Today, the New York Times editorialized in favor of stronger protections to prevent some schools from abusing Post-9/11 G.I. Bill education benefits and preventing veterans from getting the quality education they deserve.  Citing new data recently released by Senator Tom Harkin (D-IA), the editorial calls on Congress to close the 90/10 rule loophole that makes veterans and servicemembers lucrative recruiting targets for for-profit colleges.

As Chairman of the Senate Health, Education, Labor and Pensions Committee, Harkin has led an investigation into the for-profit college industry, uncovering aggressive recruiting tactics targeting veterans and active-duty servicemen and women in order to bring their federally-funded education benefits to companies that charge high tuition and have poor retention and graduation rates.

For more information, please contact Justine Sessions of Senator Harkin's HELP Committee staff at 202-224-3254.


New York Times

A Broader G.I. Bill

Published:  October 3, 2011

Starting this month, military veterans pursuing an education under the G.I. Bill have many more choices. The money for tuition, books and housing used to be just for study at colleges and universities, but now the G.I. Bill also covers non-degree institutions like vocational and technical schools, flight schools, and licensing and apprenticeship programs.

That is good news. Veterans, who deserve this country's full support, are struggling with high unemployment rates and would benefit from high-quality job training. But there is also peril in these new opportunities. Unless strong controls are put in place, the surge of G.I. Bill money will be a windfall for fly-by-night schools more interested in cashing in on veterans than educating them.

As a Senate committee warned in a recent report, a disproportionate amount of the taxpayer money spent on veterans' education has already been snapped up by private, for-profit colleges. These schools often cost much more than public institutions yet have dismal graduation rates and dubious curriculums.

The Senate Committee on Health, Education, Labor and Pensions found that for-profit schools have collected 37 percent of all G.I. Bill money but trained only 25 percent of veterans. In the 2010-11 academic year, when 5,985 institutions collected $4.4 billion in V.A. benefits, eight of the 10 biggest aid recipients were for-profit institutions, together raking in $1 billion. From those eight, the committee found, a total of 409,437 students withdrew from degree programs within a year of enrolling.

One reason for-profit colleges aggressively recruit veterans is the federal "90/10 rule," which forbids for-profit schools to take more than 90 percent of revenue from federal student aid. V.A. money does not count under that limit, so every enrolled veteran is precious to a school desperate to keep within the 90/10 ratio.

Schools recruit heavily for another reason: Because federal grants do not always cover tuition and expenses, students are often roped into private loans, another revenue stream in the booming for-profit education business.

The V.A. says it will review all for-profit schools in the 2012 fiscal year to make sure they comply with accrediting standards, and conduct annual reviews of all institutions that have more than 300 G.I. Bill students. That will make a difference only if bad schools actually end up being kicked out of the program. So far, that has seldom happened. Congress could also help by closing the 90/10 loophole that makes veterans targets for aggressive and deceptive recruiting.

Buyers, as always, need to beware. Many for-profit schools and Web sites that plug their programs are spending far more effort marketing themselves to veterans than actually educating them.


WASHINGTON, D.C. - Senator Tom Harkin (D-IA) today announced that $308,634 will be awarded to four housing centers across Iowa.  The funding comes from the United States Department of Housing and Urban Development (HUD). The funding will be used to hire Service Coordinators for housing centers that assist elderly and nonelderly individuals with disabilities who live in or are assisted by HUD housing to help them live independently. Harkin is a senior member of the Appropriations subcommittee that funds housing initiatives.

"This funding supports some of the most vulnerable in our community, allowing them to thrive and live independently, while also supporting jobs," said Harkin.  

Details of the funding are below.
Bettendorf-Spruce Hills Village $79,532
Dubuque- St. Mary's Apartments $92,250
Nevada-Meadows Apartments $67,026
Waterloo-Liberty Manor Apartments $69,826

May 25, 2011

WASHINGTON, D.C. - Senator Tom Harkin (D-IA) today announced that a total of $1,406,728 has been awarded to six AmeriCorps programs across Iowa.  This competitive funding comes from the Corporation for National and Community Service (CNCS).  Harkin has been a longtime supporter of AmeriCorps and is the Chairman of the panel that funds these initiatives.

