Obamacare would remain nearly fully funded and implementation of the exchanges would still continue on October 1, 2013.

Q:  How can Dr. Coburn support defunding Obamacare but not support the current  “Defund Obamacare” strategy with the CR?

A: Because it is not achievable and has actually allowed for focus to be taken away from increased spending.  Since there are not enough votes to secure defunding Obamacare and since Obamacare will live on even if a government shutdown occurs, conservatives should instead be focusing on the spending levels in the current CR.  The House CR actually busts the budget caps set forth in the Budget Control Act (BCA) by $20 billion and includes $18 billion more in short-term accounting gimmicks; negating much of the savings found through the sequester.

Q: But no one is talking about shutting down the government, so why is Dr. Coburn still against the “Defund Obamacare with the CR”?

A:  Because Dr. Coburn wants to shut down ALL wasteful and duplicative spending.  The “Defund Obamacare” campaign has distracted true fiscal conservatives from the fact that the current CR increases spending.  Dr. Coburn wants the debate surrounding the CR spending bill to focus on what is workable on spending, not misleading strategies meant to raise political profiles and campaign cash.

Just the Facts:

Dr. Coburn supports defunding Obamacare and is opposed to the CR, but Dr. Coburn disagrees with the misleading and ill-conceived “Defund Obamacare” strategy promulgated by special interest groups to bolster political careers and campaign coffers.  Dr. Coburn wants to cut through the smoke and mirrors of DC rhetoric to get something done: SHUTDOWN ALL WASTEFUL SPENDING. 

Supporting Documents:

Q and A 

WASHINGTON, D.C. – Today, Senate Homeland Security and Governmental Affairs Committee Chairman Tom Carper (D-Del.) and Ranking Member Tom Coburn (R-Okla.) released the following statements regarding the Committee’s ongoing oversight of government operations and the federal workforce, in particular the issue of security clearances, in the wake of the Navy Yard Shooting in Washington, D.C.:

Chairman Carper: “Our thoughts and prayers go out to the victims and the friends and families of those impacted by the tragic events at Washington, D.C.’s Navy Yard. We are deeply grateful for the efforts of our brave civil servants, law enforcement officials, and emergency medical personnel who responded to this tragedy. Our goal is to ensure that we learn as much from this tragic incident as we possibly can so we can prevent these types of incidents and reduce the chance of death and injury in the future.

“As the Committee with oversight of government operations, the federal workforce, and homeland security, we have a number of important questions that have come to light after this incident that we need to have answered. In particular, our Committee needs to take a closer look at the background check process for individuals applying for security clearances, whether they are contractors or federal employees, and we need to examine what the oversight process is once an individual obtains a security clearance. We want to make certain that, when conducting background investigations, agencies have access to the right information and are asking the right questions and getting the right answers. We also want to look at the process for gaining access privileges to secure facilities, such as the Navy Yard. While we’re beginning to gather information, we still have many more questions to ask - and more answers to get. That’s why our Committee continues to examine what happened and will hold hearings on these and other issues raised in the wake of this terrible tragedy in the very near future.”

Dr. Coburn: “We owe it to the families of the victims and the American people to uncover what went wrong. We need to take a very hard look at the security clearance process, in particular, and explore other questions as we work to prevent another tragedy like this from ever occurring again.”

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(WASHINGTON, D.C.) – Today, U.S. Senator Tom Coburn, M.D. (R-OK) introduced the PRO Sports Act, S.1524, which would amend the tax code to prohibit professional sports organizations with annual revenues over $10 million from enjoying the same tax-exempt, 501(c)(6) status as industry trade associations and public interest groups.

“Tax earmarks are essentially tax increases for everyone who doesn’t receive the benefit.  In this case, working Americans are paying artificially high rates in order to subsidize special breaks for sports leagues.  This is hardly fair,” Dr. Coburn said.  “This bill would require major professional sports leagues to be prohibited from qualifying as non-profit organizations under the tax code.  This would help give all Americans, not just athletes and owners, a break and pave the way for the kind of tax reform and job creation our economy desperately needs.”

Currently, a number of professional sports leagues have central offices registered as 501(c)(6) tax-exempt organizations allowing for the opportunity for their revenue to be tax-free.  Leagues qualify for the tax-exempt status by stating their purpose is to help promote their respective sports and membership instead of themselves.  The PRO Sports Act will not impact leagues’ 501(C)(3) charitable organizations.

Additional information here.

A response from the Joint Committee on Taxation can be found here. 

Dear Colleague letter with co-sponsor Sen. Angus King here.

###

(WASHINGTON, D.C.) – Today, U.S. Senators Tom Coburn, M.D. (R-OK) and Joe Manchin (D-WV) introduced the Audit the Pentagon Act of 2013, S. 1510, a bill that provides incentives for the Department of Defense, which is the only Federal agency that has never fully complied with financial management laws, to meet its audit schedule while also instituting consequences for further failure to follow the law.

“You can’t manage what you can’t measure.  Every year the Pentagon fails to produce a viable financial audit they not only violate the Constitution, but put our nation’s security at risk because of a failure to effectively prioritize spending,” Dr. Coburn said.  “This summer the Pentagon cancelled important training and furloughed thousands of civilian personnel while it continued to waste billions on non-defense spending that had nothing to do with its core mission. A full and complete audit is the only way the department will be able to make better decisions about how it uses valuable taxpayer dollars.  This bill helps the Pentagon help itself by simply requiring the Pentagon to meet its own deadlines.  The Senate should pass this bill without delay.”

"The United States of America has – and will continue to have – the greatest military in the world. In order to maintain our great military strength, we need to make sure that we are cutting the fat and not the muscle from our Defense Department,” Sen. Manchin said. “We must ensure that we’re using our limited resources most efficiently to support the men and women in uniform. One of best ways to get the most accurate information about our spending and our military’s priorities is to shed light on the Department of Defense budget, without jeopardizing our national security secrets. It is simply unacceptable that the Department of Defense is the only major federal agency that has not completed a financial audit. Our bill will help to solve that problem.”

Key Findings and Provisions of the Audit the Pentagon Act:

• The Department of Defense has never fully complied with these laws and has been on the Government Accountability Office’s “High Risk” list for waste, fraud,
  abuse, and mismanagement every year since 1995.
• Secretary Hagel has affirmed his commitment to achieving audit-ready budget statements by the end of 2014, stating that he ‘will do everything he can to fulfill this commitment’ and confirming that auditable financial statements are essential to the Department of Defense not only improving the quality of its financial information, but also to reassuring the public and the Congress that it is a good steward of public funds.” 
• Mandates that failure to obtain a clean audit opinion in 2018 will result in the military services not being allowed to fund new major defense acquisition programs past Milestone B, meaning that the Pentagon would not be able to enter into engineering and manufacturing development on a new weapon system until it passed a clean audit.
• Requires the Department of Defense to amend its policies to prohibit the purchase of any “off-the-shelf” IT system that will take longer than three years to install and include provisions in the contracts for termination if the IT system is not delivered on schedule.     

###

Dr. Coburn sent the following letter to Speaker Boehner and Leader Reid:

September 12, 2013

Dear Speaker Boehner and Leader Reid,

            Americans are fed up with Congress’ inability to keep its promises and control spending.  Just two years ago, we committed to the taxpayers and each other to begin an era of fiscal restraint with passage of the Budget Control Act of 2011, and already efforts are underway to unravel that agreement. 

As the only major bipartisan deficit reduction bargain in the last fifteen years, the Budget Control Act provided a ten year blue print to restrain federal spending, accepted in exchange for a $2 trillion increase in the national debt limit.  The balanced compromise reduced both defense and non-defense spending, but for only two years.  Under the bipartisan agreement, total discretionary spending in FY 2014 is capped at $967 billion.  Most of this spending would still be financed with borrowed money as the deficit for the year is still projected to be $560 billion.              

As you know, fiscal year 2014 is the last year discretionary spending will actually be reduced as a result of the Budget Control Act.  After next year, the law allows discretionary spending to once again increase annually.  Removing the spending restrains for 2014 would, therefore, make a mockery of the agreement to restrain spending because spending would have only be reduced for one year. 

This is an all too familiar Washington narrative that explains why our national debt is nearly $17 trillion.  Just today, the Congressional Budget Office revealed the initial House CR would exceed the current spending limits by $19 billion.  Congress cannot break its commitment to restrain spending while expecting another debt limit increase to pay for its broken promises with even more borrowed money. 

We reject the temptation of any short term political victory that paves the way for bigger debt, bigger borrowing, and bigger government.  Therefore, we absolutely oppose any continuing resolution or appropriations legislation that would increase spending above the levels provided under the Budget Control Act.  Furthermore, if Congress cannot keep its word to control spending as agreed to in the bipartisan Budget Control Act, we will not agree to additional increases in the debt limit. We do not need another bipartisan agreement to increase spending and borrowing. 

