Reducing Health Care Costs: Striving to Eliminate Excess Health Care Spending While Decreasing Administrative Spending


By Nicholas L. Cavarocchi, Vice President

When attempting to get at the root of the problem of the rising cost of health care and what is causing it, the one major factor that comes to mind is waste.  This can include high administrative and overhead costs or medical tests, services, procedures, or medications that a patient doesn’t need.  Waste consumes about one out of every three of the dollars the U.S. spends on health care, and drives up premiums and coinsurance for all Americans.  Therefore, it is important to find ways to maintain high quality health care for patients while drastically reducing administrative costs and unnecessary services. 

For a clinician to provide safe, effective, efficient care, he or she needs access to patients’ medical history and other records that can affect diagnoses and treatment.  This access can reduce administrative costs associated with arcane record production, as well as the high costs that stem from providing unnecessary or ineffective care.  That is why the federal government must continue to facilitate providers’ move to electronic medical records that are interoperable between health care systems and clinicians.  

Health care delivery has not systematically managed which drugs are administered to patients to optimize value, along with results.  Federal investments in outcomes research can help determine whether less expensive medications and treatment options can produce similar results. 

Administrative costs account for eight percent of all health care spending in the U.S. and tend to be much higher than in other countries, largely the result of the costs of compliance with federal and state regulations and insurance billing requirements.  By eliminating half of the administrative cost burdens of billing and insurance, medical spending in the U.S. can be reduced by up to 15 percent.

While categorizing waste may help identify and measure general types and sources of waste, successful reduction strategies must integrate the administrative, operational, and clinical components of care, and proceed by identifying goals, changing systemic incentives, and making specific process improvements.  Unfortunately, instead of trying to resolve the problem of waste in health care spending, some proposals under consideration threaten to make it worse by allowing insurance companies to offer junk plans that impose strict coverage limits, leave people with preexisting conditions unprotected, and otherwise diminish quality of care. . 

A possible solution to reduce costs in the American health care system would be to make data trans-parent to the public while providers compete on their ability to successfully help their patients get the care that they need.  Purchasers and individuals must be able to choose their treatments and their providers based on useful information about outcomes and cost.  Therefore, there needs to be better aligning and applying regulatory requirements within and across federal agencies and programs.

Even if the United States implemented all the approaches to waste reduction whose effectiveness has been measured, only 40 percent of the estimated $1 trillion of wasteful spending would be curtailed.  While the scale of the issue is massive, effective means to address it offer a huge opportunity to both improve care and reduce the cost of health care. 

CRD’s Holubowich Selected for Prestigious Leadership Fairfax Institute

Emily Holubowich, Senior Vice President at CRD Associates, has been selected for the Leadership Fairfax Institute—a 10-month program that provides a forum for senior leaders in the business, nonprofit, and public sectors to strengthen themselves as a professional and a community leader. Participants are selected based on their demonstrated capacity for leadership and record of volunteer service in Fairfax County, Virginia. In September, Emily will join established leaders of large and small businesses, educators, government officials, and nonprofit executives in expanding her commitment to voluntary civic responsibility and deepening her understanding of the major issues facing Fairfax County.


In The Hot Seat: Tips for Nailing Your Congressional Testimony

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Emily J. Holubowich, MPP, Senior Vice President

I have prepped many a congressional hearing witness over the last 20 years. Last week, I had my first opportunity to be a witness when I testified before the Joint Select Committee on Budget and Appropriations Process Reform on behalf of the Convergence Building a Better Budget Process Project (video here).

Let’s just say I have a whole new perspective on the experience. For example, I will never again tell a witness, “Don’t be nervous, you’ll be great!”

(But what if I’m NOT? EEEK!)

Sure. No pressure.

Testifying before Congress is intimidating. Nerves are inevitable, and natural. Beyond taking a page from Amy Cuddy’s TED Talk about striking the “Super Man” pose, there’s not much many of us can do to completely turn off that “flight” response. What you can do is prepare. The more prepared you are, the more comfortable and effective you will be during the hearing. Here are some tips based on my experience—as both prepper and preppee—to help you nail your congressional testimony.

Clear Your Calendar. You’ve been invited to testify before a committee, and given five minutes to deliver your remarks. How much time could you possibly need to prepare for five minutes? A lot more than you think.  In a nutshell:

  • Write your written statement for the Congressional Record, and have someone review it before submitting it to the committee;
  • Pare that written statement down into your five-minute oral statement;
  • Think through how you’ll answer likely questions from the lawmakers and reporters;
  • Learn more about those lawmakers, your fellow panelists, and reporters who cover that beat;
  • Practice (yes, read your statement out loud, preferably to someone else);
  • Work with your organization or institution on the media outreach and interactions;
  • Promote your appearance through your social media networks;
  • Be prepared to submit written responses to questions for the record; and
  • Promote your appearance after the fact.

