[House Report 117-427]
[From the U.S. Government Publishing Office]
117th Congress } { Report
HOUSE OF REPRESENTATIVES
2d Session } { 117-427
======================================================================
SOUTH ASIAN HEART HEALTH AWARENESS AND RESEARCH ACT OF 2022
_______
July 21, 2022.--Committed to the Committee of the Whole House on the
State of the Union and ordered to be printed
_______
Mr. Pallone, from the Committee on Energy and Commerce, submitted the
following
R E P O R T
together with
MINORITY VIEWS
[To accompany H.R. 3771]
The Committee on Energy and Commerce, to whom was referred
the bill (H.R. 3771) to amend the Public Health Service Act to
provide for research and improvement of cardiovascular health
among the South Asian population of the United States, and for
other purposes, having considered the same, reports favorably
thereon with an amendment and recommends that the bill as
amended do pass.
CONTENTS
Page
I. Purpose and Summary.............................................2
II. Background and Need for the Legislation.........................3
III. Committee Hearings..............................................4
IV. Committee Consideration.........................................4
V. Committee Votes.................................................5
VI. Oversight Findings..............................................7
VII. New Budget Authority, Entitlement Authority, and Tax Expenditure7
VIII. Federal Mandates Statement......................................7
IX. Statement of General Performance Goals and Objectives...........7
X. Duplication of Federal Programs.................................7
XI. Committee Cost Estimate.........................................7
XII. Earmarks, Limited Tax Benefits, and Limited Tariff Benefits.....7
XIII. Advisory Committee Statement....................................8
XIV. Applicability to Legislative Branch.............................8
XV. Section-by-Section Analysis of the Legislation..................8
XVI. Changes in Existing Law Made by the Bill, as Reported...........8
XVII. Minority Views.................................................11
The amendment is as follows:
Strike all after the enacting clause and insert the
following:
SECTION 1. SHORT TITLE.
This Act may be cited as the ``South Asian Heart Health Awareness and
Research Act of 2022''.
SEC. 2. HEART HEALTH PROMOTION GRANTS.
Title III of the Public Health Service Act (42 U.S.C. 241 et seq.) is
amended by inserting after section 317U (42 U.S.C. 247b-23) the
following new section:
``SEC. 317V. HEART HEALTH PROMOTION GRANTS.
``(a) In General.--The Secretary may make grants to States for the
purpose of promoting awareness of the increasing prevalence of heart
disease, including, where appropriate, its relationship to type 2
diabetes, in communities disproportionately affected by heart disease
such as South Asian communities in the United States.
``(b) Use of Funds.--A State that receives a grant under subsection
(a) shall use such grant funds--
``(1) to develop culturally appropriate materials on
evidence-based heart health promotion topics, such as nutrition
education, optimal diet plans, and programs for regular
exercise;
``(2) to support heart health promotion activities of
community organizations that work with or serve communities
disproportionately affected by heart disease, such as South
Asian communities in the United States; or
``(3) to support, with respect to research conducted relating
to heart disease, conferences and workshops on how practices,
methodologies, and designs of such research should be changed
to include in such research more members of communities
disproportionately affected by heart disease, such as South
Asian communities in the United States.
``(c) Annual Report to Congress.--Not later than 180 days after the
date of the enactment of the South Asian Heart Health Awareness and
Research Act of 2022, and annually thereafter, the Secretary shall
submit to Congress a report on outreach efforts and data relating to
heart disease in communities disproportionately affected by heart
disease, such as South Asian communities in the United States.
``(d) Authorization of Appropriations.--For purposes of carrying out
this section, there is authorized to be appropriated $1,000,000 for
each of fiscal years 2023 through 2027.''.
SEC. 3. HEART HEALTH RESEARCH.
Part B of title IV of the Public Health Service Act (42 U.S.C. 284 et
seq.) is amended by adding at the end the following new section:
``SEC. 409K. HEART HEALTH RESEARCH.
``(a) In General.--The Secretary may--
``(1) conduct or support research and related activities
regarding cardiovascular disease, type 2 diabetes, and other
heart health-related ailments among at-risk populations,
including South Asian communities in the United States; and
``(2) establish an internet clearinghouse to catalog existing
evidence-based heart health research and treatment options for
communities disproportionately affected by heart disease, such
as South Asian communities in the United States, to prevent,
treat, or reverse heart disease and diabetes.
