Congress has failed to fund the government on time again. In this episode, Graham Elwood joins Jen as she geeks out on all the dingleberries attached to the new law extending Congress’s funding deadline until December 16th. Please Support Congressional Dish – Quick Links Contribute monthly or a lump sum via Support Congressional Dish via (donations per episode) Send Zelle payments to: Donation@congressionaldish.com Send Venmo payments to: @Jennifer-Briney Send Cash App payments to: $CongressionalDish or Donation@congressionaldish.com Use your bank’s online bill pay function to mail contributions to: Please make checks payable to Congressional Dish Thank you for supporting truly independent media! Executive Producer Recommended Sources August 8, 2022. The Peter Collins Show. Background Sources Recommended Congressional Dish Episodes FDA User Fees Katie Hobbins. Oct 3, 2022. Medical Device + Diagnostic Industry (MD+DI). New Mexico Fire Ryan Boetel. Sept 29, 2022. Albuquerque Journal. Associated Press. Jun 21, 2022. The Guardian. Elizabeth Miller and Jason Samenow. May 5, 2022. The Washington Post. Republicans and Disaster Relief Funding Sharon Zhang. Oct 3, 2022. Truthout. Zach Schonfeld. Oct 3, 2022. Lauren Book. Oct 3, 2022. Sanjana Karanth. Oct 2, 2022. HuffPost. Anna Skinner. Sept 30, 2022. Newsweek. Sergio Bustos. Sept 30, 2022. Tallahassee Democrat. Patrick Leahy. Sept 9, 2022. Vermont Biz. Jackson Water Crisis Anthony Warren. Sept 30, 2022. Jackson WLBT. Michael Goldberg. Sept 27, 2022. Yahoo News. Annie Snider and Lara Priluck. Sept 21, 2022. Politico. James Brasuell. Aug 20, 2022. Planetizen. Continuing Resolution Aidan Quigley. Sept 30, 2022. Roll Call. David Hawkings. Sept 7, 2016. Roll Call. Ukraine James Bradley. Oct 4, 2022. Emily Cochrane. Sept 29, 2022. The New York Times. Chelsey Cox. Sept 29, 2022. CNBC. Jackie Walorski Crash Marek Mazurek. Sept 16, 2022. Appropriations Congressional Research Service. Jeff Sachs Jeff Sachs on Bloomberg Global Financial News LIVE. Oct 3, 2022. Bono. Apr 18, 2005. TIME. Peter Passell. Jun 27, 1993. The New York Times. Campaign Contributions from the Defense Industry Open Secrets. Afghanistan Craig Whitlock. The Afghanistan Papers: A Secret History of the War. Simon & Schuster: 2021. Spencer Ackerman. Apr 29, 2013. U.S. Infrastructure and Global Rankings Contaminated Water in the United States Gloria Oladipo. Sep 6, 2022. The Guardian. Emily Holden et. al. Feb 26, 2021. The Guardian. Maura Allaire. Feb 12, 2018. The Proceedings of the National Academy of Sciences (PNAS) 115(9). Paul Pelosi Chip Stock Caroline Vakil. Jul 27, 2022. The Hill. Starbucks Unionization Union Election Data. Laws and Treaties Audio Sources Oct 3, 2022 Jeff Sachs: The main fact is that the European economy is getting hammered by this by the sudden cut off of energy. And now to make it definitive the destruction of the Nord Stream pipeline, which I would bet was a US action, perhaps the US and Poland. This is a speculation — Bloomberg Host: That's quite a statement. Why do you feel that that was a US action? What evidence do you have of that? Jeff Sachs: Well, first of all, there's direct radar evidence that US helicopters, military helicopters that are normally based in Gdansk, we're circling over this area. We also had the threats from the United States earlier in this year that one way or another, we are going to end Nord Stream. We also have a remarkable statement by Secretary Blinken, last Friday in a press conference, he says this is also a tremendous opportunity. It's a strange way to talk if you're worried about piracy on international infrastructure of vital significance. I know this runs counter to our narrative, that you're not allowed to say these things in the West, but the fact of the matter is, all over the world, when I talk to people, they think the US did it. And by the way, even reporters on our papers that are involved tell me privately, “Well, of course,” but it doesn't show up in our media. September 30, 2022 September 29, 2022 April 30, 1998 Cover Art Design by Only Child Imaginations Music Presented in This Episode by

A new law, known as the CHIPS Act, provides over $50 billion to existing, profitable companies to fund new semiconductor production facilities in the United States. In this episode, we examine why Congress decided to gift these companies our tax money now and explore the geopolitical implications of this funding decision. Beyond semiconductors, the law provides further corporate welfare for the creation of things that many of us tax payers likely support. This law is complicated; let's get nuanced. Please Support Congressional Dish – Quick Links Contribute monthly or a lump sum via Support Congressional Dish via (donations per episode) Send Zelle payments to: Donation@congressionaldish.com Send Venmo payments to: @Jennifer-Briney Send Cash App payments to: $CongressionalDish or Donation@congressionaldish.com Use your bank’s online bill pay function to mail contributions to: Please make checks payable to Congressional Dish Thank you for supporting truly independent media! Background Sources Recommended Congressional Dish Episodes Semiconductor Industry July 2022. Semiconductor Industry Association. February 2022. Semiconductor Industry Association. September 2021. Semiconductor Industry Association. Taiwan Bansari Mayur Kamdar and Medha Singh. Aug 2, 2022. Reuters. Karen M. Sutter. Mar 7, 2022. Congressional Research Service. Yimou Lee, Norihiko Shirouzu and David Lague. Dec 27, 2021. Reuters. PRISM Program Derek B. Johnson. Aug 27, 2018. FCW. Wealthy Shareholders Juliana Kaplan and Andy Kiersz. Oct 19, 2021. Insider. National Endowment for Democracy National Endowment for Democracy. National Science Foundation Directorate Mitch Ambrose. Mar 17, 2022. American Institute of Physics. Mar 17, 2022. House Committee on Science, Space, and Technology. Fusion Research Diffen. Open Secrets. Open Secrets. K&L Gates. American Exception Book Aaron Good. 2022. Skyhorse Publishing. The Law Bills Later Added to the CHIPS Act Audio Sources Sept 18, 2022 60 Minutes Scott Pelley: What should Chinese President Xi know about your commitment to Taiwan? President Joe Biden: We agree with what we signed on to a long time ago, that there's a One China policy and Taiwan makes their own judgments about their independence. We are not moving, we're not encouraging their being independent. That's their decision. Scott Pelley: But would US forces defend the island? President Joe Biden: Yes, if in fact, there was an unprecedented attack. Scott Pelley: [overdub] After our interview, a White House official told us US policy has not changed. Officially, the US will not say whether American forces would defend Taiwan. But the Commander in Chief had a view of his own. [interview] So unlike Ukraine, to be clear, sir, US forces, US men and women would defend Taiwan in the event of a Chinese invasion? President Joe Biden: Yes. Jul 27, 2022 Dec 8, 2021 Senate Committee on Foreign Affairs 30:45 Sen. James Risch (R-ID): A unilateral change in the status quo regarding Taiwan would not only threaten the security and liberty of 23 million Taiwanese, but also significantly damage vital US interests and alliances in the Indo Pacific. We would lose a model of democracy at a time of creeping authoritarianism. It would give China a platform in the first island chain to dominate the Western Pacific and threaten, indeed, US homeland. The consequences for Japan security, and therefore, the US-Japan alliance, are hard to overstate. Semiconductor supply chains would fall into China's hands, and it would emboldened China in other territorial disputes, including with India, and in the South China Sea. November 17, 2021 House Committee on Science, Space, and Technology, Subcommittee on Energy Witnesses: Dr. Troy Carter, Director, Plasma Science and Technology Institute, University of California, Los Angeles and Chair, Fusion Energy Sciences Advisory Committee Long Range Planning Subcommittee Dr. Tammy Ma, Program Element Leader for High Energy Density Science, Lawrence Livermore National Laboratory Dr. Robert Mumgaard, CEO, Commonwealth Fusion Systems Dr. Kathryn McCarthy, Director, U.S. ITER Project Office Dr. Steven Cowley, Director, Princeton Plasma Physics Laboratory Clips Robert Mumgaard: However, from where I sit, I see three reasons why I'm very optimistic the US can create a definitive lead in this new industry. First, the growth of the private sector. Over $2.4 billion in private capital has been invested in the fusion companies that now number nearly 30. This is a similar amount of capital as in all the nuclear fission small modular reactor companies. This is coming from a large range of investors across venture capitalists, to university endowments, to large energy companies. And they're putting capital at risk in fusion because they understand that the world needs a fundamentally new source of clean energy if we are going to meet our decarbonization goals. And these companies are highly ambitious, with a recent survey stating that 84% of them believe that fusion will be on the grid in the 2030s or earlier. Robert Mumgaard: We will proceed with the commercialization of our first fusion pilot plant called ARC. We hope to have that online in the early 2030s. Robert Mumgaard: The second reason I'm optimistic is that the public program has produced a consensus plan. Detailed in the National Academies and FESAC (Fusion Energy Sciences Advisory Committee) Recommendations is a transition of the public funded program towards the US developing commercial energy. We need to stop some activities and transition to others. But the researchers are enthusiastic and they are ready. We have a new generation of leaders at national laboratories and universities hungry to develop that technology. And that plan has been authorized but has not yet been implemented. Robert Mumgaard: And we're not alone. The other companies like TAE and General Fusion, Helion, Tokamak Energy, are looking at similar timeframes and experiencing similar growth. All these companies are looking to see which governments are going to be the best partners. And unfortunately, we are already seeing defections, with a major facility that could have been built in the US, instead being built in the UK. It'd be much better if the US public program leveraged the private sector, aligning with the technical goals and timelines to keep it happening here. Robert Mumgaard: The third reason I'm hopeful is the movement towards public private partnerships and we know that when the public and private sectors work together and recognize what each side is good at, we create vibrant ecosystems. We saw this in commercial space, with NASA and SpaceX. We saw it even more recently with the COVID-19 vaccine October 1, 2020 Senate Committee on Armed Services, Subcommittee on Readiness and Management Support Witness: Ellen M. Lord, Under Secretary of Defense for Acquisition and Sustainment 1:22:10 Ellen Lord: I believe there may well be a lot of this, frankly: not continuing to engage with these Chinese companies on sensitive issues, but in turn, developing industrial bases here that makes us not reliant on that back and forth. There's quite a bit of discussion within the inner agency right now about constraining Chinese involvement from everything from investments to specific commodities. But again, I think one of the areas where we could have the most impact on China broadly, is reshoring microelectronics. And right now, my team is working very closely across DOD, as well as the inner agency to come up with a very specific recommendation for some public-private partnerships in order to develop the capability here domestically. We at DOD are only about 1% of the overall microelectronics market, however, we have some critical needs. July 16, 2020 15:20 Attorney General Bill Barr: “Made in China 2025” is the latest iteration of the PRC’s state-led, mercantilist economic model. For American companies in the global marketplace, free and fair competition with China has long been a fantasy. To tilt the playing field to its advantage, China’s communist government has perfected a wide array of predatory and often unlawful tactics: currency manipulation, tariffs, quotas, state-led strategic investment and acquisitions, theft and forced transfer of intellectual property, state subsidies, dumping, cyberattacks, and industrial espionage. Cover Art Design by Only Child Imaginations Music Presented in This Episode by

On August 3rd, Senate Republicans held a hearing examining gain of function research: its possible role in creating the COVID-19 pandemic; the problems with oversight of this dangerous research; and recommendations to Congress for how to fix those problems. Please Support Congressional Dish – Quick Links Contribute monthly or a lump sum via Support Congressional Dish via (donations per episode) Send Zelle payments to: Donation@congressionaldish.com Send Venmo payments to: @Jennifer-Briney Send Cash App payments to: $CongressionalDish or Donation@congressionaldish.com Use your bank’s online bill pay function to mail contributions to: Please make checks payable to Congressional Dish Thank you for supporting truly independent media! Background Sources Gain-of-function Research Talha Burki. Feb 1, 2018. The Lancet Infectious Diseases 18(2): pp 148-149. 2017. U.S. Department of Health and Human Services. Michael J. Selgelid. Aug 8, 2016. Science and Engineering Ethics 22(4): pp 923-964. Sara Reardon. October 22, 2014. Nature 514: pp 411-412. Oct 17, 2014. The White House Blog. Board on Life Sciences; Division on Earth and Life Studies; Committee on Science, Technology, and Law; Policy and Global Affairs; Board on Health Sciences Policy; National Research Council; Institute of Medicine. April 13, 2015. National Academies Press. Marc Lipsitch. Jun 29, 2014. The New York Times. COVID-19 Origin Theories Gary Ruskin. Sep 14, 2022. U.S. Right to Know. Alina Chan. Jul 30, 2022. Medium. Maria Cheng and Janey Keaten. Jun 9, 2022. AP News. Jun 9, 2022. World Health Organization. Carl Zimmer and James Gorman. Updated Oct 13, 2021. The New York Times. Richard Muller and Steven Quay. Oct 5, 2021. The Wall Street Journal. Steven Quay and Richard Muller. Jun 6, 2021. The Wall Street Journal. May 30, 2021. This Week in Virology [Podcast]. Glenn Kessler. May 25, 2021. The Washington Post. Jorge Casesmeiro Roger. Mar 24, 2021. Independent Science News. Josh Rogin. Mar 8, 2021. Politico. Jane Qiu. Jun 1, 2020. Scientific American. EcoHealth Alliance and Funding for Coronavirus Research Katherine Eban. March 31, 2022. Vanity Fair. Sharon Lerner and Maia Hibbett. Sep, 23 2021. The Intercept. Glenn Kessler. May 18, 2021. The Washington Post. Meredith Wadman and Jon Cohen. Apr 30, 2020. Science. National Institutes of Health. May 27, 2014. NIH RePORTER. NIH Database Data Removal Amy Dockser Marcus. Jun 23, 2021. The Hearing August 3, 2022 Senate Committee on Homeland Security and Governmental Affairs: Subcommittee on Emerging Threats and Spending Oversight Witnesses: Richard H. Ebright, Professor of Chemistry and Chemical Biology and Laboratory Director, Rutgers University Waksman Institute of Microbiology Steven Quay, CEO and Founder, Atossa Therapeutics, Inc. Kevin M. Esvelt, Associate Professor of Media Arts and Sciences, Massachusetts Institute of Technology Cover Art Design by Only Child Imaginations Music Presented in This Episode by

After decades of our government denying healthcare to veterans they exposed to poisonous toxins, the PACT Act - which will eventually provide this hard-fought-for care - is now law. In this episode, learn exactly who qualifies for these new benefits and when, discover the shocking but little-known events that led to their poisonings, and find out what exactly happened during those 6 days when Senate Republicans delayed the passage of the PACT Act. Please Support Congressional Dish – Quick Links Contribute monthly or a lump sum via Support Congressional Dish via (donations per episode) Send Zelle payments to: Donation@congressionaldish.com Send Venmo payments to: @Jennifer-Briney Send Cash App payments to: $CongressionalDish or Donation@congressionaldish.com Use your bank’s online bill pay function to mail contributions to: Please make checks payable to Congressional Dish Thank you for supporting truly independent media! Background Sources Recommended Congressional Dish Episodes What the PACT Does and Doesn’t Do Aug 10, 2022. VA Claims Insider. Abraham Mahshie. Aug 10, 2022. Air Force Magazine. Leo Shane III. Aug 4, 2022. Military Times. U.S. Department of Veterans Affairs. The VA Sidath Viranga Panangal, Jared S. Sussma, and Heather M. Salaza. Jun 28, 2022. Congressional Research Service. U.S. Department of Veterans Affairs. U.S. Department of Veterans Affairs. U.S. Department of Veterans Affairs. Toxic Exposures Burn Pits November 20th, 2014. VAntage Point. Feb 8, 2010. Military Times. U.S. Army Center of Military History. U.S. Army Center of Military History. Agent Orange Donnie La Curan. April 1, 2021. Veterans Resources. Charles Dunst. Jul 20, 2019. The Atlantic. Patricia Kime. May 11, 2020. Military.com. May 11, 2020. Yale Law School. Vietnam Security Police Association. Susan E. Davis. Apr 9, 1991. The Washington Post. Enewetak Atoll Chris Shearer. Dec 28, 2020. Vice. March 2018. U.S. Defense Threat Reduction Agency. Dave Philipps. Jan 28, 2017. The New York Times. Palomares, Spain Nuclear Accident November 1, 2021. Yale Law School Today. Dave Philipps. June 19, 2016. The New York Times. April 2001. United States Air Force. U.S. Department of Energy. February 1966 U.S. Department of Energy Archives. Thule, Greenland Nuclear Accident Robert Mitchell. Jan 21, 2018. The Washington Post. 897 F.Supp. 1098 (1995). United States District Court, N.D. Illinois, Eastern Division. June 1982. History and Research Division, Headquarters, Strategic Air Command. Captain Robert E. McElwee. U.S. Defense Technical Information Center. South Carolina Nuclear “Storage” Doug Pardue. May 21, 2017 (Updated Jun 28, 2021). The Post & Courier. Gulf War Illness Johns Hopkins Medicine. May 11, 2022. UT Southwestern Medical Center Newsroom. Camp Lejeune Water Contamination The Carlson Law Firm on YouTube. Agency for Toxic Substances and Disease Registry. Agency for Toxic Substances and Disease Registry. Agency for Toxic Substances and Disease Registry. Oct 18, 2009. St. Lawrence County Government. St. Louis Area Nuclear Contamination Chris Hayes. Jul 27, 2022. Fox 2 Now - St. Louis. Jim Salter. Mar 19, 2022. St. Louis Post-Dispatch. Jesse Bogan. Dec 20, 2021. St. Louis Post-Dispatch. Apr 30, 2019. U.S. Agency for Toxic Substances and Disease Registry. Robert Alvarez. February 11, 2016. Bulletin of the Atomic Scientists. U.S. Environmental Protection Agency. HBO Documentaries. Hanford Waste Management Site Jul 26, 2019. The International Campaign to Abolish Nuclear Weapons. Biden Drone Bombing Aug 7, 2022. The Express Tribune. Jon Stewart People Staff. August 11, 2022. People. Republican F*ckery Ryan Cooper. Aug 3, 2022. The American Prospect. Jordain Carney and Anthony Adragna. August 1, 2022. Politico. Oct 10, 2022. Clerk of the U.S. House of Representatives. U.S. Foreign Wars No One Talks About Ellen Knickmeyer. Jun, 16 2022. Military.com. Joseph R. Biden. June 08, 2022. The White House. Muhammad Fraser-Rahim. Oct 16, 2017. Newsweek. Overseas Contingency Operations Emily M. Morgenstern. Updated August 13, 2021. Congressional Research Service. Todd Harrison. Jan 11, 2017. Center for Strategic and International Studies The Law Timeline of Votes and Changes July 12, 2022. U.S. House of Representatives. August 1, 2022. Congressional Record -- Senate. Audio Sources August 10, 2022 PBS NewsHour on YouTube August 1, 2022 Global News on YouTube The Carlson Law Firm on YouTube July 31, 2022 CNN Clips 7:00 Sen. Pat Toomey (R-PA): Here's what you need to keep in mind, Jake. First of all, this is the oldest trick in Washington. People take a sympathetic group of Americans — it could be children with an illness, it could be victims of crime, it could be veterans who have been exposed to toxic chemicals — craft a bill to address their problems, and then sneak in something completely unrelated that they know could never pass on its own and dare Republicans to do anything about it because they know they'll unleash their allies in the media and maybe a pseudo-celebrity to make up false accusations to try to get us to just swallow what shouldn't be there. That's what's happening here, Jake. 10:40 Jake Tapper: So one of the questions that I think people have about what you're claiming is a budgetary gimmick is, the VA budgets will always remain subject to congressional oversight, they can't just spend this money any way they want. And from how I read this legislation, it says that this money has to be spent on health care for veterans who suffered exposure from toxic burned pits. Sen. Pat Toomey (R-PA): This is why they do this sort of thing, Jake, because it gets very deep in the weeds and very confusing for people very quickly. It's not really about veteran spending. It's about what category of government bookkeeping, they put the veterans spending in. My change, the honest people acknowledge it will have no effect on the amount of money or the circumstances under which the money for veterans is being spent. But what I want to do is treat it, for government accounting purposes, the way we've always treated it for government accounting purposes. Because if we change it to the way that the Democrats want, it creates room in future budgets for $400 billion of totally unrelated, extraneous spending on other matters. July 31, 2022 CBS News Clips 4:10 John Dickerson: 123 Republicans in the House voted for this, 34 Senate Republicans voted for it. Same bill. This week, the bill didn't change but the Republican votes did. Why? Sen. Pat Toomey (R-PA): Now, the Republican votes didn't change on the substance of the bill. Republicans have said we want an amendment to change a provision that has nothing to do with veterans health care. The Republicans support this. The Democrats added a provision that has nothing to do with veterans health care, and it's designed to change government accounting rules so that they can have a $400 billion spending spree. 