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Sen. Mike Enzi (Wyo.), senior Republican on the Senate education committee, is slamming a White House proposal designed to prevent students at for-profit career colleges from defaulting on their loans.

The proposal, Enzi said in comments submitted this month to the Department of Education (DOE), would not only disadvantage for-profit schools relative to their nonprofit competitors, but also limit access for many low-income and minority students, who tend to enroll in for-profits disproportionately.

"Admissions at for-profit institutions may become more selective, and otherwise academically qualified students may be denied admittance," Enzi wrote. "This outcome is contrary to nearly 50 years of Congressional efforts to make postsecondary education accessible to all Americans." 

The comments echo those of scores of other lawmakers — many of them Democrats — who are pushing the administration to delay the rule until the issue can be studied further. 

The issue is of great importance for the health sector because an enormous number of the nation's health professionals — from nurses to medical technicians — get their training at for-profits.

Under the proposed rule, for-profit programs would have to demonstrate that annual loan payments among recent graduates are less than 8 percent of their starting salaries. The idea is to ensure that graduates will be earning enough to pay off their debts after graduation.

The penalty for non-compliance is steep: Programs that fail to meet the standards could lose access to federal financial aid — of which 23 percent ($24 billion) went to for-profit schools last year.

Enzi said applying the new standards only to for-profit schools "will be sending the message that the Federal government is not concerned with the outcomes for over 75 percent of the Federal investment in student financial assistance."

Moreover, Enzi argued, it's not the government's role to ensure that students' educational choices "pay off." 

"Federal student financial assistance has historically been provided to increase access and help make postsecondary education more affordable," Enzi wrote. "It does not remove the responsibility of students and their families to make informed choices and to understand the financial consequences of those decisions." 

The comments put Enzi at sharp odds with Sen. Tom Harkin (D-Iowa), the chairman of the Senate education committee who's urging the White House to adopt the so-called "gainful employment" rule as quickly as possible.

“High student loan debt coupled with low repayment rates signal a questionable investment for students and taxpayers,” Harkin wrote to the DOE on Sept. 9. “[W]e encourage swift implementation of the gainful employment regulation and would be concerned with any efforts to weaken the proposal.”

Bolstering Harkin's argument, the Education Department this month issued new figures showing that the student-loan default rate at for-profits rose from 11 percent in 2007 to 11.6 percent in 2008 — much higher than default rates at nonprofit schools. 

"While for-profit schools have profited and prospered thanks to federal dollars, some of their students have not," DOE Secretary Arne Duncan said in a statement announcing the figures.

Still, not all liberals are supporting the rule. Jesse Jackson, head of the Rainbow PUSH Coalition, is on Enzi's side, arguing that the change, while well intended, would hurt minority students.

"The amount of debt a student incurs and the student’s ability to repay that debt are not reflections of the quality of an institution," Jackson wrote in his own comments submitted to DOE. "To apply a standard that looks at debt and repayment as a measure of quality misses a greater opportunity to hold all institutions to a higher standard of student outcomes, namely, graduation rates and successful post-graduation careers."

The DOE is hoping to finalize its rule by Nov. 1.

A top House Democrat this week is blasting the Defense Department (DOD) over the tens of thousands of veteran discharges the agency has attributed to personality disorders in recent years. 

Rep. Bob Filner (D-Calif.), chairman of the House Veterans' Affairs Committee, said he's "deeply puzzled" how the agency could deem soldiers combat-ready, only to discover a pre-existing personality disorder after they've been injured — a diagnosis that can threaten a veteran's eligibility for government-sponsored health benefits. 

“DoD reports that the use of personality disorder discharges has decreased and that no soldiers have been wrongly discharged,” Filner said Monday in a statement. "I cannot help but suspect that our men and women are not getting the help that they need and are struggling with PTSD [post-traumatic stress disorder], TBI [traumatic brain injuries], and other stresses of war on their own because of wrongful personality disorder discharges."

Filner said he wants to take a closer look at the criteria used by DOD to guide personality disorder discharges, which numbered 22,600 between 2002 and 2007.  