``(b) Authorization of Appropriations.--For purposes of carrying out
this section, there is authorized to be appropriated $1,000,000 for
each of fiscal years 2023 through 2027.''.
I. Purpose and Summary
H.R. 3771, the ``South Asian Heart Health Awareness and
Research Act of 2021,'' authorizes the Secretary of Health and
Human Services (Secretary) to award grants to states for the
purpose of promoting awareness of the increasing prevalence of
heart disease, including its relationship to type 2 diabetes,
in communities disproportionately affected by heart disease,
such as South Asian communities in the United States. The
legislation also authorizes the Secretary to conduct or support
research related to cardiovascular disease, type 2 diabetes,
and other heart-related ailments among at-risk populations,
including the South Asian population in the United States. The
Secretary may also establish an internet clearinghouse to
catalog existing heart health research and treatment options
for vulnerable communities.
II. Background and Need for Legislation
Heart disease is the leading cause of death for adults in
the United States,\1\ and risk of death from heart disease
varies widely based on an individual's race or ethnicity.\2\
Risk of and death rates from heart disease are shaped by
systemic health disparities, as members of minority groups
often confront more barriers to heart health care, including
less culturally-competent care, and fewer proactive heart
health interventions.\3\\4\ In turn, racial and ethnic
minorities face an elevated risk of morbidity and mortality due
to heart disease.\5\
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\1\Centers for Disease Control and Prevention, NCHS Data Brief,
Mortality in the United States, 2020 (Dec. 2021) (www.cdc.gov/nchs/
data/databriefs/db427.pdf).
\2\Centers for Disease Control and Prevention, Heart Disease, Heart
Disease Facts (www.cdc.gov/heartdisease/facts.htm) (accessed July 17,
2022).
\3\Garth Graham, Disparities in cardiovascular disease risk in the
United States, Current Cardiology Review (Aug. 2015).
\4\Sandeep Krishnan, South Asians and Cardiovascular Disease: The
Hidden Threat, Cardiology Magazine American College of Cardiology (May
17, 2019).
\5\Id.
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Black men have a 70 percent higher risk of heart failure
compared to White men, and Black women have a 50 percent higher
risk compared to White women.\6\ These trends have decreased
the average lifespan of Black Americans to make it
significantly shorter than that of White Americans--in fact,
heart disease and stroke contributed to more than two million
years of life lost among Black Americans between 1999 and
2010.\7\ Heart disease is the leading cause of death among
Hispanic men, and for Hispanic women, heart disease is second
only to cancer.\8\ While South Asians comprise 23 percent of
the world's population as of 2020, they carry approximately 60
percent of the world's global burden of heart disease.\9\ South
Asian Americans are also more likely to die of atherosclerotic
cardiovascular disease (ASCVD) than other Asian Americans and
non-Hispanic White Americans.\10\ In addition, the increased
risk and disproportionate impact that heart disease has on the
South Asian American community is often obscured due to lack of
data, since South Asian Americans are often grouped with other
Asian Americans.\11\ In 2019, the American Heart Association
and other medical groups issued updated cholesterol guidelines
that, for the first time, urged doctors to consider ethnicity
when determining a patient's cardiovascular risk and treatment
options.\12\
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\6\Cleveland Clinic, How Race and Ethnicity Impact Heart Disease
(my.clevelandclinic.org/health/articles/23051-ethnicity-and-heart-
disease) (accessed July 18, 2022).
\7\Mercedes R. Carnethon, et al., Cardiovascular Health in African
Americans: A Scientific Statement From the American Heart Association,
Circulation (Oct. 23, 2017).
\8\See note 2.
\9\Pablo Martinez-Amezcua et al., The Upcoming Epidemic of Heart
Failure in South Asia, Circulation: Heart Failure An American Heart
Association Journal (Sep. 23, 2020).
\10\Annabelle Santos Volgman et al., Atherosclerotic Cardiovascular
Disease in South Asians in the United States: Epidemiology, Risk
Factors, and Treatments: A Scientific Statement from the American Heart
Association, Circulation: An American Heart Association Journal (May
24, 2018).
\11\Sandeep Krishnan, South Asians and Cardiovascular Disease: The
Hidden Threat, Cardiology Magazine (May 17, 2019).