6:25 Sen. Pat Toomey (R-PA): Honest Democrats evaluating this will tell you: if my amendment passes, not a dime change in spending on veterans programs. What changes is how the government accounts for it. John Dickerson: I understand, but the accounting change, as you know, is a result — the reason they put it in that other bucket is that it doesn't subject it to the normal triage of budgeting. And the argument is that the values at stake here are more important than leaving it to the normal cut and thrust of budgeting. July 29, 2022 The Problem with Jon Stewart on Youtube Clips 00:20 Sen. Ted Cruz (R-TX): What the dispute is about is the Democrats played a budgetary trick, which is they took $400 billion in discretionary spending and they shifted it to a mandatory one. Jon Stewart: What Ted Cruz is describing is inaccurate, not true, bulls ** t. This is no trick. Everything in the government is either mandatory or discretionary spending depending on which bucket they feel like putting it in. The whole place is basically a f * ing shell game. And he's pretending that this is some new thing that the Democrats pulled out, stuck into the bill, and snuck it past one Ted Cruz. Now I'm not a big-city Harvard educated lawyer, but I can read. It's always been mandatory spending so that the government can't just cut off their funding at any point. No trick, no gimmick, [it’s] been there the whole f**king time. 1:50 Sen. Ted Cruz (R-TX): What's the Republicans made clear is, if we leave that spending as discretionary — don't play the budgetary trick — the bill will pass with 80 or 90 votes. Jon Stewart: I don't know how many other ways to say this, but there was no budgetary trick and it was always mandatory. And when they voted in the Senate on June 16, they actually got 84 votes. And you know who voted for that? Ted f*cking Cruz and every other one of those Republicans that switched their votes. There was no reason for them to switch the votes. The bill that passed the Senate 84 to 14 on June 16 has not had one word added to it by Democrats, or spending fairies, or anybody else. It's the same f*cking bill. July 28, 2022 The Problem with John Stewart on YouTube Clips 3:20 Jon Stewart: June 16, they passed the PACT Act 84 to 14. You don't even see those scores in the Senate anymore. They passed it. Every one of these individuals that has been fighting for years, standing on the shoulders of Vietnam veterans who have been fighting for years, standing on the shoulders of Persian Gulf War veterans fighting for years, Desert Storm veterans, to just get the health care and benefits that they earn from their service. And I don't care if they were fighting for our freedom. I don't care if they were fighting for the flag. I don't care if they were fighting because they wanted to get out of a drug treatment center, or it was jail or the army. I don't give a shit. They lived up to their oath. And yesterday, they spit on it in abject cruelty. These people thought they could finally breathe. You think their struggles end because the PACT Act passes? All it means is they don't have to decide between their cancer drugs and their house. Their struggle continues. From the crowd: This bill does a lot more than just give us health care. Jon Stewart: It gives them health care, gives them benefits, lets them live. From the crowd: Keeps veterans from going homeless keeps veterans from become an addict, keeps veterans from committing suicide. Jon Stewart: Senator Toomey is not going to hear that because he won't sit down with this man. Because he is a fucking coward. You hear me? A coward. 5:15 Jon Stewart: Pat Toomey stood up there — Patriot Pat Toomey, excuse me, I'm sorry. I want to give him his propers, I want to make sure that I give him his propers. Patriot Pat Toomey stood on the floor and said “this is a slush fund, they're gonna use $400 billion to spend on whatever they want.” That's nonsense. I call bullshit. This isn't a slush fund. You know, what's a slush fund? The OSO, the Overseas Contingency Operations Fund. $60 billion, $70 billion every year on top of $500 billion, $600 billion, $700 billion of a defense budget. That's a slush fund, unaccountable. No guardrails? Did Pat Toomey stand up and say, this is irresponsible. The guard rails? No, not one of them. Did they vote for it year after year after year? You don't support the troops. You support the war machine. 7:10 Jon Stewart: And now they say, “Well, this will get done. Maybe after we get back from our summer recess, maybe during the lame duck…” because they're on Senate time. Do you understand? You live around here. Senate time is ridiculous. These motherfuckers live to 200 — they’re tortoises. They live forever and they never lose their jobs and they never lose their benefits and they never lose all those things. Well, [sick veterans are] not on Senate time. They're on human time. Cancer time. 8:20 Jon Stewart: I honestly don't even know what to say anymore. But we need your help, because we're not leaving. These people cannot go away. I don't know if you know this, you know, obviously, I'm not a military expert. I didn't serve in the military, but from what I understand, you're not allowed to just leave your post when the mission isn't completed. Apparently you take an oath, you swear an oath, and you can't leave, that these folks can leave because they're on Senate time. Go ahead, go home, spend time with your families, because these people can't do it anymore. So they can't leave until this gets done. July 26, 2022 Senate Session July 13, 2022 House Session 3:38:20 **Rep. Mark Takano (D-CA): The way this country has dealt with toxic exposure has been piecemeal and inadequate. President Biden recognizes this, too. Shortly after he was sworn in, I met with the President about our shared priorities for veterans. Upon learning of my goal to pass comprehensive legislation to help toxic-exposed veterans, the President leaned over to me and talked about his son, Beau, who served near burn pits in Iraq and Kosovo. It might be hard for most Americans to imagine what a burn pit looks like because they are illegal in the United States. Picture walking next to and breathing fumes from a burning pit the size of a football field. This pit contained everything from household trash, plastics, and human waste to jet fuel and discarded equipment burning day and night. Beau Biden lived near these burn pits and breathed the fumes that emanated from them. President Biden believes that con- stant exposure to these burn pits, and the toxic fumes they emitted, led to Beau’s cancer and early death. It was during that meeting when I knew I had a partner in President Biden. 2017 HBO Documentaries November 27, 2017 Australian Broadcasting Corporation - Foreign Correspondent Cover Art Design by Only Child Imaginations Music Presented in This Episode by

Seresto Flea and Tick Collars for dogs and cats have been sold to Americans since 2013. During that time, the EPA has received approximately 100,000 reports of illnesses and 2,500 reports of deaths of animals that wore a Seresto Flea and Tick collar, by far the most reports received about any flea and tick treatment on the market. In this episode, hear testimony from scientists about the Environmental Protection Agency’s disturbingly lax review processes for pesticides in pet products and learn why your vote in November is likely to determine if these popular but dangerous products will stay on American shelves. Please Support Congressional Dish – Quick Links Contribute monthly or a lump sum via Support Congressional Dish via (donations per episode) Send Zelle payments to: Donation@congressionaldish.com Send Venmo payments to: @Jennifer-Briney Send Cash App payments to: $CongressionalDish or Donation@congressionaldish.com Use your bank’s online bill pay function to mail contributions to: Please make checks payable to Congressional Dish Thank you for supporting truly independent media! Listen to the latest episode of Jen's new podcast with Andrew Heaton and Justin Robert Young — We're Not Wrong Episode 12: To report an incident directly to the EPA via email Report.Pesticide.Incident@epa.gov Executive Producer Recommended Sources Bruce Bueno de Mesquita and Alastair Smith. Public Affairs: 2011. Background Sources Recommended Congressional Dish Episodes Reports on Seresto and Pesticides Jun 15, 2022. House Committee on Oversight and Reform. House Committee on Oversight and Reform, Subcommittee on Economic and Consumer Policy. June 2022. Lauretta Joseph. May 19, 2022. Johnathan Hettinger. Sept. 24, 2021. USA Today. Jordan Liles. Mar 8, 2021. Snopes. Johnathan Hettinger. Mar 2, 2021. USA Today. Lawrence J. Dyckman et al. July 1995. U.S. Government Accountability Office. Lobbying 2022. Open Secrets. Open Secrets. Open Secrets. The Hearing June 15, 2022 Witnesses: Faye Hemsley & Omarion Hemsley, Owners of Deceased Pet Thomas Maiorino, Owner of Deceased Pet Jeffrey Simmons, President and Chief Executive Officer, Elanco Animal Health Incorporated Nathan Donley, Ph.D, Environmental Health Science Director, Center for Biological Diversity Karen McCormack, Former Scientist, Policy Analyst, and Communications Officer (ret.), Office of Pesticide Programs, Environmental Protection Agency Carrie Sheffield (minority witness), Senior Policy Analyst, Independent Women’s Voice Clips 1:20 Rep. Raja Krishnamoorthi (D-IL): As early as 2015, just a few years after the collar entered the US market, an EPA investigation found that among similar products, the Seresto collar “ranked number one” by a wide margin in terms of total incidents, major incidents and deaths, even after factoring in companies’ relative sales. Those findings weren't enough to drive the makers of Seresto collar or the EPA to act. 1:50 Rep. Raja Krishnamoorthi (D-IL): In 2016, Canada's equivalent of the EPA known as the PMRA, concluded based on a review of the same American data available to the EPA that the collar posed too great a risk to pets and their owners to be ever sold in Canada. 2:10 Rep. Raja Krishnamoorthi (D-IL): Even as the death count rose, the EPA allowed Seresto to remain on the market here without even so much as requiring additional warning labels that regulators mandated in places ranging from Australia to Colombia to the European Union. 2:30 Rep. Raja Krishnamoorthi (D-IL): The companies that manufactured the Seresto collar first Bayer animal health and then later Elanco were also aware of the risks, the incidents and the deaths, but they too failed to act. Instead, they hired third party industry insiders to conduct so-called independent reviews of the incident data, which ended up protecting their $300 million a year market but ended up endangering pets. So the Seresto collar stayed the same and so did the consequences. 4:15 Rep. Raja Krishnamoorthi (D-IL): This particular collar has caused 100,000 incidents reported to the EPA and over 2500 pet deaths reported to the EPA. 4:30 Rep. Raja Krishnamoorthi (D-IL): The steps that we are asking for today are crucial, because it's important to protect our pets and our families, too. I now call upon my distinguished colleague, Mr. Cloud for his opening statement. Rep. Michael Cloud (R-TX): Thank you, Chairman. This is the first hearing of the Economic and Consumer Policy Subcommittee this year, and we've been in session for 52 days this year. And our first hearing is on pet collars. And I do realize that our pets are a huge part of our lives, they enrich our families, they provide companionship for my kids, they've helped foster responsibility and compassion and care, important ethics we need in our society. Just recently, our family mourned the loss of our guinea pig, biscuit. And so pets are a huge part of our family lives. But I have to admit that when I saw that this was going to be on the agenda for this week, I cannot help but be concerned, especially coming from South Texas about the 1000s 10s of 1000s of human lives that have passed away due to fentanyl and due to an open border and due to the policies of this administration to continue to aid and abet cartels. And I realized that this is the economic and Consumer Policy Subcommittee. And so I think about economic policy happening right now and where the minds of the American people are. Gas is now averaging $5 A gallon nationwide. For the first time in history. We have not had a hearing. Inflation is at a 40 year high. We have not had a hearing, the American people cannot find baby formula. We still haven't had a hearing. I've mentioned fentanyl is killing Americans, especially our teens at unprecedented rates. We have not had a hearing. Biden's systemic elimination of the safe and secure border he inherited has led to the worst humanitarian and national security crisis in this country's history. We have not had a hearing this term, we could talk about how inflation is affecting the cost of owning a pet, including the increased cost of food, toys, accessories, but we're not talking about that either. Instead, we're holding a hearing on the pet collar, which fights fleas and ticks. And as any pet owner knows fleas and tick management is an essential part of pet care. But I'm not sure it's an essential part of congressional oversight, especially when we take in mind where the American people are at. And frankly, I've talked to a number of people in my district and others who live in other parts of the country and they are really surprised that this has risen to one of the top priorities of commerce at this time in juncture. The subcommittee Republicans would rather explore efforts to help American consumers during these trying times, we would gladly have joined the chairman in holding a hearing on the shortage of baby formula. Moreover, we have welcomed the chance to explore TikTok’s troubling practice of showing dangerous content to minors, an investigation you all started last year. In fact, it's now come to light that teenagers are using tick tock and other social media platforms to purchase illicit drugs including unknowingly in many cases, in most cases, fentanyl. Social media platforms are also using it to recruit young people into the gig economy of human trafficking. A hearing on that crisis could be incredibly important. And on the subject of our nation's youth, CDC bureaucrats have actively pursued an agenda to close schools during the pandemic instead of following the science damaging our children's financial, mental, physical, emotional, and also their learning for years to come. But we still have not had a hearing. Americans are facing incredible economic issues which require us as elected officials to listen and to respond. I do appreciate the fact that our pets play an important part of our lives. We should be kind to animals and we should teach our children to do the same. But I do care immensely more about the human lives that we were elected to serve. 10:20 Rep. Raja Krishnamoorthi (D-IL): A recorded vote has been requested — we will pause while the we will get the clerk out. 12:00 Rep. Byron Donalds (R-FL): Mr. Chairman, it's already been about what? A minute and a half. Where's the clerk? Is the clerk on lunch and not here today? Rep. Krishnamoorthi (D-IL): I think the clerk is on the way Mr. Donalds, thank you. Rep. Donalds: Is the clerk sitting in the side office just hanging out? I mean, come on, Mr. Chairman. 21:20 Clerk: Mr. Cloud? Rep. Michael Cloud (R-TX): Yes Clerk: Mr. Cloud votes yes. Mr. Keller? Rep. Fred Keller (R-PA): Yes Clerk: Mr. Keller votes yes. Mr. Franklin? Rep. C. Scott Franklin (R-FL): Yes Clerk: Mr. Franklin votes yes. Mr. Clyde? Rep. Andrew Clyde (R-GA): Yes. Clerk: Mr. Clyde votes yes. Mr. Donalds? Rep. Byron Donalds (R-FL): Yes Clerk: Mr. Donalds votes yes. 26:31 Thomas Maiorino: My name is Thomas Maiorina. I reside in Mount Laurel, New Jersey with my wife Monica. I am the father of three boys. My youngest son, Robert turned 12 in 2011. After years of asking for a dog, he wore us down and we decided to rescue a dog from a southern shelter for my son's birthday. After researching online, we adopted a mixed breed mutt that Robbie and his two other brothers named Rooney. Rooney swiftly became a loved member of our family. A bit rambunctious, she was just what a 12 year old boy needed. She loved the run and chase anything the move in the yard. By all measures, we took great care to ensure Rooney had a healthy and happy life. We took her on daily walks, sometimes three a day, hikes on park trails. We monitor her diet and made sure she was seen by the veterinarian as needed, and she received all of her shots. Because she was a bit rambunctious and we lived in a wooded area where there's a lot of wildlife, we were constantly concerned about the problems of fleas and ticks. We consulted with a veterinarian after getting Rooney to determine the best way to protect her against this. We use a variety of prevention methods for the first few years and when we changed veterinarians in approximately 2013 or 14, the new veterinarian strongly recommended that we use the Seresto flea and tick collar, based on all of our options. We heeded that advice and purchased Seresto collars from our local PetSmart. The collars were intended to provide protection for up to eight months. We noticed that after fixing a collar to Rooney’s neck, she began to itch and first had that treated and tested for allergies. We took her to the vet several times during 2018 seeking to find the cause for the ever increasing itching. After several visits and multielement medications, they were unable to determine the cause and we switched to a specialist in 2019 to seek further assistance, where they provided allergy shots and other medications to address the worsening itching and related symptoms. Rooney's behavior then became more erratic as the months wore on she began linking her paws so feverishly they would bleed. She also developed bleeding patches on her stomach. Ultimately, in October 2020, Rooney suffered horrendous grand mal seizure in the presence of myself and my wife. The damage done by the seizure was irreversible. She was a shell of her former self and ultimately, the family decided the most humane thing would be to put Rooney to sleep at the age of nine. In early March 2021, I read an article online about Seresto pet collars resulting in the deaths of 1700 Pets without any warnings from the EPA or the manufacturer. I sought out legal representation not because I wanted financial compensation, but because I took great pains to care for Rooney. The final 18 months of her life were agonizing to watch if I could help prevent another family from going through what my family went through. I wanted to act. I'm here today in furtherance of that effort. I appreciate the committee taking the time to investigate this matter. And thank you for your time. 33:30 Jeffrey Simmons: There are a few points I'd like to emphasize upfront. First, the EPA approved Seresto following more than 80 safety and toxicity studies, all of which show that Seresto and its ingredients have a strong safety profile. Second, more than 80 regulatory bodies around the world have approved Seresto. Seresto is widely used and more than 80 million collars worn over the past decade to protect dogs and cats from fleas and ticks around the world. 