Monday, December 23, 2013

WASHINGTON- Sen. Chuck Grassley has joined 42 other senators in requesting the Occupational Safety and Health Administration (OSHA) to stop unlawful regulations on small family farms.

Since 1976, Congress has exempted small, family-run farms with 10 or fewer employees from OSHA regulations.  However, in a 2011 memo, OSHA asserted that on-farm grain storage and handling was not part of farm operations.  By viewing grain storage as distinct from the farming operation, the senators' request said OSHA is creating an artificial distinction that would subject virtually every farm to OSHA regulations without allowing for congressional review and public comment, and in defiance of the law.

"OSHA is overstepping its bounds here," Grassley said.  "Grain storage is an essential part of farming.  The federal government is expanding its reach to include farms that should be exempt, and is doing so despite the clear intent of Congress."

The request from senators was made in a letter to Department of Labor Secretary Thomas Perez, who oversees OSHA, as well as to OSHA, asking that OSHA update guidance correcting its misinterpretation of the law.

This bipartisan effort is led by Sen. Mike Johanns (R-Neb.).  The letter also was signed by Sens. Lamar Alexander (R-Tenn.), Kelly Ayotte (R-N.H.), John Barrasso (R-Wyo.), Michael Bennet (D-Colo.), Roy Blunt (R-Mo.), John Boozman (R-Ark.), Richard Burr (R-N.C.), Saxby Chambliss (R-Ga.), Dan Coats (R-Ind.), Tom Coburn (R-Okla.), Thad Cochran (R-Miss.), John Cornyn (R-Texas), Mike Crapo (R-Idaho), Mike Enzi (R-Wyo.), Deb Fischer (R-Neb.), Jeff Flake (R-Ariz.), Lindsey Graham (R-S.C.), Orrin Hatch (R-Utah), John Hoeven (R-N.D.), Jim Inhofe (R-Okla.), Johnny Isakson (R-Ga.), Ron Johnson (R-Wis.), Mark Kirk (R-Ill.), Mike Lee (R-Utah), John McCain (R-Ariz.), Mitch McConnell (R-Ky.), Jerry Moran (R-Kan.), Rand Paul (R-Ky.), Rob Portman (R-Ohio), Mark Pryor (D-Ark.), Jim Risch (R-Idaho), Pat Roberts (R-Kan.), Marco Rubio (R-Fla.), Tim Scott (R-S.C.), Jeff Sessions (R-Ala.), Jeanne Shaheen (D-N.H.), Richard Shelby (R-Ala.), Pat Toomey (R-Pa.), John Thune (R-S.D.), David Vitter (R-La.) and Roger Wicker (R-Miss.).

The text of the letter is below. A copy of the signed letter can be found here.

 

December 20, 2013 

The Honorable Thomas E. Perez
Secretary
U.S. Department of Labor
200 Constitution Avenue, N.W.
Washington, DC 20210

Dear Secretary Perez:

We write to you regarding reports that regulators at the Occupational Safety and Health Administration (OSHA) have begun taking regulatory actions against farms that are specifically exempted by Congress from regulatory enforcement conducted by OSHA. Since 1976, Congress has included specific language in appropriations bills prohibiting OSHA from using appropriated funds to apply requirements under the Occupational Safety and Health Act of 1976 to farming operations with 10 or fewer employees.

It has come to our attention that OSHA is now interpreting this provision so narrowly that virtually every grain farm in the country would be subject to OSHA regulations.  OSHA's interpretation defies the intent of Congress in exempting farming operations from the standards of the Occupational Safety and Health Act.

In viewing a farm's "grain bin operation" as somehow distinct from its farming operation, OSHA is creating an artificial distinction in an apparent effort to circumvent the Congressional prohibition on regulating farms.  The use of grain bins is an integral part of farming operations.  Without grain bins, farmers must sell corn and soybeans immediately after harvest, when prices are usually low.  Storing grain in bins is thus a fundamental aspect of farming.  Any farm that employs 10 or fewer employees and used grain bins only for storage prior to marketing should be exempt, as required by law, from OSHA regulations.