\12\Ethnicity a `risk-enhancing' factor under new cholesterol
guidelines, American Heart Association News (Jan. 11, 2019)
(www.heart.org/en/news/2019/01/11/ethnicity-a-risk-enhancing-factor-
under-new-cholesterol-guidelines).
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H.R. 3771 aims to address these trends by allowing states
to direct culturally appropriate resources to communities that
are disproportionately impacted by heart disease, with the goal
of increasing awareness and promoting prevention tools and
methods. These grants may also support conferences and
workshops on how practices, methodologies, and designs of heart
disease research should be changed to include those
disproportionately affected by the disease. The legislation
also supports research efforts on cardiovascular disease, type
2 diabetes, and other heart health-related ailments among at
risk populations.
Heart disease risk in the United States has also been
exacerbated by the coronavirus disease of 2019 (COVID-19)
pandemic. One study found that beyond the first 30 days of
infection, people with COVID-19 exhibited increased risks of
cardiovascular diseases, including cerebrovascular disorders,
dysrhythmias, inflammatory heart disease, ischemic heart
disease, heart failure, thromboembolic disease and other
cardiac disorders.\13\ In addition, during the COVID-19
pandemic in the United States, Black, Hispanic, and Asian
populations experienced a disproportionate rise in deaths
caused by heart disease and cerebrovascular disease.\14\
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\13\Yan Xie, et. al., Long-term cardiovascular outcomes of COVID-
19, Nature Medicine (Feb. 7, 2022).
\14\Rishi K. Wadhera, et. al., Racial and Ethnic Disparities in
Heart and Cerebrovascular Disease Deaths During the COVID-19 Pandemic
in the United States (May 18, 2021).
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Due to the ``silent'' nature of heart disease, it is
sometimes not diagnosed until an individual experiences the
signs or symptoms of a heart attack, heart failure, or
arrhythmia.\15\ Heart disease prevention, particularly the
awareness, research, and treatment options that will be
promoted through this legislation, is important to decrease
these negative outcomes.
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\15\Centers for Disease Control and Prevention, About Heart Disease
(www.cdc.gov/heartdisease/about.htm) (accessed July 18, 2022).
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III. Committee Hearings
For the purposes of section 3(c) of rule XIII of the Rules
of the House of Representatives, the following hearing was used
to develop or consider H.R. 3771:
The Subcommittee on Health held a hearing on Wednesday,
June 17, 2020, entitled, ``Heath Care Inequality: Confronting
Racial and Ethnic Disparities in COVID-19 and the Health Care
System.'' The Subcommittee received testimony from the
following witnesses:
Rhea Boyd, M.D., M.P.H., Pediatrician and
Child Health Advocate, Palo Alto Medical Foundation;
Oliver T. Brooks, M.D., President, National
Medical Association;
Avik S. A. Roy, President, The Foundation
for Research on Equal Opportunity.
IV. Committee Consideration
H.R. 3771, the ``South Asian Heart Health Awareness and
Research Act of 2021,'' was introduced on June 8, 2021, by
Representative Jayapal (D-WA) and 19 original bipartisan
cosponsors and referred to the Committee on Energy and
Commerce. Subsequently, on June 9, 2021, the bill was referred
to the Subcommittee on Health.
On May 11, 2022, the Subcommittee on Health met in open
markup session, pursuant to notice, to consider H.R. 3771 and
five other bills. During consideration of the bill, an
amendment was offered by Representative Pallone and agreed to
by a voice vote. Upon conclusion of consideration of the bill,
the Subcommittee on Health agreed to report the bill favorably
to the full Committee, amended, by a voice vote.
On May 18, 2022, the full Committee met in open markup
session, pursuant to notice, to consider H.R. 3771 and five
other bills. During consideration of the bill, no amendments
were offered. Upon conclusion of consideration of the bill, the
full Committee agreed to a motion on final passage offered by
Representative Pallone, Chairman of the Committee, to order
H.R. 3771 reported favorably to the House, as amended by the
Subcommittee on Health, by a roll call vote of 31 yeas to 24
nays.
V. Committee Votes
Clause 3(b) of rule XIII of the Rules of the House of
Representatives requires the Committee to list each record vote
on the motion to report legislation and amendments thereto. The
Committee advises that there was one record vote taken on H.R.
