January 25, 2006

The Honorable J. Dennis Hastert

Speaker of the House of Representatives

Washington, DC 20515

Dear Mr. Speaker:

We are writing to ask you to open an investigation into the role that
the Alexander Strategy Group, a lobbying firm closely linked to Tom
DeLay and Jack Abramoff, played in crafting the Medicare Prescription
Drug Act of 2003 and the budget reconciliation bill currently pending
before Congress.

The Medicare Prescription Drug Act, which has caused so much confusion
and havoc since January 1, was a product of a corrupt legislative
process. When the bill passed, we knew that Democratic members had been
denied opportunities to offer amendments and that the vote had been held
open for hours in the dead of night to twist arms. Afterwards, we
learned that crucial cost estimates were illegally withheld from
Democratic members; that the key Administration official responsible for
writing the bill was simultaneously negotiating a high-paying job
representing drug and insurance companies; and that the Republican
chairman responsible for steering the legislation through Congress
subsequently accepted a lucrative job in the pharmaceutical industry. We
further learned about a Republican member who had alleged that a bribe
had been offered him on the House floor.

Recently, with the indictments of Tom DeLay and Jack Abramoff, new
questions have arisen about the role of the Alexander Strategy Group in
this dishonest process. We know from lobby disclosure forms that the
largest single client of the Alexander Strategy Group was the
pharmaceutical industry, which paid the small firm over \$2.5 million,
including nearly \$1 million in 2003 when the prescription drug law was
being written. We also know from these records that the primary lobbyist
for the drug industry at Alexander Strategy Group was Tony Rudy, who
previously worked for both Mr. DeLay and Mr. Abramoff and who is
identified as "Staffer A" in Mr. Abramoff's indictment. And we know from
multiple accounts in the news media that the Alexander Strategy Group
has been deeply implicated in the scandals now sweeping through
Washington.

These facts, taken together, provide more than a sufficient basis for
further investigation. We therefore ask you to direct a congressional
committee of jurisdiction to examine the process that produced the
Medicare Prescription Drug Act, with a special focus on the role of the
Alexander Strategy Group.

The Medicare Prescription Drug Act symbolizes all that has gone wrong in
Congress. The bill's monstrous complexity frustrates nearly everyone,
and its high drug prices enrich the pharmaceutical industry at the
expense of seniors and taxpayers. The primary beneficiaries of the
legislation have become the special interests that gave millions to
Republicans in Congress, not the millions of seniors and persons with
disabilities that the legislation was supposed to help. We have an
obligation to the public --- and especially to the seniors of America
--- to find out how the legislative process went astray and to hold
those responsible to account.

We also urge you to extend this investigation to examine the role of the
Alexander Strategy Group in the pharmaceutical provisions of the pending
budget reconciliation legislation and to delay the final vote on the
reconciliation bill until this investigation is complete.

**[The Medicare Prescription Drug Act of 2003]{.underline}**

The Medicare Prescription Drug Act, which went into effect on January 1,
is a product of the culture of corruption that has infected Washington.
Over a year ago, senior Democrats in the House and the Senate asked you
and Senate Majority Leader Frist to investigate some of the serious
irregularities in the process.[^1] You both failed to respond, and there
has been no official investigation into the how the bill was enacted.
Even so, there is abundant evidence that the process was dishonest and
deeply flawed.

At this point, we know:

\(1\) **Key Cost Estimates Were Withheld from Democrats.** During the
legislative debate, President Bush, Secretary of Health and Human
Services Tommy Thompson, and Centers for Medicare and Medicaid Services
(CMS) Administrator Tom Scully repeatedly assured Congress and the
public that the Medicare drug benefit would not cost more than \$400
billion over ten years.[^2] In fact, the Medicare actuary, Richard
Foster, was correctly predicting that the legislation would cost far
more, perhaps as much as \$600 billion.[^3] Mr. Scully threatened Mr.
Foster with the loss of his job if he shared this information with
congressional Democrats.[^4] According to the Government Accountability
Office, this action and the withholding of the cost estimates violated
multiple federal laws.[^5]

\(2\) **Democrats Were Denied Opportunities to Offer Amendments.** On
June 26, 2003, the House passed H. Res. 299, the rule for consideration
of H.R. 1, the Medicare Prescription Drug Act. In this rule, Democrats
were allowed to introduce only one amendment, an amendment in the nature
of a substitute.[^6] No other amendments were permitted, effectively
denying Democratic members the opportunity to address the deficiencies
in the bill.