Sincerely,

Tom Coburn, M.D.

(WASHINGTON, D.C.) – U.S. Senator Tom Coburn, M.D. (R-OK) released the following statement today following House passage of H.R. 2775, the “No Subsidies Without Verification Act,” a bill that will require the Obama administration to have an income verification in place before doling out Obamacare subsidies. Dr. Coburn has filed a companion bill to the Senate energy efficient bill. 

“I applaud the House, and particularly Representative Diane Black, for taking this important step to stop billions of dollars of fraudulent Obamacare payments. Obamacare, as currently written, invites fraud because it caps the amount of money the federal government can recoup from overpayments sent to Americans who are not eligible for them.  This embarrassing lack of verification means taxpayers across America will be forced to subsidize the health care of individuals who may not qualify for benefits,” Dr. Coburn said.

“Sadly, the administration has already threatened to veto this legislation, which verifies my concerns about fraud.  If the administration was confident in its verification system they should welcome this legislation.  They obviously know their system is not adequate, yet they are prepared to defraud millions of working families rather fix an absurd ‘honor system’ that makes the pre-crash housing market look like the gold-standard of accountability. 

“Senate Majority Leader Reid should take up the House bill and reject the administration’s justification of fraud.  I would also urge organizations dedicated to defunding, repealing and replacing Obamacare to join this effort and not give the administration tacit support with their silence. 

“At a time when reformers are debating the best way to defund, repeal and replace Obamacare, this approach stands out as a successful path forward.  The American people want results, not rhetoric.  They are tired of gimmicky quick-fix strategies that are designed to help Washington politicians and fundraisers rather than change laws and help patients and working families.  Reformers have shown time again that Obamacare can be undermined when we unite around sound strategies.  As the non-partisan Congressional Research Service has noted, Obamacare has already been modified 19 times.  This bill can bring that count to 20,” Dr. Coburn said.

###

 1. DHS has spent more than $35 billion on homeland security grants, but cannot measure whether we are safer from terrorist attacks.  The December 2012 report, Safety at Any Price, found that DHS has struggled to assess and measure risk, and that many grant dollars instead subsidize state and local public safety.

 2. Mission creep has expanded DHS from its original focus on counter-terrorism to become an “all-hazards” preparedness agency.  In an era of a $17 trillion national debt, high unemployment and unsustainable spending, DHS cannot afford to continue to expand its mission, particularly when it’s unclear that the agency’s original mission is being executed. Recent years have seen the department provide local police with equipment to protect the Keene Pumpkin Festival in New Hampshire, sno-cone machines in Michigan and drones in Seattle.

 3. Key aspects of DHS’s intelligence mission are failing to provide value to the federal government.  A bipartisan investigation into DHS’s fusion center program with Sen. Carl Levin found that, despite spending as much as $1.4 billion, state and local fusion centers were providing little value for the federal government’s counter terrorism mission.

4. Despite spending as much as $90 billion on border security initiatives over the past decade, the border remains unsecure.  The Council on Foreign Relations reported that the “apprehension rate along the southwest land border between the ports of entry is likely in the range of 40 to 55 percent.” 

5. Despite DHS’s growing responsibilities for cyber security, the Department is struggling to fulfill its cyber and information technology missions, including securing its own networks.  The DHS Inspector General reported to me that DHS has not addressed nearly four dozen recommendations for bringing the Department’s cyber security up to required standards.  A new report from the Office of Inspector General found that DHS’s “inadequate continuity and contingency planning increases the risk that the Department may not be able to respond effectively in case of an emergency or disaster.”

6. A growing share of DHS’s budget is being spent on natural disasters, but FEMA’s process for declaring disasters is outdated and arbitrary.   The federal government is declaring roughly four times as many disasters each year than we were decades ago.  The statistical formula DHS uses to determine when to declare a disaster is unfair and has not been properly updated in nearly 30 years – giving an advantage to states with fewer people. GAO, FEMA administrator Craig Fugate, and former DHS Secretary Janet Napolitano have all called for the formula to be reworked.  Last Congress the Senate voted on a Coburn amendment to fix the formula by assuring funds only went to states truly overwhelmed by a disaster, which received bipartisan support.

7. Despite spending $2.8 billion to secure our ports – a key component of critical infrastructure – DHS has failed to establish clear metrics for assessing and measuring our progress on port security.  Significant challenges remain to ensure adequate screening of cargo and secure access at port facilities.

8. Despite its broad mandate to protect critical infrastructure, DHS has struggled when given a mandate to regulate chemical facility security.  Since 2007, despite spending nearly half of a billion dollars, it is not clear the Chemical Facility Anti-Terrorism Standards (CFATS) program has improved security at chemical facilities.  To date, only five percent of all covered facilities have approved security plans and no facility has undergone a compliance inspection – more than five years after the program was to be up and running.

9. DHS struggles to manage its acquisitions effectively and efficiently.  Underneath most of DHS’ core missions lie contracts used to purchase equipment, information technology, and support services. While DHS has made progress in establishing a policy to guide acquisition management, too often we hear about poorly managed programs that fail to deliver needed capabilities to DHS’s front lines on time and on budget.  Today, the DHS Inspector General released a report that found $28 million of radio equipment collecting dust on a shelf while operators in the field faced equipment shortages.  Last year, GAO found that 16 of DHS major programs experienced cost growth of 166 percent from $19.7 billion to $52.2 billion because of DHS’ failure to provide effective management and oversight.  

10. DHS continues to struggle to coordinate and manage its component agencies.  Despite the effort to create “One DHS,” DHS continues to struggle to manage and coordinate its component agencies.

February 2012 – National Rural Health Association Voices Opposition, Expresses Concern, Over Bay State Bailout in Health Reform Law

April 2012— CMS Regulation Confirms Dr. Coburn’s Warning of “Bay State Bailout” in the Health Reform Law

January 2013 – North Carolina Hospital Association Supports Hospital Payments Fairness Act

January 2013 – Coburn and McCaskill Introduce S. 183, a Bill to End Medicare Payment Gimmick in Health Reform Law

March 2013 - Dr. Coburn introduces amendment #409 to end Bay State Boondoggle to the Senate Budget Resolution.  Additional information on amendment available here.   Amendment passed 68-31.   *Budget and amendments do not have the force of law.*

June 2013 – Coburn and McCaskill Seek Support from Colleagues on Hospital Payments Fairness Act

June 2013 - Oklahoma Hospital Association endorses Hospital Payment Fairness Act of 2013.

August 2013 - Centers for Medicare and Medicaid Services (CMS) issued a rule highlighting the distortions of the Bay State Boondoggle.

On September 5, 2013, Dr. Coburn and former Senator Joe Lieberman sent House Ways and Means Chairman Dave Chairman Camp a letter regarding the “Bipartisan Plan to Save Medicare” which they proposed two years ago.

In the letter, Dr. Coburn and Sen. Lieberman applaud the Committee’s transparent process of using hearings on entitlement reform as a means to evaluate a variety of proposals to protect and preserve the program. 

Enclosed with the letter the plan’s authors also enclosed:

• A summary of their 2011 “Bipartisan Proposal to Save Medicare & Reduce Debt”
• Draft legislative text of their proposal
• An analysis of the effects of their proposal by the Office of the Actuary (OACT) at the Centers for Medicare and Medicaid Services (CMS).

OACT found the Lieberman-Coburn plan would reduce Medicare outlays by more than $535 billion over a decade and keep Medicare solvent for the next several decades. The CMS Actuary also found that if the base premium increase was removed from their proposal, premiums under their plan would be lower than current law (pg. 6 of the memo). 

(WASHINGTON, D.C.) – Today, U.S. Senator Tom Coburn, M.D. (R-OK) announced the schedule for a series of town hall meetings that will take place in August at various locations across Oklahoma. Dr. Coburn will take questions and address important issues for Oklahoma and the nation at each event.

“I am eager to hear the concerns of Oklahomans and inform them of my legislative efforts in the Senate,” said Dr. Coburn.

Wednesday, August 21, 2013

Miami Town Hall Meeting

2:00 p.m.

Miami Civic Center

129 5th Ave. NW

Miami, OK

Muskogee Town Hall Meeting

*NEW LOCATION*

5:00 p.m.

Muskogee Civic Center, Room D

425 Boston Street, Muskogee OK

Thursday, August 22, 2013

Stigler Town Hall Meeting

8:00 a.m.

The Eaton Hole

504 E. Main Street

Stigler, OK

Hugo Town Hall Meeting

12:00 p.m.

Kiamichi Technology Center North Seminar Room

107 S. 15th Street

Hugo, OK

Atoka Town Hall Meeting

2:30 p.m.