3771, including a motion by Mr. Pallone ordering H.R. 3771
favorably reported to the House, amended. The motion on final
passage of the bill was approved by a record vote of 31 yeas to
24 nays. The following are the record votes taken during
Committee consideration, including the names of those members
voting for and against:
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
VI. Oversight Findings
Pursuant to clause 3(c)(1) of rule XIII and clause 2(b)(1)
of rule X of the Rules of the House of Representatives, the
oversight findings and recommendations of the Committee are
reflected in the descriptive portion of the report.
VII. New Budget Authority, Entitlement Authority, and Tax Expenditures
Pursuant to 3(c)(2) of rule XIII of the Rules of the House
of Representatives, the Committee adopts as its own the
estimate of new budget authority, entitlement authority, or tax
expenditures or revenues contained in the cost estimate
prepared by the Director of the Congressional Budget Office
pursuant to section 402 of the Congressional Budget Act of
1974.
The Committee has requested but not received from the
Director of the Congressional Budget Office a statement as to
whether this bill contains any new budget authority, spending
authority, credit authority, or an increase or decrease in
revenues or tax expenditures.
VIII. Federal Mandates Statement
The Committee adopts as its own the estimate of Federal
mandates prepared by the Director of the Congressional Budget
Office pursuant to section 423 of the Unfunded Mandates Reform
Act.
IX. Statement of General Performance Goals and Objectives
Pursuant to clause 3(c)(4) of rule XIII, the general
performance goal or objective of this legislation is to provide
for research and improvement of cardiovascular health among the
South Asian population of the United States, and for other
purposes.
X. Duplication of Federal Programs
Pursuant to clause 3(c)(5) of rule XIII, no provision of
H.R. 3771 is known to be duplicative of another Federal
program, including any program that was included in a report to
Congress pursuant to section 21 of Public Law 111-139 or the
most recent Catalog of Federal Domestic Assistance.
XI. Committee Cost Estimate
Pursuant to clause 3(d)(1) of rule XIII, the Committee
adopts as its own the cost estimate prepared by the Director of
the Congressional Budget Office pursuant to section 402 of the
Congressional Budget Act of 1974.
XII. Earmarks, Limited Tax Benefits, and Limited Tariff Benefits
Pursuant to clause 9(e), 9(f), and 9(g) of rule XXI, the
Committee finds that H.R. 3771 contains no earmarks, limited
tax benefits, or limited tariff benefits.
XIII. Advisory Committee Statement
No advisory committee within the meaning of section 5(b) of
the Federal Advisory Committee Act was created by this
legislation.
XIV. Applicability to Legislative Branch
The Committee finds that the legislation does not relate to
the terms and conditions of employment or access to public
services or accommodations within the meaning of section
102(b)(3) of the Congressional Accountability Act.
XV. Section-by-Section Analysis of the Legislation
Section 1. Short title
Section 1 designates that the short title may be cited as
the ``South Asian Heart Health Awareness and Research Act of
2021.''
Sec. 2. Heart health promotion grants
Section 2 authorizes the Secretary to make grants for the
purpose of promoting awareness of the increasing prevalence of
heart disease, including, where appropriate, its relationship
to type 2 diabetes, in communities disproportionately affected
by heart disease such as South Asian communities in the United
States. These grants may be used to: (1) develop culturally
appropriate materials on evidence-based heart health promotion
topics, such as nutrition education, optimal diet plans, and
programs for regular exercise; (2) support heart health
promotion activities of community organizations that work with
or serve communities disproportionately affected by heart
disease; and (3) support conferences and workshops relating to
heart disease. Section 2 also requires the Secretary to submit
a report to Congress on outreach efforts and data relating to
heart disease in communities disproportionately affected by
heart disease no later than 18 months after enactment, and
annually thereafter. For the purposes of carrying out this
section, the legislation authorizes $1 million for each of
fiscal years 2023 through 2027.
Sec. 3. Heart health research
Section 3 authorizes the Secretary to conduct or support
research and related activities regarding cardiovascular
disease, type 2 diabetes, and other heart health-related
ailments among at risk populations, including South Asian
communities in the United States, and to establish an internet
clearinghouse to catalog existing evidence-based heart health
research and treatment options for communities
disproportionately affected by heart disease. For the purposes
of carrying out this section, the legislation authorizes $1
million for each of fiscal years 2023 through 2027.