\(3\) **The Vote Was Held Open for Three Hours in the Dead of Night.**
H.R. 1 was brought before the House for final passage at 3 a.m. on
Saturday, November 22, 2003. Instead of the 15 minutes usually reserved
for roll call votes, the House Republican leadership held open the vote
for an unprecedented three hours while pressuring Republican members to
change their votes.[^7] During the vote, the Republican leadership
abandoned the traditions of the House by permitting a member of the
President's cabinet, HHS Secretary Thompson, to be present on the floor
to persuade members.[^8]

\(4\) **The Lead Administration Negotiator Was Simultaneously Pursuing
Job Representing Drug and Insurance Companies.** During the time the
Medicare bill was being drafted and considered, the Bush
Administration's lead negotiator, CMS Administrator Tom Scully, was
negotiating possible jobs representing the pharmaceutical and insurance
industries.[^9] These negotiations were sanctioned by the
Administration, which granted Mr. Scully a waiver from the normal ethics
rules.[^10] After the legislation was signed into law, Mr. Scully left
CMS to take a job at Alston & Bird, a firm that represents multiple
pharmaceutical companies, where he registered as a lobbyist for these
companies.[^11]

\(5\) **Key Republican Chairmen Accepted Lucrative Jobs with the
Pharmaceutical Industry.** Two key Republican chairmen also accepted
jobs representing the pharmaceutical industry after passage of the
Medicare Prescription Drug Act. Former Rep. Billy Tauzin, who was the
Chairman of the House Energy and Commerce Committee and the lead House
sponsor of the bill, left Congress to become the president of the
Pharmaceutical Research and Manufacturers of America (PhRMA), the drug
industry's biggest trade group.[^12] Former Rep. James Greenwood, who
was the Chairman of the House Energy and Commerce Oversight and
Investigations Subcommittee, left Congress to become the president the
Biotechnology Industry Organization, the trade association of the
biotechnology industry.[^13]

\(6\) **A Republican Member Said He Was Offered a Bribe on the House
Floor.** Former Rep. Nick Smith alleged that during the floor vote,
former Majority Leader Tom DeLay offered him a bribe in return for his
vote on the bill. According to Mr. Smith, Mr. DeLay offered campaign
support for Mr. Smith's son, who planned to run for Rep. Smith's seat
upon his retirement.[^14] Mr. DeLay was later admonished by the Ethics
Committee for his role in this incident.[^15]

The final bill reflects this deplorable breakdown in the legislative
process. The extraordinary complexity of the legislation is a direct
result of political decisions made by Republicans in Congress.[^16]
These choices benefit the drug and insurance industries, but they are
profoundly disruptive for seniors. Moreover, because the
Republican-controlled Congress rejected Democratic proposals to allow
Medicare to negotiate for low drug prices, the legislation has produced
exceptionally high pharmaceutical prices. According to one study, the
drug prices currently available under the Medicare drug plans are over
80% more expensive than those negotiated by the federal government and
over 60% more expensive than in Canada.[^17]

In effect, millions of seniors and the U.S. taxpayer are paying a costly
"corruption tax." The triumph of the special interests produced a drug
benefit that is far more complicated than necessary and far less helpful
to seniors than possible.

**[The Involvement of the Alexander Strategy Group]{.underline}**

On January 9, 2006, the Alexander Strategy Group announced that it would
shut its lobbying operations at the end of January 2006 because of
extensive reporting linking the lobby firm to Tom DeLay and Jack
Abramoff, both of whom have been indicted in political corruption
cases.[^18] As one paper reported, "the firm had fallen victim to the
ever expanding lobbying and corruption scandal."[^19]

The Alexander Strategy Group was formed in 1998 by Ed Buckham, a
licensed minister who also served as Chief of Staff and personal pastor
to then-House Majority Whip Tom DeLay.[^20] The group's startup was
funded through a large contract that Rep. DeLay secured from Enron.[^21]
Among the individuals with close ties to Mr. DeLay who worked for the
Alexander Strategy Group were Tony Rudy, a former deputy chief of staff
to Mr. DeLay; Karl Gallant, a former director of Americans for a
Republican Majority PAC (ARMPAC), Mr. DeLay's leadership PAC; and Mr.
DeLay's wife, Christine, who was on the Alexander payroll for four
years.[^22] The wives of other prominent Republican members, including
Rep. John T. Doolittle, were also hired at various points by the
Alexander Strategy Group.[^23]

Alexander Strategy Group has been described as "one of the crown jewels
of the ... 'K Street project.'"[^24] Other reports have linked the firm
or its lobbyists to an expanding number of scandals. These include
suspect arrangements involving Indian gambling,[^25] the U.S. Family
Network,[^26] the Northern Marianas Islands,[^27] defrauding
clients,[^28] and corrupt schemes to stop legislation involving internet
gambling and to oppose postal rate increases.[^29] Tom DeLay and Jack
Abramoff figure prominently in these scandals.