A memo issued by the Director of Enforcement Programs on June 28, 2011, stated that "many of these small farm employers mistakenly assume that the Appropriations Rider precludes OSHA from conducting enforcement activities regardless of the type of operations performed on the farm."  The memo declares that all activities under SIC 072?including drying and fumigating grain?are subject to all OSHA requirements (the memo did not even mention grain storage).  There are many farms that have grain dryers on-farm to address wet harvest conditions or fumigate grain to prevent pests from ruining a crop prior to marketing.  These are basic, common, and responsible farming activities that OSHA has arbitrarily decided are non-exempt.

Worker safety is an important concern for all of us?including the many farmers who probably know better than OSHA regulators how to keep themselves and their employees safe on farms.  If the Administration believes that OSHA should be able to enforce its regulations on farms, it should make that case to Congress rather than twisting the law in the service of bureaucratic mission creep.  Until then, Congress has spoken clearly and we sincerely hope that you will support America's farmers and respect the intent of Congress by reining in OSHA.

We would ask that you direct OSHA to take the following three steps to alleviate this concern.  First, OSHA should cease all actions predicated on this interpretation, which is inconsistent with Congressional intent.  It is important that OSHA also issue guidance correcting this misinterpretation of the law.  We suggest consulting with the U.S. Department of Agriculture and organizations representing farmers to assist with this guidance.  Finally, we ask that OSHA provide a list and description of regulatory actions taken against farms with incorrectly categorized non-farming activities and 10 or fewer employees since the June 2011 memo.  Given the nearly four decades of Congressional prohibition of OSHA enforcement against farms, this should be a simple request to fulfil.

We would appreciate your response by February 1, 2014, to include a copy of the corrected guidance, the data regarding enforcement actions on farms, and confirmation that OSHA will cease such enforcement.

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Friday, December 20, 2013

Senator Chuck Grassley of Iowa, one of two working family farmers in the Senate, made the following comment about the current status of the farm and nutrition bill negotiations and his provisions to place a hard cap on farm payments and the actively engaged loophole.

"As members of Congress head home for the holidays, farm bill negotiators still have a to-do list.  It's my understanding that the last remaining issue to be resolved is my provision to place a hard cap on farm payments and close the loophole that tens of thousands of people are using claiming to be actively engaged in the business of farming.  These provisions are in both bills, and should not be subject to negotiation.  They should have DO NOT TOUCH stamped across that section of the bill.  Unfortunately, the minority in both the House and Senate who voted against these provisions are a majority on the conference committee, so it remains a fight to the end.  To close loopholes for food stamps, but leave open loopholes for the biggest farmers to exploit taxpayers is the wrong way to do business.  We ought to apply scrutiny and end abuse in all programs."


Friday, Dec. 20, 2013

WASHINGTON -- Sen. Chuck Grassley of Iowa and Sen. Bob Casey of Pennsylvania said today they hope to advance their proposal to make it easier for the residents of Continuing Care Retirement Communities to receive Medicare services through care coordination and disease management services provided onsite.  These services would avoid hospitalizations and lower the total cost of care for seniors as they age in place, and their needs increase.

"The physician payments bill approved in committee depends on the creation of models where providers are willing to take on risk and provide quality care," Grassley said.  "If nursing home communities are willing to meet those goals and standards, we should allow them that opportunity.  The Center for Medicare and Medicaid Innovation should be testing models like the one suggested in this amendment."

"While Congress has taken steps to more toward better care coordination, we must continue to look for innovative ways to move the Medicare program forward when treating beneficiaries with multiple chronic conditions," Casey said.  "I believe Continuing Care Retirement Communities (CCRC) in Pennsylvania and around the country are up to this challenge."

Grassley and Casey filed but not offer an amendment to the physician payments bill considered in the Finance Committee last week that would require the federal Center for Medicare and Medicaid Innovation to consider allowing Continuing Care Retirement Communities to receive Medicare services provided under a risk-adjusted, per-person payment arrangement.   Grassley and Casey said these arrangements could improve the efficiency and quality of senior care and align incentives to provide the right care, at the right time, in the right setting.

Medical homes, care coordination and disease management are among the most promising strategies for cost containment and quality improvement in health care delivery, especially the costs associated with Medicare beneficiaries with chronic conditions, the senators said.  There are currently 2,000 Continuing Care Retirement Communities in the United States.  Recent studies, including one in the New England Journal of Medicine, demonstrate that a congregate senior living environment such as in Continuing Care Retirement Communities is the ideal setting to integrate strategies to lower costs and improve outcomes for Medicare seniors because of the near-constant interaction between staff and residents.