And don’t forget to send those thank you notes!

I delve into this more below but the bottom line is: all of this takes time—and lots of it. If you’re lucky you’ll have a week to prepare, at most, so clear your calendar and give yourself plenty of time to focus on the tasks at hand.

Do Your Homework. Rule #1 in communications is “know your audience.” Take time to learn everything you can about the committee, the lawmakers on the committee, their positions on the hearing topic, and how the committee and previous hearings have been run. You will find answers to all of these questions and more online. Information about lawmakers—bios, interests, committee assignments, bills sponsored—is publicly available on their websites, and the committee’s website will have recordings of past hearings to better understand the committee’s culture and the interactions between members.

In doing your homework, don’t forget to learn more about the other witnesses on the panel and reading anything they’ve published on the topic, and connecting with them on LinkedIn and Twitter. Don’t be shy about introducing yourself via email, asking them (or the committee staff) for copies of their written statements in advance of the hearing, and sharing yours. You don’t want to be caught off guard during the hearing, so do your best to find out what they’re going to say in advance.

Refine Your Message. Writing your testimony and then reading your oral statement are actually the easiest part of the experience. It’s the Q&A portion of the hearing that is most intimidating—at least, it was for me. Part of that fear is not knowing what you’ll be asked. That’s where doing your homework about the committee, the lawmakers, and the witnesses can really help you be ready for anything. But you should also think of the Q&A as an opportunity to hammer home your message, repeat your key points, and if necessary, cover material that may not fit in your five minute statement.  

Practice, Practice, Practice. And when you think you can’t stand another minute of practice, practice some more. Invite one or two trusted colleagues/friends to be there with you and coach you through it. Read your oral statement aloud to ensure the statement flows, and have your coaches time you to ensure you stay within the designated time limit. Draft some questions you think you may be asked and have your coaches grill you, and time your responses. Ask your coaches to give critical feedback about your cadence, body language, facial expressions, eye contact, and responses to the sample questions. If their only feedback is, “You’re GREAT,” find some new coaches who can give it to you straight.

Treat this practice session as a true “dress rehearsal” and set the stage accordingly: wear a suit, sit at a conference table with your coaches across from you, even set up a tent card with your name. It may feel goofy, but setting the stage for your dry run will make you feel more comfortable the day of.

Say “I Don’t Know.” The Senator has asked you a question that is out of left field. What now? It is perfectly appropriate to say, “That is an excellent question, Senator. I don’t know the answer, but I’d be happy to respond to your question in writing for the record.” Don’t think of “I don’t know” as a personal failing, but a useful tool to buy some time. You can use it when you truly don’t know, and when you do know but you’re not sure if/how you want to respond in that moment. “I don’t know” also provides a great opportunity to keep the conversation going with Members of Congress and their staff after the hearing.

Be Yourself. Lawmakers know a lot about a lot of things, but they don’t know everything. They’ve invited you to testify because you are the expert on this topic and they value your perspective and expertise. Be confident in what you know, and let it show. At the same time, always be respectful in your tone and demeanor—even if the lawmakers don’t afford you the same respect. Smile. Thank. Listen. Being authentic will help you connect with lawmakers, and make them want to come back to you as a trusted expert on this issue and others in the future.

Get Help. Preparing for a congressional testimony is a lot of work, especially when you have a day job. You don’t have to go it alone. The government relations and strategic communications professionals at CRD Associates are well-equipped to help you in all aspects of your hearing prep—research, drafting, coaching—and thinking through how to promote you, before and after the fact.

When you get that call, let us know how we can help!

Rescissions would have severe costs

By Matt Dennis, Senior Vice President

If one were to design in a laboratory specific legislation intended to encumber stable governing and inhibit responsible, bipartisan legislating, it would be hard to develop one as noxious as a rescissions package clawing back budget authority appropriated in the recently-enacted Omnibus Appropriations bill.

Such a gambit would pull the rug out from federal, state and local agencies, which are – quite reasonably – planning budgets based on the enacted law.  How can any agency function with stability when it is whipsawed over the course of a year between budget cuts, two government shutdowns, a budget increase, and then the possibility of an unexpected reduction or elimination?

Even the introduction or debate about a rescissions package would force agencies to put on hold grants, contracts, hiring, capital investments, and other routine actions of a functional government. Whether Americans want a big government or small government, all Americans have an interest in an efficient government.  Advancing a rescissions package would introduce new inefficiencies for purely political reasons.

This budget uncertainty at the federal, state and local level would also trickle down and have negative consequences for organizations that partner with government at all levels, as well as their employees and the populations they serve.

Corporations that depend on government contracts would be unable to hire and retain employees or invest in new services, equipment, or facilities while agencies’ budgets are on hold.  Nonprofit organizations that rely on public grants to provide health care services, improve schools, and develop communities would be paralyzed, taking the hardest toll on those most in need of services.