"Getting people involved in service to improve their community and enhance the lives of those around them, all while growing themselves, is important for any society and is what is at the heart of AmeriCorps programs," said Harkin. "From teaching and mentoring children to building houses for the poor to restoring wildlife habitats, today's funding will improve the lives of countless Iowans and help us build an even greater state."

Details of the grants follow:

Iowa Dept. of Natural Resources - $506,727 - to provide wildlife habitat restoration and trail improvement to reduce water quality decline in the Environmental Stewardship priority area. The program will serve all residents, particularly in rural communities, throughout the state of Iowa.

Habitat for Humanity of Iowa, Inc. - $274,576 - to recruit and support volunteers to build low income housing units to eliminate substandard, unaffordable housing in the state of Iowa. The program will serve low-income families in Cedar Rapids, Iowa City, Quad Cities, Des Moines, K Knoxville, Mason City, Marshalltown, Council Bluffs, Sioux City, Webster/Humboldt, and Greene/Boone counties of Iowa.

Graceland University - $145,612 - to provide positive youth development services such as mentoring, recreational activities and after school assistance in the areas of Education and Healthy Futures. The program will serve youth in the six-county region (Clarke, Decatur, Lucas, Ringgold, Union and Wayne) of South Central Iowa.

Boys & Girls Club of Central Iowa Inc. - $216,468 - to provide after school homework help, healthy choices programming and case management support in the Education priority area to increase positive attendance patterns in schools. The program will serve students (ages 5 - 18) in Des Moines, Cedar Rapids, Waterloo, Council Bluffs, Carter Lake, Sioux City, Adair, and Davenport, Iowa.

Big Brothers Big Sisters of the Mississippi Valley - $130,000 - to recruit and support volunteers to mentor disadvantaged youth at risk to leave school without a diploma. The mentoring will resulting in improved academic achievement among these youth. The program will serve students in 58 counties in Eastern Iowa.

United Way of East Central Iowa - $133,345 - to provide early literacy activities and tutoring during out-of-school time to children, and provide outreach services for families of children with disabilities. Members will serve in Eastern Iowa.

WASHINGTON, D.C. - In a letter to President Obama, Senator Tom Harkin (D-IA) today joined a group of 41 Senators in urging an extension of Trade Adjustment Assistance (TAA), including a long term extension of the 2009 bipartisan reforms, before the president submits pending trade agreements with South Korea, Colombia, and Panama.  TAA provides benefits to jobless workers adversely affected by foreign trade, including partial wage replacement and training assistance.  The 2009 reforms expanded these benefits to additional workers, such as workers in the service sector.  Harkin is Chairman of the Senate Health, Education, Labor and Pensions (HELP) Committee.

Since TAA reforms were implemented in May 2009, an estimated 435,000 workers nationally were certified to receive TAA services, approximately 185,000 of those workers might not have been eligible without the 2009 reforms.  More than 4100 Iowa workers currently rely on this assistance.  Since the 2009 reforms expired earlier this year, the Labor Department has had to deny workers' TAA petitions filed under pre-2009 eligibility rules.

"We agree with you that strengthening the safety net for the middle class by extending TAA should be a prerequisite for the consideration of new trade agreements," wrote the lawmakers.  

The full text of the letter follows.  It was also signed by Senators Sherrod Brown (D-OH), Debbie Stabenow (D-MI), Jay Rockefeller (D-WV), Robert P. Casey, Jr. (D-PA), Jeff Bingaman (D-NM), Maria Cantwell (D-WA), Ron Wyden (D-OR), Patty Murray (D-WA, Chuck Schumer (D-NY), Dick Durbin (D-IL), Ben Cardin (D-MD), Barbara Boxer (D-CA), Carl Levin (D-MI), Kirsten Gillibrand (D-NY), Richard Blumenthal (D-CT), Tom Udall (D-NM), Sheldon Whitehouse (D-RI), Jack Reed (D-RI), Kent Conrad (D-ND), Bob Menendez (D-NJ), Michael Bennet (D-CO), Al Franken (D-MN), Amy Klobuchar (D-NM), Herb Kohl (D-WI), Jeff Merkley (D-OR), Frank Lautenberg (D-NJ), Mark Begich (D-AK), Chris Coons (D-DE), Kay Hagan (D-NC), Claire McCaskill (D-MO), Barbara Mikulski (D-MD), Jeanne Shaheen (D-NH), Bernie Sanders (D-VT), Joe Manchin (D-WV), Daniel Akaka (D-HI), Mark Udall (D-CO), Jon Tester (D-MT), Tom Carper (D-DE), Daniel Inouye (D-HI), and Patrick Leahy (D-VT).