34:00 Jeffrey Simmons: Third, adverse event reports are not intended to be, and in fact are absolutely not, proof of causation. Reports require further investigation and analysis to determine cause. And after years of review, our pharmacovigilance team made up of veterinarians and other experts who study adverse event reports has not identified a single death caused by the active ingredients in the collar. 36:45 Jeffrey Simmons: No product is without risk. What matters is whether those risks are reasonable. And in light of the benefits and numerous studies and the incident report data for Seresto demonstrate the product does not pose an unreasonable risk and has a strong safety profile, which is why the American Veterinary Medical Association opposed canceling Seresto’s EPA registration. 38:05 Nathan Donley: My name is Dr. Nathan Donley. I'm the science director for the Environmental Health Program at the Center for Biological Diversity. I have a PhD in Cell and Developmental Biology from Oregon Health and Sciences University. The last seven years of my professional life have been spent researching how pesticides impact people and the environment and the regulatory failures that can actually facilitate harm rather than prevent it. I published three peer reviewed scientific articles and five technical reports on this subject. I've authored over 100 technical scientific comments to the EPA on pesticide documents, including flumethrin and imidacloprid, the two active ingredients in the Seresto collar. I've read through 1000s of pages of FOIA documents I requested on matters related to the approval and continued use of Seresto. 39:40 Nathan Donley: While other agencies like the FDA have robust systems in place to surveil harms from products under their purview, EPA only requires minimal information be submitted four times a year and they delegate this responsibility to the pesticide industry itself. The limited information that is collected includes only the pesticide product name, where the incident occurred, and the severity of the incident. That's it. Oftentimes, the agency doesn't even know if the incident involves a dog or a cat. Even though the EPA determines what incident information it collects, it then turns around and laments that the incident data are insufficient to take regulatory action to protect public health, the environment and our pets. It's a system designed to achieve nothing other than maintaining the status quo. Worse yet, reported incidents significantly underestimate the true scope of harm. The EPA recently estimated that only one in 25 pesticide incidents involving another pesticide called Kamba was actually reported to the authorities. That's only a 4% reporting rate. Given that 100,000 people have reported their concerns about Seresto, this is very alarming because the true number of harmful incidents to pets could be potentially far higher. 41:05 Nathan Donley: The EPA’s counterpart in Canada was so concerned about Seresto incidents and harms of pets and humans that it denied Seresto approval in 2016. Canada analyzed U incident data and determined that Seresto collars had an incident rate 50 times greater than the average flea collar and 36 times greater than Canada's trigger for review. 41:25 Nathan Donley: EPA has no trigger for review of any pesticide product, no matter how much harm is being reported. And because the agency has no mandated trigger for reviewing pesticides like Seresto, rather than choosing to use incident reporting data to inform a robust regulatory process and take dangerous products off the market, EPA routinely chooses to do nothing at all. And that's especially troubling when you consider that Seresto is just one of 18,000 pesticide products currently approved by the EPA. 42:40 Karen McCormack: My name is Karen McCormack. At the present time I am a retired government employee after working over 40 years at the Environmental Protection Agency. During my career at EPA, I first worked in an EPA laboratory as a research coordinator. And in that capacity, I conducted research on numerous pesticides. Later I transferred to EPA headquarters in Washington DC, and worked in various positions in the pesticide program as a scientist, policy analyst, and a communications officer. I also worked in a number of offices at EPA including the Office of the Assistant Administrator for Pesticides and Toxins. Although I'm retired from EPA, I'm still closely following a number of environmental topics and one of those topics of interest to me has been the impact of flea and tick pet products on cats and dogs. 43:30 Karen McCormack: The US Environmental Protection Agency is charged with regulating products that contain pesticides and in ensuring that all pesticide products are safe to use. Before 1996, EPA did not consistently require manufacturers to conduct animal safety studies for pet products containing pesticides. Because pet products with pesticides were available readily in commercial stores, consumers thought they must be safe. This is not necessarily the case. Flea and tick products are designed to kill insects, and they often contain poisonous chemicals. When combined with pesticides that are used outside the home and in the water and food that people drink and eat, the aggregate risks from all these sources of pesticides can be high, especially for children who are vulnerable to toxic chemicals -- much more vulnerable than adults. And it wasn't until the passage of the 1996 Food Quality Protection Act that EPA began to examine the risks from sources other than food, including risks from pet products containing pesticides. After the passage of FQPA, pesticide manufacturers were required to submit to EPA animal safety studies and incident reports showing harm to animals and humans exposed to pesticides and pet products. Between 2012 and the present time the EPA received an increasing number of incident reports related to the use of flea and tick pet collars for dogs and cats. The toxic effects that were described in these many incident reports from the use of certain pet collars ranged from mild effects, such as skin irritation to more severe effects such as intense tremors, seizures, paralysis, organ failure and death. The largest number of incident rate counts that EPA received during this period were from the use of pet collar called Seresto. 45:35 Karen McCormack: Between January 2012 and the present time, EPA has received over 100,000 incident reports, and these incident reports include human incidents as well as pet incidents. These reports also include at least 2300 reports of pet deaths. The number is most likely a very low estimate of the actual number of incidents that are occurring since many pet owners do not know that they can report incidents to EPA and they may not know how to correlate the adverse effects in their pets with a particular pet product. 46:30 Karen McCormack: There are no independent organizations that rank the safety of pet products. And the sales data which is needed to rank the safety of pet products is considered confidential business information by the manufacturers. EPA’s risk assessments also do not tell the full story of what pet products are safe, as they rely heavily on industry generated studies that were conducted on mice and rats rather than dogs and cats. And EPA’s risk assessments also are based mainly on studies that were conducted with only one pesticide in Seresto rather than the combined pesticides in this pet product. 47:10 Karen McCormack: Although the original manufacturers of Seresto, Bayer, did conduct a number of efficacy and safety studies in dogs and cats treated with Seresto, the company did not conduct two very critical studies that are important for determining the safety of a pet product. These tests include a pet transferable residue study, a petting study, to determine the exposure of humans to Seresto. And they did not conduct a study that measures the amount of pesticide that gets in the blood of treated dogs and cats. 48:45 Carrie Sheffield: My name is Carrie Sheffield and I'm a senior policy analyst at the Center for Economic Opportunity at Independent Women's Forum. We are a nonprofit organization committed to increasing the number of women who value free markets and personal liberty. 2:44:20 Rep. Raja Krishnamoorthi (D-IL): Let me just show you some analysis that was conducted by Elanco, which we would just refer to as well as the EPA, as well as the Canadian equivalent of the EPA, which is called the PMRA. Essentially, we look at this chart here, and we see that at the top Elanco computed that 0.51% of pet deaths were “possibly or probably” caused by the Seresto collar. The PMRA in Canada, looking at a sample of pet deaths concluded that 33% of those pet deaths were possibly or probably caused by Seresto collars. And the EPA here, concluded that 45% were possibly or probably caused by pet by the Seresto collar. Now, sir, I think originally, you said that there is no scientific evidence, no evidence of a causal link, this is clearly evidence, it was so compelling that the Canadian equivalent of the EPA never allowed for Seresto collars to be sold in Canada, correct? Jeffrey Simmons: Yes, I'm aware of that decision. I would also add that 80 other countries have approved this product, we've had over 80 million collars actually used. I'm not familiar with this data comparison, but what I can say is following the EPA regulatory process around the oversight, that we have pharmacovigilance, close to 200 veterinarians and staff on our team, looking at the data through the way the EPA wants us to we have not seen a linkage from the active ingredients. Rep. Krishnamoorthi: I understand that sir, I understand you haven't seen the linkage, although other authorities have and their scientists who are not paid by you have done so. 2:46:25 Nathan Donley: This is what we commonly see, quite frankly, when the regulated industry is doing their own research. It commonly finds that their products are safer than when government agencies or academic scientists take on a similar analysis. 2:46:55 Rep. Raja Krishnamoorthi (D-IL): We have FOIA documents from the EPA, and emails internal to the EPA talking about the Seresto collar. Here's just one of them. This is from an employee who basically voiced their opinion about recent coverage of the Seresto controversy, he said, “looks like the sh*t has hit the fan….will be interesting seeing where this goes. I hope there is a FOIA for all communications on this so that our emails are made public. We have been screaming about Seresto for many years.” I presume that you've heard some of these screams and concerns, correct, Ms. McCormack? Karen McCormack: That's correct. A number of EPA employees have contacted me and given me detailed descriptions about what's happening with Seresto and they were very upset that EPA refused to do anything about it. 2:48:25 Karen McCormack: A number of the scientists, and this is not unusual, feel that the decision makers are not considering the science and they're making decisions based on political reasons. I don't know if I have time to talk about this, but I did look at the science that the Canadian government did, the causality analysis. They looked at the consistency and toxicity of effects from exposure of pets to Seresto. And what they found was very disturbing. It was so disturbing that they decided the risks were too high to approve Seresto and they could not be mitigated by putting a label statement on the product or by issuing warning labels, so they refused to approve Seresto. 2:49:25 Rep. Michael Cloud (R-TX): Thank you, Ms. McCormack, for acknowledging that the EPA sometimes makes political decisions, so that's something we'll definitely be coming back to next term. 2:55:05 Rep. Katie Porter (D-CA): Are the active ingredients for Seresto in the United States different from the active ingredients for Seresto collars in other countries? Jeffrey Simmons: No, I do not believe they're any different than the other 80 countries. Rep. Porter: In other countries like in Colombia and Australia, the warning labels for Seresto collars classify the collar as highly toxic and as poison. 2:55:50 Rep. Katie Porter (D-CA): Does the label in the United States have language? Like highly toxic or poison? Yes or no? Jeffrey Simmons: It does not. Rep. Porter: Okay. So the warning label here in the United States, though does say that mild reactions may occur and mentions hair loss, scratching and redness. The most severe symptoms listed are eczema and lesions. This is the warning label: does it mention the potential for death? Jeffrey Simmons: It does not. Rep. Porter: So a pet owner looking at this label that we're looking at would have absolutely no reason, no way to know that Seresto may have caused roughly 100 pet deaths. That's what both the Canadian Pest Management Agency, the PMRA, and the EPA found. Will you change this label, so that it includes deaths as a possible side effect? Jeffrey Simmons: Congresswoman, we do not believe the scientific data warrants a label change. And again, that is not just the 80 studies were submitted. There's been 20 additional added studies since and all of the oversight data that's been done on the 33 million pets over the 10 years. So again, following an EPA regulated process, we're always open if a data warranted, some need for a change, we would do that. 2:57:30 Rep. Katie Porter (D-CA): The EPA encouraged both your predecessor, Bayer, and your company, Elanco, to update the warning label. Yet, you just said that you never have. So the federal government did in fact advise you to update the label and you failed to do so. Is that correct? Jeffrey Simmons: I do not believe that is correct. We are in regular engagement with EPA. We have not received any formal…there's no data that warrants that and there's been no formal engagement on that. 2:58:15 Rep. Katie Porter (D-CA): The EPA asked Bayer, the predecessor here, in 2019 to help the agency collect data on adverse incidents for cats and dogs using the Seresto collar. EPA asked Bayer to split the registration for cats and dogs, so the agency could better understand and evaluate the risks for each type of pet. They refused, saying that change might have, “an adverse impact on sales” and they also said, “it would be a substantial increase in work.” Mr. Simmons, are you willing to make that change and split the registration for cats and dogs as the EPA requested? Or do you believe it's too much work? Jeffrey Simmons: I am willing to engage with the EPA on anything that the scientific data and the engagement under the regulatory body of the EPA merits the right thing to do. We believe the 80 studies and all of the pharmacovigilance data that we've submitted to them stands that this is a safe product. 3:00:10 Rep. Andrew Clyde (R-GA): I feel obligated to begin by stating the obvious this afternoon. Today's hearing is a colossal waste of time and resources. 3:13:25 Rep. Henry Johnson (D-GA): And the only reason that the public knew about the harm caused by this pesticide is because the Center for Biological Diversity publicly petitioned the EPA to cancel registration for Seresto flea collars. If they had not bought this to light, do you think we would even know of the dangers presented by these collars? Nathan Donley: No, we wouldn't. You know, the investigation that came out in USA Today in 2021 really brought this to the public attention. And if there wasn't that amount of pressure from the public, this would just still be completely unknown. EPA, for the last 10 years, has not done anything to alert consumers to the harms associated with this product or any other pesticide products where there are a very high number of incidents. 3:15:10 Karen McCormack: I think some of the people at EPA are programmed to go along with whatever industry says. It makes life easier for you, you can go home earlier and you can also get promoted easier if you go along with what industry says. It's unfortunate a problem there. And I've seen it over the years and it's very hard to do something about it. 3:15:40 Karen McCormack: Canada's analysis was very scientific. It was not only based on incident data and sales data, it was based on the toxicity of the two pesticides in Seresto. And they looked at the consistency and what happened eventually with the pets that were exposed to Seresto. 3:19:20 Rep. Raja Krishnamoorthi (D-IL): And so because of the tremendous number of pet incidents, the tremendous number of deaths, even when factoring in sales, I sadly have no choice but to recommend that the EPA commence a notice of intent to cancel proceedings and to fully investigate what's going on with the Seresto collar, and I respectfully request Elanco to voluntarily recall these collars at this time, pending this further investigation. Cover Art Design by Only Child Imaginations Music Presented in This Episode by