Kiamichi Technology Center Business Center

1301 W. Liberty Rd.

Atoka, OK

Monday, August 26, 2013

Shawnee Town Hall Meeting - *CANCELED*

###

WASHINGTON, D.C. – Last night, the Senate Homeland Security and Governmental Affairs Committee Chairman Tom Carper (D-Del.) and Ranking Member Tom Coburn (R-Okla.) introduced the bipartisan Postal Reform Act of 2013 (S. 1486).

The financial condition of the Postal Service has been deteriorating for years, but the 2008 economic downturn and the near universal use of the internet for communications and commerce have hastened its downward spiral. The Postal Service currently maintains an outstanding debt of over $15.9 billion and lacks the operating capital to begin repaying that debt, let alone meet congressionally-mandated payments exceeding $5 billion due to the U.S. Treasury at the end of Fiscal Year 2013.

Congressional leaders have long called for legislation that addresses the systemic causes of the Postal Service’s difficulties, and this compromise builds on years of bipartisan, bicameral work. Without serious, long-term reform, this iconic American institution – enshrined in our Constitution – will take on more and more debt. The bipartisan Postal Reform Act of 2013 seeks to address the Postal Service’s financial challenges by helping it streamline operations and giving it new tools it can use to introduce innovative new products and generate additional revenue. It does this while preserving essential services.

Chairman Carper said: “One year ago, the United States Postal Service defaulted for the first time in its history. As Businessweek put it: ‘The U.S. Postal Service essentially went broke today.’ The agency was – and is – facing its worst financial challenges in 200 years. Over the past year, Americans have realized the hard truth that the Postal Service is on the verge of financial collapse. If it were to shut down, the impact on our economy would be devastating. Although the situation is dire, it isn’t hopeless. With the right tools and quick action from Congress, the Postal Service can reform, right-size and modernize. The bill that Dr. Coburn and I introduced last night presents a comprehensive and bipartisan solution to the Postal Service’s financial challenges that would prevent collapse, protect millions of mailing industry jobs, and enable this critical institution to serve the American public for years to come. This bill isn’t perfect and will certainly change as Dr. Coburn and I hear from colleagues and stakeholders, including postal employees and customers. But the time to act is now. It is my hope that Congress and the Obama Administration can come together to enhance this plan in order to save the Postal Service before it’s too late.”

Ranking Member Coburn said: “This proposal is a rough draft of an agreement subject to change that I hope will move us closer to a solution that will protect taxpayers and ensure the Postal Service can remain economically viable while providing vital services for the American people.”

Highlights of the Postal Reform Act (PRA) of 2013:

Pension Reforms: The PRA would require that the Office of Personnel Management (OPM) use data in determining how much the Postal Service must pay into the two federal pension programs – the Federal Employees Retirement System (FERS) and the Civil Service Retirement System (CSRS) – that more accurately reflects the amount of the Postal Service’s projected liability, in light of differences between the postal and non-postal federal workforces.  This reform is expected to reduce the amount the Postal Service pays into both FERS and CSRS and to result in a Postal Service FERS surplus.  The Postal Service would be permitted to request and receive up to $6 billion of any surplus, which could be spent to retire Postal Service debt and give it needed liquidity.

In addition, the bill would allow the Postal Service and postal unions to bargain over the extent of new postal employees’ participation in FERS and the Thrift Savings Program (TSP).

Health Care Reforms: The PRA would eliminate the Postal Service’s statutory retiree health pre-funding and replace it with a less aggressive 40-year amortization of the Postal Service’s retiree health liability.  This provision, combined with language allowing premiums for current retirees to come out of the account containing health care funds that the Postal Service has already pre-funded, could reduce the Postal Service’s total retiree health costs by roughly half.  Those costs could be reduced even further through the implementation of provisions in the PRA requiring that 1) health plans be created to meet the needs of postal retirees enrolled in Medicare parts A and B, some of whom currently purchase full Medicare and Federal Employees Health Benefit Plan (FEHBP) coverage; and 2) postal retirees not enrolled in Medicare be given the opportunity to do so penalty-free.  Participation in Medicare parts A and B and these new health plans would be voluntary, but these two provisions are expected to increase Medicare enrollment among postal retirees and significantly reduce the Postal Service’s long-term retiree health liabilities.

In addition, the PRA would also allow the Postal Service and the postal unions to bargain over the creation of a new health plan for postal employees, either within or outside of FEHBP.

Service Changes

• The Postal Service last year proposed a service standard change for certain classes of mail that would have largely eliminated the overnight delivery of mail and led to the closure or consolidation of a significant number of mail processing plants.  The PRA would place a moratorium on service standard changes and plant closings for two years, keeping all plants open as of the date of enactment in operation for the duration of the moratorium.
• The PRA would codify the Postal Service’s current plan to find savings in its retail operations without closing post offices.
• The PRA would preserve Saturday delivery for at least a year.
• The PRA would require the Postal Service to use the most cost effective means of mail delivery, requiring centralized or curbside delivery for new addresses and business addresses.  It would also require the Postal Service to seek to convert residential addresses from door delivery to centralized or curbside delivery on a voluntary basis. 

Revenue and Innovation

• The PRA would streamline the current rate-setting process, giving the Postal Service more authority to set prices on its own while preserving a more flexible CPI rate cap until 2016, when the rate cap would expire.
• The PRA would give the Postal Service enhanced authority to innovate and introduce new non-postal products that take advantage of its retail and mail processing, transportation, and delivery network.
• The PRA would authorize the Postal Service to offer services on behalf of federal, state, or local government agencies.
• The Postal Service is prohibited under current law from shipping beer, wine, and distilled spirits.  The PRA would lift this prohibition and allow the Postal Service to deliver beer, wine and distilled spirits under the same rules as private sector shippers.

Federal Workers Compensation Reform

The PRA contains the Workers Compensation Act of 2013, which reforms the workers' compensation program for federal employees who are injured on the job.  The Act would bring compensation levels for older workers more in line with retirement benefits, strengthen programs for helping injured workers get back on the job, make other updates and improvements.

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Dr. Coburn released a report from the Congressional Research Service regarding the potential effects of a funding lapse and related government shutdown on the implementation of Obamacare.  CRS determined funding for Obamacare would still continue even if the government were shut down.  A summary of the memo can be found here.  

WASHINGTON – Today, Senate Homeland Security and Governmental Affairs Committee Chairman Tom Carper (D-Del.), Ranking Member Tom Coburn (R-Okla.) and Committee Members Mark Pryor (D-Ark.), Rob Portman (R-Ohio), and Mark Begich (D-Alaska) introduced important legislation that would assist federal agencies in improving the disposal and management of federal buildings and facilities. The Federal Real Property Asset Management Reform Act of 2013 would help facilitate the disposal of unneeded federal property and establish a framework for federal agencies to better manage existing space in a more cost-effective manner

“It’s been clear to me and to others for a long time now that we can get better results and save taxpayer money by improving the way we manage federal property," said Chairman Carper. "Excess and underutilized federal properties cost taxpayers billions of dollars each year in maintenance, security, and others costs. The good news is that we can solve this problem by taking some common sense steps to improve federal property management. The Federal Real Property Asset Management Reform Act of 2013 will help to reduce waste and inefficiency by requiring all federal agencies to not only maintain a comprehensive inventory of their properties, but to also take a hard look at which assets they actually need and which could be sold or put to better use. The unnecessary expenses associated with maintaining unneeded properties are the type of low hanging fruit that we need to go after in order to help reduce our federal deficit and ensure that our government is financially responsible. Fortunately, both Congress and the Obama Administration are united in their commitment to address this issue and I look forward to working with my colleagues to move this important bill forward.” 

“Abandoned and underutilized federal properties serve little to no purpose for the government and taxpayers alike,” said Dr. Coburn.  “This bill provides the provisions necessary for agencies to liquidate such properties effectively.” 

“We’re wasting hundreds of millions of taxpayer dollars each year on unnecessary federal property and maintenance costs, and that needs to stop,” said Senator Pryor. “This bill is a common-sense, bipartisan way we can cut our spending and secure our nation’s economic future.” 

“Against a background of record deficits and debt, reforming the federal government’s bureaucratic real property procedures is a bipartisan no-brainer,” said Senator Portman.  “The government spends billions of dollars to maintain tens of thousands of excess or underutilized properties across the country.  This is an unnecessary drain on the public purse and we can realize major savings simply by speeding up the sale of surplus and excess property and subjecting costly government leases to greater scrutiny.” 

“We need better management of our taxpayer dollars across our government agencies and this bill is a great first step to managing unneeded federal property,” said Senator Begich. “It’s crazy that the federal government is throwing away money on property we don’t even use which is why I’m grateful to Senators Carper, Coburn, Portman and Pryor for coming together in a bipartisan fashion to introduce this common sense bill which, instead of wasting dollars, will help us actually pay down our debt and deficit.” 

