The relevance of Sen. Susan Collins' support for her party's tax reform package may once more be in play after it was revealed that at least one of the Maine lawmaker's Republican colleagues would not be in Washington to vote on the bill, while another's endorsement may again be in jeopardy.
The status as a key player once again may potentially give Collins more leverage to get two healthcare bills through the House and the Senate — an outcome on which she partially hinged her support for the tax legislation.
Collins has argued that the two healthcare measures, one of which she co-sponsored, would counter any negative effects of the provision in the tax reform package that would eliminate the Affordable Care Act's individual mandate, a requirement for eligible Americans to buy health insurance or pay a tax penalty.
Collins' vote on the final tax reform package had been viewed as critical to its passage.
But that changed Dec. 15 after Sen. Bob Corker, R-Tenn., reversed course, declaring the "once-in-a-generation opportunity to make U.S. businesses domestically more productive and internationally more competitive" outweighed his concern over the tax bill's impact in raising the nation's deficit.
After Sen. Marco Rubio, R-Fla., also came around to supporting the tax bill, Republicans appeared to have the 50 votes they needed without Collins, meaning her vote was no longer as vital as it once was.
"I'm confident we'll pass this bill, probably on Tuesday," Sen. John Cornyn, R-Texas, the second in command in the Senate, said Dec. 17 on ABC's "This Week."
"I have no doubt" Congress will pass the tax bill, Treasury Secretary Steven Mnuchin said on "Fox News Sunday."
"People said we wouldn't get this done, [but] we're on the verge of getting this done," Mnuchin added on CBS' "Face the Nation."
Speaking on Fox's "Sunday Morning Futures," Rep. Kevin Brady, R-Texas, chairman of the House Ways and Means Committee, also expressed confidence.
"We are on the 1-yard line and we intend to punch it in, in a good strong way," Brady said.
But after news broke that a provision that was slipped into the final bill would greatly benefit people with large commercial real estate holdings, including Corker and President Donald Trump, the Tennessee senator, who claimed he was unaware of the measure's addition before lending his support to the legislation, raised concerns. Corker called on Senate Finance Committee Chairman Orrin Hatch, R-Utah, on Dec. 17 to explain how the measure made it into the final tax reform package.
It remains unclear whether Corker will again withdraw his support, but with an ailing Sen. John McCain, R-Ariz., whose office said Dec. 17 that he would now not return to the Senate until January — meaning he will miss the tax vote — and the uncertainty over the health of Sen. Thad Cochran, R-Miss., the status of where Collins stands on the legislation is again more significant.
The Maine senator has put her trust in Senate Majority Leader Mitch McConnell, R-Ky., and House Speaker Paul Ryan, R-Wis., in getting their Republican colleagues on board with the healthcare bills.
McConnell told Collins he supported the passage of the two healthcare measures "certainly before the end of this year."
Collins is anticipating the healthcare bills to be attached to the continuing resolution to fund the U.S. government, which needs to be voted on by Dec. 22 to keep federal agencies open.
But the House is scheduled to vote on the tax reform package ahead of the government funding measure — on Dec. 19 — with the Senate expected to follow shortly thereafter.
So even if Collins votes in favor of the tax package, she has no guarantee the two healthcare bills she supports will be enacted.
Them's fightin' words
The new head of the Centers for Disease Control and Prevention said Dec. 17 that her agency has not banned the use of certain terms, such as vulnerable and diversity.
CDC Director Brenda Fitzgerald was responding to criticism of her agency after The Washington Post reported that government policy analysts were directed not to use seven specific terms — vulnerable, entitlement, diversity, transgender, fetus, evidence-based and science-based — in preparing budgetary documents and related materials and communications.
According to the Post's Dec. 15 report, analysts were told to instead use alternative phrases. For instance, in place of science-based or evidence-based, they were advised to use "CDC bases its recommendations on science in consideration with community standards and wishes," the Post said, citing anonymous sources, who claimed to work at the agency.
But in a series of tweets, Fitzgerald disputed the Post's reports, claiming the assertion the CDC and its parent agency, Health and Human Services, or HHS, had banned the use of certain words was a "complete mischaracterization of discussions regarding the budget formulation process."
"HHS will continue to use the best scientific evidence available to improve the health of all Americans," she tweeted.
"I want to assure you there are no banned words at CDC," Fitzgerald wrote on Twitter. "We will continue to talk about all our important public health programs."
"You may be understandably concerned about recent media reports alleging that CDC is banned from using certain words in budget documents. I want to assure you that CDC remains committed to our public health mission as a science- and evidence-based institution," she continued.
"As part of our commitment to provide for the common defense of the country against health threats, science is and will remain the foundation of our work," she said. "CDC has a long-standing history of making public health and budget decisions that are based on the best available science and data and for the benefit of all people — and we will continue to do so.
"HHS also strongly encourages the use of outcome and evidence data in program evaluations and budget decisions," Fitzgerald said.
Asked about the Post's reports, the Treasury chief, Mnuchin, said he had "absolutely" not been told to ever ban certain words.
"Nobody has told me not to use certain words, and I have never told anybody in Treasury not to use certain words," Mnuchin said during a Dec. 17 appearance on CNN's "State of the Union."
Love letters
On the same day Amicus Therapeutics Inc. said it had submitted an application seeking U.S. approval of its Fabry disease drug migalastat — reaching a milestone its CEO said months earlier would take several years to achieve — a nonprofit watchdog group revealed personal correspondences from the company's chief to the head of the Food and Drug Administration, raising questions about the agency's decision to permit the medicine's speedier path to a review.
The FDA had told Amicus in November 2016 that another study would be needed before it could accept its application for migalastat as a treatment for Fabry, a progressive inherited lysosomal storage disorder that results in pain, kidney failure, heart disease and stroke.
But the agency suddenly reversed course in July, allowing Amicus to use existing data rather than making the company complete the additional phase 3 study.
Two months earlier, Amicus CEO John Crowley had appealed directly to newly confirmed FDA Commissioner Scott Gottlieb to allow such a move.
"As discussed, the hopes and well being of so many living with rare, devastating diseases rests now with your great leadership and wisdom," Crowley wrote to Gottlieb in a handwritten personal note, which was uncovered through a Freedom of Information Act request from the nonprofit watchdog Project on Government Oversight.
In an attached letter, Crowley said the additional study requested by the FDA would take five to seven years to complete — an estimate that was unusually long for such a trial.
A few months earlier, Crowley had met with Trump, who featured Amicus in his Feb. 28 speech to a joint session of Congress, where he said the company's experiences with the FDA were an example of the agency's "slow and burdensome approval process."
An FDA spokeswoman claimed Gottlieb was not aware of Crowley's letter and was not involved in the decision to permit the company to submit its migalastat application for review without the additional phase 3 study data, according to a Dec. 15 report by the online news site Endpoints.
Amicus is now waiting to hear whether the FDA will accept for review and then approve the company's migalastat application.