Under the Grassley-Casey proposal, the Continuing Care Retirement Communities would accept a diverse group of independent, non-acute seniors whose mix of chronic conditions could benefit from the care coordination and disease management services provided onsite to avoid hospitalizations and lower the total cost of care for seniors as they age in place and their needs increase.  An interdisciplinary health care team led by salaried primary care physicians would integrate comprehensive primary and post-acute health care services into the residential community and coordinate acute and specialist care.  Beneficiaries would receive Medicare services provided under a risk-adjusted, capitated payment arrangement.

Grassley and Casey said they will look for legislative opportunities to advance this proposal in the coming months.

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December 20, 2013

~ Bipartisan Military Whistleblower Protection Act will now go the President for his signature ~

WASHINGTON - Bipartisan legislation sponsored by Sens. Mark R. Warner (D-VA), Susan Collins (R-ME), Tim Kaine (D-VA) and Chuck Grassley (R-IA)  to strengthen military whistleblower protection laws to ensure those who report sexual assault and other misconduct are not further victimized by retaliation passed the Senate and will become law. The Military Whistleblower Protection Act was passed as part of the National Defense Authorization Act (NDAA) on a bipartisan 85-14 vote and will now go to the President for his signature. The Military Whistleblower Protection Act is supported by over 50 good government, public health and veterans organizations, including the Service Women's Action Network, and leading whistleblower protection organizations including the Project on Government Oversight and the Government Accountability Project.

"This legislation is an important first step toward better protecting our military men and women from misconduct, including sexual assault," Warner said. "The Military Whistleblower Protection Act will encourage our service members to report fraud, waste and abuse and provide them with the retaliation-free working environment they deserve. Virginia has a strong military tradition and I am proud that this legislation will now become law."

"Whistleblowers play a crucial role in Congressional efforts to prevent waste, fraud, and abuse and to help ensure the effectiveness of government programs.  They provide crucial information that Congress needs to conduct proper oversight of the federal government," said Collins.  "This amendment increases whistleblower protections for the military and encourages whistleblowers to report misconduct, especially as it relates to sexual assault. Our military men and women deserve a justice system that protects them while they serve our country."

"With passage of the Military Whistleblower Protection Act, victims and witnesses of sexual assault and other serious crimes will now be better protected from retaliation," said Kaine. "Too many incidents of sexual assault go unreported, and this bill works to change that by enhancing protections for whistleblowers and fostering a safer, more supportive environment for our service members. I was proud to sponsor this legislation and will continue to support measures that tackle the longstanding problem of sexual assault in the military."

"Military personnel have an unbelievably difficult time when blowing the whistle on misconduct, fraud or even sexual assault.  Too often, these complaints get tossed into the garbage for no good reason.  To make matters worse, retaliation seems to be the norm rather than the exception.  There's a lot left to be done in this area, but inclusion of the Military Whistleblower Protection Act in the Defense Reauthorization is a good step forward for whistleblowers," Grassley said.

The bipartisan Military Whistleblower Protection Act expands whistleblower protections to witnesses as well as victims, and ensures action is taken both to provide corrective relief to victims of retaliation and to discipline those who retaliate. It also extends the current 60-day period to file a report to one year, bringing it more in line with other federal and contractor whistleblowers who have longer reporting periods?often up to three years to report misconduct. Additionally it speeds up the process and ensures accountability by compelling the Service Secretary to take action within 30 days of receiving a report from an Inspector General, and requires that the investigations are conducted by an Inspector General at least one organization higher that the individuals' involved to prevent any conflicts of interest.  Finally, it requires the service branches to actively support those with confirmed cases of retaliation by ensuring that their military record is referred to the Board for Military Correction of Records and provides legal assistance to the victim, rather than the current policy of requiring victims to navigate that difficult process on their own.

Too often, the fear of retaliation deters service members from coming forward.  This legislation addresses that and encourages those who witness or were subject to sexual and other offenses to speak up.  A Government Accountability Office audit reported that more than 60% of service members who reported sexual assaults in 2012 experienced retaliation.  Less than 1% of whistleblowers who filed reprisal complaints obtained relief, and only 19% of those whom the Inspector Generals certified had experienced retaliation ever got their records corrected.   Additionally, a Pentagon study released in May 2013 and based on a confidential survey sent to more than 100,000 active-duty service members,  found as many as 26,000 members of the military experienced offenses ranging from sexual harassment to sexual assault last year. However, fewer than 3,400 individuals reported the incidents. The Department of Defense concluded most victims did not step forward because they worried about retaliation and believed that reporting the alleged offense would negatively impact their military careers.

