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Taxpayer's Tab Issue #19

May 15, 2014




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America's Long-Term Debt Problem

Presidential TravelAlthough tax receipts to the Treasury forecast by the Government Accountability Office (GAO) are currently at a record high, taxpayers will see higher deficits and more debt over the long term. NTUF Policy Analyst Michael Tasselmyer looked at why GAO found that spending will rapidly outpace tax revenue in the coming years in a blog post on Government Bytes.

Through a combination of changing demographics (baby boomers retiring) and enacted legislation (such as the Affordable Care Act and the slow drawback of sequestration savings), taxpayers can expect their tax dollars to make up a smaller piece of the budgetary pie. Without reform, America will have to borrow more and more to sustain its entitlement programs. Check out the GAO spending comparisons and breakdowns on Michael's blog post. Leave a comment if you have an idea to cut spending!

Michael and the NTUF research team is able to get taxpayers the information they need through the support of Americans like you! We are planning to release our BillTally project findings to more grassroots activists and policy experts but we need your help. Please consider making a tax-deductible donation to help get vital spending information to taxpayers across the country.

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Most Expensive Bill of the Week

The Bill: H.R. 4496, the Covering People With Pre-Existing Conditions Act of 2014

Cost Per Year: $1.5 billion ($7.5 billion over five years)

Congressman Cory Gardner (R-CO)One of the most often recited defenses of the President’s Affordable Care Act (ACA) is that, starting this year, it prohibits insurers from denying coverage to individuals with pre-existing medical conditions. Before the overhaul prohibited this practice, companies were able to calculate the potential costs of insurance applicants and enrollees and could deny or drop them from coverage if they were found to be too expensive. Patients could appeal denials or switch to other services, including other private insurers or possibly state or federal health programs.

To bridge the gap until the establishment of the exchanges, the ACA set up a Pre-Existing Condition Insurance Plan (PCIP), also known as a high risk pool. It began providing coverage in August 2010 through $5 billion in funding from the Department of Health and Human Services (HHS). Although it was authorized through the end of last year, HHS extended PCIP through April.

By its very nature, the PCIP was an expensive program to maintain: covering large numbers of people with pre-existing conditions is a very costly proposition, and one that government officials realized could quickly become financially unsustainable. PCIP enrollment grew rapidly after its inception, and in just one year (from January 2012 to January 2013) the program went from having 84 percent of its appropriations left to less than half. HHS stopped accepting new applications in February 2013 to ensure that the program would have enough funding to cover the 114,959 people who had signed up through the program’s spring 2014 expiration (when all Americans would have access to coverage either through the ACA’s online exchanges or an employer, or directly from an insurance provider).

Of course, the ACA has been controversial ever since its introduction; the House has now voted at least 54 times on proposals (including amendments) to repeal the law in its entirety or to modify sections of it, and many lawmakers plan to continue pushing for its modification or full or partial repeal. One Representative -- Cory Gardner (R) of Colorado -- has introduced legislation that would extend coverage to many previously uninsured Americans in anticipation of the ACA’s repeal.

Rep. Gardner’s H.R. 4496 would offer federal funding for states to establish or expand high-risk insurance pools, which are similar to the PCIP program, but which actually pre-date the ACA. They are designed to provide coverage to those with pre-existing conditions without access to public or group health insurance, and have existed in some states since the 1970’s. By 2008, 34 states had operational high risk pools. They received federal funding for the first time as part of the Trade Act of 2002 ($100 million in “seed grants” and subsidies to cover operational costs).

H.R. 4496 would limit premiums in high-risk pools to 150 percent of the average standard risk rate in each state’s jurisdiction. The bill provides a total of $15 billion over ten years, an average of $1.5 billion per year, to assist states in expanding or establishing pools and covering those who enroll. An additional $10 billion is authorized to be spent from 2020 to 2024. capitol_dome_tinytaxtabhaticonalpha.png

The Bottom Line: The Covering People With Pre-Existing Conditions Act would establish high-risk pools similar to the Pre-Existing Condition Insurance Plan under the Affordable Care Act. It would cost $7.5 billion over the next five years.


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Most Friended

The Bill: H.R. 4450/S. 2250, the Travel Promotion, Enhancement, and Modernization Act of 2014

Cost Per Year: “No Cost” – No New Funding

Number of Cosponsors: 66 House Members and 25 Senators

Congressman Gus Bilirakis (R-FL)According to the Congressional Research Service, tourism accounted for 2.8 percent of U.S. GDP in 2013 and supported 5.7 million jobs. Competition for international tourism is intense, and while Europe and North America remain popular destinations, their combined share of the global market has decreased by 20 percent since 1980, and is forecast to continue to decline. Though, in raw numbers, the numbers of tourists visiting the U.S. has increased remarkably since 2003. A record 70 million tourists visited the country in 2013, second only to France.

To regain the share of global travel, President Barack Obama signed the Travel Promotion Act of 2009 during the 111th Congress. It established the Corporation for Travel Promotion -- now known as Brand USA -- which is a public/private organization dedicated to promoting international tourism to the United States. Brand USA and its 11-member board of directors acts essentially as a marketing agency, working to raise America’s profile as a travel destination, and advise Congress on how to improve tourists’ travel experiences.