The recently signed gun law, S. 2938: Bipartisan Safer Communities Act, contained a surprise dingleberry postponing a regulation designed to save seniors money on their pharmaceutical drugs by prohibiting kickbacks to an industry few have heard of: Pharmacy Benefit Managers (PBMs). This little-known but extremely powerful industry deserves much of the blame for ever rising prescription drugs costs in the United States. In this episode, Jen gives you the scoop on PBMs and how they make their money at the expense of Americans who are most dependent on medications. Please Support Congressional Dish – Quick Links Contribute monthly or a lump sum via Support Congressional Dish via (donations per episode) Send Zelle payments to: Donation@congressionaldish.com Send Venmo payments to: @Jennifer-Briney Send Cash App payments to: $CongressionalDish or Donation@congressionaldish.com Use your bank’s online bill pay function to mail contributions to: Please make checks payable to Congressional Dish Thank you for supporting truly independent media! We’re Not Wrong Berlin Meetup Contact Justin at Background Sources Recommended Congressional Dish Episodes US Healthcare Landscape Jessi Jezewska Stevens. Apr 23, 2020. Bookforum. Tanza Loudenback. Mar 7, 2019. Insider. Chuck Grassley and Ron Wyden. 2019. U.S. Senate Finance Committee. Kaiser Family Foundation. Sara R. Collins and David C. Radley. Dec 7, 2018. The Commonwealth Fund. PBMs What are PBMs? JC Scott. Jun 30, 2022. The Hill. Zach Freed. Jun 22, 2022. American Economic Liberties Project. Adam J. Fein. Jun 22, 2021. Drug Channels. Nov 11, 2021. 46brooklyn. Adam J. Fein. Feb 3, 2019. The Wall Street Journal. How PBMs Make Money National Association of Chain Drug Stores. RxSafe. True North Political Solutions. Oct 25, 2017. Pharmacy Times. ACA “Vertical Integration” Loophole Peter High. Jul 8, 2019. Forbes. Angelica LaVito. Nov 28, 2018. CNBC. David Dayen. Oct 12, 2018. The American Prospect. Jeff Byers. April 12, 2018. Healthcare Dive. Susan Morse. May 10, 2017. Healthcare Finance. Lobbying Open Secrets. The Demise of Independent Pharmacies Christine Blank. Oct 17, 2019. Drug Topics. Paulina Firozi. Aug 23, 2018. The Washington Post. What Is a Formulary? Ana Gascon Ivey. May 19, 2020. GoodRx. Previous Delays in Rebate Regulation Paige Minemyer. Jan 29, 2021. Fierce Healthcare. Paige Minemyer. Jan 12, 2021. Fierce Healthcare. May 2019. Congressional Budget Office. The Gun Law Passage Process Office of the Clerk. May 18, 2022. U.S. House of Representatives. Tampa Bay Times Editorial Board. May 12, 2022. Miami Herald. Annie Karni. Apr 12, 2022. The New York Times. Background on Most Important Provisions Mary Katherine Wildeman. May 26, 2022. CT Insider. Jeffrey Pierre. May 26, 2022. NPR. The Dingleberry Erik Sherman. Jun 30, 2022. Forbes. Molly Rutherford. Jun 28, 2022. The Hill. Marty Schladen. Jun 22, 2022. Iowa Capital Dispatch. Poland Train Station Taylor Popielarz, Maureen McManus and Justin Tasolides. Mar 25, 2022. Spectrum News NY1. The Law and the Regulation U.S. Health and Human Services Department November 30, 2020 Audio Sources November 17, 2015 House Committee on the Judiciary Witnesses: Bradley J. Arthur, R.Ph., Owner, Black Rock Pharmacy David Balto, Law Offices of David A. Balto PLLC Amy Bricker, R.Ph. Vice President of Retail Contracting & Strategy, Express Scripts Natalie A. Pons, Senior Vice President and Assistant General Counsel, CVS Health Clips 53:48 Bradley Arthur: The Big Three PBMs control almost 80% of the entire market and these PBMs have the upper hand both in negotiating the contract with the payer, as well as strongly influencing the actual plan design itself. The PBM industry typically states that they can use their economic power to harness enhanced market efficiencies, but for whom? However, the staggering annual revenues that continue to grow each year of the big three suggests that these efficiencies are going directly to their corporations’ bottom lines. Small community pharmacies like mine are faced on a daily basis with the impact of the PBMs’ disproportionate market power. Community pharmacies routinely must agree to take-it-or-leave-it contracts from the PBMs just to continue to serve our long-standing patients. As if that weren't enough, the PBMs also directly set the reimbursement rates for pharmacies, the very same pharmacies that stand in direct competition of some of these PBM-owned mail-order and specialty pharmacies. Therefore, it comes as no surprise that the PBMs present employer and government payers with carefully tailored suggested plans designs that steer beneficiaries to these PBM-owned entities. January 29, 2019 Senate Committee on Finance Witnesses: Kathy Sego, Mother of a Child with Insulin-Dependent Diabetes Douglas Holtz-Eakin, Ph.D., President, American Action Forum Mark E. Miller, Ph.D., Vice President of Health Care, Laura and John Arnold Foundation Peter B. Bach, MD, MAPP, Director, Memorial Sloan Kettering Center for Health Policy and Outcomes Clips 1:57:30 Sen. John Cornyn (R - TX): Can anybody on the panel explain to me why we have a general prohibition against kickbacks — they call them rebates — under the Social Security Act, but we nevertheless allow it for prescription drug pricing? What's the sound public policy reason for excluding prescription drug pricing from the anti-kickback rule under federal law? Douglas Holtz-Eakin: I can't explain that and won’t pretend to. [laughter] Sen. Cornyn: I thought I was the only one who didn't understand the wisdom of that. Well, it's not a transparent arrangement and it does produce upward pressure on drug prices. And obviously, the negotiations between the PBM and the pharma in terms of what the net cost is, is not transparent, nor is it delivered to the consumer. Is it Dr. Miller? Dr. Bach? Peter Bach: It's delivered to the consumer indirectly through the reduction of the total cost of the benefit, but it is not delivered to the actual consumer using the drug, and that is a disassociation, that is a problem. Because it essentially reverses the structure of insurance. Lowering the total costs are people who use it the least, and raising the costs are people who use it the most, relative to if you allowed the rebate to be used at the point of sale, including all discounts. 1:59:49 Douglas Holtz-Eakin: If we had the negotiation be about the upfront price, so instead of a high list price and a rebate, you just negotiate a lower price, that would be the price that Ms. Sego would pay and insurance companies would look at that and say, okay, she's not paying as much as she used to, we're going to have to make up that money somewhere else and they might raise premiums. That means that people who don't have extreme insulin drug costs would pay a little bit more in a premium every month, and people who have extremely devastating medical conditions and high health care costs would get less costs. That's exactly what insurance is supposed to do. And so the rebate system is more than giving strange incentives on pricing. It's undercutting the purpose of insurance in general. February 26, 2019 Senate Committee on Finance Witnesses: Richard A. Gonzalez, Chairman and Chief Executive Officer, AbbVie Inc. Pascal Soriot, Executive Director and Chief Executive Officer, AstraZeneca Giovanni Caforio, M.D., Chairman of the Board and Chief Executive Officer, Bristol-Myers Squibb Co. Jennifer Taubert, Executive Vice President, Worldwide Chairman, Janssen Pharmaceuticals, Johnson & Johnson Kenneth C. Frazier, Chairman and Chief Executive Officer, Merck & Co., Inc. Albert Bourla, DVM, Ph.D., Chief Executive Office, Pfizer Olivier Brandicourt, M.D., Former Chief Executive Officer, Sanofi Clips 1:22:03 Albert Bourla: Adverse incentives that favor higher cost biologics are keeping biosimilars from reaching patients. In many cases, insurance companies declined to include lower cost biosimilars in their formularies because they would risk losing the rebates from covering higher cost medicines. I can't think of a more concerning example of a broken system and we need to do something about it. 1:33:35 Sen. Chuck Grassley (R - IA): So many of you have voiced support for the recent rebate rule proposed by the administration. Should the administration finalized this rule, will you commit to lowering your drug prices? Richard Gonzalez [CEO, AbbVie]: Mr. Chairman, we are supportive of the rule. We'd like to see it in its final form, obviously, to make a final decision, but we are supportive of taking the discount to the patient at the point of sale. Sen Grassley: Okay. AstraZeneca? **Pascal Soriot [CEO, AstraZeneca]**The same for us Senator, I would go one step further: if the rebates were removed from the commercial sector as well, we will definitely reduce our list prices. Sen Grassley: Okay. And Bristol? Giovanni Caforio [CEO, Bristol-Myers Squibb]: We have the same positions. Sen Grassley: Okay. Johnson and Johnson? Jennifer Taubert [EVP, J&J]: Yes, we're supportive, and that definitely would be my goal. We would just need to see the final legislation, provided that there aren't additional fees that are added into the system to compensate for the rebates. Sen Grassley: Merck? **Kenneth C. Frazier: I would expect that our prices would go down if we change the system. Again, on the commercial side as well as the Medicare side. Sen Grassley: Okay, Pfizer? Albert Bourla [CEO, Pfizer]: It is a very clear intention that we will not keep a single dollar from these rebates. We will try to move every single penny to the patients and we think if this goes also to the commercial plants that will be even better for more patients. Sen Grassley: Okay. Sanofi? Olivier Brandicourt [Former CEO, Sanofi]: Lowering list price has to be linked to better access and affordability at the counter for the patients. 1:35:20 Sen. Ron Wyden (D - OR): Is it correct that your company, and nobody else, sets the starting price for all drugs sold by Pfizer? Yes or no? Albert Bourla: It is a negotiation with PBMs and they are very powerful. Sen. Wyden: But you still get to set the list price? Albert Bourla: Yes, but we set this price and the rebate limit(?). 1:35:40 Sen. Ron Wyden (D - OR): Is it correct, when a hypothetical patient, let's call her Mrs. Jones, goes to pay for her drug at the pharmacy counter, her coinsurance is based on the price of the drug you set? Albert Bourla: It is correct in many cases. Sen. Wyden: Okay. I just want you all to know that the number one reason consumers are getting hammered, is because these list prices, which you have the last word with respect to where they are, are unaffordable. And the high prices are tied to what the consumer pays at the pharmacy counter. And all this other stuff you talk about, the rebates and the discounts and the coupons, all this other stuff is window dressing, all of that. And the fact is on Part D, 40% of the drugs don't even have a rebate. So I want it understood, particularly because I've asked you, Mr. Borla, I think you and others in the industry are stonewalling on the key issue, which is actually lowering list prices. And reducing those list prices are the easiest way for American consumers to pay less at the pharmacy counter. 2:12:45 Sen. Thomas Carper (D-DE): First is eliminating rebates to PBMs. That's the first one, eliminating rebates to PBMs. The second is value based arrangements. And the third is increasing transparency industry-wide on how you set your prices. 2:13:20 Richard Gonzalez: We clearly support providing the discount at the patient level, eliminating rebates essentially. 2:14:10 Pascal Soriot: If the rebates, as I said earlier, were to be removed from Part D and the commercial sector, we would actually reduce our list prices. 2:15:10 Giovanni Caforio: I would say that not only do we support all three elements that you mentioned, but I do believe those three elements together with the continued effort to develop a generic and biosimilar market would mean significant change, and would clearly alleviate the concerns that patients have today. 2:14:44 Jennifer Taubert: We are very supportive of all three elements that you outlined 2:15:52 Kenneth Frazier: We too support all three. 2:15:55 Albert Bourla: All three elements are transformational for our industry, will disrupt it. However, we do agree that these are the three things that need to be done and also I believe that will have significant meaningful results if we do. 2:16:10 Olivier Brandicourt: We support the three Senator, but we want to keep in mind at the end of the chain the patient has to benefit, so if rebates are removed it has to be to the benefit of patients. Sen. Thomas Carper (D-DE): Good, thanks. 2:18:10 Albert Bourla: 50% of the American people are in commercial plans and these rebate rules apply to Medicare. If the rules apply to all, definitely the list price will go down. 2:18:30 Albert Bourla: The list price is not irrelevant, it's very relevant for a lot of people because they have to pay list price during the deductible period. However if the rebate rule is applied, then they become irrelevant because the patients will not be paying the list price at the purchase point. 2:19:10 Sen. John Thune (R-SD): How would manufacturers respond if the rebate rule were finalized for government programs? I mean, what does that what does that mean for the commercial market? Albert Bourla: Senator, as I said before, all these proposals that they're discussing, [undistinguishable], eliminating the rebate rule, are transformational and will disrupt the way we do business. I don't know exactly how the system will evolve, and I really don't favor a bifurcated system. I would like to have a transparent single system across both parts. So we need to see how the whole thing will evolve. 2:25:26 Johnny Isakson (R-GA): Who sets the discount and who sets the rebate? 2:26:20 Richard Gonzalez: We negotiate with payers, so managed care and PBMs— Sen. Johnny Isakson (R-GA): You’re a supplier though, so you have to go negotiate with the PBMs and those people, is that right? Richard Gonzalez: Correct, and they negotiate aggressively. Sen. Isakson: Is that pretty much true with everybody, that they're the major component between the end retail consumer price and the origin of the product? Richard Gonzalez: Yes, Senator. Sen. Isakson: Well, that seems like that's someplace we ought to focus, because that's where the distorted numbers come in. Johnson & Johnson, Janssen, in your testimony, you talked about your average list price of 8.1%, up, but an average net price change of only 4.6%. So while your gross went up 8.6, your net went down 4.6 In the same pricing period. How does that happen? If you're setting the price, how does it not go up on the bottom? Jennifer Taubert: Yeah, and in fact, in 2018, our net price actually declined 8.6%, so even more than that. The intermediaries in the system are very, very effective negotiators— Sen. Isakson: Tell me who the intermediaries are. Jennifer Taubert: Those would be the PBMs and the insurers. Sen. Isakson: …and the insurance companies? Jennifer Taubert: Right, and they set the formularies for patients. Sen. Isakson: And they're not the same. They're two different people? Jennifer Taubert: Yes, correct. 2:40:45 James Lankford (R-OK): All of you have mentioned the rebate issue has been a problem and that insurance companies and PBMs are very effective negotiators. Part of the challenge of this is, health insurance companies pay their PBM based on the quality of their negotiation skills, cutting a price off the list price. And so if a list price is higher and a rebate is higher, that also gives preference to them. So the difficulty is, as you raise list price, and the rebate gets larger, the insurance company gives that preference, making it harder for biosimilars. Am I tracking this correctly? 2:43:00 Albert Bourla: Here in the US, the penetration of biosimilars is much lower than in other places, but it is disproportional to different parts of the US healthcare system. For example, in open systems, systems where the decision maker it is a PBM, the one biosimilar we have has a market share of 5% in the US. In closed systems, in systems like Kaiser, for example, integrated healthcare systems where the one who decides has the whole cost of the healthcare system in its interest, we have 73%. 5% and 73% for the same product. I agree with what Mr. Fraser said that we need to create incentives, but I would add also that we need to break this rebate trap that creates significant disincentives for providers, and the healthcare system, and insurance companies. 3:19:25 Kenneth Frazier: If you went back a few years ago, when we negotiated to get our drugs on formulary, our goal was to have the lowest copay by patients. Today the goal is to pay into the supply chain the biggest rebate, and so that actually puts the patient at a disadvantage since they're the only ones that are paying a portion of the list price. The list price is actually working against the patient. 3:19:50 Sen. Steve Daines (R-MT): Why do we have a system today? Where you all are setting, I'll just say very, very high list prices, which is the starting point for negotiation. Why? Olivier Brandicourt: Senator, we're trying to get formulary position. With those list prices. High list price, high rebates. It's a preferred position. Unfortunately the preferred position doesn't automatically ensure affordability at the end. Kenneth C. Frazier: Senator, If you bring a product to the market with a low list price in this system, you get punished financially and you get no uptake because everyone in the supply chain makes money as a result of a higher list price. April 9, 2019 Senate Committee on Finance Witnesses: Steve Miller, MD, Former Executive Vice President and Chief Clinical Officer, Cigna Corporation Derica Rice, Former Executive Vice President and President, CVS Health and CVS Caremark William Fleming, Pharm.D., Segment President, Healthcare Services, Humana Inc. John Prince, Chief Executive Officer, OptumRx Mike Kolar, JD, Interim President & CEO, Senior Vice President and General Counsel, Prime Therapeutics LLC Clips Sen. Ron Wyden (D - OR): Pharmaceutical Benefit Managers first showed up decades ago, back when prescription drugs were being utilized more extensively. The PBMs told the insurance companies, “we're the ones who know drug pricing, we will handle the negotiations for you.” But there is little evidence that the pharmaceutical benefit managers have actually held down the prices in a meaningful way. In fact, most of the evidence shows just the opposite. Pharmaceutical Benefit Managers actually make more money when they pick a higher price drug over a lower price drug. Colleagues, let's remember that all the way through this discussion, benefit managers make more money when they pick a higher price drug over a lower price drug. The logic on this isn't exactly complicated, graduate-level economics. PBM profits are based on taking their slice of the prescription-drug pie. More expensive drugs means there's a bigger pie. When there's a bigger pie, [there are] bigger slices for the pharmaceutical benefit managers. 50:24 Mike Kolar: Rebates and the role they play have been key areas of focus in the drug cost debate. In our view, rebates are a powerful tool to offset high prices, which are set by pharmaceutical companies, and pharmaceutical companies alone. The fact that rebates are not offered on many of the highest cost drugs, and that studies show no correlation between prices and rebates underscore that rebates are a key to mitigating rather than causing high drug prices. We pass rebates through fully to our plans, and we believe our plans should be able to choose how to apply these rebates in ways that best serve their members and market needs by balancing premiums and cost sharing. 56:05 Sen. Chuck Grassley (R-IA): I'd like to talk about consolidation, including the recent integration of PBMs with insurance companies. Last year I wrote to the Justice Department on the issues, it reported that the three largest PBMs who are before us today now covers 71% of Medicaid, Medicare Part D enrollees and 86% of standalone Drug Plan enrollees. 57:45 Derica Rice: This is a highly competitive space. In addition to the three that you've pointed out here, CMS has noted there are over 60 PBMs across the US. Therefore, the competition, there's many options for the employers that are out there, government entities, as well as unions to choose from given their specific needs. 1:10:35 Sen. Debbie Stabenow (D-MI): So when we look at Express Scripts has 100 million Americans covered, CVS 90 million, OptumRx 65 million, Prime Therapeutics 27 million, Humana 21 million, and yet Americans still pay the highest prices in the world. Even though you are negotiating for millions of people. The VA has its own pharmacy benefit manager service, they negotiate for 9 million veterans, and they pay, on average, 40% less for the same drugs that the rest of the healthcare system pays for. Despite greater volume, you are unable to secure these kinds of low prices. With all due respect, you guys are pretty bad negotiators. Given the fact that the VA can get 40% less. And so I'd like to know from each of you why that's the case. Dr. Miller? Steve Miller [Former EVP and Chief Clinical Officer, Cigna Corporation]: Yes. Part of the equation is giving patients choice. At the VA, they actually limit their formulary more than any of us at this table do. So oftentimes, they'll have one beta blocker, one ace inhibitor. And so if it's going to get to that level of choice, then we could get better prices also. Sen. Stabenow: Let me jump in, in the interest of time. I know you create nationwide drug formularies, you have pre-authorization, you give preferred status to certain medications. So you don't use any of those tools that the VA is using? Because you do. Steve Miller: We definitely use those tools, but we also give people choice. It's crucial for both physicians and patients to have the choice of the products they want to be able to access. Many of our plans want us to have broad formularies and when you have more products, it means you move less market share. Sen. Stabenow: So basically you’re saying a 40% premium gives them more choice. 1:24:30 Sherrod Brown (D-OH): If the administration's rebate rule were finalized as proposed, would you in some way be required to change the way you do business? Mike Kolar: Yes, Senator we would. John Prince: Yes. William Fleming: Yes. Derica Rice: Yes. Steve Miller: Yes. Sen. Brown: Thank you. 1:25:05 Sherrod Brown (D-OH): What percentage of prescriptions that you fill across Part D actually receive a rebate? Roughly what percentage? Mike Kolar: So Senator, approximately 8% of the prescriptions that we cover in Part D are associated with a rebate. Sen. Brown: Okay, Mr. Prince? John Prince: Senator, I don’t know the exact number, I know our overall business is about 7%. Sen. Brown: Okay, thank you. William Fleming: About 7-8%. Derica Rice: Senator, I do not know the exact number but we pass through 100% of all rebates and discounts. Sen. Brown: [Grunt] Steve Miller: 90% of the prescriptions will be generic. Of the 10% that are branded, about two-thirds have rebates. So it's about seven-- Sen. Brown: 7-8% like the others. Okay. To recap, PBMs do not set drug prices. Forcing you to change the way you do business -- as the administration's rule would — will not change that fact. And while the rule might impact a small percentage of drugs and Part D that receive a rebate, it does nothing to lower costs, as your answer suggests, for the other 90% of prescriptions you fill. Most importantly, absolutely nothing in the proposed rule would require Secretary Azar’s former employer or any other pharma company to lower the price of insulin or any other drug. It's important to establish that, so thank you for that. 1:41:40 Catherine Cortez Masto (D-NV): Let me ask you, Dr. Fleming, in your testimony, you say Humana’s analysis of the rebate rule -- and we're talking about the administration's rebate rule now — found that approximately 17% of beneficiaries will see savings at the pharmacy counter as a result of this rule. Can you tell me a little bit more about who these people are? And what kind of conditions do they have? William Fleming: Senator, there will be a number of members who are taking brand drugs for which we get rebates and so it could vary all the way from the common chronic conditions, things like diabetes or hypertension or high cholesterol, all the way over to occasionally, not usually, but occasionally on the specialty drug side. When you think of some medications like treatments for rheumatoid arthritis, multiple sclerosis, places where there's competition. Cover Art Design by Only Child Imaginations Music Presented in This Episode by