The federal government currently owns over one million properties across the county, making it the largest property owner in the United States. In fact, every year since January 2003, the Government Accountability Office (GAO) has placed real property management on its list of "high risk" government activities, citing long-standing problems with excess and underutilized property; deteriorating and aging facilities; unreliable property data; and a heavy reliance on costly leasing instead of ownership to meet new needs.

The Federal Real Property Asset Management Reform Act of 2013 would address vulnerabilities in current law by requiring agencies to continually evaluate their property needs and how they manage their current property inventory. Additionally, the bill establishes a pilot project to streamline the current federal real property disposal rules in order to achieve greater efficiencies within the existing disposal process.

The legislation comes on the heels of a 2013 Obama Administration policy directive that instructs federal agencies to develop plans to restrict the growth in office and warehouse inventories and encourages increased coordination between top managers charged with managing federal property. The Federal Real Property Asset Management Reform Act of 2013 would take the directive further and provide the direction agencies need to comprehensively review existing property and determine where the government can achieve cost savings.

Specifically, the Federal Real Property Asset Management Reform Act of 2013 would:

• Require that each agency conduct an inventory of real property under its control, continuously survey its real property to identify excess and underutilized property, report any excess or underutilized property to the Administrator of the General Services Administration (GSA) and the Federal Real Property Council, and establish goals that will lead to a reduction of the agency’s excess and underutilized real property.

• Establish the Federal Real Property Council (FRPC) and charge the Council with creating an annual asset management plan and establishing performance measures that will enable Congress to track progress in achieving real property goals government-wide. The membership of the FRPC will be comprised of senior real property officers from each executive agency, the Controller at the Office of Management and Budget (OMB), and the GSA Administrator. The council will be chaired by the OMB Deputy Director for Management.

• Require the GSA Administrator to establish and maintain a single database of all real property owned by federal agencies. The Administrator is required to make the database accessible to the public at no cost within three years after the date of enactment of this bill.

• Require agencies with independent leasing authority to submit a detailed annual report describing its leases. Although GSA is responsible for leasing property on behalf of most federal agencies, some agencies have the power to enter into leases on their own.

• Establish a pilot program to expedite the disposal of surplus properties. This will provide the Director of OMB the authorization to dispose of up to 200 properties each year with priority going to those properties that have the highest fair market value. Under the pilot program, GSA is reimbursed for the costs of identifying and preparing a property for disposal. Eighty percent of the proceeds of any sale of property will be returned to the Treasury for debt reduction while 18 percent or the share of proceeds otherwise authorized to be retained under law will be retained by the agency that owned the property, and the remaining 2 percent will be used to fund homeless assistance grants.

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In a letter to Senate Minority Leader Mitch McConnell, Dr. Coburn outlines his objects to the unanimous consent agreement to pass S. 1331, legislation to amend the Trade Act of 1974 to extend the Generalized System of Preferences (GSP) until September 30, 2015.  

WASHINGTON – Today, Senate Homeland Security and Governmental Affairs Committee Chairman Tom Carper (D-Del.) and Ranking Member Tom Coburn (R-Okla.) introduced legislation that would provide agencies with the tools needed to improve agency coordination on anti-waste and fraud efforts and curb millions of dollars in improper payments to deceased individuals. The Improper Payments Agency Cooperation Enhancements Act (IPACE) is bipartisan legislation that builds upon improper payment laws, enacted in 2010 and 2012, that were championed by Chairman Carper.

“In 2011, it was reported that a Delaware man collected 28 years of Social Security payments that were meant for his deceased aunt because the federal government did not include her death in its basic records,” said Chairman Carper. “Unfortunately, stories like this are not uncommon and can too often be traced to basic errors in the way our government maintains and shares death records. Not only do these types of errors waste millions of taxpayers’ dollars annually, but they also undermine confidence in our government.  That’s frankly unacceptable, especially when this problem can be easily fixed by implementing some basic reforms. Our bill ensures that the federal government makes it a higher priority to keep track of people who have died, shares that information with key federal agencies, and ultimately prevents payments to people who are obviously no longer eligible for federal benefits and other federal payments.  By taking some long overdue and common sense steps like providing federal agencies with access to the most complete and accurate list of people who have died, we can hopefully put an end to this unacceptable practice once and for all.”

“It is inexcusable for bureaucratic red-tape to hinder the detection of individuals who are on the government’s list of deceased beneficiaries,” Dr. Coburn said.  “This bill will improve the Social Security Administration’s management of the file while increasing real-time data sharing with other agencies to ensure the most up-to-date information is available on beneficiaries before payments are disbursed.”

This legislation comes after a Homeland Security and Governmental Affairs Committeehearing in May that examined initiatives by the Executive Branch to reduce the improper payments made by federal agencies.  The hearing examined improper payments to deceased individuals, often due to inadequate sharing among federal agencies of basic death data maintained by the Social Security Administration (SSA).  SSA maintains the Death Master File (DMF), which contains identifying information on individuals who are reported to have died.  Most federal agencies rely on a slimmed down, incomplete, and less timely version of the DMF that is also publically available. IPACE will correct these problems by making the following changes:

• Allowing federal agencies access to the complete Death Master File database. Under current law, only agencies with beneficiary program have access to the complete DMF. IPACE specifically allows all federal agencies to have access to the complete DMF, for program integrity purposes, as well other needs such as public safety and health.
• Requiring use of death data to curb improper payments.  IPACE would require that federal agencies make appropriate use of the DMF in order to curb improper payments.
• Improving the Death Master File.  IPACE establishes procedures to better facilitate the sharing of data about instances of death among federal agencies, including with SSA. Currently, there are no clear procedures for agencies, such as the Department of Defense, to share their notices of death in order to update the DMF.  IPACE also establishes new requirements for correcting the DMF when errors are detected, in order to ensure accuracy.

• Ensure that federal agencies managing retirement programs share best practices. IPACE establishes a short-term task force to identify and share best practices for identifying deceased recipients.

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(WASHINGTON, D.C.) – U.S. Senators Tom Coburn, M.D. (R-OK), Kelly Ayotte (R-NH), Jeffrey Chiesa (R-NJ), Mike Enzi (R-WY), and John McCain (R-AZ) introduced a bill to reduce travel expenses by scaling back overall spending on government-sponsored conferences, establishing attendance limitations to protect from excessive and unnecessary travel, capping the amount that can be spent on a single conference at $500,000, and requiring all conference expenses to be published online.

“Time and time again, taxpayers are frustrated by extravagant and expensive conferences that are exposed after conferences take place,” said Dr. Coburn.  “This bill will help prevent such egregious spending from happening in the first place while forcing agencies to disclose how much they have spent on conferences."

“With $17 trillion in debt, it’s unacceptable that federal agencies continue to waste taxpayer dollars on excessive conference expenses,” said Senator Ayotte.  “Americans deserve to know that their tax dollars are being spent wisely and efficiently, and this legislation will set strict limits on conference spending, and boost accountability and transparency.”

"Taxpayers deserve accountability for the use of their hard earned tax dollars and we have seen far too many examples of misspent funds on lavish travel and inane conference activities,” said Senator Chiesa. “This measure will help shine a bright light on wasteful spending and raise standards for how government agencies use our money."

“Government agencies should be required to prioritize and cut the worst first,” said Senator Enzi. “By requiring costs to be put online it gives the public an opportunity to judge for themselves how their money is being spent.”

“Distrust in Washington is at an all time high due in part to ongoing reports of millions being wasted on conferences at federal agencies like the GSA and the IRS,” said Senator McCain.  “This common sense bill would provide greater transparency and accountability on how agencies spend taxpayer dollars.”

Specifically, the bill:

• Prohibits agencies from paying for travel expenses for more than 50 employees for any conference occurring outside of the United States, unless the Secretary of State certifies it is in the national interest.

• Requires agencies to post reports on their website that include each conference, including itemized expenses such as travel costs, lodging, food, costs for scouting and selecting the location, and any other cost.  Also requires detailed information about the sponsors, location, a justification of how it relates to the agency mission, cost-benefit analysis, job titles of attendees, and other information.

• Prohibits agencies from spending more than 80% of their total conference expenditure of 2010 for the next 4 years.  2010 was the pinnacle of excessive conference spending.

• Requires OMB to establish guidelines for what expenses constitute travel expenses for conferences.

• Requires agencies to publish on their website the minutes, speeches, exhibits, videos, and sponsors of conferences.

• Prohibits an agency from spending more than $500,000 on any single conference.

• Only allows agencies to expend funds on one conference each year for each outside group. 