What has not been explored, however, is the relationship between the
Alexander Strategy Group and its largest client, the pharmaceutical
industry. In particular, there has been little investigation of the role
played by the Alexander Strategy Group in passage of the Medicare
Prescription Drug Act. We do know enough, though, to raise serious
questions.

According to lobby disclosure reports, the pharmaceutical industry has
been the largest client of the Alexander Strategy Group over the last
six years. During this period, the industry's trade association, PhRMA,
paid \$1.7 million to Alexander Strategy Group,[^30] while individual
drug companies have paid an additional \$840,000.[^31] During 2003
alone, the year the Medicare Prescription Drug Act passed, Alexander
Strategy Group received \$960,000 from the drug industry, representing
15% of the firm's revenue.[^32] According to the disclosure forms, the
Alexander Strategy Group was hired specifically to lobby the House and
Senate on prescription drug issues and Medicare.[^33]

Not only was the drug industry the largest client of the Alexander
Strategy Group, the group was also the drug industry's most highly paid
outside lobbyist. In 2003, PhRMA paid the Alexander Strategy Group
\$720,000, far more than PhRMA paid any of the other seven lobby firms
it hired that year.[^34] These payments represented nearly 50% of
PhRMA's annual budget for outside lobbyists.[^35]

Moreover, the lobby disclosure forms reveal that the primary lobbyist
representing PhRMA and Eli Lilly during consideration of the Medicare
Prescription Drug Act was Tony Rudy.[^36] Mr. Rudy is perhaps the
Alexander Strategy Group lobbyist most implicated in scandal. In
addition to being the former deputy chief of staff for Mr. DeLay, Mr.
Rudy worked for Mr. Abramoff from 2001 to 2002, where he helped raise
the funds that were diverted to pay for a golfing trip to Scotland,
which included Rep. Bob Ney, indicted former White House procurement
chief David Safavian, and Republican activist Ralph Reed.[^37] In Mr.
Abramoff's indictment, Mr. Rudy is identified as "Staffer A." According
to several news reports, he used his position in Mr. DeLay's office to
influence internet gambling legislation and postal rates in exchange for
\$50,000 payments to his wife.[^38] Criminal investigators are also
looking into possible conflicts of interest during the time Mr. Rudy was
negotiating his departure from Rep. DeLay's office to work for Mr.
Abramoff.[^39]

**[The Need for a Congressional Investigation]{.underline}**

These facts urgently call for further investigation. The Medicare
Prescription Drug Act is deeply tainted legislation, and the Alexander
Strategy Group, the lobby firm most mired in the on-going corruption
scandals, was intimately involved in its passage. The millions of
American seniors who are confounded by the Act's complex provisions and
are paying inflated drug prices deserve to know what went wrong and what
role the Alexander Strategy Group played in the process.

There are multiple committees in Congress that could undertake this
investigation, including the Energy and Commerce Committee, the Ways and
Means Committee, the Government Reform Committee, and the Committee on
Standards of Official Conduct. These Committees, however, have all
resisted Democratic requests to examine the legislative process that led
to passage of the Act.[^40] They will not act on their own initiative.

Your personal intervention is needed to spur action. We therefore urge
you to direct one of these committees to commence an immediate
investigation into the involvement of the Alexander Strategy Group's
role in the development and passage of this legislation.

**[Congressional Investigation of the Budget Reconciliation
Bill]{.underline}**

The Medicare Prescription Drug Act is not the only major piece of
pharmaceutical legislation with which the Alexander Strategy Group has
been involved. In the first six months of 2005, the group was paid
\$180,000 to represent PhRMA to lobby on Medicare, Medicaid,
prescription drug issues, and the budget process.[^41] Alexander
Strategy Group was also paid an additional \$300,000 during the first
six months of last year to lobby on prescription drug issues by
pharmaceutical companies Eli Lilly, AstraZeneca, and Amgen.[^42] During
this period, the primary legislation affecting prescription drugs,
Medicaid, and the budget process was the budget reconciliation
legislation.

The budget reconciliation bill has not yet been passed by Congress. But
its final contours are known, and the conference report is scheduled for
imminent floor action, perhaps as soon as next week. Like the Medicare
legislation, the reconciliation bill sacrifices the interests of
low-income families to preserve drug industry profits.