After multiple formula-related infant deaths were reported to the FDA in February, samples from Abbott Laboratories' Sturgis, Michigan baby formula production facility tested positive for cronobacter, triggering a recall and a subsequent formula shortage. In this episode, Jen uncovers monopoly and neglect in the baby formula production industry, lack of oversight by the FDA, and the United States' refusal to adopt the World Health Organization's International Code of Marketing of Breast-Milk Substitutes. Please Support Congressional Dish – Quick Links Contribute monthly or a lump sum via Support Congressional Dish via (donations per episode) Send Zelle payments to: Donation@congressionaldish.com Send Venmo payments to: @Jennifer-Briney Send Cash App payments to: $CongressionalDish or Donation@congressionaldish.com Use your bank’s online bill pay function to mail contributions to: Please make checks payable to Congressional Dish Thank you for supporting truly independent media! Background Sources Recommended Congressional Dish Episodes The Formula Shortage Abbott. Jun 15, 2022. May 26, 2022. U.S. Senate. Center for Food Safety and Applied Nutrition. May 18, 2022. U.S. Food and Drug Administration. Annie Gasparro and Jaewon Kang. May 12, 2022. The Wall Street Journal. U.S. Food and Drug Administration. Feb 2022. Baby Formula Monopoly Matt Stoller. May 13, 2022. BIG by Matt Stoler on Substack. Sam Knight. Apr 23, 2022. Truthout. FDA Failure March 24, 2022. U.S. House of Representatives. Poisoned Baby Food House Committee on Oversight and Reform, Subcommittee on Economic and Consumer Policy Staff. Feb 4, 2021. Operation Fly Formula Brenda Goodman and Deidre McPhillips. Jun 10, 2022. CNN. The White House. May 22, 2022. White House Briefing Room: Statements and Releases. 60 minutes Segment Bill Whitaker. May 22, 2022. 60 Minutes. The WHO Code and Formula Marketing The World Health Organization. Apr 28, 2022. The World Health Organization. Apr 28, 2022. The World Health Organization. La Leche League International. Bonnie Goldstein. Jul 13, 2018. Project on Government Oversight. The World Health Organization. Jan 27, 1981. Fisher-Price Update Katie Porter [@RepKatiePorter]. Jun 15, 2022. Twitter. Laws Audio Sources May 26, 2022 Senate Committee on Health, Education, Labor, and Pensions The committee concluded a hearing to examine the infant formula crisis, focusing on addressing the shortage and getting formula on shelves. Witnesses: Robert M. Califf, Commissioner of Food and Drugs, Food and Drug Administration Clips 37:26 Dr. Robert Califf: Frankly, the inspection results were shocking. Standing water, cracks in key equipment that presented the potential for bacterial contamination to persist, particularly in the presence of moisture, leaks in the roof, a previous citation of inadequate hand washing and current poor foot sanitation, bacteria growing from multiple sides, and many signs of a disappointing lack of attention to the culture of safety in this product that is so essential to the lives of our most precious people. 38:14 Dr. Robert Califf: As soon as we receive positive cronobacter results from environmental samples at the facility that we collected during the inspection, we contacted Abbott to ask the company to issue a voluntary recall. The need to take urgent action to protect the most vulnerable of all of our people -- infants -- presented a dilemma. This was the largest plant of the dominant manufacturer, and it was the sole source of a number of metabolic formulas essential for viability of infants with no substitution possible, because Abbott had no backup plan. We knew that ceasing plant operations would create supply problems, but we had no choice given the unsanitary conditions. 50:50 Sen. Richard Burr (R-NC): Why haven't you waived labeling requirements from trusted manufacturers in countries like the UK, Australia or Canada? Couldn't manufacturers provide temporary labels on imported formula? Cans if the label is printed in a language other than English until US manufacturing is restored? Some countries have higher nutritional requirements. Why can't we provide a waiver for their products to come into the country? Dr. Robert Califf: We've waived many of the requirements that are the ones that make sense, but the directions have to be clear to Americans in language that's understandable so the formula can be mixed correctly. An error in mixing up the formula for example, can lead to a very sick infant not getting the right nutrition. 2:16:18 Dr. Robert Califf: We saw the lack of quality in the system and the lack of accountability for the problems that were there. And so we had to invoke the Justice Department to negotiate a consent decree, which is essentially Abbott saying, “Yes, we had all these problems. Here's exactly what we're going to do to fix them.” For legal reasons, I can't discuss the exact details of the negotiation, but let's just say that it took a little armwrestling to get to the point where the Justice Department got Abbott to sign the consent decree. May 25, 2022 Committee on Energy and Commerce: Subcommittee on Oversight and Investigations Witnesses: Robert M. Califf, Commissioner, Food and Drug Administration Frank Yiannas, Deputy Commissioner, Food Policy and Response, Food and Drug Administration Susan Mayne, Director, Center for Food Safety and Applied Nutrition, Food and Drug Administration Chris Calamari, Senior Vice President of U.S. Nutrition, Abbott Robert Cleveland, Senior Vice President of the Nutrition Business Unit for the US and Europe, Mead Johnson Nutrition Scott Fitz, Vice President of Technical and Production, Gerber Clips 41:55 Robert Califf: Because of the lack of the diversification of this market in the absence of a central hub for integrating supply chains, we concluded early on that getting the Sturgis facility up and running safely was a top priority. But we had no confidence in the integrity of the Abbott quality program at this facility. Accordingly, we initiated proceedings toward a consent decree, which requires Abbott to undertake steps to assure safe production of formula, including hiring an outside expert with reporting to FDA. 43:03 Robert Califf: Despite the overall numbers showing diminished but steady supply, we knew that distribution was an issue. Some areas were experiencing significant shortages, but overall, there was enough formula to go around. About a month ago, the reports of shortages on the shelf proliferated, although there was not a drop in production. This increase in consumption most likely represents heightened concern of parents and caregivers about shortages, leading to an understandable effort to purchase ahead to ensure adequate supply at home. This type of cycle has happened with other products throughout the pandemic, and we realize that the only solution is to have adequate supply to make sure shelves are stocked. 45:57 Robert Califf: Abbott's enormous market share left it with a responsibility for producing safe infant formula that was not met. We will do everything in our power to work with Abbott to make this happen as quickly and as safely possible, but this timing is an Abbott's control. 46:35 Robert Califf: Across the industry we regulate, we are seeing evidence that the just-in-time distribution system, market concentration, and sole-source contracting are leading to shortages. Multiple reports to Congress call for improved supply chain management. Until regulatory agencies have digital access to critical supply chain information and personnel to do the work, we will continue to react to supply chain disruptions rather than intervening to prevent them. 1:01:113 Robert Califf: It’s really important for people to go to the HHS website: hhs.gov/formula. There you'll find the hotline for all the manufacturers and helpful information about where to go. 1:04:12 Robert Califf: You would be surprised to know there's no just-in-time system where all the FDA employees can see what's going on. What we really need is access to the information that the manufacturers have about each of their individual supply chains. They each have their individual supply chains, but there is no national system to make sure the supplies getting where it needs to go. 1:05:11 Rep. Cathy McMorris Rodgers (R-WA): Did FDA not have a data analytics tool to monitor the supply chains of various products, including infant formula? Robert Califf: We requested funding for a tool and because we didn't get the funding, we cobbled it together. It's a start, but it's nowhere near — you know, again, I was at Google for five years. The technology at FDA, and in many federal agencies is outmoded and needs an upfit, there's just no question about. 1:07:33 Susan Mayne: We have been in discussion with infant formula manufacturers throughout COVID, but discussion is not the same thing as data and we do not have the authorities to demand data from the companies to get necessarily all the information that you would want to have to really monitor the supply chains as Dr. Califf indicated. 1:10:30 Robert Califf: But given what we saw, the only way we could have confidence was through a consent decree, where we literally have oversight of every single step. When we met with the CEO yesterday, there were hundreds of steps that they went through that they're having to do, many of which have already been done. So it's only if we have direct oversight over it that I would have confidence, but I do have confidence that we are seeing every single step both physically in-person, and also through following the documentation and the outside expert. 1:10:53 Rep. David B. McKinley (R-WV): How will the passage of last week's FDA Bill increase the production of baby formula? Robert Califf: Production is increasing already — Rep. David McKinley The criticism, that they said that on these various tweets — it was not just one there were several — that said it was unnecessary. So I want to know, how do we increase, how do we get back to production? How to put in $28 million? How would that how's that gonna increase production? Robert Califf: Well, remember, the Abbot plant needs to get up and running, we’ve got to oversee and micro detail to make sure that it's done correctly. And as we bring in supply from other countries, remember, we already have overseas plants that we import from on a regular basis, almost double digits. So as we bring that product in, we’ve got to inspect it, make sure it's of the quality that we expect in America of formula and we need to upgrade our information systems, as I've already said, to make sure that as all this goes on, we can keep track of it and make sure that we're coordinated. 1:44:55 Rep. Kim Schrier (D-WA): Is there any early warning system for products like baby formula? And not just the ingredients but for formula itself or manufacturer would let you know if they're running short or anticipate a shortage? Robert Califf: First of all, let me thank you for being a pediatrician. I sometimes call the Academy of Pediatrics just for the positive vibes that you all exude as a profession. But no, there is not such a warning system. We've repeatedly asked for that authority and have not been granted it. The industry by and large has opposed it. 1:52:21 Susan Mayne: What the data show is, we can't rule in or rule out whether or not those infants, their cronobacter was caused by this plant. The data just simply can't be used to inform it. Rep. John Joyce (R-PA): But the genetic testing you did. It does not match from the plant, correct? Susan Mayne: That is correct. But what we did not have is any sampling done at the same time that the product was manufactured that was consumed by the individuals who got sick, so we didn't have that every director 2:08:57 Rep. Ann Kuster (D-NH): I know that in this part of the country, I'm in New Hampshire, we have milk banks of mother's breast milk. And I'm wondering what is the regulation by the FDA? And can we assure our constituents that breast milk from milk bank is safe and is thoroughly vetted by the FDA? Robert Califf: You're asking some very good questions. I'm gonna refer this to Dr. Mayne who probably would have the best answer. Susan Mayne: Thank you, Congresswoman. So human breast milk is regulated as a food. And so that is reassuring and they have to have proper screening protocols and things like that in place to make sure that the donors that are donating the milk, get that, that's critical for human food safety. So that's how I would respond. Thank you. 2:26:28 Robert Califf: You would think that a critical industry like this would have resilience plans, redundancy, but we don't even have legal authority right now to require that the firms have a plan for potential failures and resilience. That’s something we've asked Congress for every year for a while, and we're asking for it again. So I hope that it happens this time. I'd also add that this is not unique to this industry. We are seeing this across the entire device and medical supply industry with frequent failures as exemplified by the 60 minutes show and the contrast medium problem that I talked about. We have gone to a just-in-time, large single source contracts that lead to lack of diversification in the industry and the industry has fought us tooth and nail on requiring that there be insight into their supply chains, so that the sum of all of the industries leads to the the avoidance of preemption. We'd like to be able to stress test and prevent these things from happening rather than waiting until they happen, and then scrambling. 2:58:58 Susan Mayne: What we've seen is, first the strain of the COVID 19 pandemic, then the strain of the recall, and now we've got the Russia-Ukraine conflict. And one of the things that we know is the Ukraine region is one of the world's biggest exporters of products like sunflower oil. Sunflower oil is used as an ingredient in many food products, including infant formula. And so we have been working with the manufacturers should they be unable to maintain their supply of sunflower oil, what they would replace it with and make sure that that would meet the nutritional requirements for infant formula. 3:26:28 Chris Calamari: We plan to start production at Sturgis the first week of June. We will begin with the production of EleCare, before turning to the production of other formulas and Similac. From restart, we estimate that it will take six to eight weeks before product is available on shelves. 4:28:51 Rep. Paul Tonko (D-NY): Your testimony also mentions global supply chain challenges as a factor the company has had to contend with. What, if any, steps has Gerber taken to maintain its production and distribution supply? Scott Fitz: Thank you for the question. Certainly, our industry is not immune to the global supply chain challenges brought on by the pandemic. We struggled with materials supply issues, intermittent materials supply issues, whether it be ingredients or packaging components, we struggled struggled with the material quality issues related to the pandemic, we've had transportation and logistics issues, just getting trucks and truck drivers available to move the products and supplies that we need. And we've had COVID related labor challenges and higher turnover than normal are all things that have impacted us. Through the course of the pandemic though we've we've resolved these on an ongoing basis, one at a time as they've come up. We are putting trying to put in more robust business continuity plans in place for critical components and ones that we know we will have challenges with in the future. 4:30:50 Rep. Paul Tonko (D-NY): Did you not think the FDA should be notified or at least aware of your struggle? Scott Fitz: Should FDA be aware of our struggle? Rep. Tonko: Yeah, should you have shared those concerns for supply chain? Scott Fitz: If it could help, we would certainly be willing to do that. Yes. Rep. Tonko: What should you have told us during the last year? Scott Fitz: Well, as I testified, the issues that have come up for us, we've been able to resolve. Through the last six months our in-stock rates have averaged 86%. 4:35:55 Chris Calamari: On the horizon, we see in the manufacture of infant formula agricultural oils are absolutely essential, paper is absolutely essential, the cost of fuel to supply and distribute the product is essential. So I would call out those key elements ranging from agricultural oils to the cost to deliver the product would be the biggest areas of focus. 4:41:42 Robert Cleveland: We reached out and spoke to the USDA almost immediately seeking flexibility, for example in the size format. And while that sounds small, it's very significant because what that means is the WIC consumer doesn't have to look for one particular size of product at the shelf. They can find any size of the shelf to fulfill their their benefits with and that's allowed us to continue production and step up to meet the requirements of those consumers. We've since worked with the USDA to find a number of other ways to flexibly administer the program, because really, the focus for the WIC consumer is the same as the others, making sure she has safe access to formula and doesn't have to compete with non-WIC consumers to get it. So the more sizes, the more formats, the more manufacturers that the program can support, the more likely she is to have her needs met. 4:47:35 Rep. Kim Schrier (D-WA): The baby formula industry in our country is really unique in that about 90% of the product is made right here in the United States. And the vast majority is made by your three companies [Abbott, Gerber, and Mead Johnson]. And so it should be no surprise that when something goes wrong, like what happened in Sturgis, it really rocks the whole industry and the facility in Sturgis is responsible for 40% of Abbott's formula on the market and makes up about 20% of the total formula on the market in the US, and that is really significant, especially when this year Similac has the contract with WIC. 5:10:40 Rep. Buddy Carter (R-GA): Okay, the supply chain issues, is that because some of the ingredients were coming from other countries? Chris Calamari: Representative, yes, so global supply chains are such that we have ingredients coming from global sources and that is the nature of our supply chain. 