• Prevents an agency from establishing or implementing a policy that discourages or prevents selecting a conference location that is perceived to be a resort or vacation destination.

Recent reports of outlandish conference spending include:

• With a history of excessive conference spending, the Department of Education is planning another Las Vegas conference for December 2013 which has been estimated to cost $970,000.
• $50 million spent by the IRS between 2010 and 2012 on 220 conferences.
• Over $800,000 spent by the GSA in 2012 on a single conference in Las Vegas.
• $58 million spent by the DOJ in 2012 for conferences in Indonesia, Senegal, and Northern Mariana Islands among others.

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Over the past year, many of my constituents have contacted my office asking for more information about the Department of Homeland Security’s plans for purchasing large amounts of ammunition.   Given my position on the Senate Homeland Security and Governmental Affairs Committee, I wrote a letter to Sec. Napolitano on November 13, 2012, asking for more information about DHS’s plans for ammunition purchases. 

On February 3, 2013, the Department of Homeland Security responded to my letter.  In the interest of promoting transparency and a constructive dialogue about this issue, I am posting my letter and their response. 

DHS Response Part 1 Here.

DHS Response Part 2 Here.  

Response to DHS Here. 

DHS Response Here.

(WASHINGTON, D.C.) – Today, U.S. Senators Tom Coburn, M.D. (R-OK), Lamar Alexander (R-TN), John Barrasso (R-WY), Richard Burr (R-NC), John Cornyn (R-TX), Mike Enzi (R-WY), James Inhofe (R-OK), Johnny Isakson (R-GA), Mike Lee (R-UT),  Rob Portman (R-OH), Jim Risch (R-ID), Marco Rubio (R-FL), John Thune (R-SD) and David Vitter (R-LA) introduced the Federal Employee Accountability Act, a bill that would reduce “official time” for government employees. Under the practice of “official time”, as authorized under 1978 Civil Service Reform Act, federal employees can be paid by taxpayers to complete duties that are not related to the mission of their agency, allowing in some cases for employees to perform union-related activities – some even full time – while on federal payroll.  According to the Office of Personnel Management, in 2011, the government spent $155 million on 3.4 million hours used for “official time.”   

“Using taxpayer dollars to finance what is often highly partisan and political full-time union work is a grievous violation of the public’s trust,” said Dr. Coburn.  “Sadly, this is a widespread problem.  Agencies like the IRS and VA have hundreds of employees on their payrolls that do nothing but full-time union work paid for by taxpayer dollars.  This bill will restore the public’s trust by ensuring federal employees – and the taxpayer funds that support them – are instead used to appropriately execute the mission of every federal agency.”  

“Hard-working taxpayers are paying federal workers to do their official jobs – period,” said Senator Barrasso.  “This bill makes it clear that union-related activities should not be funded by the American people.”

“The abuse of official time by federal employees to perform union-related activities on the taxpayer dime is costly, inefficient, and unfair to the American people,” said Senator Burr.  “Recent information shows that an alarming number of federal employees, including those responsible for providing vital services to our nation’s veterans, spend 100% of their time not serving the mission of the agency they work for.  This is unacceptable and a slap in the face to those veterans who sacrificed so much for the rest of us and to the American people who deserve to know their hard-earned tax dollars are put to proper use.  With our country buried in debt, this bill is a very common-sense measure to ensure that these types of wasteful practices no longer occur.”

“We have an obligation to ensure that the money we receive from taxpayers is used only for the legitimate duties of government, not political activity cloaked under the guise of official business,” said Senator Cornyn.  “I’m proud to support this measure to end an abuse of taxpayer funds and improve government transparency.”

“Federal workers should be paid for the work they do and not the political activity they want to do,” said Senator Enzi. “Federal agencies have a mission, and that should be the priority of their workers. The American taxpayers shouldn’t have to subsidize union activity during government work hours.” 

“At a time when our nation faces serious fiscal challenges, it is imperative that taxpayer dollars are spent wisely and efficiently,” said Senator Isakson.  I am proud to co-sponsor the Federal Employee Accountability Act because it will go a long way in ensuring that tax dollars are used to further the mission of each respective agency and not used for causes such as union activity.”   

“Federal Agencies like the VA need to make sure that they have all hands on deck to fulfill their missions,” said Senator Portman.  “Unfortunately, however, many agencies allow their taxpayer-funded employees to focus their time and energy on full-time political, union activities that don’t have anything to do with the official task at hand.  At a place like the VA, taxpayer dollars should be funding employees to tackle the challenges of the claims backlog and providing necessary medical care to our veterans.  Our veterans deserve nothing less than that, and this legislation will ensure that happens.”

“It is an embarrassment that millions of federal dollars have been wasted on federal employees spending their time on union-related work,” said Senator Risch. “This legislation puts an end to these abusive practices and will put taxpayer-paid employees back to work for the America people.”

“Hard-working taxpayers should not be footing the bill for federal employees to participate in union activities on official time,” said Senator Rubio. “It’s an abuse of government power and a waste of already scarce government resources. This bill will hold federal employees accountable and ensure that they are fulfilling their official duties instead of engaging in often partisan and political union activities on the American taxpayer’s dime.”

“The public deserves assurances that federal employees are spending their official time working on behalf of the American people and not on partisan union activities,” said Senator Thune. “The federal government must demand better oversight of our taxpayer dollars, and ensure that civil servants are performing the responsibilities for which they were hired.”

The Federal Employee Accountability Act would repeal the provisions that entitle federal employees to official time while providing an exception for circumstances where both unions and agencies agree the use of official time is “reasonable, necessary, and in the public interest.”  The bill would not affect federal employees’ ability to organize or have union representation in hearings. The bill is a companion bill to H.R. 107 sponsored by Representative Phil Gingrey, M.D., (R-GA).   

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WASHINGTON, D.C.—Senator John Thune (R-S.D.), Chairman of the Senate Republican Conference, was joined today by all 45 of his Republican Senate colleagues in sending a letter to President Obama urging him to permanently delay the implementation of ObamaCare for all Americans. Last week, the Obama administration announced that after hearing concerns from the business community, it will delay implementation of a key ObamaCare component, the employer mandate, until 2015.

In their letter the GOP senators say to the president, “[W]hile your action finally acknowledges some of the many burdens this law will place on job creators, we believe the rest of this law should be permanently delayed for everyone in order to avoid significant economic harm to American families.”

Joining Thune in his letter were Senators Lamar Alexander (R-Tenn.), Kelly Ayotte (R-N.H.), John Barrasso (R-Wyo.), Roy Blunt (R-Mo.), John Boozman (R-Ark.), Richard Burr (R-N.C.), Saxby Chambliss (R-Ga.), Jeffrey Chiesa (R-N.J.), Dan Coats (R-Ind.), Tom Coburn (R-Okla.), Thad Cochran (R-Miss.), Susan Collins (R-Maine), Bob Corker (R-Tenn.), John Cornyn (R-Texas), Mike Crapo (R-Idaho), Ted Cruz (R-Texas), Mike Enzi (R-Wyo.), Deb Fischer (R-Neb.), Jeff Flake (R-Ariz.), Lindsey Graham (R-S.C.), Charles Grassley (R-Iowa), Orrin Hatch (R-Utah), Dean Heller (R-Nev.), John Hoeven (R-N.D.), Jim Inhofe (R-Okla.), Johnny Isakson (R-Ga.), Mike Johanns (R-Neb.), Ron Johnson (R-Wis.), Mark Kirk (R-Ill.), Mike Lee (R-Utah), John McCain (R-Ariz.), Mitch McConnell (R-Ky.), Jerry Moran (R-Kan.), Lisa Murkowski (R-Alaska), Rand Paul (R-Ky.), Rob Portman (R-Ohio), Jim Risch (R-Idaho), Pat Roberts (R-Kan.), Marco Rubio (R-Fla.), Tim Scott (R-S.C.), Jeff Sessions (R-Ala.), Richard Shelby (R-Ala.), Pat Toomey (R-Pa.), David Vitter (R-La.), and Roger Wicker (R-Miss.).

(WASHINGTON, D.C.) – U.S. Senator Tom Coburn, M.D. (R-OK) and U.S. Representative Charles Boustany Jr., M.D. (R-LA) – both physicians – sent HHS Secretary Kathleen Sebelius a letter asking serious questions about “ongoing significant weaknesses in HHS’ financial management” outlined in HHS's FY2012 financial audit.

The Members noted, “many of these issues [had] been discussed every year in Ernst & Young’s audits,” so they found it “perplexing that they are appearing yet again in the 2012 audit report.”

Coburn and Boustany noted HHS’s “increasingly complex duties” related to the full implementation of the Patient Protection and Affordable Care Act and noted “it is vital the Department’s fiscal management systems are sound and orderly.” They asked for HHS’s response to a number of questions, as well as a detailed corrective action plan for the issues the audit identified by July 15, 2013.