The Senate version of the budget reconciliation bill had several
provisions that would have required drug companies to share the burden
of reducing Medicaid's costs. These provisions would have increased the
minimum rebate for brand-name drugs and extended the rebate to drugs
dispensed through Medicaid managed care plans. In total, these
provisions would have saved over \$10 billion over 10 years.[^43]

These provisions were mysteriously dropped from the conference
agreement, however. Instead, the legislation takes the budget savings
directly from the pockets of the low-income beneficiaries served by
Medicaid. The legislation specifically authorizes states to raise the
co-payments Medicaid beneficiaries have to pay for prescription drugs to
up to 20% of the total prescription costs. These provisions are
estimated to cost low-income beneficiaries up to \$5.3 billion.[^44]

We believe that any investigation into the Alexander Strategy Group
should also examine what role the firm played in the budget
reconciliation bill, specifically with regard to the prescription drug
provisions. We further urge you not to bring the reconciliation bill
before Congress until after this investigation is completed. The
lobbying disclosure filings that cover the period of the conference will
be available on February 15. At a minimum, Congress should not consider
the legislation until these filings have been studied.

**[Conclusion]{.underline}**

The image and integrity of Congress have been called into serious
question. To restore public faith in Congress, the institution must
initiate a careful examination of how corrupt practices have influenced
the legislative process. Understanding what went wrong is a prerequisite
to accountability and reform.

For these reasons, we urge you to direct an immediate investigation into
the legislative process that produced the Medicare Prescription Drug
Act, the drafting of the pharmaceutical provisions in the pending budget
reconciliation bill, and the role of the Alexander Strategy Group.

Sincerely,

> Nancy Pelosi Steny H. Hoyer Henry A. Waxman

Democratic Leader Democratic Whip Ranking Minority Member

> Committee on
>
> Government Reform

[^1]: Letter from Sen. Tom Daschle, Rep. Nancy Pelosi, Sen. Edward M.
    Kennedy, Rep. Henry A. Waxman, Sen. Bob Graham, Rep. John D.
    Dingell, Sen. Frank Lautenberg, Rep. Charles B. Rangel, Sen. Hillary
    Rodham Clinton, Rep. Fortney Pete Stark, Sen. John D. Rockefeller
    IV, Rep. Steny H. Hoyer, Rep. Sherrod Brown, and Sen. Tim Johnson to
    Senate Majority Leader William H. Frist and House Speaker J. Dennis
    Hastert (Sep. 8, 2004).

[^2]: *See. e.g.,* The White House, *President Bush Meets With
    Congressional Leaders on Medicare* (Nov. 17, 2003); House Committee
    on Energy and Commerce, Testimony of the Honorable Tommy Thompson,
    Secretary, U.S. Department of Health and Human Services, *Hearing on
    Review of the Administration FY2004 Health Care Priorities*, 108th
    Cong., 24 (Feb. 12, 2003) (Serial No. 108-8). *See also, e.g.*, The
    White House, *President Announces Framework to Modernize and Improve
    Medicare* (March 4, 2003); *Special Report With Brit Hume*, Fox News
    Network (Nov. 24, 2003); The White House, *Ask the White House*
    (Sep. 25, 2003); House Committee on Ways and Means, Testimony of
    Mitchell J. Daniels, Director, White House Office of Management and
    Budget, *Hearing on the President's Fiscal 2004 Budget With OMB
    Director Daniels*, 108th Cong., 43 (Feb. 5, 2003) (Serial No.
    108-1); Senate Committee on Finance, Testimony of Thomas Scully,
    Director, Centers for Medicare and Medicaid Services, *Hearing on
    Strengthening and Improving the Medicare Program*, 108th Cong. (June
    6, 2003).

[^3]: *White House Says Congressional Estimate of New Medicare Costs Was
    Too Low,* New York Times (Feb. 2, 2004).

[^4]: House Committee on Ways and Means, Testimony of Richard Foster,
    *Hearing on Board of Trustees 2004 Annual Reports,* 108th Cong.
    (Mar. 24, 2004).

[^5]: Government Accountability Office, *Report from GAO General*
    *Counsel Anthony H. Hamboa to Sens. Frank R. Lautenberg, Tom
    Daschle, Edward M. Kennedy, et al., Re: Department of Health and
    Human Services --- Chief Actuary's Communications with Congress*
    (Sept. 7, 2004) (B-302911).

[^6]: H.Res. 299, 108^th^ Cong. (2003).

[^7]: *Medicare Bill Squeezes Through House at Dawn,* Washington Post
    (Nov. 23, 2004).

