A Panel in Legacy-Building Mode

On a Thursday evening in early July, House Energy and Commerce Committee Chairman Fred Upton came to the well of the House floor with a poster-board photograph of himself with two smiling blonde girls.

"This is Brook and Brielle. I'm in the middle, so don't look at me," he said. "These two little girls are from my district in Michigan. Our 21st Century Cures effort seeks to capture just a sliver of the hope and optimism that Brook and Brielle exude despite incredible odds."

Brook and Brielle are sisters with spinal muscular atrophy, a rare disease that causes children's muscles to waste away. There is no cure or treatment. They are the reason that Upton teared up on the House floor that day. "We've all seen too many early goodbyes. Too many," he said. "We've seen children that are born without the gift of a future."

It had been a rough week in the House. A day before, a partisan education bill barely squeaked through passage with a few reluctant Republicans voting 'yes' in the final minutes. Then the entire appropriations process crumbled unexpectedly over protests from the Far Right about the use of the Confederate flag. Everyone was tired. The House was scheduled for a rare Friday session in which they would vote on the bill that made Upton so emotional.

That evening's debate offered a brief respite from the confusion and hurt feelings, showing respect for a legislative effort that came out of nothing other than determination on the part of committee Republicans and Democrats

THE LEGACY BILL

It's no secret that Upton considers the 21st Century Cures bill his legacy legislation, the accomplishment that will tell the story of the Energy and Commerce Committee under his six years of leadership that ends in 2016. "We traveled the country. We had probably 40 or 50 roundtables all over the place. We visited with patients, health experts. We listened. And we put pen to paper. And then we listened some more," he said.

"This is the way committees really should work," said Rep. Diana DeGette, Upton's Democratic Cures partner, in an interview. "We really did start doing a deep dive and consulting everybody, taking all the evidence about what was the state of affairs and what needed to be done."

The bill passed on an overwhelming vote of 344-77, with 70 of the "no" votes coming from Upton's own party. He had been battling with budget hawks for weeks about the measure's nearly $9 billion for the National Institutes of Health. Budget Committee Chairman Tom Price and Rep. Dave Brat of Virginia led the charge against the bill, objecting that the NIH boost was mandatory. It would, in effect, grow the government, they said.

It's hard to overstate Upton's emotional reaction to this last-minute protest, which delayed the floor vote on the committee's most visionary legislation by several weeks. He insisted early on that all the money for NIH, which everyone agreed was necessary, be paid for from other programs. "I said, 'We've got to pay for it.' I worked for Reagan and all that," he said in an interview. "We can always just authorize more. But it never gets spent. You know that game. It doesn't count."

The hawks' objections were technical, more about the philosophy of government than the substance of the bill itself. But the struggle Upton faced within his own party illustrates the difficulty of passing big legislation, even when its topic is noncontroversial. Funding NIH used to be a no-brainer, but mandatory cuts gouged its budget during the fiscal crisis. In the most recent Congress, Republican leaders heartily concurred with Democrats that the research agency should be made whole as soon as the budget squeeze ebbed.

There also was some committee history at stake. NIH was a big priority for former Chairman Joe Barton, who was one of the most conservative members of Congress before the tea party was ushered in. Barton bears responsibility for passing a long-overdue reauthorization of NIH as one of his last acts as chairman. He even convened an ad hoc working group to study ways to speed up medical innovation in the last Congress. He became one of Upton's strongest cheerleaders when the chairman launched the official Cures initiative last year.

PATIENCE REQUIRED

21st Century Cures is among several recent committee actions that demonstrate an exercise in patience. Lots and lots of patience. Last month, the House passed the committee's bill to update the way chemicals are regulated, 398-1. The law hadn't been touched since 1976. The rewrite effort had been going on for 10 years. This spring, Upton and committee ranking member Frank Pallone were the technical advisers to a whirlwind stab at repealing a troublesome Medicare payment system for doctors that had dogged lawmakers for years. They were successful, thanks to a rare accord between House Speaker John Boehner and Minority Leader Nancy Pelosi, eliminating a "doc fix" burden that had been a constant thorn in the committee's side since 1997.