5:19:29 Rep. Diana DeGette (D-CO): Let's say my daughter, who has a six-week-old baby, called me up and said, “I need to get some formula for my baby. And my store shelves are bare.” What can we tell them between now and all of the emergency measures we put into place to start putting formula on the shelves? Who should they call? Where can they go to try to get some of this limited product right now? What's the practical suggestion? Robert Cleveland: It's very unfortunate that you have to answer that question or ask that question, but let me do my best to answer it. I think the shelves — the reality is they don't have anywhere near the product that they do. So one of the things I've often said during this crisis is it takes a village to raise a child. In this case, sometimes it's taking a village to find infant formula. So the first thing to do is work with your network of family and friends, and as they go to the stores, look for the product that's there. And I've seen many mothers and grandmothers and fathers and cousins doing this on the shelf. You can call our Consumer Response Center. Now to be fair, those folks are doing a phenomenal job of fielding waves and waves of calls. But we will help you if you call. That's one other resource. The physician's office is another. Sometimes they do have the samples that are required, and they can help transition between finding product on the shelf. And then I would be sure to look online as well as in-person at the store and be open to other formats. Many mothers and fathers have a particular type of format they like. You may need to be more flexible in the format that you use. But all infant formula regulated by the FDA is safe for your infant, whether it's a liquid or a powder or what size it's in. And so I would say shop widely. See your doctor or enroll your family friends, give us a call if you need to, and be flexible. May 25, 2022 Committee on Appropriations: Subcommittee on Agriculture, Rural Development, Food and Drug Administration, and Related Agencies Witnesses: Ginger Carney, Director of Clinical Nutrition, St. Jude Children’s Research Hospital Sarah Chamberlin, Executive Director, National PKU News Michael Gay, Owner and Manager, Food Fresh Brian Ronholm, Director of Food Policy, Consumer Reports Linkedin Clips 32:29 Michael Gay: WIC’s rigid rules have made it difficult for the program to be responsive to critical shortages throughout the pandemic and now during the formula crisis. Substitutions may be easily available when situations like this arise. The emergency waivers instituted by the USDA during the pandemic have provided flexibility in some states, but those waivers were only available because of the pandemic. To prevent this issue from happening in the future, Congress should allow WIC vendors operating during severe supply shortages, disasters or public health emergencies to automatically substitute limited WIC approved products impacted by supply chain disruptions. The USDA should direct states to include product substitutions for WIC in their emergency preparedness plan. These changes would have allowed families to immediately switch to another formula in states with shortages allowing for smooth continuation of feeding infants. 33:27 Michael Gay: Secondly, there's a significant need for USDA to examine the long term effects of cost containment, competitiveness and peer grouping formulas for WIC vendors. States operate a peer group system to monitor vendor prices and determine reimbursements are cost competitive. These cost containment measures have led to reduced retail embursement and reduced retailer participation in the program, leading to fewer locations for families to access formula. 33:55 Michael Gay: WIC infant formula cost containment measures have led to extreme consolidation in the formula marketplace, leaving it highly vulnerable to supply disruptions like we are experiencing now. These contracting policies must be reviewed to ensure future food security of the nation's babies and families. 41:50 Brian Ronholm: The evidence suggests that the agency was too slow to act, failed to take this issue seriously, and was not forthcoming with information to parents and caregivers. The infant formula crisis exposed a greater structure and culture problem that has long existed FDA. This was merely one symptom of the overall problem, and it is clear that confidence in the food program at the FDA is eroding. A big reason for this is the food program has second class status within FDA, and it's resulted in serious problems. The FDA also lacks a single, full-time, fully empowered expert leader of all aspects of the food program. As you know, in recent decades, most FDA commissioners have been medical specialists who naturally focus on the programs impacting medical products. This is certainly warranted considering the impact these programs have on public health. And the pandemic is a perfect example of this. However, this usually results in intense competition for the commissioner’s time and support and focus on the food program is typically what has suffered under this dynamic. It has become impossible for an FDA commissioner to possess the bandwidth to provide leadership and accountability to a set of offices that regulates 80% of our food supply. 51:45 Ginger Carney: I would want to warn parents not to make homemade formulas — the American Academy of Pediatrics warns against that — they should not dilute the formula, as both of these situations can lead to disastrous results and lead possibly to hospital admissions. 56:40 Brian Ronholm: Splitting out the food safety functions of the agency as it exists now and creating separate agencies while still remaining under the HHS umbrella would be an effective approach that would get to the issues that I think everyone has become aware of during this crisis. 59:32 Rep. Rosa DeLauro (D-CT): We now have 15 agencies at the federal level who deal with some form of food safety, the principal ones are USDA and FDA. It should be one single agency! 1:06:30 Michael Gay: In a rural area such as ours, probably 85-90% of my formula is WIC formula, which is just down to one type of formula. So even like today, for example, or my truck Monday, I got about 20 cases of Gerber formula in a different variety, but that's not approved on what and the Georgia WIC office just approved some substitutions for formulas that were, you know, prescribed by the doctor with the contract formula. So therein lies the problem is there's no easy way to substitute that for the customer. 1:23:29 Brian Ronholm: Four companies that control 90% of the market and only three of them actually bid on WIC rebate contracts. Abbott is by far the largest one and I believe they have contracts in 30 or 31 states, I think it was the latest figure. So when those contracts come up, these companies submit based on their ability to meet the demand in a particular state, and Abbott is usually the only one that's big enough to do that. We mentioned that they have a large part of the market, I think when it comes to the WIC market, they have approximately 55 to 60% of the WIC market. So that's a significant size of the market that it really needs to be examined so when situations like this hit, how does it impact that particular….And it's obviously going to have a bigger impact because these companies use the WIC market to get into the overall non-WIC market to even increase the share of their market, so that creates further shortage problems. 1:40:35 Ginger Carney: One thing that we really haven't talked about is the WHO code for marketing breast milk substitutes. And that's what these formulas are, they’re breast milk substitutes. So if we look at the WHO code in other countries, other developed countries are abiding by the WHO code and this gives guidelines for how companies can market their infant formulas in a safe way. So maybe we should go back to that and think about what is it about the WHO code that would benefit all of our families in the country so that they are assured when they do have to reach for infant formula when breastfeeding cannot be an option or will not be an option? What are the things that are marketed directly to our families that tell them about the formula? 1:44:20 Rep. Debbie Wasserman Schultz (D-FL): Half of all US formula consumption goes through the WIC program, which provides free infant formula as we've been talking about today, where states negotiate bulk discounts in exchange for market exclusivity. Now, I'll take you back to 1989 when Republican President George Bush enacted legislation requiring all state WIC programs to use competitive bidding for the purchase of infant formula. In practice, this means that the state of Florida for example is required to use a single supplier for the entire state supply of WIC baby formula. The competitive bidding process has yielded $1.3 billion to $2 billion a year in savings and allowing WIC to serve about 2 million more participants annually because of the discounts. However, when there's a supply shock caused by one of the four market participants, like what happened with Abbott in this case, it creates a serious risk to infant health across the country. 1:48:00 Rep. Debbie Wasserman Schultz (D-FL): We know that in Europe, they consistently produce a baby formula surplus. But there are rigid labeling and nutritional requirements for formula containers here in the US that the FDA requires and they prohibit the sale of many European-made products, even though the formulas themselves meet FDA nutritional and purity standards. So what sort of policy changes would you like to see undertaken to ease restrictions on baby formula imports, while still ensuring that the product meets our safety standards? Brian Ronholm: Yeah, I think it's critical that we maintain those safety standards that FDA has set on infant formula, that's absolutely critical. There's a comfort level with consumers when they're able to purchase something that they know is an FDA inspected facility overseas. But to your point, sometimes these regulations, these really strict regulations are thinly disguised trade protection measures. And so you know, that's certainly an issue that we'd have to examine carefully to make sure that we can have that access. Cover Art Design by Only Child Imaginations Music Presented in This Episode by

Since the Russian invasion of Ukraine began, Congress has signed four laws that send enormous amounts of money and weapons to Ukraine, attempting to punish Russia for President Putin’s invasion. In this episode, we examine these laws to find out where our money will actually go and attempt to understand the shifting goals of the Biden administration. The big picture, as it’s being explained to Congress, differs from what we’re being sold. Please Support Congressional Dish – Quick Links Contribute monthly or a lump sum via Support Congressional Dish via (donations per episode) Send Zelle payments to: Donation@congressionaldish.com Send Venmo payments to: @Jennifer-Briney Send Cash App payments to: $CongressionalDish or Donation@congressionaldish.com Use your bank’s online bill pay function to mail contributions to: Please make checks payable to Congressional Dish Thank you for supporting truly independent media! Background Sources Recommended Congressional Dish Content Ukraine and Russia Syria World Trade System Russian Blockade Shane Harris. May 24, 2022. The Washington Post. NATO Expansion Jim Garamone. Jun 1, 2022. U.S. Department of Defense News. Matthew Lee. May 27, 2022. AP News. Ted Kemp. May 19, 2022. CNBC. U.S. Involvement in Ukraine Helene Cooper, Eric Schmitt and Julian E. Barnes. May 5, 2022. The New York Times. Julian E. Barnes, Helene Cooper and Eric Schmitt. May 4, 2022. The New York Times. Private Security Contractors Christopher Caldwell. May 31, 2022. The New York Times. Joaquin Sapien and Joshua Kaplan. May 27, 2022. ProPublica. H.R. 7691 Background How It Passed Glenn Greenwald. May 13, 2022. Glenn Greenwald on Substack. Catie Edmondson and Emily Cochrane. May 10, 2022. The New York Times. Republican Holdouts Glenn Greenwald and Anthony Tobin. May 24, 2022. Glenn Greenwald on Substack. Amy Cheng and Eugene Scott. May 13, 2022. The Washington Post. Morgan Watkins. May 13, 2022. USA Today. Stephen Semler. May 26, 2022. Jacobin. Biden Signs in South Korea Kate Sullivan. May 20, 2022. CNN. How Much Money, and Where Will It Go? Stephen Semler. May 23, 2022. Speaking Security on Substack. May 11 2022. Congressional Budget Office. Christina Arabia, Andrew Bowen, and Cory Welt. Updated Apr 29, 2022. Congressional Research Service. Legal Information Institute, Cornell School of Law. Representatives’ Raytheon and Lockheed Martin Stocks Kimberly Leonard. May 19, 2022. Insider. Kimberly Leonard. Mar 21, 2022. Insider. Marjorie Taylor Green [@RepMTG]. Feb 24, 2022. Twitter. GovTrack. “Rules Based Order” Anthony Dworkin. Sep 8, 2020. *The World Trade Organization Inequality.org Apr 23, 2007. NPR. Crimea Kenneth Rapoza. Mar 20, 2015. Forbes. March 16, 2014. BBC. Shifting Strategies Economic War Larry Elliott. Jun 2, 2022. The Guardian. Nigel Gould-Davies. May 12, 2022. The New York Times. Weapons Escalation Jake Johnson. Jun 1, 2022. Common Dreams. C. Todd Lopez. Jun 1, 2022. U.S. Department of Defense News. Greg Norman. Jun 1, 2022. Fox News. Christian Esch et al. May 30, 2022. Spiegel International. Alastair Gale. May 24, 2022. The Wall Street Journal. Mike Stone. Mar 11, 2022. Reuters. Secretary Austin and the Pentagon Jim Garamone. May 20, 2022. U.S. Department of Defense News. Natasha Bertrand et al. Apr 26, 2022. CNN. David Sanger. Apr 25, 2022. The New York Times. Mike Stone. Apr 12, 2022. Reuters. Glenn Greenwald. Dec 8, 2020. Glenn Greenwald on Substack. Democrats Still All In Marc Santora. May 1, 2022. The New York Times. RFE/RL's Ukrainian Service. May 1, 2022. Radio Free Europe/Radio Liberty. Mar 26, 2022. Sky News. The Laws Passed by Voice Vote in the Senate (amended the original House bill) (on original version) (final version) Audio Sources May 23, 2022 Clips Sen. Joe Manchin (D-WV): Speaking about Ukraine, first what Putin, Putin’s war on Ukraine and Ukraine's determination, resolving the sacrifices they've made for the cause of freedom has united the whole world, that it's united, US Senate and Congress, I think like nothing I've seen in my lifetime. I think we're totally committed to supporting Ukraine, in every way possible, as long as we have the rest of NATO and the free world helping. I think we're all in this together. And I am totally committed as one person to seeing Ukraine to the end with a win, not basically resolving in some type of a treaty. I don't think that is where we are and where we should be. Reporter: Can I just follow up and ask you what you mean by a win for Ukraine? ** Sen. Joe Manchin:** I mean, basically moving Putin back to Russia and hopefully getting rid of Putin. May 19, 2022 Committee on Foreign Affairs, Subcommittee on Asia, the Pacific, Central Asia, and Nonproliferation Witnesses: Charles Edel, Ph.D., Australia Chair and Senior Adviser, Center for Strategic and International Studies Bonny Lin, Ph.D., Director, China Power Project, Center for Strategic and International Studies Tanvi Madan, Ph.D.Director, The India Project, Brookings Institution Dan Blumenthal, Ph.D., Senior Fellow and Director of Asian Studies, American Enterprise Institute Clips 6:57 Tanvi Madan: One implication that is already evident, most visibly in Sri Lanka, is the adverse economic impact. The rise in commodity prices in particular has led to fiscal food and energy security concerns and these, in turn, could have political implications and could create a strategic vacuum. 7:15 Tanvi Madan: A separate and longer term economic impact of the crisis could be renewed goals, perhaps especially in India, for self reliance and building resilience not just against Chinese pressure, but also against Western sanctions. 7:28 Tanvi Madan: The second potential implication of the Russia-Ukraine war could be that Beijing might seek to take advantage in the Indo-Pacific while the world's focus is on Europe, between the Taiwan or the East or South China Sea contingencies. The contingency that would have the most direct impact in South Asia would be further action by the PLA at the China-India boundary, or at the Bhutan-China boundary that could draw in India. This potential for Sino-Indian crisis escalation has indeed shaped Delhi's response to the Russia-Ukraine war. Despite its recent diversification efforts, the Indian military continues to be dependent, if not over dependent, on Russia for supplies and spare parts for crucial frontline equipment. India has also been concerned about moving Moscow away from neutrality towards taking China's side. Nonetheless, there is simultaneously concern that Russia's war with Ukraine might, in any case, make Moscow more beholden to Beijing and also less able to supply India, and that will have implications for India's military readiness. 10:10 Tanvi Madan: The fourth implication in South Asia could flow from the war's effect on the Russia-China relationship flows. The Sino-Russian ties in recent years have benefited Pakistan. However, they have been of great concern to India. If China-Russia relations deepened further, it could lead to increased Indian concern about Russian reliability. And a Dheli that is concerned about Moscow's ability and willingness to supply India militarily or supported in international forums will seek alternative partners and suppliers a potential opportunity for the US as well as its allies and partners. 18:15 Bonny Lin: China has shifted its position on the Ukraine conflict to be less fully pro Russia. Xi Jinping has expressed that he is deeply grieved by the outbreak of war. China has engaged in diplomacy, called for a ceasefire, proposed a six point humanitarian initiative, and provided humanitarian aid to Ukraine. China's position on Ukraine, however, is far from neutral. China has not condemned Russia or called its aggression an evasion. Xi has yet to speak to President Zelenskyy. There is no evidence that China has sought to pressure Russia in any way or form. China has amplified Russian disinformation and pushed back against Western sanctions. To date, Beijing has not provided direct military support to Russia and has not engaged in systemic efforts to help Russia evade sanctions. However, China's ambassador to Russia has encouraged Chinese companies to quote "fill the void in the Russian market." 19:14 Bonny Lin: The Ukraine crisis has reinforced China's view that US military expansion could provoke conflict in the Indo-Pacific. Chinese interlocutors have voiced concern that the United States and NATO are fighting Russia today, but might fight China next. China views NATO expansion as one of the key causes of the Korean conflict and sees parallels between NATO activities in Europe and US efforts in the Indo-Pacific. Beijing is worried that increasing US and ally support for Taiwan and other regional allies and partners elevates the risk of US-China military confrontation. This pessimistic assessment is why Beijing will continue to stand by Russia as a close strategic partner. 19:56 Bonny Lin: The Ukraine crisis has reinforced and strengthened China's desire to be more self reliant. China is investing more to ensure the security of food, energy, and raw materials. Beijing is also seeking more resilient industrial supply chains, as well as PRC-led systems, including alternatives to Swift. At the same time, Beijing is likely to further cultivate dependencies on China, such that any potential Western led sanctions on China or international-community-led sanctions on China in the future will be painful to the West and difficult to sustain. 