XVI. Changes in Existing Law Made by the Bill, as Reported
In compliance with clause 3(e) of rule XIII of the Rules of
the House of Representatives, changes in existing law made by
the bill, as reported, are shown as follows (new matter is
printed in italics and existing law in which no change is
proposed is shown in roman):
PUBLIC HEALTH SERVICE ACT
* * * * * * *
TITLE III--GENERAL POWERS AND DUTIES OF PUBLIC HEALTH SERVICE
* * * * * * *
Part B--Federal-State Cooperation
* * * * * * *
SEC. 317V. HEART HEALTH PROMOTION GRANTS.
(a) In General.--The Secretary may make grants to States for
the purpose of promoting awareness of the increasing prevalence
of heart disease, including, where appropriate, its
relationship to type 2 diabetes, in communities
disproportionately affected by heart disease such as South
Asian communities in the United States.
(b) Use of Funds.--A State that receives a grant under
subsection (a) shall use such grant funds--
(1) to develop culturally appropriate materials on
evidence-based heart health promotion topics, such as
nutrition education, optimal diet plans, and programs
for regular exercise;
(2) to support heart health promotion activities of
community organizations that work with or serve
communities disproportionately affected by heart
disease, such as South Asian communities in the United
States; or
(3) to support, with respect to research conducted
relating to heart disease, conferences and workshops on
how practices, methodologies, and designs of such
research should be changed to include in such research
more members of communities disproportionately affected
by heart disease, such as South Asian communities in
the United States.
(c) Annual Report to Congress.--Not later than 180 days after
the date of the enactment of the South Asian Heart Health
Awareness and Research Act of 2022, and annually thereafter,
the Secretary shall submit to Congress a report on outreach
efforts and data relating to heart disease in communities
disproportionately affected by heart disease, such as South
Asian communities in the United States.
(d) Authorization of Appropriations.--For purposes of
carrying out this section, there is authorized to be
appropriated $1,000,000 for each of fiscal years 2023 through
2027.
* * * * * * *
TITLE IV--NATIONAL RESEARCH INSTITUTES
* * * * * * *
Part B--General Provisions Respecting National Research Institutes
* * * * * * *
SEC. 409K. HEART HEALTH RESEARCH.
(a) In General.--The Secretary may--
(1) conduct or support research and related
activities regarding cardiovascular disease, type 2
diabetes, and other heart health-related ailments among
at-risk populations, including South Asian communities
in the United States; and
(2) establish an internet clearinghouse to catalog
existing evidence-based heart health research and
treatment options for communities disproportionately
affected by heart disease, such as South Asian
communities in the United States, to prevent, treat, or
reverse heart disease and diabetes.
(b) Authorization of Appropriations.--For purposes of
carrying out this section, there is authorized to be
appropriated $1,000,000 for each of fiscal years 2023 through
2027.
* * * * * * *
XVII. MINORITY VIEWS
Strengthening critical public health infrastructure,
investing in pandemic preparedness, and reducing the burden of
disease continue to be important issues to Americans. House
Republicans have consistently shown a commitment to advancing
these initiatives, through passage of the 21st Century Cures
Act, reauthorization of the Pandemic and All Hazards
Preparedness Act, and reauthorization Food and Drug
Administration user fee programs. Furthermore, Republicans have
been steadfast in their support for heart health promotion and
cardiovascular research through consistent and robust funding
of the National Institutes of Health (NIH) and through passage
of H.R. 1193, Cardiovascular Advances in Research and
Opportunities Legacy (CAROL) Act. Unfortunately, H.R. 3771, the
South Asian Heart Health Awareness and Research Act of 2022,
misses the mark and does nothing to meaningfully improve
cardiovascular health of Americans. Not is not the time to
create duplicative authorizations that contribute to mission
creep at the Centers for Disease Control and Prevention (CDC),
when the CDC's management of an ongoing pandemic has arguably
been abysmal.