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Floor Statement of Sen. Chuck Grassley

Iowans' Sticker Shock Under the Affordable Care Act

Delivered Thursday, Dec. 19, 2013

Mr. President, I come to the floor again to share the voice of one many Iowans who have contacted me over the sticker shock they're experiencing under the Affordable Care Act.

A constituent in Sioux County writes:

QUOTE:  I am a pastor in rural Iowa and early this past summer, trusting naively in the integrity of our President's repeated promise that "If you like your health insurance you can keep it. Period[,]" I made a change to my policy, moving to a higher deductible to save the church money.

Now I have been informed that because of that change, my policy is no longer grandfathered and therefore I will be forced out of it in a year and compelled to purchase a MUCH MORE EXPENSIVE (Un)Affordable Care Act compliant policy.

I am young, male, healthy -- and will not qualify for any subsidy.

In effect, because of legislation Democrats supported -- my government is kicking me off from health coverage that I carefully researched, chose, and like a lot -- and forcing me to buy coverage that I do not need at a price I scarcely can afford.

And [the government] has the audacity to resort to Orwellian doublespeak and call such a draconian policy the "Affordable Care Act."

Please convey to your Democratic colleagues that I grew up on a dairy farm and now pastor a church of farmers.  I am the epitome of middle class America that they claim to champion.

This bill is unjust. It is based on lies to Americans like myself.  It hurts real people -- including the church I serve.  END OF QUOTE.

I have done my job, Mr. President. I have shared this constituent's message with my colleagues.  I hope they were listening.  I yield the floor.

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The Medicaid and CHIP Payment and Access Commission (MACPAC) and the Medicare Payment Advisory Commission (MedPAC) have released a new data book, "Beneficiaries Dually Eligible for Medicare and Medicaid."  The merging of data to help inform Congress on the critical issue of dually eligible beneficiaries is an important step that Sen. Chuck Grassley of Iowa has advocated.  Grassley has previously used information that was produced from jointly reconciled data by the two organizations that was the precursor to this report. Grassley made the following comment on this development.

"Providing better coordinated care and reducing costs for high-cost beneficiaries is critical for the future of Medicare and Medicaid.   All of us need to understand the needs and the costs of covering the dually eligible and other high-cost beneficiaries before we can find rational ways to control costs and preserve needed services.  I appreciate the work of these two expert commissions to inform the debate."

The joint analysis is available here.

Sen. Chuck Grassley of Iowa, ranking member of the Senate Judiciary Committee and co-chairman of the Senate Caucus on International Narcotics Control, today made the following comment on the National Institutes of Health's 2013 Monitoring the Future Survey.  The survey measures drug use and attitudes among the nation's 8th, 10th, and 12th graders. The current survey shows high rates of marijuana use in this age group, as well as an increase in the number of students who do not view regular marijuana use as harmful.  It also shows decreases in the abuse of pain relievers and synthetic drugs.  Grassley comment -

"It's worrisome to see both increased marijuana use and a decrease in the perception of harm associated with that use.  The facts make clear that marijuana is anything but harmless.  The National Institute on Drug Abuse reports that marijuana is addictive.  In Iowa, marijuana was involved in one-fifth of all drug-related emergency department visits in 2011.  Driving while under the influence of marijuana is a growing problem within the states that have legalized its use.

"Unfortunately, some of the Obama Administration's policy priorities are contributing to the perception of marijuana's harmlessness.  The Administration's decision not to prioritize the prosecution of the large-scale trafficking and sale of marijuana sends the message to teen-agers that marijuana use is fine.  Also, as a result of the lack of enforcement at the federal and state levels, law enforcement officers in Iowa are reporting increases in marijuana coming to Iowa from Colorado.

"The good news is synthetic drug use declined significantly in the last year, going from over 11 percent to just under 8 percent among 12th graders.   It appears the legislation I helped to enact and the continued work of the Drug Enforcement Administration, state law enforcement and drug control advocates are having a positive effect there."