May 23, 2011

President Barack Obama
The White House
Washington, DC 20500

Dear President Obama:

We share the goal of your National Export Initiative to double U.S. exports and are looking forward to working with you on implementing a strong trade and competitiveness strategy. We are writing to support your decision to insist that Congress agree to extend Trade Adjustment Assistance (TAA), including a long term extension of the 2009 bipartisan reforms, before you submit the pending trade agreements with South Korea, Colombia, and Panama. We recognize, as you do, that such a deal will be challenging to secure because it requires significant bipartisan commitments in both chambers of Congress to vote in favor of a TAA extension. The challenge is worth it. We agree with you that strengthening the safety net for the middle class by extending TAA should be a prerequisite for the consideration of new trade agreements

TAA has been a core pillar of U.S. trade policy. The program ensures that workers who lose their jobs and financial security as a result of globalization have an opportunity to transition to new jobs and emerging sectors of the economy. Important reforms were made to TAA in 2009, which have helped streamline the program and make it more efficient for beneficiaries. In 2009, Congress also expanded eligibility to all workers whose jobs have been moved offshore, regardless of whether the United States has a trade agreement with the particular country. It also recognized the important role of the service industry in the U.S. economy by bringing service workers into TAA.

The program also improved and expanded access to TAA's Health Coverage Tax Credit (HCTC) - an initiative that promotes private health insurance access for recipients, and makes health insurance coverage more affordable to workers who lose their jobs due to trade and offshoring.  In the absence of this program, more Americans would need public assistance and more individuals nearing retirement would be forced to use the emergency room as their sole source of health care.

These bipartisan reforms to the TAA program help hundreds of thousands of workers, in every state, by moving workers more quickly from government support to private sector jobs. Since TAA reforms began in May 2009, the program has assisted 185,000 Americans who may have otherwise been ineligible for services. The 2009 reforms also help ensure accountability and results by requiring data on performance and worker outcomes, enabling Congress to identify where improvements are needed.  Unfortunately, these critical TAA reforms expired on February 12, 2011. Just this month, the Department of Labor denied the first three petitions filed by groups of workers seeking TAA assistance under pre-2009 eligibility. The continued denial of critical training will impede private sector employment in emerging sectors of the economy.

While we the undersigned may have differing views on elements of the trade agenda - with some of us looking forward to supporting the pending trade agreements with South Korea, Colombia, and Panama, and others skeptical of the impact of the agreements -we are unified in our belief that the first order of business, before we should consider any FTA, is securing a long-term TAA extension.  

We look forward to working with you to extend and implement TAA as part of a broader trade and competitiveness strategy that creates jobs and builds the middle class.

WASHINGTON, D.C. - Senators Tom Harkin (D-IA) and Olympia Snowe (R-ME) today introduced legislation to help individuals with hearing loss purchase hearing aids.  The bipartisan Hearing Aid Assistance Tax Credit Act seeks to provide a $500 credit for the purchase of hearing aids for both adults and children.  Hearing loss is a serious problem for millions of Americans, as are the financial costs of hearing aids.  68 percent of those with hearing loss cite financial constraints as a core reason for not seeking treatment and only about 25 percent of people with hearing loss actually use a hearing aid, even though 95 percent of people with hearing loss can be successfully treated with hearing aids.  The $500 credit allowed under the bill would apply for each hearing aid, and it would be available every five years.  Co-sponsors of the bill include Senators Herb Kohl (D-WI), Thad Cochran (R-MS), Tim Johnson (D-SD), Richard Blumenthal (D-CT), Amy Klobuchar (D-MN) and Kirsten Gillibrand (D-NY).

"Growing up with a brother who was deaf, I saw firsthand the challenges that individuals with hearing loss faces every day.  For many, the solution is as simple as getting a hearing aid, but sadly, many Americans are not able to afford this life-changing device," said Senator Harkin. "We must do more to help people who cannot afford hearing aids to live happier, more productive lives.  This bill makes long-term economic sense and improves the lives of our friends, family members, and neighbors with hearing loss."