Congress and the White House should be working to minimize uncertainty and support contractors and grantees, but advancing a rescissions package would do the exact opposite.

Beyond the substance, reneging on the Omnibus – which was enacted with an overwhelming bipartisan majority of Congress and the president’s signature – would have severe political consequences as well.

Given the near certainty that a rescissions package would target non-defense discretionary investments important to Democrats, it would render bipartisan deals in the future impossible – not just on appropriations, but on anything.

For example, why would any party in the minority consider earnest, bipartisan work on a farm bill, surface transportation reauthorization, or telecommunications reform when evidence suggests that as soon as the bill is enacted into law, the majority might attempt to reverse the agreements already made by both parties in Congress and the White House.

Advancing a rescissions package would cause further postponement of the 2019 appropriations process, which is already significantly late as a result of the six-month delay in enacting the 2018 Omnibus. Such a delay increases the likelihood of long-term Continuing Resolutions and brinkmanship over unrelated issues.

Republican appropriators in the House and Senate are largely cool to the idea because they understand that your word is your bond. They also know that if Democrats win the majority in the House and/or Senate in the upcoming election, the actions they take today could have serious repercussions tomorrow.

The 2018 Omnibus provided reason for guarded optimism that Congress and the White House are still capable of enacting responsible, bipartisan legislation that improves Americans’ lives. Advancing a substantively harmful and politically damaging rescissions package would be a counterpoint showing that optimism may have been misplaced.

Matt Dennis is a Senior Vice President at CRD Associates and former Appropriations Committee staff.

Opioid Legislation and the Cost of Treating Addiction

By Nick Cavarocchi, Jr., Vice President

The ongoing opioid crisis is unquestionably a major public health challenge. Since the mid-2000s, the annual cost of treating opioid addiction and treating patients who overdose on opioids has drastically increased. Opioid-related deaths have risen over the last three years – up by 28 percent in 2016 alone. The Food and Drug Administration (FDA) is looking closely at certain opioids that may have a higher abuse potential, with a view to making sure patients are prescribed opioids only when medically indicated. 

According to a recent analysis done by The Kaiser Family Foundation, in 2016, people that got their health coverage through their employer received $2.6 billion in opioid treatment services, compared to $273 million in 2004. 

On April 24, Senate Health, Education, Labor, and Pension (HELP) Committee Chairman Lamar Alexander (R-TN) plans to mark up the Opioid Crisis Response Act, a bill intended to combat the opioid epidemic by making it easier to prescribe smaller packs of opioids for shorter periods; develop non-addictive painkillers; and detect illegal drugs coming across the border. This legislation updates how certain opioid treatment and prevention grants are allocated to states, with states more severely affected by the epidemic receiving more funding. 

Some specific populations face particularly acute risk.  Nearly one infant is born every fifteen minutes with signs of drug withdrawal, and babies born to mothers using opioids are at risk for neonatal abstinence syndrome (NAS) along with other health problems.  States and local communities are making every effort to help children and families affected by opioid abuse and ensuring that newborns and children affected by drug abuse get the care they need. Congress also must do its part by supporting these local efforts.   That is why Sen. Alexander’s bill provides further funding and support to states to strengthen their health care workforce to increase access to substance use disorder treatment, including medication-assisted treatment, and access to mental health services in schools.  This legislation will also provide grants to states to improve data collection.

The cost of treatment for opioid dependency presents a serious hurdle to recovery.  Private insurance and Medicaid coverage of outpatient methadone treatment, including medication and integrated support services, varies across states and can still entail daily out-of-pocket costs for a population that may be unable to afford it.  For the uninsured, costs of daily treatment can reach several hundred dollars per month. 

As with every public health crisis, the costs of inaction are severe, in the form of costs associated with criminal justice justice, treating babies born with dependence on opioids, greater transmission of infectious diseases, and treating overdoses. 

Media Alert:CRD Associates Launches Communications Practice Led by Matt Dennis

Media Alert                                                             Contact Information
                                                                                   Domenic Ruscio
                                                                                   202 484-1100

CRD Associates Launches Communications Practice Led by Matt Dennis                    

CRD Associates is pleased to announce that Matt Dennis has joined the firm as Senior Vice President. Matt, who will lead the firm’s new Communications practice, brings more than 15 years of experience on Capitol Hill and on several political campaigns. 

His practice focuses on strategic communications for corporations, nonprofit organizations, advocacy groups and other organizations. His experience will help clients communicate effectively on public policy, federal funding, regulatory issues and any other challenge through:

  • Message development
  • Media training
  • Media relations
  • Crisis communications
  • Speechwriting
  • Internal communications
  • Social media

Prior to joining CRD Associates, Matt was the Communications Director for the House Appropriations Committee Democrats. In that role, he served as public spokesperson and managed media relations for the Ranking Member and Committee Democrats on legislation appropriating more than $1 trillion annually. He also previously served as Communications Director for Rep. Nita Lowey (D-NY) and Rep. Rush Holt (D-NJ), and on several political campaigns.