21:15 Bonny Lin: China has observed that Russia put its nuclear and strategic forces on high alert and NATO did not send conventional forces to Ukraine. This is leading China to question its nuclear policy and posture. 21:57 Bonny Lin: As Beijing watches the Western and particularly G7-led unity among advanced democracies, it is also seeing that a number of countries in the developing world are not joining in on the sanctions. As a result, Beijing has tried to increase its influence and in many ways building on Russian influence in developing regions. And Beijing is likely to try to get all that influence moving forward. 24:24 Dan Blumenthal: China took the opportunity of Russia's invasion on February 4 to lay out a document that criticizes, very specifically, almost all aspects of United States global policy. Very specifically, including Oculus for NATO enlargement to Oculus to the Indo Pacific strategy. It got Russia to sign up to Xi Jinping's theory that we're in a new era of geopolitics that will replace US leadership, that US leadership is faulty and it's dividing the world into blocks such as NATO, that NATO expansion is the problem, that Indo-Pacific strategy is the same thing as NATO expansion. 25:45 Dan Blumenthal: We should take very seriously what they say, particularly in Chinese, and what they're saying is very clearly pro-Russia and very clear, specific, searing critiques of the US-led world order. 26:47 Dan Blumenthal: And frankly, while the West is unified, and the US and the West and some of our Asian allies are unified, most of the rest of the world is not with us on this issue of China and Russia being these authoritarian, revisionist great powers, and that's a real problem. May 18, 2022 House Committee on Foreign Affairs: Subcommittee on the Middle East, North Africa, and Global Counterterrorism Witnesses: Dr. Hanna Notte, Senior Research Associate, Vienna Center for Disarmament and Non-Proliferation Dr. Frederic Wehrey, Senior Fellow, Carnegie Endowment for International Peace Caitlin Welsh, Director of the Global Food Security Program, Center for Strategic and International Studies Grant Rumley, Senior Fellow, The Washington Institute for Near East Policy Clips 12:55 Hanna Notte: First, Moscow's military presence in Syria has given it a buffer zone on its southern flank to counter perceived threats from within the region, but also to deter NATO outside the European theater. And second, Russia has turned to the region to diversify its economic relations with a focus on arms sales, civilian nuclear exports and wheat supplies. And in building influence, Russia has largely followed what I call a low cost high disruption approach, also using hybrid tactics such as private military companies and disinformation. Now, these Russian interests in the region will not fundamentally change with the invasion of Ukraine. Today, Russia's regional diplomacy remains highly active, aimed at offsetting the impact of Western sanctions and demonstrating that Moscow is not isolated internationally. 14:09 Hanna Notte: Starting with arms control and Non-Proliferation, though Moscow seemed intent on spoiling negotiations to restore the JCPOA in early March. It subsequently dropped demands for written guarantees that its cooperation with Iran would not be hindered by sanctions imposed over Ukraine. But still, I think the geopolitical situation might make Moscow less willing to help finalize a nuclear deal. As in the past, Russia is also unlikely to support any US efforts to curb Iran's use of missiles and proxies in the region, because essentially, Iran's regional strategy pins down us resources while elevating Russia as a regional mediator, which serves Russian interests well. 15:17 Hanna Notte: Just a few words on Syria. Security Council resolution 2585 on the provision of humanitarian aid to northwest Syria is up for renewal in July. Now, Rationally speaking, the Kremlin should cooperate to avoid a worsening of serious food crisis, especially if an end game in Ukraine remains out of reach. But considering the current level of tensions between Russia and the West, I think the United States should be prepared for a Russian Security Council veto regardless, alongside continued Russian stalling on the Syrian constitutional committee. Moscow has no serious interest in seeing the committee advance. It will instead try to foster a Gulf Arab counterweight to Iran in Syria through normalization, especially for the contingency that Russia may need to scale back its own presence in Syria due to Ukraine. 16:14 Hanna Notte: First, unfortunately I think there's a widespread perception that the Ukraine war is not their war, that it's a Great Power NATO-Russia war, partially fueled by NATO and US actions visa vis Russia. 16:27 Hanna Notte: Second, there are accusations of Western double standards. The military support to Kyiv, the reception of Ukrainian refugees, these are rightly or wrongly viewed as proof that the West cares significantly more about conflict in Europe's neighborhood than those in the Middle East. 16:42 Hanna Notte: Third, regional elites worry about US conventional security guarantees. They fear that the threats posed by Russia and China will accelerate a decline in US power in the Middle East. And they also fear that the US will have limited bandwidth to confront Iran's missile and proxy activities. And with those fears, they feel they cannot afford to put all their eggs into the US basket. 17:07 Hanna Notte: And then finally, each regional state has very distinct business and security interests with Russia. As a result, and I'll end here, I think us opportunities to get regional states to turn against Russia are circumscribed. loosening these ties that states have been building with Russia will require a heavy lift. 18:57 Frederic Wehrey: This engagement is largely opportunistic and ad hoc. It seizes on instability and power vacuums and exploits the insecurities of US partners in the region about the reliability of US support, and their displeasure with the conditionality that the US sometimes attaches to its arms sales. Russian arms deliveries, in contrast, are faster and free from restrictions related to human rights. But Russia cannot provide the security guarantees that many Arab states have depended on from the United States. 19:29 Frederic Wehrey: Now, in the wake of its invasion of Ukraine, Russia is trying to reap dividends from its investment in the region, call in favors, and capitalize on local ambivalence and hostility to the United States, both from states and from Arab publics. America's Arab security partners have differed on joining the Western condemnation of Russian aggression, and some of refuse to join efforts to isolate Russia economically. 20:31 Frederic Wehrey: Russia's disastrous war in Ukraine is tarnishing its reputation as an arms supplier in the Middle East. Russian weapons have been shown to be flawed in combat and often fatally. So, Battlefield expenditures and attrition have whittled away Russia's inventory, especially precision munitions, and sanctions have eroded its defense industrial base, especially electronic components. As a result, Russia won't be able to fulfill its existing commitments, and potential buyers will be increasingly dissuaded from turning to Russia. This shortfall could be modestly exploited by China, which possesses large quantities of Russian made arms and spare parts, which you could use to keep existing inventories in the region up and running. It could also intensify its efforts to sell its own advanced weaponry like drones. 23:50 Caitlin Welsh: The war has reduced supplies and increased prices of foods exported from Ukraine and Russia, namely wheat, maize and sunflower oil, driven up demand for substitute products and reduced fertilizer exports from the Black Sea. Today's high cost of energy puts further pressure on food and fertilizer prices. Most vulnerable to the impact of these price spikes are countries for whom wheat is a major source of calories that rely on imports to meet their food security needs, and that source a significant proportion of their imports from Ukraine and Russia. 24:38 Caitlin Welsh: Egypt is the world's largest importer of wheat, sourcing over 70% of its wheat from the Black Sea. 25:42 Caitlin Welsh: The Russian Ukraine war is limiting access to wheat for Lebanon, already in one of the worst economic crises in the world. Lebanon has not recorded economic growth since 2017 and food price inflation inflation reached 400% in December 2021. Lebanon procures approximately 75% of its wheat from Russia and Ukraine. 28:48 Grant Rumley: Russia is one of the few countries in the world to maintain a relatively positive diplomatic standing with nearly every country in the Middle East. It does so through a combination of an active military presence, high level diplomatic engagement, and a concerted effort to position itself as a viable source of arms, should countries seek non-US material. 29:08 Grant Rumley: Russia's military presence in the region is well documented by Russian MOD statements. Russia has deployed over 60,000 troops to Syria since intervening in 2015. From its two bases in Syria, Hmeimim and Tartous, Russia is able to project power into the eastern Mediterranean, influence the course of the Syrian civil war, and intervene in countries like Libya. 29:47 Grant Rumley: Russia's invasion of Ukraine, however, threatens Russia standing in the region. Already reports indicate Russia has begun withdrawing some troops and mercenaries from the region to support its invasion of Ukraine. While we can expect these reports to continue if the war continues to go poorly for Russia, I'm skeptical of a full Russian withdrawal, and instead expect Russia to continue to consolidate its forces until it's left with a skeleton presence at Hmeimim and Tartous, its most strategic assets in the region. 30:26 Grant Rumley: On arms sales, the Russian defense industry, which has struggled to produce key platforms following sanctions initially placed after its 2014 invasion of Ukraine, will likely have to prioritize replenishing the Russian military over exporting. Further, customers of Russian arms may struggle with the resources to maintain and sustain the material in their inventory. Still, so long as Russia is able to make platforms, there will likely always be potential customers of Russian arms. 41:25 Grant Rumley: I definitely think customers of Russian arms are going to have several hurdles going forward, not only with simply maintaining and sustaining what they've already purchased, but in some of the basic logistics, even the payment process. Russian bank complained last month that it wasn't able to process close to a billion dollars in payments from India and Egypt over arms sales. I think countries that purchase Russian arms will also now have to consider the potential that they may incur secondary sanctions, in addition to running afoul of CAATSA . I think from from our standpoint, there are many ways that we can amend our security cooperation approach. The Middle East, I think is a key theater for the future of great power competition, not only have we been competing with Russia in terms of arms sales there, but China increasingly has sold armed drones to the region. They've sold it to traditional partners, Jordan, Saudi Arabia, Egypt, and the UAE. And what they're doing is is oftentimes what we're not willing to do, our partners in the region seek co-production, they seek technology sharing. China and Russia are willing to work together to build these advanced platforms, Russia and the UAE inked an agreement several years ago to produce a fifth generation fighter. Nothing's come of that yet. China and Saudi Arabia, however, signed an agreement a couple of months ago to jointly produce armed drones in Saudi Arabia. And so I think the US may want to think creatively in terms of both what we sell, how we sell it, and what we're doing to make this more of a relationship and something beyond a strict transaction. 43:39 Grant Rumley: Their presence in Syria has evolved from a modest airstrip in 2015, to a base at Hmeimim that by open source reporting can serve as a logistics hub, a medical hub, it has the runways to host Russia's most advanced bombers. There was reports before Ukraine that Russia was deploying two 22 bombers there and hypersonic missiles. Their facility at Tartous, likewise. Their ability to stage naval assets there has expanded to they can now stage up to 11 ships there. So it has grown from from a rather modest beginning to something much more challenging from a US standpoint. In terms of what we can we can do, I think we can continue to support Ukraine and the defense of Ukraine, and the longer that Russia is bogged down in Ukraine, the harder it will be for Russia's military to extend and maintain its presence in the Middle East. 1:01:45 Grant Rumley: I think the US has several partners in the middle of major Russian arms purchases that we can, like Turkey and the S 400, that has requested the F 16, or Egypt and Sukhoi Su-35, that has requested the F 15. I'm not saying we have to make a deal right now for that, but I think it's clear that these countries are going to have gaps in their capabilities where they had planned on having Russian platforms to complement, and we can work with our partners and work with our own defense industry and see if there's ways in which we can provide off ramps for them to gradually disinvest these Russian platforms. 1:03:00 Frederic Wehrey: When countries in the in the region buy US arms, they believe they're buying much more than the capability, the hardware, that they're purchasing an insurance policy. I think especially for states in the Gulf, there's a fundamental sense of insecurity. These are states that face Iran, but they're also autocrats. They're insecure because of their political systems. They face dissent from within. We saw that with Egypt. So they're purchasing a whole stream of US assurances -- they believe they are. 1:06:00 Grant Rumley: The issue of of co-production is one means to address a common complaint, which is buying from America takes too long. That its too complicated, that if we get in line to buy something from the US, we're going to have to wait years to get it. A good example is the F 16. There are over 20 countries in the world that fly the F 16. We currently -- Lockheed Martin builds it out of one facility. That facility, if you get in line today, you're probably not getting the F 16 for five years from when you sign on the dotted line for it. In the 70s and 80s, we co-produced the F 16 with three other European countries and we were able to get them off the line faster. The initial order at those facilities was for 1000 F 16s. The initial order for the F 16 plant in South Carolina was for 90 F 16s for Taiwan and Morocco. And so from an industry standpoint, it's a question of scale. And so they're not able to ramp up the production because while the demand may get closer to 1000 over time, it's at 128. Last I checked, it's not there yet. And so I think we can use foreign military financing, longer security cooperation planning, working with our partners on multi-year acquisition timetables to then also communicate and send a signal to the defense industry that these are orders for upgrades, for new kits that are going to come down the road. You can start to plan around that and potentially address some of these production lags. 1:17:52 Grant Rumley: China has a lot of legacy Russian platforms, and will likely be a leading candidate to transfer some of these platforms to countries that had purchased Russian arms in the past and may be seeking maintenance and sustainment for them. I think China's already active in the Middle East, it's already flooding the market with armed drones. It's already looking to market other platforms as well. It's sold air defense systems to Serbia. It's looking to advance its arm sales. And so if if we aren't going to be the supplier, China is going to step in. 1:18:57 Caitlin Welsh: USDA has projected that 35% of the current wheat crop from Ukraine will not be harvested this year. So their exports are curtailed, at the same time Russia's exports are continuing. Russia has been exempted. Russia's agricultural exports and fertilizer has been exempted from sanctions for the United States, EU and other countries. So Russia continues to export. In fact, USDA is estimating that Russia's exports are increasing at this time. And I'm also seeing open source reporting of Russia stealing grain from Ukraine, relabeling it, and exporting it at a premium to countries in the Middle East and North Africa. May 12, 2022 NBC News Clips Sen. Rand Paul (R-KY): My oath of office is to the US Constitution, not to any foreign nation. And no matter how sympathetic the cause, my oath of office is to the national security of the United States of America. We cannot save Ukraine by dooming the US economy. This bill under consideration would spend $40 billion. This is the second spending bill for Ukraine in two months. And this bill is three times larger than the first. Our military aid to Ukraine is nothing new, though. Since 2014, the United States has provided more than $6 billion dollars in security assistance to Ukraine, in addition to the $14 billion Congress authorized just a month ago. If this bill passes, the US will have authorized roughly $60 billion in total spending for Ukraine Sen. Rand Paul (R-KY): The cost of this package we are voting on today is more than the US spent during the first year of the US conflict in Afghanistan. Congress authorized force, and the President sent troops into the conflict. The same cannot be said of Ukraine. This proposal towers over domestic priorities as well. The massive package of $60 billion to Ukraine dwarfs the $6 million spent on cancer research annually. $60 billion is more than the amount that government collects in gas taxes each year to build roads and bridges. The $60 billion to Ukraine could fund substantial portions or entire large Cabinet departments. The $60 billion nearly equals the entire State Department budget. The 60 billion exceeds the budget for the Department of Homeland Security and for the Department of Energy. And Congress just wants to keep on spending and spending. May 12, 2022 Senate Committee on Foreign Relations Witnesses: Jessica Lewis, Assistant Secretary of State for Political-Military Affairs Erin McKee, Assistant Administrator for Europe and Eurasia, U.S. Agency for International Development Karen Donfried, Assistant Secretary of State for European and Eurasian Affairs, U.S. Department of State Beth Van Schaack, Ambassador-at-Large for Global Criminal Justice, U.S. Department of State Clips Sen. Ed Markey (D-MA): Are we making it very clear to Russia that we do not want to pose an existential threat to them, that our only goal is to restore the territorial integrity of Ukraine? Karen Donfried: We are making it very clear to Russia that this is not a conflict between Russia and the United States. We are not going to engage directly in this war. President Biden has been explicit in saying we are not sending US troops to fight in this war. So I do believe we have made that clear. Our goal here is to end a war not to enlarge it. Sen. Rob Portman (R-OH): As you all are waking up every morning, I know with the thought in mind that America's role here is to help Ukraine win and I want to talk a little about how we define victory. When Secretary Austin said after meeting with President Zelenskyy, that we can win this war against Russia -- this happened a few weeks ago -- I thought that was positive. On Monday, the foreign minister of Ukraine, who all of us have had a chance to visit with said, of course, the victory for us in this war will be a liberation of the rest of the territory. So Assistant Secretary Donfried, first, just a yes or no. Do you believe Ukraine can win this war? Karen Donfried: Yes. Sen. Rob Portman: And how would you define victory? Would you define victory as requiring the return of all Ukraine sovereign territory, including that that the Russians seized in 2014? Karen Donfried: Well, Senator Portman, thank you for that question. And thank you for your engagement on these issues. Your question very much relates to where Chairman Menendez began, which is, are we in a position of believing that it is Ukraine that should be defining what winning means? And I agreed with Chairman Menendez's statement on that, and that is where the administration is. We believe Ukraine should define what victory means. And our policy is trying to ensure Ukraine success, both by — Sen. Rob Portman: So the administration's official position on victory is getting Crimea back and getting the Donetsk and Luhansk region back as well. Karen Donfried: Again, I believe that is for the Ukrainians to define. Karen Donfried: Against this threat to regional security, global stability, and our shared values, we are supporting freedom, democracy, and the rules based order that make our own security and prosperity and that of the world possible. Sen. Bob Menendez (D-NJ): I believe we must also think about reconstruction efforts in Ukraine, the tools and ongoing governance and economic reforms, specifically in the judicial space, that will facilitate rebuilding critical Ukrainian sectors and attracting foreign investment. May 11, 2022 House Committee on Appropriations, Subcommittee on Defense held a budget hearing on the Department of Defense. Witnesses: Lloyd J. Austin III, Secretary of Defense Michael J. McCord, Under Secretary of Defense (Comptroller)/Chief Financial Officer General Mark A. Milley, Chairman, Joint Chiefs of Staff Clips 21:40 General Mark Milley: Alongside our allies and partners, at any given time approximately 400,000 of us are currently standing watch in 155 countries and conducting operations every day to keep Americans safe. 21:56 General Mark Milley: Currently we are supporting our European allies and guarding NATO's eastern flank, in the face of the unnecessary war of aggression by Russia, against the people of Ukraine, and the assault on the democratic institutions and the rules based international order that have prevented great power war for the last 78 years since the end of World War Two. We are now facing two global powers, China and Russia, each with significant military capabilities, both who intend to fundamentally change the current rules based order. May 9, 2022 Clips Sen. Lindsay Graham (R-SC): If Putin still standing after all this then the world is going to be a very dark place China's going to get the wrong signal and we'll have a mess on our hands in Europe for decades to come so let's take out Putin by helping Ukraine April 25, 2022 March 26, 2022 November 4, 2015 House Foreign Affairs Committee Cover Art Design by Only Child Imaginations Music Presented in This Episode by

