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Bill language expected to ask for study but not to stop new TB rule
As the war of nerves escalates in the debate over whether the country will get new federal guidelines aimed at protecting health care workers against TB, members of the House Appro priations Subcommittee have struck a verbal agreement to include language asking for a study of TB risks as part of an appropriations bill. The language intentionally avoids more drastic remedies, such as cutting off funding to the Office of Safety and Health Administration (OSHA) or asking Congress to block the proposed standard. That means, theoretically, OSHA could stay on track with its schedule, and the new TB standard could assume force of law by early next year.
Lobbyists for the Washington, DC-based Association of Professionals in Infection Control (APIC), which opposes the proposed standard, were banking hard that OSHA would blink. Specifically, the hope was that the feds wouldn’t go ahead until the study was completed, lest findings unfavorable to OSHA’s position would force an embarrassing retraction of an already-published standard. As this issue of TB Monitor went to press, OSHA officials, betting the bill language would be scrapped before it could do any damage, kept mum on the subject of what they would do next.
Last month, in what the standard’s opponents describe as a fresh tactic, APIC members tried to call OSHA’s bluff by asking only for the study of TB risk, instead of seeking to block the standard more directly. OSHA officials held their own cards close as they waited to see what Congress would do.
"You say they’re just adding bill language,’ but what this sounds like to me is a rider," says Frank Kaine, OSHA spokesman. "And the head of Senate Appropriations [Sen. Bill Archer (R-TX)] has made it clear he doesn’t like riders," which are often viewed as sneaky backdoor maneuvers. "So it seems premature to make a comment."
The next day, Kaine called back with the agency’s official statement on the subject: "Given that we’ve re-opened the record twice for new information, we hope Congress doesn’t take any action to further delay the standard, since more delay will lead to more ways of contracting TB."
That left some observers wondering why opponents of the TB standard didn’t just go for broke and ask Congress directly to stop the standard. The decision not to was a calculated gamble, says Jennifer Thomas, director of govern ment and public affairs for APIC and author of the proposed bill language. "Trying to stop it altogether could cause certain members of Congress to take a lot of heat and potentially could cause huge problems," she says. "So we agreed it would be better to make it look like an objective decision — to let the science speak for itself."
Though she’s not worried that a study, if commissioned and carried out, would find evidence solidly in APIC’s favor, the tack still could backfire, Thomas concedes. "There’s no guarantee at all that OSHA will hold off on issuing the rule," she says. "They’ve done it before — issued a ruling while a study was still under way."
IOM asked to conduct TB study
What the language asks for specifically is a study to be carried out by the Institute of Medi cine (IOM). Three IOM members reportedly have met with Thomas and Rep. Thomas Wicker (R-MS), the official sponsor of the bill language. At that meeting, all present agreed on the need for a study, Thomas says; plus, the IOM representatives promised the institute would do the study if Congress asked. "That itself is a huge step forward," she adds.
Still, the language asking for the study has made it only to first base, insiders point out; that is, although verbal agreements are usually considered to be binding, they still don’t hold the weight of words on paper.
That stage wasn’t expected to take place until sometime after Sept. 6, and perhaps as late as Sept. 13 or 14, when the bill is expected to go to what’s called "mark-up" — the lengthy and often grueling session where subcommittee members meet and literally "mark up" the text of a proposed piece of legislation, adding and subtracting portions of text as they go.
Along with Wicker, the designated "water- carrier" for the language, there are said to be other anti-OSHA allies in Congress. Most importantly, Rep. John Porter (R-IL) — chair of the House Appropriations Subcommittee that apportions out funding to labor, health and human services, and education — has agreed to lend his behind-the-scenes support for the move, Thomas says. Though Porter reportedly can’t lend direct support (which wouldn’t be politically kosher because he’s the subcommittee chair), he’s still said to be eager to corral votes and mediate disputes when the time comes.
Trying to predict the outcome of anything related to the appropriations process is notoriously tricky, says Thomas. "I hear labor groups are really upset about this latest move. I expect we’ll be taking a pounding from them."
If the dour mood in the headquarters of one union is any sign of what lies ahead, Thomas might want to break out the champagne. "Quite frankly, I’m sick of all this," says William K. Borwegen, MPH, occupational safety and health director of the Washington, DC-based Service Employees’ International Union, which represents about 650,000 health care workers. "I feel like there’s nothing more I can do. I’m ready to move onto other stuff."