The survey results are available here.


Sen. Chuck Grassley of Iowa today participated in a bipartisan senators' meeting with Environmental Protection Agency (EPA) Administrator Gina McCarthy to discuss the Obama Administration's proposed reduction in the Renewable Fuel Standard (RFS).  Grassley made the following comment after the meeting.

"I'm glad Administrator McCarthy listened to senators' concerns.  I tried to impress upon her that while President Obama and his administration have claimed to be in favor of domestic biofuels, this proposal is a step backward and will harm our efforts to further diversify our fuel supply.  The fact is, the blend wall is a result of Big Oil's obstruction to higher ethanol blends, and EPA's proposal rewards its obstruction.  The Administrator heard a lot about the harm this proposal would do to the environment, our national and energy security, and our rural economies.  I also personally relayed the request of the entire Iowa delegation to host a field hearing in Iowa to hear directly from farmers and biofuels producers about the benefits of the RFS."

The bipartisan letter requesting a field hearing in Iowa is available here.

More on Grassley's views on the proposed reduction is available here.
Wednesday, December 18, 2013

WASHINGTON - Senator Chuck Grassley has nominated 55 outstanding Iowa students for consideration for appointments to the U.S. service academies.

"Young Iowans who want to enter the academies and serve our country are remarkable for their accomplishments and leadership.  These candidates are an impressive reflection on our state and signal continued excellence in the U.S. armed forces," Grassley said.

Each year Grassley has the opportunity as a U.S. senator to nominate either current or future Iowa high school graduates for a select few service academy placements.  The Air Force, Military, and Naval academies all select at least one qualified student from Grassley's nominations.  The Merchant Marine Academy makes selections in proportion to states' representation in Congress.

Grassley said he encourages Iowa students to consider applying to more than one service academy due to the highly competitive nature of admissions.  "The academies offer some of the best options for higher education, and they offer an outstanding way to serve our country," Grassley said. "It's a tremendous opportunity for young Iowans."

Students interested in academy appointments should begin the application process in the spring of their junior year of high school.  The academies select students based on the number of vacancies available for the next school year.  Senator Tom Harkin and Iowa Representatives in the U.S. House of Representatives also make nominations.  Traditionally, the high quality of Iowa nominees results in several Iowa students being selected to attend each of the service academies.

Grassley said he will make announcements as appointments to the academies are offered to Iowans.

The lists below include the names, high schools and hometowns of Grassley's nominees for the 2014-2015 school year.

 

U.S. Air Force Academy
Clayton Beck, Bondurant-Farrar High School, Bondurant

Maija Bennett, Burlington High School, Burlington

Tyler Bennink, Thomas Jefferson High School, Cedar Rapids

Dalton Doom, Waukee High School, Urbandale

Ryan Finn, Hudson High School, Hudson

Katie Gibson, Sioux Central High School, Sioux Rapids*

Tyler Runyon, Van Buren High School, Keosauqua

Tyler Stewart, Springville High School, Marion

Conner Tillo, West Burlington High School, West Burlington

Jack Walker, Wapello High School, Wapello

 

U.S. Military Academy at West Point
Anamaria Angel, Van Meter High School, Waukee

Walter DeDoncker, Pleasant Valley High School, Davenport

Hannah Fairfield, Iowa City West High School, Coralville

Harrison Farrell, Dowling Catholic High School, Des Moines

Connor Gillette, Theodore Roosevelt High School, Des Moines

Matthew Haijsman, Lewis Central High School, McClelland

Neil Harte, Iowa City High School, Iowa City

Seth Horsley, Carroll High School, Carroll

Noah Irons, Lake Mills High School, Lake Mills*

Emily Junker, Van Meter High School, West Des Moines*

Cameron Lawler, Southeast Polk, Mitchellville

Peter Meyers, Gladbrook Reinbeck High School, Reinbeck*

Jose Olivo, Griswold High School, Griswold

Ethan Pieper, Norwalk High School, Johnston

Drew Piersma, North High School, Sioux City

Phillip Ramirez, Vilseck High School, Germany

Devinder Sandhu, Valley High School, Clive

Roy Schindler, Davenport Central High School, Davenport

Thomas Wilgenbusch, Roland-Story High School, Story City

Christian Zvokel, Bondurant-Farrar High School, Bondurant

 