The doctors also questioned Secretary Sebelius in 2012 regarding findings from the FY2011 HHS financial audit, and in 2011 regarding findings from the FY2010 audit. 

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By Sen. Tom Coburn (R-Okla.)

Now that the Senate has passed a flawed $46 billion immigration bill it’s time for the House to be the higher chamber and start over. Do what the Senate failed to do. Pass a bill — or series of bills — that balances the two fundamental American values at stake in this debate: openness to immigration and respect for the rule of law.

The first task for House Republicans, I would argue, is to understand that you don’t solve a messaging or political problem with bad legislation. You solve it with good policy that honors our values, respects the rule of law, and improves people’s lives.

President Reagan, in his farewell address, gave today’s Republicans a blueprint for how to approach immigration. Of his “shining city on the hill,” he said, “It was a tall, proud city built on rocks stronger than oceans, wind-swept, God-blessed, and teeming with people of all kinds living in harmony and peace; a city with free ports that hummed with commerce and creativity. And if there had to be city walls, the walls had doors and the doors were open to anyone with the will and the heart to get here.”

In the House, “walls with doors” is an immigration policy that could unite our nation. But Reagan was describing something even more profound — a deep belief in American exceptionalism, which is something we don’t hear enough of today.

America, of course, is exceptional because it is a miracle of assimilation unrivaled in human history. The fire beneath our melting pot is not our economic or material wealth, but an immaterial idea that all people are created equal and are endowed by the Creator — not the State — with certain rights. Every immigrant who longs for freedom and “comes hurtling through the darkness, toward home,” as Reagan said, makes that fire brighter and our nation stronger.

Republicans ought to invoke these themes whenever they open their mouths on immigration. This should be natural for conservatives because our views on American exceptionalism, individual liberty, and immigration aren’t diluted by political correctness or identity politics.

The House’s second task, I believe, is to balance an unapologetic pro-legal-immigration message with an equally emphatic emphasis on the rule of law, which is what the debate about border security is really about.

The rule of law is critical because it is the glue that holds our nation together and guarantees the freedom that has drawn millions to our country. It says that because we’re created equal we also ought to be treated equally under the law. Unfortunately, the Senate bill ignored the rule of law. It allows the secretary of Homeland Security to waive almost every provision. That’s not the rule of law. That’s the rule of rulers.

Some argue the border can’t be made any more secure, but the facts say otherwise. According to the Council on Foreign Relations, our border is only 40 to 55 percent secure. I also know the border is not secure based on what I learn on the Intelligence Committee, and through my oversight work as the ranking member of Senate Homeland Security and Governmental Affairs Committee — the committee that has jurisdiction over the border. For instance, I’ve been asking DHS for a report on border-security performance — and metrics for how they define security — for more than a year with no response. I also asked Secretary Napolitano for DHS’s sector-by-sector plan over breakfast a month ago. “I’ll have it for you tomorrow,” she said. I got a piece of paper, but it wasn’t a plan.

The truth is the administration doesn’t know if the border is secure and they don’t care, and they won’t start caring until Congress and the American people make them care.

The House would be wise to force this issue with the White House and the Senate. What the American people really want, I believe, is not so much a perfect policy solution or series of triggers that will lead to other reforms. Those decisions are important, but what the public wants is to see that we have the political will to secure the border and respect the rule of law. Once that happens, the American people will be extremely gracious and generous about supporting a pathway to legal status for the 11 million people who are here illegally. After all, the public isn’t mad at aspiring immigrants. They’re mad at Washington. And rightly so. Nothing undermines the rule of law more than politicians who pass laws they have no intention of enforcing.

And how will the American people measure political will when it comes to the border? They’ll know it when they see it. Political will — in a security sense — is what people see every time they go through an airport. They know we are committed to stopping another 9/11. They want to see some of that zeal shifted to the border. A commitment to spend billions on border stimulus for contractors doesn’t count.

Another way the House could communicate seriousness would be to transfer DHS dollars dedicated to the militarization of small-town America to more-pressing border-security needs. For example, why not start by shifting resources from lower-priority programs like the one that gave the town of Keene, N.H. a BearCat armored personnel carrier to patrol a pumpkin festival?

The House could take many additional steps as well, such as improving interior enforcement. Forty percent of all people who are here illegally walked through the front door and overstayed their visas. If interior enforcement isn’t improved we’ll be passing another “reform” bill in ten years.

Many in Washington are betting the House’s efforts on immigration will fail. I’m convinced the House will prove them wrong. With cold reason, hard facts, and a passionate defense of legal immigration and the rule of law, the House can get reform right.

In a letter to Acting IRS Commissioner Daniel Werfel, Dr. Coburn and Congressman Phil Gingrey, M.D., ask for the agency to expound on its procedures and practices for the 200 employees that are paid by taxpayers to do union work full time.

(WASHINGTON, D.C.) – U.S. Senator Tom Coburn, M.D. (R-OK) released the following statement today regarding the passage of S. 744:

“This bill is a historic missed opportunity for the United States Senate.  It is a $48 billion border stimulus package that grants amnesty to politicians who want to say they are securing the border when in fact they are not.  I very much wanted to support an immigration reform proposal that balances our fundamental American values of legal immigration and the rule of law.  Sadly, this bill fails that test.  

“Speaker Boehner and House Republicans now have all the justification they need to start over.  I would encourage the House to use President Reagan’s view of immigration as a blueprint.  In his farewell address Reagan described what he saw when he talked about America as the ‘shining city on the Hill.’ 

“Reagan said, ‘it was a tall, proud city built on rocks stronger than oceans, wind-swept, God-blessed, and teeming with people of all kinds living in harmony and peace; a city with free ports that hummed with commerce and creativity.  And if there had to be city walls, the walls had doors and the doors were open to anyone with the will and the heart to get here.’ 

“‘Walls with doors’ is an immigration policy that can unite our nation.  But, today, Democrats sound like they want only doors; Republicans only walls.  The truth is we have neither.  We have chaos.  

“House Republicans have a chance to be the higher chamber and get reform right.  They should first remind the public that America is exceptional because it is a miracle of assimilation unrivaled in human history.  The fire beneath our melting pot is not our economic or material wealth, but an immaterial idea that all people are created equal and are endowed by the Creator – not the State – with certain rights.  Every legal immigrant who ‘comes hurtling through the darkness, toward home,’ as Reagan said, makes that fire brighter and our nation stronger.  

“The House also has an obligation to defend the rule of law, which is what the debate about border security is really about.  According to the Council on Foreign Relations, our border is only 40 to 55 percent secure.  At the same time, under the Senate bill, illegal immigration will drop by only 25 percent according the Congressional Budget Office.  Meanwhile, more than 40 percent of all people who are currently here illegally came through the front door and have overstayed their visas. 

“The rule of law is the glue that holds our nation together and it guarantees the freedom that has drawn millions to our country.  As a nation, we have an obligation to our citizens – and to legal immigrants – to uphold the rule of law and ensure the process is fair to all.  Unfortunately, this bill is full of holes as far as the rule of law is considered.  It is written so that the Secretary of Homeland Security can waive almost every portion of it.  That’s not the rule of law.  That’s the rule of rulers. 

“The House can, and must, do better.  But we should be precise about what the problem is.  Oklahomans and people across this country aren’t mad at illegal immigrants.  They’re mad at Washington.  And they are right to be angry.  Politicians who pass laws they have no intention of enforcing do more to undermine the rule of law than a Guatemalan father of four who crosses the border twice a year to help feed his extended family.  We can’t welcome everyone, but we should be delighted people want to come to this country, and we should do everything in our power to treat aspiring Americans fairly and with dignity.

“I filed 19 amendments to improve this bill, including amendments to help secure the border and increase interior enforcement.  Unfortunately, those amendments were not considered.  The House now has an opportunity to give the American people the debate they want and deserve.” 

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(WASHINGTON, D.C.) – U.S. Senator Tom Coburn, M.D. (R-OK) released the following statement today regarding the Supreme Court’s ruling on the Defense of Marriage Act:

“In its ruling on the Defense of Marriage Act, I’m disappointed the Supreme Court made a decision that overrides the clear intent of two branches of government.  With this decision, five judges have violated the freedom of conscience of millions of Americans.  Regardless of what people believe about this issue, it should be resolved by We the People, not the Courts.  Our nation was fully capable of resolving this issue without the Court’s cultural and moral commentary.  By taking sides in this debate, the Supreme Court has discouraged any American who believes marriage is a union between one man and one woman from legislating – and even thinking – differently from the Court. 