"Hearing aids make a world of difference for the millions of Americans who suffer from hearing loss, yet limited health care coverage of these vital devices leave many patients unable to benefit from this essential medical care," said Senator Snowe.  "For patients who rely on these devices to better interact with their families and their communities, access to these devices can significantly improve their quality of life and productivity."

Currently, hearing aids are excluded from Medicare coverage, and 61 percent of all hearing aid purchases involve no third party payment.  The average cost for a hearing aid in 2008 was $1,675 per ear, including fitting, evaluation, and post-fitting treatment.  80 percent of people require two devices.  The lack of action to provide hearing aids to Americans who need them has consequences including:

• Children who do not receive early intervention cost schools an additional $420,000 and are faced with overall lifetime costs of $1 million in special education, lost wages, and health complications.  Children can be fitted with hearing aids soon after birth.

• A 2005 survey of 80,000 households by the Better Hearing Institute indicated that untreated hearing loss results in an average loss of income per household of up to $12,000/year.  

• For seniors, a 1999 National Council on the Aging (NCOA) study demonstrated that untreated hearing loss often results in distorted communication, isolation, withdrawal, depression, anger and severely reduced overall psychological health.
DATE: May 6, 2011

On Friday, April 15th, the U.S. House of Representatives passed a budget for the upcoming year on a party line vote.  The plan sharply reduces the federal government's investments in education and infrastructure - investments that are necessary to ensure our country remains competitive in the global economy and generates jobs in both the short and long term.  It makes huge reductions in spending that are largely offset by completely extending the Bush 2001 and 2003 tax breaks, which were targeted towards the very wealthy.  

The House Republican plan would also significantly reduce funding for state and local law enforcement assistance provided by the Department of Justice by calling for the same cuts proposed in H.R.1, the budget proposal that was put forth by the House, and rejected by the Senate, earlier this year. These cuts would eliminate $250 million from state and local law enforcement, most significantly impacting the Edward Byrne Memorial Justice Assistance Grants (JAG) program and Community Oriented Police Services (COPS).

Last year, over $24 million in Byrne grants came to Iowa, supporting jobs for over 90 Iowans who are directly responsible for making our state safer.

In Iowa, Byrne-funded drug task forces:
  • Were responsible for over 2,400 felony arrests;
  • Dismantled 275 gangs;
  • Seized over 8,200 illegal firearms;
  • Seized nearly 20,000 kilograms of illicit drugs, like heroin, cocaine and methamphetamine.

In Iowa, COPS grants have funded over 770 police offers and sheriff deputies, and last year funded over 25 police officers on Iowa's streets. If the House budget were to be approved, 15 of these officers would lose their jobs.

During a recovering economy, crime does not stop and we should not abdicate government's responsibility to keep communities safe. Cuts to law enforcement will make streets less safe and the nation less secure. For FY11, Senator Harkin fought hard to keep the dangerous cuts in H.R. 1 from being enacted and he intends to do the same as the Senate considers FY12 budget proposals.

The measure now comes to the U.S. Senate for consideration.  

"This budget proposal is an unprecedented assault on middle class Americans who are already struggling to make ends meet," said Harkin.  "What is particularly egregious is the devastating impact these cuts would have on the safety of Iowa communities, which rely on federal assistance to keep law enforcement officials on the streets.  Iowans deserve to know that they can have the peace of mind that comes from residing in a safe community.  There is no question that the time has come for tough budget decisions, but the smart way to bring down the deficit is for Congress to pursue a balanced approach of major spending cuts and necessary revenue increases, not by indiscriminately cutting common sense law enforcement funds that keep our families and communities secure."

Harkin's full statement on the House budget proposal can be found here.

Rather than a pessimistic budget, which says America can't afford to maintain and rebuild the middle class, Senator Harkin believes we need a budget that creates a better future - one that creates jobs, keeps our promises to seniors, educates our children, and reduces the deficit with smart spending cuts and by asking millionaires and billionaires to pay their fair share.

Washington, D.C. - Senator Tom Harkin (D-IA), yesterday joined Sen. Sherrod Brown (D-OH) and 48 other Senators in writing to President Barack Obama to express opposition to the privatization of Medicare that is contained in the U.S. House Republican budget proposal.   The letter was forwarded to House Majority Leader Eric Cantor to demonstrate that the Republican plan will not make it through the Senate.