Matt holds a Master of Public Policy from The George Washington University and a Bachelor of Arts in Government from the University of Virginia.

Rescissions: Just when you thought it was safe to move on!


By Domenic Ruscio, Partner

You’ve probably seen the headlines: “Republicans Mull Cutting Omnibus Funds Under Little-Used Law.” According to press accounts, President Trump and congressional Republican leaders are mulling a way to effectively cut some of the funds they just approved in the 2018 Consolidated Appropriations Act. 

As if we didn’t endure enough drama leading up to the enactment of the latest omnibus spending bill, some in Congress are looking for ways to roll back spending by impounding (i.e. not spending) billions of dollars in nondefense appropriations contained in the bill.

How would they do it?

Evidently, the plan is to rescind some enacted appropriations through a mechanism first established under the Congressional Budget and Impoundment Control Act of 1974. That law came about because Congress was frustrated with President Nixon’s impoundment of appropriated funds. Not that other presidents hadn’t done the same thing. Historically the amounts impounded were small, the rationale was sound, and appropriators were consulted. But Nixon took it to a new level, impounding tens of billions of dollars, usually to gut programs he didn’t like.

In addition to creating the budget committees, CBO and a budget resolution process, Title X of the 1974 law limits when and how a president can impound funds.

How does the rescission process work?

First and foremost, the law established new reporting requirements. The president, through OMB, must inform Congress of all proposed rescissions in a special message. GAO is responsible for overseeing compliance with the law and report to Congress if the president fails to report an impoundment.

Once a rescission or package of rescissions are officially transmitted to Congress, lawmakers must act within 45 legislative days of continuous session. (Weekends and recesses of more than three days are not counted towards the 45-day deadline.) The funds may only be impounded until the 45-day period elapses.

If the president continues to impound funds beyond 45 days, GAO’s Comptroller General is empowered to sue the executive branch for any violations of the impoundment law.

What options does Congress have?

Congress can alter the amount proposed for rescission, either up or down, or approve it or disapprove it in toto. If Congress rejects a rescission, the law prohibits the president from proposing it again (i.e. seriatim rescissions) simply to re-start the 45-day clock.

But here’s the rub: Absent a specific request from the president, Congress on its own accord can initiate a rescission by cancelling previously appropriated funds in a subsequent law.  

In other words, even though the 45-day period may have elapsed—and provided that the funds have not been obligated—Congress can initiate its own rescission. (A GAO study covering 1974-1992 found that the total amount rescinded came to nearly $107.7 billion, of which 80 percent came from congressionally-initiated rescissions.)

What are the legislative steps involved?

Once a rescission bill is introduced, it is referred to the appropriate committee, which has 25 calendar days of continuous session to act. If the committee hasn’t reported it out at the end of 25 days, a motion can be made to discharge the committee from further consideration of the proposal. In the House a motion to discharge requires only one-fifth of the House and debate on the motion is limited to one hour. Senate debate on the motion is also limited to one hour.

In the House, floor debate on a rescission bill is limited to no more than two hours. In the Senate, debate is limited to 10 hours, but no more than two hours on any amendment.

As with any other legislation, differences between a House- and Senate-passed rescission bill are resolved by a conference committee.

It’s worth noting here that Senate rules do NOT permit a filibuster on a rescission bill. The bill can pass with only a simple majority.         

Finally, what are the long-term implications of a rescission bill?

The deal struck in early February to raise the spending caps on discretionary programs reflected broad bipartisan acknowledgement that those caps were far too low to meet our nation’s needs. On the nondefense side of the equation, even the higher spending caps leave discretionary spending below its 2010 level, when adjusted for inflation.

Apart from the fact that relitigated the FY2018 appropriations process would only further delay work on FY2019 spending bills, if Congress were to renege on this year’s budget deal by rescinding already enacted appropriations—appropriations that were negotiated in good faith—it’s hard to envision any degree of bipartisan cooperation in the foreseeable future. This may be a bridge too far, particularly for moderate Senate Republicans.  

Congratulations to the Tuberous Sclerosis Alliance March on the Hill 2018

By Mark Vieth, Senior Vice President

Congratulations to our client, the Tuberous Sclerosis Alliance, who brought more than 100 advocates to Capitol Hill last week to lobby for the Tuberous Sclerosis Complex Research Program (TSCRP) at the Department of Defense.

TS Alliance members scheduled meetings with the offices of more than 350 U.S. Representatives and 84 U.S. Senators. In just a matter of a few days, they secured the support of 68 Republican and Democratic Representatives onto a bipartisan letter circulated by Reps. Ileana Ros-Lehtinen (R-FL) and Dave Loebsack (D-IA) expressing support for continued funding for the TSCRP.