Under current rules, service members diagnosed with personality disorders lose eligibility for disability benefits from the Department of Veterans Affairs (VA) because such a disorder isn't considered service-related. The distinction has sparked concerns among veterans advocates that misdiagnoses may have caused some soldiers to be unfairly denied their due benefits.

"A personality disorder discharge is a contradiction in terms," Joshua Kors, an investigative reporter who's covered the issue extensively, testified before Filner's committee last week. "Recruits who have a severe, pre-existing illness like a personality disorder do not pass the rigorous screening process and are not accepted into the Army."

A DOD official defended the agency's record, telling lawmakers the department is "confident" that those suffering service-related mental conditions "are being diagnosed and that those diagnoses are being considered prior to separation."

Filner isn't so sure. 

"I remain extremely concerned that our dedicated service members struggle to get the proper mental health care and support while fighting America's wars," said the California Democrat. "I hope that the military’s inattention to this particular issue is not the typical manner which the services address the needs of its troops, although I’m not optimistic that is the case."

The meeting comes after Franken held a summit in Minnesota last month with medical device manufacturers to hear their concerns.

Census numbers out: Nearly 51 million Americans lacked health insurance last year, a jump of more than 4 million individuals from 2008, the U.S. Census Bureau reported Thursday. The findings mark the first decrease in the number of insured Americans since the Census Bureau began keeping those figures in 1987. The 50.7 million people without coverage represent 16.7 percent of the nation's population — up from 15.4 percent in 2008. http://bit.ly/aZb7qL

Democrats jumped on the report to make the case for healthcare reform: "The increase in uninsured Americans last year is clear evidence of how critical it was to take action to protect patients," Finance Committee Chairman Max Baucus (D-Mont.) said in a statement, "and that’s exactly what the Affordable Care Act will do."

Among the other key findings:

- The real number of folks with insurance coverage dropped from 255.1 million in 2008 to 253.6 million last year;

- Private health insurance coverage plunged from 201 million to 194.5 million between 2008 and 2009, while government-sponsored programs saw their enrollment increase, from 87.4 million to 93.2 million;

- Employer-based coverage fell from 176.3 million in 2008 to 169.7 million last year;

- Medicaid enrollment jumped from 42.6 million to 47.8 million;

- Roughly 9.9 million of the uninsured in 2009 were not citizens, up from 9.5 million in 2008. The Census Bureau does not distinguish between those in the country legally and illegally. 

Voters not driven by healthcare reform: The new healthcare reform law will have little influence over voters' choices when they hit the polls in November, according to new survey results released Thursday. Forty-one percent of respondents said a lawmaker's vote on the reform law would "not make much difference" in choosing a candidate, according to the CBS News/New York Times survey. 

Furthermore, the percentage of voters (28 percent) saying they're "more likely" to choose a member who supported the reforms is precisely the same as those who said they'd be "less likely" to pick that candidate — a wash suggesting a certain futility in both party's efforts to use the law to their advantage in November's midterms. http://bit.ly/932qWt

Still, Democrats are hoping that popular provisions that start on the six-month anniversary of the law next Thursday — including a ban on denying coverage for sick children, first-dollar coverage of prevention services, an end to rescissions and restrictions on annual and lifetime caps — will get voters excited. "Next week we'll be talking about issues that come due on Sept. 23 that we're very proud of," House Speaker Nancy Pelosi (D-Calif.) said at her weekly press conference Thursday.

Public health bills clear House panel: The Energy and Commerce Health subpanel on Thursday referred 16 public health bills to the full committee with recommendation for passage during markup next week. All but one, requiring the Department of Health and Human Services to set up voluntary data collection on the sexual orientation and gender identity of people who apply for HHS services or respond to its surveys, garnered unanimous bipartisan support. http://bit.ly/96F5VB

New Medicaid regs unveiled: The Centers for Medicare and Medicaid Services announced new proposed regulations Thursday implementing provisions of the healthcare reform law. The regulations establish transparency and public notice and comment procedures for experimental, pilot and demonstration projects approved for Medicaid and the Children’s Health Insurance Program (CHIP). http://bit.ly/9qS6GH

Treasure trove of insurance information now available: The National Association of Insurance Commissioners has released the inaugural edition of its Accident and Health Policy Experience Report. The report includes aggregated countrywide and company-level premium information, loss ratios, number of policies, number of covered lives, market share and more. http://bit.ly/dAYKmP

Among the key findings: 

- In 2009, the Top 10 companies in the grand total (individual, group and other) business accounted for 45.5 percent of the overall market;

- Total premiums increased by 15.0 percent to $214 billion from 2008 to 2009;

- The number of policies increased by 2.6 percent from 2008 to 2009, while the number of covered lives decreased by 7.0 percent from 2008 to 2009.