Section 2 of the legislation mandates that the CDC make
grants to states for the purposes of promoting awareness of the
increasing prevalence of heart disease, targeting South Asian
communities. The CDC's National Center for Chronic Disease
Prevention and Health Promotion, which received over a billion
dollars for fiscal year 2022, includes the Division for Heart
Disease and Stroke Prevention (DHDSP), which already supports
outreach to populations, including South Asian Americans, at
high risk for heart disease. CDC-supported heart health
initiatives currently exist in all 50 states and the District
of Columbia, local health departments, and tribes.
Creation of a duplicative authorization at the CDC is not
what the Congress should be focusing on. The CDC is tasked with
``fighting diseases before they reach our borders and detecting
and confronting new germs and diseases around the globe to
increase our national security.''\1\ Given the failures of the
agency throughout the ongoing pandemic with emerging Covid-19
variants, and the poorly managed control of the current
Monkeypox outbreak, Republicans are disappointed with the
timing of this legislation and the message it sends to the
agency to double down on the wrong priorities.
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\1\Centers for Disease Control and Prevention, Mission, Role and
Pledge (https://www.cdc.gov/about/organization/mission.htm) (accessed
July 20, 2022).
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Section 3 of the legislation authorizes additional NIH
research on heart health. Republicans on the Energy and
Commerce Committee have a strong and consistent record of
supporting research on heart disease for at-risk populations,
including South Asian communities. However, the Federal
government, including the NIH and the CDC, already has numerous
programs underway that support heart health and cardiovascular
research. Energy and Commerce Committee Republicans are
exhausted by the continued unending efforts by Democrats to
create and mandate new programs that duplicate existing
programs.
Section 3 also mandates the establishment of an Internet-
based clearinghouse to catalog existing research and treatment
for communities disproportionately affected by heart disease
and diabetes. The NIH, CDC, the Patient-Centered Outcomes
Research Institute (PCORI) and other private foundations
including the American Heart Association already provide easily
accessibly information on the Internet regarding their
cardiovascular programs, campaigns, and research. Republicans
are disappointed that Democrats failed to review these existing
initiatives before advancing this legislation in to avoid
duplication of effort. The CDC especially currently has an
extensive repository of resources,\2\ open to the public and
all healthcare providers including:
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\2\Centers for Disease Control and Prevention, Heart Disease
(https://www.cdc.gov/heartdisease/index.htm) (accessed July 20, 2022).
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About Health Disease
Know your Risk for Heart Disease
Prevent Heart Disease
Resources for Health Professionals--tools to
help your patients
Women and Heart Disease
WISEWOMEN
2022 Million Hearts Hypertension Challenge
Alliance for Million Hearts Campaign Toolkit
As of December 2021, PCORI has awarded $397 million dollars
to fund 83 comparative clinical effectiveness research studies
related to cardiovascular disease, studies including those that
target women and special populations.\3\ Over the past decade,
the NIH has spent billions on federal grants targeting heart
disease and coronary heart disease, and even has an institute,
the National Heart, Lung Blood Institute (NHLBI) that is
specifically dedicated to cardiovascular research, prioritizing
research for persons at high-risk for heart disease.\4\
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\3\Patient-Centered Outcomes Research Institute, PCORI Funded
Studies Spotlight Heart Disease in Women (February 22, 2022) (https://
www.pcori.org/blog/pcori-funded-studies-spotlight-heart-disease-women).
\4\National Institutes of Health, Estimates of Funding for Various
Research, Condition,
and Disease Categories (RCDC) (May 16, 2022) (https://report.nih.gov/
funding/categorical-spending#/).
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In summary, Republicans support ongoing focus on efforts to
reduce the risk of heart disease and improve the lives of
Americans with cardiovascular health issues. However, unlike
Democrats, Republicans seek accountability and evaluation of
the NIH and CDC's ongoing programs prior to supporting new and
duplicative authorizations. Republicans continue to be good
stewards of precious taxpayer dollars and look for
opportunities to reduce duplication of services and programs
across the federal government. This is not the time for more
federal programs when the country is already experiencing
record high inflation, the likes of which have not been seen in
40 years, and due to profligate federal spending.\5\
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\5\US Inflation Calculator, Historical Inflation Rates: 1914-2022
(https://www.usinflationcalculator.com/inflation/historical-inflation-
rates/) (accessed July 20, 2022).
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Cathy McMorris Rodgers,
Republican Leader, Committee on Energy and Commerce.
[all]