I was also honored by the Tuberous Sclerosis Alliance for my 15 years of service with the organization.  Proud to be standing here in this photo with my co-awardee, Debora Moritz, one of the most amazing patient advocates I have ever met!

CRD Names Lindsey Trischler Senior Policy Associate

CRD Associates is pleased to announce that Lindsey Trischler has been promoted to Senior Policy Associate. Lindsey joined the firm September 2016 and her work has been focused on policy related to personalized medicine and genetics, as well as patient advocacy.

In her new role, Lindsey’s responsibilities will include: helping implement clients’ lobbying strategies, facilitating relationships between clients and like-minded stakeholders, tracking and identifying emerging policy issues of importance to client interests, and organizing congressional briefings and policy symposiums.

Prior to joining CRD Associates, Lindsey was an Advocacy Associate at the International Myeloma Foundation where she was responsible for expanding the IMF’s state and federal policy initiatives. She focused on the promotion of funding for medical research and innovation, equality in access to treatments and the expansion of access to unapproved therapies and treatments for patients with multiple myeloma. Additionally, Lindsey helped lead two coalitions comprised of over 20 patient, provider and industry organizations working at the state and federal levels to pass oral parity legislation. She also led a national network of advocates that she trained to help the IMF carry out its policy priorities.

Lindsey previously completed a policy fellowship at CRD Associates in 2015 and is a graduate of the University of Cincinnati, where she received a Bachelor of Arts in Communication and a Public Relations Certificate.

Media Alert : CRD Associates Announces Expansion of its Health & Education Policy Teams

Media Alert     

CRD Associates Announces Expansion of its Health & Education Policy Teams

January 30, 2018 - Cavarocchi Ruscio Dennis (CRD) Associates, LLC is pleased to announce the addition of three individuals well-versed in the intricacies of federal health and education policy.  

Celia Hagan, MPH joins the firm as Vice President, where her primary focus will be on the National Independent Laboratory Association, global health, infectious diseases and regulatory affairs. Her expertise brings together science and policy to help shape national health outcomes. Celia excels at translating complex scientific concepts and developing strategic plans to meet client needs. She has experience working with several federal agencies including the FDA, CDC, CMS and HRSA.

Celia previously worked at the Association of Public Health Laboratories where she focused on regulatory and policy issues related to laboratory developed tests, public health emergencies, human subject research protections, device reclassification and laboratory reimbursement. During her tenure at APHL she provided strategic direction and strengthened the Association’s capacity to respond to regulatory issues affecting public health laboratories, including challenges surrounding emergency use authorization in public health emergencies. She also advocated on Capitol Hill for a strong public health laboratory network. Prior to APHL, Celia worked in the laboratory at the Fred Hutchinson Cancer Research Center and at a clinical hematology  laboratory in Seattle, WA. Celia holds a BA in Biochemistry, Biophysics and Molecular Biology from Whitman College and an MPH from the Johns Hopkins School of Public Health.

Julie Keenan has joined our team as Senior Policy Associate, where her focus will be on the firm’s work with university systems and public health organizations, including the Coalition for Health Funding. Prior to joining the firm, Julie worked at Fireside21, a software company that provides customer relationship management, newsletter and website services to the House of Representatives. While at Fireside21, she helped congressional offices improve communications practices with their constituents. Prior to that, Julie worked in Florida International University’s Office of Federal Relations, where she analyzed federal policy and funding legislation to support the University's priorities, including STEM research, university- school outreach and workforce training programs. No stranger to the firm, Julie was a 2013 Policy Fellow at CRD Associates, during which time she produced research and analyses on a variety of issues, including Pell grants, student loan regulations and public health policy. Julie received a Bachelor of Arts degree in International Relations from Florida International University, where she graduated with honors.

Michaela Hollis joins the firm as Policy Associate, where she will be working with a variety of organizations, including patient advocacy organizations, physician specialty groups and renewable energy and energy efficiency systems. 

A Certified Nursing Assistant, Michaela’s experience includes work in hospital, home care and research settings. She has provided hands-on care for patients of all ages and diagnoses, while also educating and recruiting patients for clinical drug trials. She also has taken part in several medical mission trips providing health care services to individuals in rural and impoverished communities. Michaela was a 2017 Policy Fellow at CRD Associates, providing the firm with support on issues affecting clients in health care, education, and defense sectors. During her fellowship, Michaela also assisted in planning and organizing meetings and briefings on Capitol Hill. 

Michaela graduated from Florida State University in 2016 with a Bachelor’s degree in Family and Child Sciences and a concentration in pre-medical studies. She is currently pursuing a Master’s degree in Public Health, focusing on Health Policy.