Judge provides detailed healthcare lawsuit timeline: The federal district judge overseeing a multi-state challenge to the healthcare reform law has unveiled a detailed schedule for the suit's next steps. The hearing and oral argument on the motion for summary judgment will be held Dec. 16. http://bit.ly/ckKGZX

House to examine Johnson & Johnson 'phantom recall': House Democrats are asking the head of Johnson & Johnson to testify later this month over the April recall of 135 million bottles of infant and children's medicine. http://bit.ly/dcqi6w

New funding for health workforce training announced: Health and Human Services Secretary Kathleen Sebelius and Mary Wakefield, administrator of the Health Resources and Services Administration, host a conference call with reporters to announce a significant investment in America’s health workforce being made possible through last year's Recovery Act. http://bit.ly/dvjzps

Mining news: The federal Mine Safety and Health Administration in the morning holds a news conference on its investigation of the explosion at Upper Big Branch Mine.

The Energy and Commerce Health subpanel on Thursday referred 16 public health bills to the full committee with recommendation for passage during markup next week.

All but one, requiring the Department of Health and Human Services to set up voluntary data collection on the sexual orientation and gender identity of people who apply for HHS services or respond to its surveys, garnered unanimous bipartisan support. The measure's author, Rep. Tammy Baldwin (D-Wis.), said lesbian, gay, bisexual and transgender (LGBT) Americans are ill-served by a "lack of cultural competency" among federal officials that leaves the U.S. with "gaping holes in our knowledge on LGBT health."

Baldwin is one of only three openly gay members of Congress.

Republicans on the panel all voted against the bill, which cleared markup on a 12-10 party-line vote. 

A top Senate Democrat vowed Congress will intervene if courts roll back the Obama administration's expansion of embryonic stem cell research.

Rep. Joe Barton (R-Texas) said he was unaware of any Republicans supporting the Health Data Collection Improvement Act, one of 16 public health bills being marked up by the Energy and Commerce health subpanel Thursday. The bill, introduced by Rep. Tammy Baldwin (D-Wis.), would ensure that all Health and Human Services programs and surveys provide for the voluntary collection of data on the sexual orientation and gender identity of people who apply for the services or respond to the surveys.

The other 15 bills coming up Thursday morning are believed to be uncontroversial.

Consideration of the Arthritis Prevention, Control and Cure Act of 2009 will occur in the full committee next week, panel Chairman Frank Pallone Jr. (D-N.J.) said. The bill's sponsor, Rep. Anna Eshoo (D-Calif.), is out of Congress because of a family emergency.

The other bills are:

- H.R. 758, Pediatric Research Consortia Establishment Act

- H.R. 1032, Heart Disease Education, Analysis Research, and Treatment for Women Act

- H.R. 1230, Bone Marrow Failure Disease Research and Treatment Act of 2009

- H.R. 1347, Concussion Treatment and Care Tools Act of 2009

- H.R. 1362, National MS and Parkinson's Disease Registries Act

- H.R. 1995, Eliminating Disparities in Diabetes Prevention Access and Care Act of 2009

- H.R. 2408, Scleroderma Research and Awareness Act

- H.R. 2818, Methamphetamine Education, Treatment, and Hope Act of 2009

- H.R. 2941, Johanna’s Law Reauthorization

- H.R. 2999, Veterinary Public Health Workforce and Education Act

- H.R. 5354, Gestational Diabetes Act of 2009 or GEDI Act

- H.R. 5462, Birth Defects Prevention, Risk Reduction, and Awareness Act of 2010

- H.R. 5986, Neglected Infections of Impoverished Americans Act of 2010

- H.R. 6012, To direct the Secretary of Health and Human Services to review uptake and utilization of diabetes screening benefits and establish an outreach program with respect to such benefits, and for other purpose

- H.R. 6081, Stem Cell Therapeutic and Research Reauthorization Act of 2010

Congress hears concerns with Medicare bidding for homecare supplies: House lawmakers got an earful from providers on Wednesday at an Energy and Commerce health subpanel hearing on the competitive bidding program for durable medical equipment. The new healthcare reform law expands the existing bidding program to 91 metropolitan areas (for a total of 100), but suppliers say the prices offered are too low. More than half of House members - 255 - have signed onto Florida Democrat Kendrick Meek's bill to repeal the program.