“Even though the Court refrained from striking down state laws like the one in Oklahoma, those laws are far from safe.  As Justice Scalia wrote, ‘By formally declaring anyone opposed to same-sex marriage an enemy of human decency, the majority arms well every challenger to a state law restricting marriage to its traditional definition.’” 

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WASHINGTON, D.C. – U.S. Sen. Jim Inhofe (R-Okla.), a senior member of the Environment and Public Works (EPW) Committee, today reintroduced the Fracturing Regulations are Effective in State Hands (FRESH) Act of 2013 (S.1234) for the 113^th Congress. The bill is cosponsored by the EPW committee’s Ranking Member Sen. David Vitter (R-La.) along with Sens. Jeff Sessions (R-Ala.), Pat Roberts (R-Kan.), Rob Portman (R-Ohio), Rand Paul (R-Ky.), Tom Coburn (R-Okla.), Mike Crapo (R-Idaho), Jim Risch (R-Idaho), Tim Scott (R-S.C.), Ted Cruz (R-Texas), Orrin Hatch (R-Utah), Ron Johnson (R-Wis.), John Cornyn (R-Texas), Roger Wicker (R-Miss.), Mike Lee (R-Utah), John Boozman (R-Ark.), and John Hoeven (R-N.D.). Congressman Louie Gohmert (R-Texas) has reintroduced companion legislation in the House of Representatives. 

“States have been safely and effectively regulating hydraulic fracturing since it was first done in Duncan, Oklahoma in 1949,” said Inhofe.  “Since then, a robust regulatory structure has emerged in every state where hydraulic fracturing occurs.  States and industry have developed strong working relationships so that today’s regulations match the industry’s practices and provide effective environmental protection.  The Department of Interior’s foray into this space is simply an attempt to further hinder oil and gas production on federal lands and makes it more difficult for us to achieve domestic energy independence. 

Streamlined regulations are critical if we are going to achieve this important goal, but the DOI’s rules are duplicative and add unnecessary layers of complication and compliance to the already frustrating business of developing energy in the federal mineral estate.  The DOI should abandon its rulemaking effort and simply defer to the states to continue effectively regulating the process when it occurs on federal lands.” 

Sen. Vitter added, “All too often we see the federal government using flawed science on hydraulic fracturing, even though the states have shown they are capable of regulating themselves. There has been such positive progress with hydraulic fracturing – clearly the brightest spot in our otherwise slumping economy - and this bill gives states the freedom they need to be effective in providing proper safety protocols while growing American businesses. Just recently the EPA was forced to step aside in Wyoming and allow the state to take the lead, and we want this to be the case nationwide.”

“Hydraulic fracturing has allowed for an unprecedented increase in the production of domestic sources of oil and gas, moving us closer to being energy independent, while providing land owners with welcome royalty payments,” Sen.Roberts said. “To continue this progress, it is essential that states, not federal bureaucrats in Washington, be in charge of regulating this form of energy development. I’ve spoken to my Kansas land owners, independent oil and gas producers, and state geological survey, and the consensus is that our state regulators know what’s best for Kansas.”

Sen. Paul added, “Our nation is fortunate to have an abundance of natural resources, and for too many years now we have been constrained by self-imposed regulations. The FRESH Act takes the control out of the hands of the federal bureaucrats in Washington, and hands it back to the states. Fracking continues to be an important issue to the state of Kentucky by creating well-paying jobs, lowering the prices of energy domestically and helping us reach the goal of being energy independent.” 

“We must take full advantage of energy innovations and resources here at home in order to end our dangerous dependency on foreign sources,” Dr. Coburn said.  “Hydraulic fracturing is safer and more efficient than traditional drilling techniques, and states already exercise extensive testing and regulation of the process.  We should continue to allow the states to regulate the practice without interference from the Environmental Protection Agency (EPA) in Washington.  Former EPA Administrator Carol Browner recognized the close regulation states maintain over the process and stated the EPA does not believe it is legally required to regulate hydraulic fracturing.  State regulators are much more in tune with what is needed than federal bureaucrats in Washington.”

Congressman Gohmert said, “The Obama Administration is more interested in pandering to its liberal left that it is in creating and preserving American jobs. With the issuance of new hydraulic fracturing regulations, it’s clear that this administration wants to hinder the production of our own natural resources and ‘necessarily’ cause the price of our own energy to ‘skyrocket’ despite the devastation that creates for hardworking middle and low income families and individuals. It is amazing to realize that this administration has abandoned helping America's most needy in favor of more affluent leftists. States should have the sole authority to regulate such activities within its boundaries, so it is time to put people to work producing our own energy while lowering the cost of living which is a double win. This action by the administration is a triple loss for jobs, cheaper energy, and more national energy independence.” 

The FRESH Act would clarify that States have the sole authority to regulate hydraulic fracturing on all land within the boundaries of the State. Companies with hydraulic fracturing operations on Federal lands would be forced to comply with the applicable State laws.

During the 112^th Congress, on March 28^th, 2012 Inhofe and a group of republican senators introduced the FRESH Act, and Congressman Gohmert introduced a version of the bill in the House of Representatives.

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Late yesterday Senators Coburn, Hatch and Enzi, sent a letter to CMS Administrator Marilyn Tavenner regarding possible waste and duplication at CMS’s Innovation Center.  The Senators asked a series of follow-up questions based on the findings in a report by the Government Accountability Office showing the Innovation Center could be inefficiently duplicating other efforts. The Senators also asked Tavenner to identify steps the Center is taking “to ensure that funded initiatives are not wasting taxpayer dollars.”

WASHINGTON - In a letter to Health and Human Services Secretary Kathleen Sebelius today, nine Senators, led by Finance Committee Ranking Member Orrin Hatch (R-Utah), said the health law's Navigator Program lacked appropriate safeguards to protect the privacy of consumers and demanded more details on its requirements.

Established under the Patient Protection and Affordable Care Act (PPACA), the Navigator Program provides grants to organizations to help individuals enroll in the new health insurance plans through exchanges. Navigators assist the uninsured in determining what type of coverage they qualify for and often have access to personal information, such as Social Security numbers, tax returns, and household income. However, the training and requirements for navigators eligible to receive funding under this program is very limited and could potentially put consumers at risk of fraud and identity theft.

“The standards proposed by your Department could result in a convicted felon receiving federal dollars and gaining access to confidential taxpayer information.  The same standards allow any individual who has registered with the exchange and completed two days of training to facilitate enrollment, as if the decision to purchase health insurance is similar to the decision of registering to vote,” wrote the Senators.  “The unreasonably low standard for becoming a navigator not only undermines the state’s ability to ensure consumers are protected but raises questions about the appropriate use of federal resources and the protection of highly sensitive consumer information.”

Joining Hatch on the letter were Senators Johnny Isakson (R-Ga.), Tom Coburn (R-Okla.), John Barrasso (R-Wyo.), Pat Roberts (R-Kan.), Mike Enzi (R-Wyo.), Richard Burr (R-N.C.), John Thune (R-S.D.) and John Cornyn (R-Texas).

A signed copy of the letter can be found HERE and the text of the letter is below: 

June 20, 2013

The Honorable Kathleen Sebelius 
U.S. Department of Health and Human Services 
200 Independence Avenue, S.W. 
Washington, D.C. 20201

Dear Secretary Sebelius:

We write to express concern regarding the recently published Patient Protection and Affordable Care Act; Exchange Functions: Standards for Navigators and Non-Navigator Assistance Personnel notice of proposed rulemaking. The guidelines you have proposed for navigators, assisters, application counselors and other consumer outreach personnel provide significantly less protection to patients and consumers than the states have provided through licensed insurance producers for decades. 

As you are well aware, health insurance agents and brokers are subject to strict state-level exam-based licensing laws and annual continuing education requirements, as well as significant federal and state privacy, security and market conduct requirements.  Furthermore, agents and brokers have a personal legal and financial liability to comply with all of these laws and requirements, as well as a requirement to maintain professional liability insurance to protect consumers. 

The leniency the proposed rule takes with regard to consumer protections for individuals and small businesses poised to purchase health insurance in the new exchanges is not only a lower standard than already exists at the state level, but is also inconsistent with the Administration’s stance on oversight of professional tax preparers.  Since 2009, the Department of Treasury has aggressively pursued reforms to provide comprehensive oversight of tax professionals including registration of individual preparers, background checks, certification, competency examinations and continuing education requirements. 

Exchange navigators, assisters, application counselors, and other consumer outreach professionals will have similar access to sensitive consumer financial information, yet the proposed rule has no similar consumer protections.  In fact, the standards proposed by your Department could result in a convicted felon receiving federal dollars and gaining access to confidential taxpayer information.  The same standards allow any individual who has registered with the exchange and completed two days of training to facilitate enrollment, as if the decision to purchase health insurance is similar to the decision of registering to vote.