Phelan-McDermid Syndrome Foundation Awarded Grant from Global Genes

By Mark Vieth, Senior Vice President

 Ashley and Ollie

Ashley and Ollie

Congratulations to our client, the Phelan-McDermid Syndrome Foundation (PMSF), who was recently awarded one of twelve 2018 “RARE Patient Impact Grants” from Global Genes (

Representing more than 1,500 families of individuals with Phelan-McDermid Syndrome, PMSF seeks to improve the quality of life of people affected by the Syndrome by providing family support, accelerating research and raising awareness. Phelan-McDermid Syndrome is a rare genetic condition caused by a deletion or other structural change of the terminal end of chromosome 22 in the 22q13 region or a disease-causing mutation of the SHANK3 gene. Manifestations of the disorder include intellectual disability of varying degrees, delayed or absent speech, symptoms of autism spectrum disorder, low muscle tone, motor delays, and epilepsy.

The grant was submitted by PMSF advocate Ashley Shattles, whose son, Olie, passed away last year. The grant will support the “PMSF Angels End of Life Toolkit” developed by Ashley, which will provide a focal point composed of support resources to prepare families at the end of their PMS child’s life. While a child’s potential death is a difficult issue to discuss, the PMSF Angels End of Life Toolkit will provide tangible information while the patient is alive and immediate value when a death occurs. The toolkit will include a family resource guide, a PMS angels support group, Voices of Support multimedia materials and a foundation-level support program.

CRD Associates is fortunate to be able to work with the Phelan-McDermid Syndrome Foundation, and particularly to work with dedicated advocates like Ashley, who fight every day to make a better life for their families, their community and our country!

The full list of grantees can be viewed here:

Welcome to 2018 at CRD Associates!


On behalf of everyone here at CRD Associates, I would like to wish you all a Safe, Happy and Healthy New Year.  While the year is off to a frigid start (at least for those of us in the “frost belt”), we feel confident that it will be a great year for our firm and, most importantly, for our clients.

We would like to offer a special welcome to those of you that are new to our blog list – and to CRD Associates – as new clients and new friends.  We deeply appreciate you joining with us and look forward to sharing long and productive relationships.

Over the next two months, we expect to announce the addition of four new employees to enable us to accommodate the growth we have been honored to have and to continue to provide all our clients with the kind of quality service you have come to expect.  More on that will be announced in the coming weeks.

Finally, I hope that you will not hesitate to reach out anytime you need something, have a compliment or a concern, want to float an idea, or for any other purpose.  CRD Associates has maintained an ethos of quality service to our clients for 38 years.  There is no chance that we are going to let that change now.

Again, best wishes for the New Year!

Lyle Dennis, Partner

The Fate of the Children’s Health Insurance Program: Can It Be Saved?


by Nick Cavarocchi, Vice President

Tax reform, statutory spending caps, continuing resolutions and omnibus appropriations all contribute to the traditional year-end high drama called the legislative process. But what’s at risk of being overlooked in the fray is funding for the Children’s Health Insurance Program, or CHIP.

Created for the purpose of providing health coverage for vulnerable children in families that cannot afford private insurance coverage—but do not qualify for Medicaid—CHIP was crafted two decades ago by Senators Edward M. Kennedy (D-MA) and Orrin Hatch (R-UT) to help families be more self-sufficient and less dependent on financial assistance. Since then, CHIP has played an important role in providing insurance coverage and access to health care for millions of children in families with incomes just above Medicaid eligibility threshold.

An estimated 9 million children are insured through CHIP, and the program enjoys bipartisan support in Congress. 

Unfortunately, Congress missed a September 30 deadline to extend CHIP, which is jointly funded by both states and the federal government. But even though several states are financially stable enough to keep their individual programs active for a few more months, five states and the District of Columbia may run out of money in late December.

Last week, in fact, Colorado became the first state to notify families that children who receive health insurance through CHIP are in danger of losing their coverage. Texas plans to notify families in January that the program could end soon, while officials in West Virginia voted to shut the program down in February if Congress fails to act. 

What’s the hang-up? Money, of course. Congress can’t agree on how to pay for the $15 billion program.

In November, the House passed a bill to extend CHIP funding for five years. But the House bill is paid for, in part, by cuts to the Prevention and Public Health Fund. The problem is that the Fund makes up more than 12 percent of the Centers for Disease Control and Prevention (CDC) budget, including core public health programs that provide essential funds to help states keep communities healthy and safe, like immunization programs, cancer screenings, chronic disease prevention and other critically important programs.

But there’s a glimmer of hope—at least for the short-term. Over the weekend, the House appropriations committee released a two-week continuing resolution that would allow states to continue running CHIP in the absence of a formal reauthorization, at least through the end of the year. In the meantime, the Centers for Medicare and Medicaid Services is redistributing some unused CHIP grants to those states in greatest need.