A new study released last week adds credence to that argument. "The CB program’s emphasis on price competition may result in unsustainable price reductions, eroding supplier competition based on quality service and equipment, and producing a range of unintended consequences," according to a  Dobson DaVanzo study for the American Association for Homecare. "This could result in Medicare’s most vulnerable beneficiaries experiencing medical complications, increasing their use of hospital, emergency room, and physician care, and losing their ability to live independently." http://bit.ly/dsVu3z

For its part, the Department of Health and Human Services testified Wednesday that the program "can provide savings, value, and benefits to both beneficiaries and the Medicare program, while ensuring delivery of quality items and services." And the Government Accountability Office testified that HHS has fixed many problems with the bidding process since the first round of bidding was terminated in 2008 because of "numerous concerns" with the program. http://bit.ly/cjO1L9

The industry group representing medical devices released a new report on Wednesday that touts the safety of a federal approval process the Obama administration wants to overhaul.

Researchers with Battelle examined more than 47,000 devices approved since 1998 through the Food and Drug Administration's 510(k) premarket review process for low- and moderate-risk devices. Battelle scoured FDA recall notices and press releases and found only 77 Class I recalls, which involve  products that could cause serious injury or death, between Jan. 1, 2005, and May 1, 2010 — a .16 percent recall rate.

"What this study shows is that the 510(k) process has an extraordinary safety record," said David Nexon, senior executive vice-president for the Advanced Medical Technology Association (AdvaMed), which funded the study. "If you look at the data, you'll see a situation where it's hard to imagine any other regulatory process that will have as good a record at weeding out unsafe products before they reach patients."

The FDA is currently debating more than 70 changes to the 510(k) process amid concerns that approval rules are too lax, and will be gathering public input through Oct. 4. AdvaMed supports some changes to the program, such as increased reviewer training, development of additional guidance, and greater communication of reviewer decision rationale to prevent delays and inconsistencies in the program. But the industry argues that the basic expedited review process is sound and should be preserved to help American products get to market quickly and efficiently.

"Our view," Nexon said on a conference call, "is that this study reinforces a message we've putting out for some time: Reform of the 510(k) program is appropriate, but you need a scalpel, not a meat axe."

Sens. Jon Tester (D-Mont.) and George Voinovich (R-Ohio) introduced legislation this week aimed at aligning federal efforts regarding prostate-cancer research, awareness and healthcare delivery.

The bill establishes a federal interagency task force, convened by the Department of Veterans Affairs with representation from the Department of Health and Human Services and the Department of Defense.

Rep. Edolphus Towns (D-N.Y.) is expected to introduce companion legislation to the Prostate Research, Outreach, Screening, Testing, Access and Treatment Effectiveness (PROSTATE) Act of 2010 in the House.

The bill comes as prostate-cancer activists are marking National Prostate Cancer Awareness Month with several requests from lawmakers:

• Increase the National Cancer Institute’s $5 billion annual budget to accelerate basic and treatment sciences research for human prostate cancer from $294 million to a transparent $400 million;

• Increase the appropriation for the Congressionally Directed Medical Research Program for Prostate Cancer at the Department of Defense to $120 million from $80 million;

• Establish an Office on Men’s Health (OMH) in the Department of Health and Human Services equivalent to The Office on Women’s Health (OWH) established in 1991;

• Create a Prostate Cancer Scientific Advisory Board for the Office of the Chief Scientist at the U.S. Food and Drug Administration to accelerate real-time sharing of the latest research data and accelerate movement of new medicines to patients;

• Create human capital by launching more careers of the best and brightest scientists in the U.S. to solve the prostate cancer problem.