"The House Republican budget for Fiscal Year 2012 would end Medicare as we know it and throw seniors into the private market with no more than an insufficient voucher to offset the rising cost of private health insurance," the letter states. "So-called 'premium support' - giving seniors a voucher of approximately $8,000 as proposed by the Republican budget - is a reckless and irresponsible way to address the health care needs of older Americans.  And it is an unacceptable means by which to finance tax cuts for those who are earning ten times or more than the retirement income of the average Medicare recipient."  

A copy of the letter sent to the President is below.

The Honorable Barack Obama
The White House
1600 Pennsylvania Ave., N.W.
Washington, D.C. 20500

Dear Mr. President:

We are writing to commend you for your opposition to turning Medicare into a voucher system as proposed in the House Republican's FY2012 budget.  Since the enactment of Medicare in 1965, America's seniors have no longer lived in fear of losing affordable, comprehensive health insurance when they retire.  Unfortunately, some in Congress want to dismantle Medicare in order to help offset the costs of tax cuts for the very wealthiest in our country.

The House Republican budget for Fiscal Year 2012 would end Medicare as we know it and throw seniors into the private market with no more than an insufficient voucher to offset the rising cost of private health insurance.  So-called "premium support" - giving  seniors a voucher of approximately $8,000 as proposed by the Republican budget - is a reckless and irresponsible way to address the health care needs of older Americans.  And it is an unacceptable means by which to finance tax cuts for those who are earning ten times or more than the retirement income of the average Medicare recipient.  

Seniors, who have paid into the system their entire working lives, deserve affordable, secure health coverage upon retirement.  According to the Congressional Budget Office (CBO), in the first year of the voucher program, out-of-pocket expenses for seniors would double under the Republican plan to more than $12,500 annually.  For seniors on a fixed income, a doubling of out-of-pocket expenses is simply unaffordable, particularly when the average Social Security benefit is only $14,000 per year.  

The Republican budget proposal would not keep pace with the rate of inflation for health care, meaning seniors would pay ever higher out-of-pocket costs.  Under the proposal, the annual increase for the vouchers will fall short of the actual rate of inflation for health care - meaning out-of-pocket expenses for seniors will continue to soar. And to make matters worse, the Republican budget would repeal the only credible means of restraining health care costs - the Patient Protection and Affordable Care Act. 

While deficit reduction is essential, balancing the budget by dismantling Medicare is both unfair to hard-working Americans and counterproductive.  Seniors who are unable to afford Medicare or its equivalent will skip preventive services, not take necessary medication, and delay treatment leading to potentially undetected illnesses and more expensive care.  If Medicare is turned into a voucher system and the health reform law is dismantled, millions of seniors will be left under- or uninsured.  This will add to the burden on our nation's already overwhelmed emergency rooms and result in increased demands on Medicaid as seniors exhaust their life savings.  

Before the passage of Medicare, only half of America's seniors had health insurance, and most of those with insurance only had coverage for inpatient hospital costs.  Additionally, approximately 30 percent of seniors lived below the poverty line before Medicare.  Now, only 1.8 percent lack health coverage and less than 9 percent live below the poverty line. We cannot afford to reverse these gains through the ultimate form of rationing health care for seniors: the replacement of Medicare as we know it with insufficient vouchers for private health coverage.

We urge you to protect America's seniors and oppose any attempts to dismantle Medicare.


Senator Sherrod Brown
Senator Harry Reid
Senator Tom Harkin
Senator Max Baucus
Senator Jon Tester
Senator Mark Begich
Senator Jeff Merkley
Senator Jack Reed
Senator Patrick Leahy
Senator Barbara Mikulski
Senator Benjamin L. Cardin
Senator Dianne Feinstein
Senator John F. Kerry
Senator Daniel Kahikina Akaka
Senator Barbara Boxer
Senator Jeff Bingaman
Senator Charles E. Schumer
Senator Bernard Sanders
Senator Mark Udall
Senator Robert Menendez
Senator Debbie Stabenow
Senator Kent Conrad
Senator Ron Wyden
Senator Tim Johnson
Senator Richard Blumenthal
Senator Mary Landrieu
Senator Frank R. Lautenberg
Senator Dick Durbin
Senator Al Franken
Senator Sheldon Whitehouse
Senator Patty Murray
Senator Chris Coons
Senator Daniel Inouye
Senator Mark Warner
Senator Michael Bennet
Senator Joe Manchin
Senator Claire McCaskill
Senator John D. Rockefeller IV
Senator Robert P. Casey Jr.
Senator Amy Klobuchar
Senator Jeanne Shaheen
Senator Kirsten Gillibrand
Senator Tom Udall
Senator Herb Kohl
Senator Ben Nelson
Senator Jim Webb
Senator Maria Cantwell
Senator Kay Hagan
Senator Mark Pryor
Senator Bill Nelson
WASHINGTON, D.C. - May 3, 2011 - Senator Tom Harkin (D-IA) today wrote to Postmaster General Patrick Donahoe in opposition to a proposed regulation that would give the U.S. Postal Service (USPS) the right to convert post offices into stations or branches of larger post offices at their discretion.  Once converted, the USPS would then be able to close rural post offices without any consultation with local citizens or concern about the impact on a rural economy.  As Harkin points out in the letter, it appears that the proposed regulations are designed specifically to circumvent current laws to ensure local voices are heard.  Currently in Iowa, many post offices are facing potential closures that would disrupt service.