CRD Associates Establishes Global Health Practice

by Erin Will Morton

CRD Associates, LLC is pleased to announce that Erin Will Morton, MA, has joined our team as Senior Vice President. In addition to representing the National Independent Laboratory Association and the American Association of Bioanalysts, Ms. Morton will head the firm’s global health practice, which includes working with global health product development partnerships on domestic and global health policy and advocacy. Prior to joining the firm, Ms. Morton was Director of External Affairs at the TB Alliance in New York City, where she managed advocacy and donor relations.

Bringing over ten years of advocacy experience to CRD Associates, Ms. Morton specializes in global health research funding, patient advocacy, and Medicare reimbursement. Her global health expertise includes tuberculosis, malaria, neglected tropical diseases, and drug development. Erin was Director of the Global Health Technologies Coalition (GHTC) where she led advocacy in the US and globally to sustain and strengthen investments in global health research and product development. She also spearheaded a strategic rebranding for GHTC. As a Senior Policy and Advocacy Advisor to the District Policy Group at Drinker Biddle, Ms. Morton provided strategic guidance to global and domestic health care clients, and represented the interests of patients, health care providers, and researchers before the US Congress and federal agencies. Ms. Morton began her career at NARAL Pro-Choice America, where she coordinated grassroots efforts for congressional campaigns.

Ms. Morton holds a master’s degree in American Government from the Johns Hopkins University and a bachelor’s degree in Political Science from Dickinson College. 

CRD Associates VP Tiffany Kaszuba Opinion Piece Published in The Hill


CRD Associates is proud to note that an opinion piece penned by our VP, Tiffany Kaszuba, appeared in the October 26 edition of The Hill. Tiffany’s piece is part of a larger campaign launched by NDD United, calling attention to the very real impact budget cuts are having on Americans from all walks of life.

NDD United is a coalition of more than 2,000 organizations spanning interests as varied as education, housing, public health and safety, infrastructure and law enforcement. The programs advocated by these organizations support economic growth and strengthen the safety and security of every American in every state and community across the nation.

Tiffany is the director of NDD United. You can read her opinion piece here.

Defense Health Research Consortium Mobilizes Bipartisan Letters in Support of DoD Medical Research


by Mark Vieth, Senior Vice President

Few issues before Congress generate more bipartisan support than medical research. But despite the incredible strength and breadth of Congressional support, we occasionally witness threats to research buried deep in massive pieces of legislation. 

Most recently, threats to Congressionally-directed research came in the form of four provisions included in the Senate version of the National Defense Authorization Act (NDAA) that would severely restrict the medical research programs at the Department of Defense (DoD). A bipartisan amendment filed by Senators Richard Durbin (D-IL) and Roy Blunt (R-MO) to strip these provisions from the bill was blocked from a vote, so these provisions survived intact when the Senate ultimately approved its version of the NDAA. Thankfully, no similar provisions were included in the House version of the bill.

In response, the Defense Health Research Consortium (, a coalition of 36 patient advocacy, medical provider and veterans organizations created and coordinated by CRD Associates, contacted Members of Congress, urging them to sign onto bipartisan “Dear Colleague” letters circulating in the House and Senate. These letters called for the removal of the onerous provisions. The Consortium was joined by dozens of allied organizations in a broad national grassroots advocacy campaign designed to secure support for these letters.

On October 10, the Senate letter, circulated by Senators Durbin and Blunt and signed by 54 Republican and Democratic Senators, was sent to the House-Senate conference committee for the NDAA. On October 24, a similar letter circulated by Reps. Ryan Costello (R-PA), Peter King (R-NY), Sanford Bishop (D-GA) and Dave Loebsack (D-IA) drew the support of 180 Republican and Democratic Representatives.

House and Senate conferees have convened, and hopefully they will hear the message from their colleagues in both chambers: Take these provision out of the bill and protect groundbreaking medical research at DoD!

Jennifer Leib to Address Medical Innovation Summit


By Jennifer Leib, Senior Vice President

CRD Associates is proud to announce that Jennifer Leib has been invited to address the 15th annual Medical Innovation Summit, hosted by the Cleveland Clinic. The Summit is one of the premiere events bringing together thought leaders and decision makers from around the world for timely, high-level discussion of medical innovation, its marketable output and its contribution to improving patient care. This year’s theme is Genomics & Precision Medicine and Jennifer will be a panelist on Patients First: Methods and Benefits of Bringing the Patient to the Innovation Table.

Given her background in genetic counseling and her more than a decade of experience in precision medicine advocacy, Jennifer understands the value of the patient voice in fostering innovation, and the need to enact privacy protections and other policies to encourage patients’ continued involvement. Other speakers include GE Ventures CEO Sue Siegel, CMS Administrator Seema Verma, NHGRI Director Eric Green, and more. Additional information on the Medical Innovation Summit, including the full agenda, can be found here

Doomsday Delayed?


by Dom Ruscio, Partner

Last week, Congress and the president struck a deal on a continuing resolution that keeps the government operating and suspends the federal debt ceiling, both until December 8.