The Women’s Health Protection Act is a bill written by Democrats that would guarantee access to abortion services in the United States. While this bill is unlikely to become law, learning what exactly the Democrats are proposing is instructive, as many of us will be voting with abortion in mind later this year. Now that the Supreme Court is poised to overturn previous decisions that guaranteed access to abortion services for the past 50 years, what do Democrats hope to do in response? Please Support Congressional Dish – Quick Links Contribute monthly or a lump sum via Support Congressional Dish via (donations per episode) Send Zelle payments to: Donation@congressionaldish.com Send Venmo payments to: @Jennifer-Briney Send Cash App payments to: $CongressionalDish or Donation@congressionaldish.com Use your bank’s online bill pay function to mail contributions to: Please make checks payable to Congressional Dish Thank you for supporting truly independent media! Links to We’re Not Wrong Executive Producer Recommended Episode : A Coup for Capitalism Follow up reading: Tom Phillips, Patrick Wintour and Julian Borger. May 19, 2022. The Guardian. Background Sources Recommended Congressional Dish Episode : The Abortion Bill Abortion Background Laura Temme. May 12, 2022. FindLaw. Grace Panetta, Shayanne Gal, and Taylor Tyson. Updated May 9, 2022. Business Insider. Jon O. Shimabukuro. Feb 25, 2022. Congressional Research Service. Katherine Kortsmit et. al. Nov 27, 2020. Centers for Disease Control and Prevention. United Kingdom National Health Service. Start for Life. A. Pawlowski. Nov 9, 2017. Today. Supreme Court of the United States. Jun 29, 1992. Justia. The Draft Decision Adeel Hassan. May 6, 2022. The New York Times. Supreme Court of the United States. Feb 10, 2022. Bills Sponsor: Rep. Judy Chu (D-CA) Sponsor: Sen. Richard Blumenthal (D-CT) Bill Outline Gives health care providers the right to provide abortion services and gives patients the right to receive abortion services "without any of the following limitations or requirements": Requirements to perform specific tests or medical procedures prior to an abortion Requirements that direct health providers to provide medically inaccurate information before or during abortion services Limitations on the health care provider's ability to provide drugs to the patient Limitations preventing the health care provider from performing abortion services via telemedicine Limitations placed on abortion providing facilities that are not placed on hospitals and other facilities where similar procedures are performed Requirements that the patient attend medically unnecessary pre-abortion in-person office visits Limitations on abortions "at any point or points in time prior to fetal viability" Limitations on abortions "after fetal viability when, in the good-faith medical judgement of the treating health care provider, continuation of the pregnancy would pose a risk to the pregnant patient's life or health." Requirements that patients disclose the reason they want an abortion prior to fetal viability. Allows the courts to consider the following in determining if a requirement illegally impedes access to abortion services: If the requirement interferes with a health care providers ability to provide care and services or poses a risk to the patient's health or safety If the requirement would likely delay or deter some patients from accessing abortion services If the requirement is likely to increase the financial costs of providing or obtaining abortion services If the requirement would likely limit the availability of abortion services in a State or geographic region If the requirement imposes penalties on health care providers that are not imposed on or are more severe than penalties imposed on other health care providers for comparable conduct or failures to act This law would apply to the Federal Government and "each State government" and no State government can implement and enforce any law or regulation that conflicts with this law. The law would not govern physical access to clinic entrances, insurance coverage for abortions, contracts, or bans on partial birth abortions. Immediately upon enactment. Allows the Attorney General to sue any State or government official who implements or enforcement limitations or requirements that would be prohibited by this law. Allows individuals, "entities", and health care providers adversely affected by violations of the law to also sue the State that violates the law with illegal limitations and requirements The costs of the trial and attorney's fees would be paid by the State if the State loses the case. The person suing could not be forced to pay for attorney's fees if the claim was judged to be "non-frivolous" even if they lose. Sponsor: Trent Franks (R-AZ) Status: Died in 113th Congress Audio Sources May 10, 2022 September 24, 2021 Cover Art Design by Only Child Imaginations Music Presented in This Episode by

The recently signed infrastructure law continues the United States’ over-reliance on the most dangerous way to travel: driving a vehicle. Did Congress make sufficient safety improvements to decrease the dangers posed by driving in the United States? This episode will examine all vehicle-related safety provisions to help you weigh your own transportation options. Please Support Congressional Dish – Quick Links Contribute monthly or a lump sum via Support Congressional Dish via (donations per episode) Send Zelle payments to: Donation@congressionaldish.com Send Venmo payments to: @Jennifer-Briney Send Cash App payments to: $CongressionalDish or Donation@congressionaldish.com Use your bank’s online bill pay function to mail contributions to: Please make checks payable to Congressional Dish Thank you for supporting truly independent media! Background Sources Recommended Congressional Dish Episodes : BIF: Appalachian Chemical Storage : BIF: The Growth of US Railroads : BIF: The Infrastructure BILL : Trailblazer vs. ThinThread Why You Should Be Afraid of Cars Apr 12, 2022. Statista. National Highway Traffic Safety Administration. Mar 2022. U.S. Department of Transportation. Jun 2021. Statista. Injury Facts. National Safety Council. Jon Ziomek. Sept 28, 2020. Historynet. National Highway Traffic Safety Administration. U.S. Department of Transportation. Problems the Law Does (and Does Not) Address Jake Blumgart. Nov 15, 2021. Governing. Self Driving Cars Neal E. Boudette. May 3, 2022. San Francisco Examiner. Natasha Yee. Apr 1, 2022. Phoenix New Times. Feb 20, 2022. Carsurance. Neal E. Boudette. Jul 5, 2021. The New York Times. Clifford Law Offices PC. May 5, 2021. The National Law Review. Katie Shepherd and Faiz Siddiqui. Apr. 19, 2021. The Washington Post. Riley Beggin. Jan 15, 2021. Government Technology. Faiz Siddiqui. Oct 22, 2020. The Washington Post. Niraj Chokshi. Feb 25, 2020. The New York Times. Michael Laris. Feb 11, 2020. The Washington Post. Alex Davies. May 16, 2019. Wired. Neal E. Boudette and Bill Vlasic. Sept 12, 2017. The New York Times. Rachel Abrams and Annalyn Kurtz. Jul 1, 2016. The New York Times. Alcohol Detection Systems Isaac Serna-Diez. Nov 23, 2021. YourTango. Keyless Entry Carbon Monoxide Deaths Jun 20, 2019. Kelley Uustal Trial Attorneys. Jun 7, 2019. KidsAndCars.org. Kids Left in Cars Morgan Hines. Aug 2, 2019. USA Today. Scottie Andrew and AJ Willingham. July 30, 2019. CNN. John Bacon. Jul 28, 2019. USA Today. Eric Stafford. May 6, 2019. [“Children Can Die When Left in the Back Seat on a Warm Day—and 800 Already Have. Car and Driver. National Highway Traffic Safety Administration. U.S. Department of Transportation. Motorcycle Helmets May 2022. Insurance Institute for Highway Safety. Insurance Information Institute. Adam E. M. Eltorai et. al. March 16, 2016. BMC Public Health. Truck Safety Rechtien. Non-motorist Safety Governors Highway Safety Association. March 2021. Governors Highway Safety Association. John Wenzel. Jan 6, 2020. Saint Paul Sign & Bollard. Richard Peace. Feb 20, 2019. Electric Bike Report. 911 System Upgrades Mark L. Goldstein. January 2018. Government Accountability Office. National 911 Program. December 2016. U.S. Department of Transportation. CD021: Trailblazer vs. ThinThread Followup The Chertoff Group. Atlantic Council. Tim Shorrock. Apr 15 2013. The Nation. The Law Law Outline Authorizes appropriations for Federal-Aid for highways at between $52 billion and $56 billion per year through fiscal year 2026 (over $273 billion total). Authorizes $300 million for for 2022, which increases by $100 million per year (maxing out at $700 million in 2026) Authorizes between $25 million and $30 million per year for "community resilience and evacuation route grants" on top of equal amounts for "at risk coastal infrastructure grants" Authorizes a total of $6.53 billion (from two funds) for the bridge investment program Caps the annual total funding from all laws (with many exceptions) that can be spent on Federal highway programs. Total through 2026: $300.3 billion Adds protected bike lanes to the list of projects allowed to be funded by the highway safety improvement project Adds "vulnerable road users" (non-motorists) to the list of people who must be protected by highway safety improvement projects If 15% or more of a state's annual crash fatalities are made up of non-motorists, that state will be required to spend at least 15% of its highway safety improvement project money on projects designed to improve safety for non-motorists. Each state, by the end of 2023, will have to complete a vulnerable road user safety assessment that includes specific information about each non-motorist fatality and serious injury in the last five years, identifies high-risk locations, and identifies possible projects and strategies for improving safety for non-motorists in those locations. Creates a new program to improve the ability of children to walk and ride their bikes to school by funding projects including sidewalk improvements, speed reduction improvements, crosswalk improvements, bike parking, and traffic diversions away from schools. Up to 30% of the money can be used for public awareness campaigns, media relations, education, and staffing. No additional funding is provided. It will be funded with existing funds for "administrative expenses". Each state will get a minimum of $1 million. Non-profit organizations are eligible, along with local governments, to receive and spend the funding. Non-profits are the only entities eligible to receive money for educational programs about safe routes to school. Allows the Transportation Secretary to allocate funds for dedicated bus lanes Adds "shared micromobility" projects (like bike shares) to the list of projects that can be funded as a highway project Electric bike-share bikes must stop assisting the rider at a maximum of 28 mph to be classified as an "electric bicycle" Requires each state, in return for funding, to carry out 1 or more project to increase accessible for multiple travel modes. The projects can be... The enactment of "complete streets standards" (which ensure the safe and adequate accommodation of all users of the transportation system) Connections of bikeways, pedestrian walkways, and public transportation to community centers and neighborhoods Increasing public transportation ridership Improving safety of bike riders and pedestrians Intercity passenger rail There's a way for State's to get this requirement waived if they already have Complete Streets standards in place Creates a grant program, funded at a minimum of $10 million per grant, for projects aimed at reducing highway congestion. Eligible projects include congestion management systems, fees for entering cities, deployment of toll lanes, parking fees, and congestion pricing, operating commuter buses and vans, and carpool encouragement programs. Buses, transit, and paratransit vehicles "shall" be allowed to use toll lanes "at a discount rate or without charge" By the end of 2022, the Secretary of Transportation needs to create a competitive grant pilot program to fund "bollard installation projects", which are projects that raise concrete or metal posts on a sidewalk next to a road that are designed to slow or stop a motor vehicle. The grants will pay for 100% of the project costs Appropriates only $5 million per year through 2026 By early 2023, the Transportation Department has to conduct a study on the existing and future effects of self-driving cars on infrastructure, mobility, the environment, and safety. Creates a grant program authorized for $1 billion total that will fund walking and biking infrastructure projects that each cost $15 million or more and connect communities to each other, including communities in different states, and to connect to public transportation. The Federal government will pay for 80% of the project costs, except in communities with a poverty rate over 40% (the Federal government will pay 100% of the project costs in impoverished communities). A Federal regulation will be created by November 2023 which will require new commercial vehicles to be equipped with automatic braking systems and there will be performance standards for those braking systems. Creates a three year pilot program, capped at 3,000 participants at a time, for people under 21 to be trained by people over the age of 26 to become commercial truck drivers. Drivers under the age of 21 are not allowed to transport any passengers or hazardous cargo A Federal regulation will be created by November 2023 requiring that limousines have a seat belts at every seating position, including side facing seats. Prohibit the Federal Government from withholding highway safety money to the states that refuse to require helmets for motorcycle drivers or passengers who are over the age of 18. Creates a grant program (by November 2023) that will fund states that want to create a process for notifying vehicle owners about any open recalls on their cars when they register their cars with the DMV. The state receiving the money is only required to provide the notifications for two years and participation in general is voluntary. Creates financial incentives for states to create laws that prohibit drivers from holding "a personal wireless communications device" while driving, has fines for breaking that law, and has no exemptions for texting when stopped in traffic. There are exceptions for using a cell phone for navigation in a "hands-free manner" Creates financial incentives for states to create laws that require curriculum in driver's education courses to include information about law enforcement procedures during traffic stops and the rights and responsibilities of the drivers when being stopped. The states would also have to have training programs for the officers for implementing the procedures that would be explained to drivers. Requires the Secretary of Transportation to implement all of the national-level recommendations outlined in a by the end of November 2022. Authorizes a little over $1 billion total for vehicle safety programs from 2022 through 2026 By November 2023, the Transportation Department will have to issue a regulation requiring fossil fuel powered vehicles with keyless ignitions to have an automatic shutoff system to prevent carbon monoxide poisoning. The amount of time that must trigger the shut off will be determined by the regulators. If the regulation is issued on time, this would go into effect most likely on September 1, 2024. The Secretary of Transportation must issue a regulation establishing minimum standards for crash avoidance technology that must be included in all vehicles sold in the United States starting on a date that will be chosen by the Secretary of Transportation. The technology must alert the driver of an imminent crash and apply the breaks automatically if the driver doesn't do so. The technology must include a land departure system that warns the driver that they are not in their lane and correct the course of travel if the driver doesn't do so. Repeals that required the Transportation Department to publish criteria that established timelines and performance requirements for anyone who got a grant to implement the Next Generation 9-1-1 project. By November 2024, the Secretary of Transportation will have to finish a regulation that requires passenger motor vehicles to be standard equipped with "advanced and impaired driving prevention technology" The technology must be able to monitor the performance of a driver and/or their blood alcohol level and be able to prevent or limit the car's operation if impairment is detected or if the blood alcohol is above the legal limit. This will apply to new cars sold after November 2030 at the latest. By November 2023, the Secretary of Transportation must finish a regulation requiring all new passenger vehicles to have a system alerting the driver visually and audibly to check the back seat when the car is turned off. Says it will be activated "when the vehicle motor is deactivated by the operator" Hearings February 2, 2022 Overview: The purpose of this hearing is for Members of the Subcommittee to explore the impact of automated vehicle deployment, including automated trucks and buses, on mobility, infrastructure, safety, workforce, and other economic and societal implications or benefits. Cover Art Design by Only Child Imaginations Music Presented in This Episode by