The unreasonably low standard for becoming a navigator not only undermines the state’s ability to ensure consumers are protected but raises questions about the appropriate use of federal resources and the protection of highly sensitive consumer information.  To fully understand the Department’s plans to ensure the appropriate use of federal funds and that all health insurance consumers are fully protected, please provide a response to the following:

1. A list of the minimum requirements for individuals who either directly or indirectly receive federal, and/or exchange-based funds to assist consumers, either through the navigator, assister, application counselor or other consumer outreach programs.  For example, is a high school diploma required? Is there a minimum age requirement?  Are criminal and other appropriate background checks to protect consumers required?  Please list all minimum requirements.  
2. All materials used to train navigators, assisters, application counselors and other consumer outreach personnel and identify the minimum training each will be required to complete as well as the minimum score they must achieve to pass the required examinations.
3. Will the navigators, assisters, application counselors and other consumer outreach personnel be contractors of the Department?  If so, provide sample copies of the contracts that will be used by the Department to obtain the services of organizations performing these services.  
4. Do you plan to limit the scope and standardize information that navigators, assisters, application counselors and other consumer outreach personnel may provide to consumers about qualified health plans (QHP) sold through exchanges?
5. Will navigators, assisters, application counselors or other consumer outreach personnel obtain access to confidential taxpayer returns and return information protected by section 6103 of the Internal Revenue Code?  If so, provide copies of all guidelines promulgated to ensure the proper handling of taxpayer information. 
6. Will navigators, assistors and other outreach contractors that receive taxpayer returns and return information in the course of the performance of their duties be advised of their potential criminal liability, pursuant to section 7213(a)(2) of the Code, for unauthorized disclosure of such information?  Please provide copies of all training materials that inform grantees and grantee staff of their potential criminal liability in this regard.
7. How will the distinction between advising consumers about QHP options and merely helping consumers through the eligibility and enrollment process be made, monitored and enforced?
8. What is your statutory authority for the creation of the non-navigator program, application counselor and assister programs?
9. Why does the proposed rule limit the definition of navigator and non-navigator assistance personnel conflict of interests to relationships with health insurance issuers?  Do you consider a financial relationship with a health care provider to be a conflict of interest?  How will you address potential steering by navigators, assisters, application counselors and other consumer outreach personnel to certain provider networks and groups?
10. How do you plan to enforce the proposed conflict of interest standards and what will be the consequences for violations?
11. Where does liability rest in the case of a navigator, assister, application counselor or other consumer outreach personnel who causes harm to a consumer, either purposefully or unintentionally?  Does liability rest with the individual who had direct consumer contact, the entity that received federal or exchange-generated funds for consumer outreach, or with the federally-facilitated, state-based and partnership exchanges?  Is financial and legal responsibility for addressing and rectifying such issues shared? Where does a consumer go for recourse?
12. How will the privacy requirements that apply to navigators, assisters, application counselors or other consumer outreach professionals be enforced?  How does your Department plan to protect consumers from identity theft and related crimes?
13. Do you plan to require that entities that receive federal and/or exchange-generated funds for consumer outreach activities carry some sort of professional liability insurance?
14. How does your Department plan to inform state regulators about which entities and individuals may be performing federally-funded, out-of-state consumer outreach activities in their states, so that they will be aware of who may be interacting with their constituents and may enforce state-based consumer protection and licensing requirements?
15. How does your Department plan to prevent potential fraud by entities and individuals that may disingenuously represent themselves as navigators or other assisters to unsuspecting consumers for nefarious purposes, including any plans to provide assistance and relief to defrauded consumers?

We appreciate your prompt attention to these critical questions and request a response by August 1. 

Sincerely,

HATCH
ISAKSON
COBURN
BARRASSO
ROBERTS
ENZI
BURR
THUNE
CORNYN

In a letter to Comptroller General Gene Dodaro, Senators Klobuchar, Toomey, Shaheen, and Coburn request that the GAO examine the extent to which Medicare beneficiaries have transparent price and quality data available for decision-making.

Washington, D.C. – U.S. Senators Barbara Boxer (D-CA) and Tom Coburn (R-OK) praised the Senate’s passage last night of the HOPE Act (HIV Organ Policy Equity Act), legislation that would end the federal ban on research into organ donations from HIV-positive donors to HIV-positive recipients. 

The bipartisan measure – which is also sponsored by Senators Tammy Baldwin (D-WI), Rand Paul (R-KY), Richard Burr (R-NC), Michael Enzi (R-WY), Elizabeth Warren (D-MA), Mark Kirk (R-IL), Dianne Feinstein (D-CA), Mary Landrieu (D-LA), Brian Schatz (D-HI), Richard Blumenthal (D-CT), Roy Blunt (R-MO), Mark Pryor (D-AR) and Carl Levin (D-MI) – would open a pathway for the eventual transplantation of these organs, offering hope to thousands of HIV-positive patients who are on waiting lists for life-saving organs. Currently, even researching the feasibility of these potentially life-saving transplants is banned under federal law.

“I applaud the Senate for moving to end this outdated ban on research into organ donations between HIV-positive individuals,” Senator Boxer said. “This legislation offers hope for thousands of patients who are waiting for transplants by allowing scientists to research safe and effective ways to transplant these organs and save lives.”

“The passage of the HOPE Act is an encouraging step forward for HIV-positive individuals who need organ transplants,” Dr. Coburn said.  “By lifting these arcane federal regulations, we give hope by allowing doctors and scientists to explore potentially transformative research into organ donations between HIV-positive patients.” 

The HOPE Act would establish a regular review process in which the Health and Human Services (HHS) Secretary evaluates the progress of medical research into these procedures. If the research demonstrates that transplants from HIV-positive donors to HIV-positive recipients can be safely and successfully completed, the HHS Secretary will have the authority to direct the Organ Procurement and Transplantation Network to establish procedures to begin such transplantations.

The ban on the donation of organs from HIV-positive donors and on related research was put into place as part of the Organ Transplant Amendments Act of 1988, but is now medically outdated. Thanks to advances in antiretroviral therapy, many HIV-positive patients are living longer. However, these patients are now more likely to face chronic conditions such as liver and kidney failure, for which organ transplants are the standard form of care.

There are currently more than 100,000 patients on the active waiting list for organ transplants in the United States and about 50,000 people are added to the list each year – but fewer than 30,000 transplants are performed annually. Tragically, many patients die while waiting for a transplant.

According to a study published in the American Journal of Transplantation, allowing organ transplants from HIV-positive donors to HIV-positive recipients could increase the organ donation pool by 500-600 donors a year and save hundreds of lives.

This legislation has broad support from the medical community and advocacy groups, including the American Medical Association, American Society of Transplant Surgeons, American Society of Transplantation, Association of Organ Procurement Organizations, American Academy of HIV Medicine, American Society for the Study of Liver Disease, the Human Rights Campaign, National Minority AIDS Council, HIV Medicine Association, National Coalition for LGBT Health, Infectious Diseases Society of America, Gay and Lesbian Medical Association, United Network for Organ Sharing, The AIDS Institute, amfAR (American Foundation for AIDS Research), Lambda Legal, the Treatment Access Group (TAG), and AIDS United.

In the House, the HOPE Act has been introduced by a bipartisan group of lawmakers led by Representatives Lois Capps (D-CA) and Andy Harris (R-MD). 

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On May 31, 2013, the Medicare Trustees released their annual report assessing the future of Medicare spending. However, the Office of the Actuary at the Centers for Medicare and Medicaid Services (CMS) also produced a 2013 "alternative scenario" of Medicare spending. Here is how the Office of Actuary explained the purpose of the second examination of Medicare outlays:

"The future of The Trustees Report is necessarily based on current law; as a result of questions regarding the operations of certain Medicare provisions, however, the projections shown in the report under current law are clearly unrealistic with respect to physician expenditures and, in addition, may well understate expenditures for most other categories of health care providers. The purpose of this memorandum is to present a set of Medicare projections under hypothetical alternatives to these provisions to help illustrate and quantify the potential magnitude of the cost understatement under current law."

The Actuary’s office said their intent was "to help inform Congress and the public at large that an evaluation of the financial status of Medicare, based on the provisions of current law, is likely to portray an unduly optimistic outcome." They said they also wanted to "promote awareness of these issues, to illustrate and quantify the amount by which the Medicare projections are potentially understated, and to help inform discussions of potential policy reactions to the situation."

As the Actuary’s office ominously warned, "the sizable differences in projected Medicare cost levels between current law and the illustrative alternative scenarios highlight the critical importance of finding ways to bring Medicare costs—and health care costs in the U.S. generally—more in line with society’s ability to afford them." To read more click here.

Supporting Documents:

A Medicare Trustee's Commentary on Medicare's Oulook in 2013 here