U.S. Naval Academy
Joshua Bailey, Heritage Christian Academy (Home School), Otley

Jacob Baur, Winterset Senior High School, Van Meter

Trevor Bounds, South Central Calhoun High School, Lytton

Jeffrey Bright, Home School, Ames

Maeve Broeg, Williamsburg High School, Parnell

Keaton Carter, Southeast Polk High School, Altoona

Erin Evans, Solon High School, Solon

Micaela Finney, Bettendorf High School, Bettendorf*

Shannon Gorman, George Washington High School, Springville

Benjamin Halley, Waukee High School, Clive

Kyle Hollenback, Pleasant Valley High School, Bettendorf

Nick Krone, Holy Trinity Catholic High School, Fort Madison

Jacob Matthies, OA-BCIG High School, Ida Grove

Henry Oberman, Waukee High School, Clive

Jacob Pence, Cedar Falls High School, Cedar Falls

Alex Reed, Davenport West High School, Blue Grass

Kennedy Salow, Center Point-Urbana High School, Walker

Luke Schmitz, Harlan High School, Harlan

Connor Schueler, Iowa City West High School, Coralville

Zachary Weston, George Washington High School, Cedar Rapids

 

U.S. Merchant Marine Academy

Jacob Cline, Grinnell-Newburg High School, Grinnell

Gustave Doll, St. Albert High School, Council Bluffs

John Gorman, Marion High School, Marion

Rhett Nowotny, HLV High School, Brooklyn

Nicholas Swartz, John F. Kennedy High School, Cedar Rapids

 

Students denoted with an asterisks(*) were also nominated for appointments to the U.S. Merchant Marine Academy in addition to the Air Force, Military or Naval Academies.

 

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WASHINGTON - Sen. Chuck Grassley of Iowa, Sen. Jay Rockefeller of West Virginia and Sen. Tom Carper of Delaware said today they will look for opportunities to advance their bipartisan proposal to provide coverage of intensive behavioral therapy for obesity and the coordination of programs to prevent and treat obesity in Medicare and Medicaid.

"The costs to society caused by diabetes and obesity are tremendous," Grassley said.  "There are ways to reduce the incidence of both those conditions.  Working with the Finance Committee on a bipartisan basis and the Congressional Budget Office, I'm confident we can take steps to achieve better health for Americans battling these two conditions."

"I've long held that preventive measures are one of the best ways we can improve health outcomes and save money on health care," Rockefeller said.  "Chronic diseases like diabetes are expensive to manage and, if left unaddressed, lead to additional health problems down the road. Our effort works to prevent and manage obesity and diabetes through increased access to prevention programs for Medicare and Medicaid subscribers. This will lead to greater health care savings and has the potential to improve overall health outcomes which will boost the productivity and well being of our communities."

"We all know that obesity and diabetes are two of the main drivers of poor health and increasing health care costs in our country," Carper said. "If we do not rein in the growth of obesity and diabetes, this may be the first generation of Americans with a shorter life span than earlier generations.  Overweight and obese patients are at increased risk for cancer, cardiovascular disorders, and other adverse health outcomes. Spending on diabetes treatment alone is one of the fastest growing parts of Medicare. To get this epidemic under control, we need to ensure that Medicare covers the full range of therapies and treatments that might help lower our country's obesity rates and better prevent chronic diseases like diabetes."

Grassley, Rockefeller and Carper sponsored an amendment, which was offered and withdrawn, to the physician payments bill considered in the Finance Committee last week that would provide coverage of intensive behavioral therapy for obesity and the coordination of programs to prevent and treat obesity in Medicare and Medicaid.  The proposal would establish diabetes prevention program services for eligible diabetes prevention program participants.  It also would broaden coverage of prescription drugs for weight loss management under Medicaid and Medicare Part D.

 

The proposal is meant to take advantage of existing anti-diabetes efforts and a new spate of federally approved weight loss drugs to address both diabetes and obesity, conditions that often interact.

Grassley, Rockefeller and Carper said they will look for legislative opportunities to advance this proposal in the coming months while continuing to work with other sponsors of the legislation including Sens. Al Franken, Susan Collins and Lisa Murkowski.  The senators also recognized the work of several senators and House members in this issue area and said they hope for bipartisan advancement of proposals to combat obesity and diabetes.

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