"Conveniently located post offices and a reliable postal delivery system are essential to keeping communities connected and businesses strong - particularly in rural areas of the country," said Harkin.  "Allowing the USPS to close post offices without listening to local concerns could interrupt reliable service to residents and hurt local businesses, all without consulting those it would most directly impact.  While I strongly believe that we must push for a more cost effective and efficient postal system, this proposed regulation is simply misguided and I urge the Postmaster General to change his course on this issue."

A copy of the letter can be found here.

Additionally, Harkin yesterday joined with Senator Chuck Grassley (R-IA) and Representative Steve King (R-IA) in writing to the USPS to ask that the Postal Service make public the details of the Area Mail Processing (AMP) Study that is being used by the Postal Service to weigh the move of Sioux City's mail processing operations to Sioux Falls.  A copy of that letter can be found here.

WASHINGTON - April 28, 2011 - Senator Tom Harkin (D-IA) welcomed new proposed guidelines to encourage companies to make the foods they market to kids healthier announced today by the Interagency Working Group on Food Marketed to Children.  The Working Group was created by a measure Harkin authored in 2009 directing the Federal Trade Commission to establish the group and charge them with developing a set of principles to guide industry efforts to improve the nutritional profile of foods marketed directly to children ages 2 to 17 years.  Harkin is Chairman of the Senate Health, Education, Labor and Pensions Committee and the Appropriations Subcommittee that funds health and wellness efforts.

"I commend the interagency working group and all of the representatives from the FTC, CDC, USDA and FDA for devising these proposed guidelines on food marketing to kids.  These guidelines make the healthy choice the easy choice, and they take an important step in the fight against childhood obesity - a fight we cannot afford to lose as a nation.

"On a daily basis, kids across the country are barraged with ads for junk foods and it is long past time that we put some limits on the advertising of these unhealthy foods.  Armed with these guidelines, it is now my hope that companies will voluntarily abide by them and work to implement them as soon as possible.  Our kids' health cannot wait," Harkin said.

Harkin is a longtime champion of food policy and wellness initiatives, fighting for fresh and healthy school lunches, disclosure of nutritional facts in chain restaurants, and food assistance programs like the Supplemental Nutritional Assistance Program (SNAP).


WASHINGTON, D.C. - March 30, 2010 - Senator Tom Harkin (D-IA), Chairman of the Senate Health, Education, Labor and Pensions Committee (HELP), today congratulated Dr. Andrea McGuire of Iowa on being appointed by the Secretary of Health and Human Services Kathleen Sebelius to the National Advisory Council for Healthcare Research and Quality.  Dr. McGuire is the Chief Medical Officer and Vice President of Medical and Network Management/Risk Selection at American Enterprise Group in Des Moines.

"Dr. McGuire's passion for patient advocacy coupled with her experience in research, disease management, and quality improvement will greatly benefit the Advisory Council," said Harkin.  "She understands the economics of healthcare and the impact that quality and research have on these economics.  In addition, she has dedicated much of her career to the improvement of the quality of care of patients with chronic disease.  I congratulate Dr. McGuire on this appointment."

The 21-member panel is comprised of private-sector experts who contribute a varied perspective on the health care system and most pressing needs of research to promote improvements in the quality, outcomes, and cost-effectiveness of clinical practice.  Members are appointed by the Secretary to serve 3-year terms.