In each instance, there were naysayers. Some health advocates grumbled that the Cures bill didn't go far enough. They said NIH needed more money. They worried that speeding up drug approvals might be dangerous. Upton and Pallone shrugged off those complaints, insisting that the bill only include provisions that wouldn't upset the Right or the Left. Even with that mandate, the measure contains a trove of technical changes to NIH and Food and Drug Administration operations that medical professionals say will speed the efficiency of disease research and treatments.

Former FDA Commissioner Andrew von Eschenbach was an adviser on the 21st Century Cures bill. He spent hours with staffers working through a laundry list of proposed changes on a host of issues, such as how clinical drug trials are conducted and precision medicine is rolled out. "It really was built from the grassroots up," he said of the bill. "It was a long process, a thoughtful, deliberative one. It had a very strong foundation that was set in place by very strong bipartisan effort. … Were there tensions and issues along the way? Of course! There always are."

In passing the chemical-safety bill, committee members also tackled a long history of scrutiny and bickering, particularly on the part of environmental groups who questioned whether the endeavor was worth it. In order to get Republicans on board, the bill fell far short of what they wanted. But in the end, environmentalists stayed silent on it, preferring a modest win over nothing at all. "They were quiet. That's big," said Rep. John Shimkus, the GOP committee member who took the lead in shepherding the bill through the House. "Their silence was helpful."

Shimkus said he even got a private nod of approval from one environmental group he declined to name. Absent opposition from any large constituency group, the chemical-safety bill passed under streamlined House procedures generally reserved for noncontroversial niche legislation. There was little floor debate.

Shimkus's goal was to present the Senate with an overwhelming vote that would both inform that chamber's own deliberations and spur it to act. The gambit worked. Senate Majority Leader Mitch McConnell has pledged to put a toxic-chemical-safety bill on the floor later this year.

"I don't think the members really understood what a big deal it was," Shimkus added. "I think it was underplayed."

Committee staffers also think the doc-fix repeal was underplayed. A decade of congressional lore said it was impossible to pass a full repeal because the cost—$100 billion and counting—was overwhelming. Yet the repeal measure slid all the way to the president's desk while the congressional news was dominated by Iran nuclear negotiations and trade promotion authority. Maybe the lack of attention was because the opposition was relatively muted. Maybe it was because Boehner and Pelosi were determined to go forward before another Medicare reimbursement cliff came and went. Whatever the reason, it turns out that kind of resolve can be pretty effective.

WHAT'S NEXT

Pallone says the Medicare payment fix broke a dam inside the Energy and Commerce Committee, allowing Republicans and Democrats to work together on legislation that had been waiting for this kind of a bipartisan moment. "There was a realization on the part of the Republican leadership that they needed to come to the Democrats and get things done," he said. "I think there really is an opportunity to work on a bipartisan basis on a bunch of issues."

Upton would like nothing better. He and Pallone already have agreed to tackle mental health legislation later this year. They await the Senate's solution on chemical safety. They are working their way toward House passage of an energy infrastructure bill.

They still have work to do on 21st Century Cures. It needs to push through the Senate on a relatively fast pace if it is to get signed into law before Upton's term is up. DeGette says she and Upton will soon be telling the story of how they got to where they are for the benefit of the Senate Health, Education, Labor, and Pensions Committee.

"I don't think they have a full understanding of the depth of the work that went into this on the substance. So what we need to talk to them about is how they don't need to reinvent the wheel," she said. "There's been a lot of consensus among all of the groups plus the administration."

Upton has his poster of Brooke and Brielle propped on an easel next to his desk. He has a year and a half to tie up the agenda that he began working on four years ago. The key, he says, is working together. "We know that if we can get a bipartisan, strong vote, bingo! You can't stop us," he said.