While us denizens of DC breathed a collective sigh of relief, for some reason I was reminded of an early review of Melville’s Moby Dick, that read-

Our author must be henceforth numbered in the company of the incorrigibles who occasionally tantalize us with indications of genius, while they constantly summon us to endure monstrosities, carelessnesses, and other such harassing manifestations of bad taste as daring or disordered ingenuity can devise…

Those who follow these things closely knows that the federal government’s fiscal year ends on September 30. Since Congress has yet to pass any of the 12 appropriations bills required to keep government departments and agencies operating, once again, we were looking down the barrel of yet another government shutdown.

Not that that’s unusual. Over the last four decades, we’ve experienced 18 lapses in funding. Most occurred over a weekend, but three resulted in a true shutdown of government operations—twice for a total of 26 days and the last one, in 2013, for 16 days.

How much money was saved, you ask? Actually, it cost the taxpayer $2.5 billion in pay and benefits for furloughed federal workers and about $10 billion in penalty interest payments and lost fee collections, according to the Office of Management and Budget.

And the costs would have been much greater had Congress and the president not suspended the debt limit. Unless that was done, the government would have temporarily defaulted on many of its obligations, from Social Security payments to veterans’ benefits and salaries for federal civilian employees. Even a threat of default would have raised borrowing costs and destabilized U.S. and global markets.

Last week, pundits were analyzing who got the better of the deal. But if Congress and the president fail to do their jobs before December 8, we all lose. 

Faces of Austerity: How Budget Cuts Make Us Sicker, Poorer, and Less Secure


by Nick Cavarocchi, Vice President

The fiscal year 2018 budget the Trump administration sent to Congress in late May prompted a collective gasp in Washington, DC, by calling for devastating budget cuts to nondefense discretionary (NDD) programs that protect and promote the health and well-being of millions of Americans. The fact that Congress has thus far rejected the idea of arbitrarily slashing programs is heartening. But the notion that we are out of the woods is misguided.

As NDD United, an alliance of hundreds of national, state and community organization recently wrote in a letter to Senate Appropriations Committee leaders, the status quo can’t make up for seven years of austerity.

Under the terms of the Budget Control Act, nondefense discretionary programs are on track to be slashed by almost $2 trillion by 2022 as a result of post-sequestration budget cuts—cuts that take their toll on everything from heating assistance for low-income elderly to federal investments in public health, education and job training programs.  

Unless Congress take steps to raise the spending cap, in 2018 NDD programs are projected to decline to 3.1 percent of GDP—the lowest level in more than five decades.

Far too many low-income children are without access to high-quality early learning opportunities. Too many workers lack the education and skills to fill the demand for approximately five million jobs. And too many research breakthroughs are being delayed—or lost forever—even as new and emerging public health threats challenge the U.S.

In an effort to stop the threat of sequestration and advance critical investments in nondefense discretionary programs, NDD United is calling on Congress and the president to Raise the Caps. 

Watch this space! This fall, NDD United will be issuing an updated Faces of Austerity: How Budget Cuts Make Us Sicker, Poorer, and Less Secure report featuring individuals from across the nation whose lives have been adversely affected by federal spending policy.  

Hopelessly Lost…But Making Good Time


By Dom Ruscio, Partner

By the end of this week, the House appropriations committee hopes to have reported out all 12 of the annual appropriations bills. Rank-and-file lawmakers would then be given a few days to study the bills while the appropriators combine them into a single bill that would be passed before the August recess.

Wait, what?

Yes, that’s the process set out during a July 14 closed-door meeting of House Republicans. GOP lawmakers were told to take the weekend to read the bills and ponder how much time would be saved if the House passed a single, 1,600-plus page omnibus appropriations bill.

(It took me nearly three weeks to slog through Dostoevsky’s The Idiot and that was only 667 pages!)

Whether or not House lawmakers agree to the plan—and we should know in a few days—the fact that this scheme is even up for discussion says a lot about the state of legislative stewardship these days.

First and foremost, the fact that it was a junior appropriator, Rep. Tom Graves (R-GA), who first raised the idea, is a symbolic dagger in the heart of a committee with a longstanding tradition of following regular order.

Second, how could rank-and-file lawmakers willingly give up opportunities to scrutinize over a trillion dollars of spending, let alone weigh in with their own priorities—priorities their constituents sent them Washington to advocate? They might as well sign up for auto-pay when sworn into office.

Lastly, why would GOP leaders, who fought so hard for their majorities, forgo the opportunity to actually govern?

Granted, Executive branch transitions can be disruptive, especially from one national party to another. But Congress can usually be relied upon to lend a measure of stability to a time-tested process.