The program marked the re-establishment of a standing federal entity dedicated to promote travel. In 1996, Congress eliminated the former United State Travel and Tourism Administration ($18 million in outlays in FY 1995). Brand USA works closely with the National Travel and Tourism Office in the Commerce Department’s International Trade and Investment Administration.

Senator Amy Klobuchar (D-MN)Brand USA’s funding comes from a combination of private donations and up to $100 million from fees collected by the federal government as part of its Electronic System for Travel Authorization (ESTA), an automated program that verifies international travelers are eligible to pass through U.S. Customs. ESTA fees currently cost each visitor $4 to apply and an additional $10 if they receive authorization to travel to the U.S. For FY 2014, Brand USA projected about $125 million in expenses, including $3 million for marketing research, $35 million for marketing materials and activities, and $53 million for “partnership services.” In 2009 CBO estimated similar amounts, with outlays totaling $630 million over the 2010-2014 period (or about $126 million per year).

The program is authorized until 2015, and in order to preserve the organization, Congressman Gus Bilirakis (R-FL), who is co-chair of the Congressional Travel and Tourism Caucus, and Senator Amy Klobuchar (D-MN) introduced the Travel Promotion, Enhancement, and Modernization Act. The legislation would extend the Travel Promotion Act’s provisions through 2020, and modify some of the metrics by which Brand USA measures its impact. Additionally, the bill would require periodic reports to Congress justifying the marketing strategies it employs to increase international tourism to the U.S.

The Travel Promotion Act’s reauthorization is also included in the House’s immigration reform bill, but legislative inactivity prompted Rep. Bilirakis and Sen. Klobuchar to introduce a separate measure.

The legislation extends Brand USA’s authorization without increasing or adjusting federal funding and matching requirements. Bills that extend authorizations of programs without making substantive changes are not included in BillTally because they result in no net change to the budget. Moreover many programs with expired authorizations continue to receive funding anyway. Each January, the Congressional Budget Office (CBO) compiles a list of unauthorized appropriations and expired authorizations.

Cosponsors include 42 Democratic and 19 Republican House Members. The Act is currently supported by 13 Democratic and 12 Republican Senators. capitol_dome_tinycapitol_dome_tinytaxtabhaticonalpha.png

The Bottom Line: The Travel Promotion, Enhancement, and Modernization Act of 2014 would reauthorize the Travel Promotion Act of 2009 through 2020. The organization receives up to $100 million in government funding per year via offsetting fees on travelers from abroad.


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The Wildcard

The Bill: H.R. 2285/S. 2236, the Strategies to Address Antimicrobial Resistance (STAAR) Act

Cost Per Year: $100 million ($500 million over five years)

Congressman Jim Matheson (D-UT)According to the Centers for Disease Control and Prevention (CDC), over 2 million Americans contract infections from bacteria that are resistant to antibiotics; at least 23,000 of them die as a result. Antibiotic resistance occurs when particular strains of bacteria adapt over time to the drugs used to treat infected patients. In a recent report, the CDC lists three specific types of bacteria as “urgent” threats, representing “immediate public health threats that require urgent and aggressive action.” Many more are listed as slightly lesser “serious” threats.

In its FY 2015 budget justification, the CDC requested $445 million for activities related to “Emerging and Zoonotic Infection Diseases,” including $30 million above FY 2014 funding levels for antimicrobial resistance initiatives. Congressman Jim Matheson (D-UT) and Senator Sherrod Brown (D-OH) felt that more is needed to be done on the issue and introduced the Strategies to Address Antimicrobial Resistance (STAAR) Act in their respective Chambers. “Antibiotics and other antimicrobial drugs have been a victim of their own success. ... We need a comprehensive strategy to address antimicrobial resistance,” Sen. Brown said in a statement.

Senator Sherrod Brown (D-OH)One of the provisions in the STAAR Act reauthorizes the Interagency Task Force on Antimicrobial Resistance (“the Task Force”). The Task Force is made up of representatives from several government agencies, including the National Institutes of Health, the Food and Drug Administration, and the CDC. Together, they coordinate research and outreach efforts aimed at mitigating the spread of antibiotic resistance, which includes advocating for proper antibiotic prescription, tracking infections that could develop resistance, and researching and developing new antibiotic drugs.

Because certain diseases are more or less prevalent in different parts of the country, the bill also establishes regional health centers and programs designed to “implement evidence-based interventions” to prevent further infections. The legislation would require the CDC to set up at least 10 Antimicrobial Resistance Surveillance and Laboratory Network sites across the country to expand research- and prevention-related activities. It is unclear whether this will require additional funding.

H.R. 2285 and S. 2236 would reauthorize certain antimicrobial resistance programs established in the Public Health Service Act through 2019. It would also create a new program within the National Institute of Allergy and Infectious Diseases (NIAID) to conduct additional research and development, funded at $100 million per year. The bill states that the funding comes from “the existing budget” of the NIAID but there are no offsetting provisions; because of this, NTUF assumes, unless the CBO determines otherwise, that those amounts will actually be in addition to existing budgetary resources. For FY14, the NIAID’s budget authority for research related to emerging infectious diseases was about $1.27 billion. capitol_dome_tinycapitol_dome_tinytaxtabhaticonalpha.png

The Bottom Line:The STAAR Act would increase federal spending by $100 million per year for research that prevents antibiotic resistance.