[^8]: *Time Was GOP's Ally on the Vote*, Washington Post (Nov. 23,
    2003). *See also,* House Committee on Standards of Official Conduct,
    *Investigation of Certain Allegations Related to Voting on the
    Medicare Prescription Drug, Improvement, and Modernization Act of
    2003* (Sept. 30, 2004).

[^9]: *Health Industry Bidding to Hire Medicaid Chief,* New York Times
    (Dec. 3, 2003).

[^10]: *Id.*

[^11]: Lobbying Disclosure Forms Filed by Alston & Bird with the Senate
    Office of Public Affairs. The drug companies for which Mr. Scully
    registered as a lobbyist in 2004 included Aventis, Abbott
    Laboratories, and Praecis Pharmaceuticals.

[^12]: *House's Author of Drug Benefit Joins Lobbyists*, New York Times
    (Dec. 16, 2004).

[^13]: *Congressman to Lead Biotech Trade Group*, New York Times (July
    23, 2004).

[^14]: *House Ethics Panel Says DeLay Tried to Trade Favor for a Vote*,
    New York Times (Oct. 1, 2004).

[^15]: House Committee on Standards of Official Conduct, *Investigation
    of Certain Allegations Related to Voting on the Medicare
    Prescription Drug, Improvement, and Modernization Act of 2003*
    (Sept. 30, 2004).

[^16]: House Committee on Government Reform, *Minority Briefing on the
    Implementation of the New Medicare Drug Benefit*, Statement of Jack
    Hoadley, Ph.D., Research Professor, Health Policy Institute,
    Georgetown University (Jan. 20, 2006).

[^17]: Minority Staff, House Committee on Government Reform, *New
    Medicare Drug Plans Fail to Provide Meaningful Drug Discounts* (Nov.
    2005) (online at
    www.democrats.reform.house.gov/story.asp?ID=975&Issue=Medicaid+and+Medicare)

[^18]: *Lobby Firm Is Scandal Casualty*, Washington Post (Jan. 10,
    2006).

[^19]: *Key Clients Quit Alexander Strategy Group; Others Weigh
    Options*, Roll Call (Jan. 10, 2006).

[^20]: *DeLay and Company,* Time Magazine (Mar. 21, 2005).

[^21]: *Tom DeLay's Tammany Fall,* The New Republic (June 20, 2005).

[^22]: *Id., See also, Lobby Firm Is Scandal Casualty, supra* note 18.

[^23]: *Lobbying Firm Is Scandal Casualty, supra* note 18.

[^24]: *Officials Focus on a 2^nd^ Firm Tied to DeLay*, New York Times
    (Jan. 7, 2006).

[^25]: *See, e.g.,* *Insiders Worked Both Sides of Gaming Issue,*
    Washington Post (Sep. 28, 2004).

[^26]: *The Man Who Bought Washington*, Time Magazine (Jan. 16, 2006).

[^27]: *A Question of Influence*, Los Angeles Times (May 6, 2005).

[^28]: Defendant's Plea Agreement, *U.S. vs. Jack Abramoff*, D.D.C., 7-8
    (Jan. 3, 2006).

[^29]: Defendant's Plea Agreement, *U.S. vs. Jack Abramoff*, D.D.C.,
    9-14 (Jan. 3, 2006).

[^30]: This number was derived from analysis of Alexander Strategy
    Group's lobbying disclosure forms, on file with the Senate Office of
    Public Records, for PhRMA from 2000 through 2005.

[^31]: This number was derived from analysis of Alexander Strategy
    Group's lobbying disclosure forms, filed with the Senate Office of
    Public Records, for Eli Lilly from 2002 through 2005, Amgen from
    2004 through 2005, and AstraZeneca for 2005.

[^32]: Analysis of Alexander Strategy Group's lobbying disclosure forms
    for 2003 show that the firm was paid a total of \$6,486,000 by its
    clients for lobbying activities, of which \$960,000 was paid by
    PhRMA and Eli Lilly, or 15%.

[^33]: Lobbying Disclosure Midyear and Year End Reports filed by
    Alexander Strategy Group with the Senate Office of Public Records
    (Aug. 14, 2003 and Feb. 17, 2004).

[^34]: Lobbying Disclosure Midyear and Year End Reports filed by
    Alexander Strategy Group, Bergner Bockorny Castagnetti Hawkins &
    Brain, C2 Group, Capitol Hill Strategies, Clark & Weinstock, Gorlin
    Group, Murphy & Associates, and Wise & Associates with the Senate
    Office of Public Records (Aug. 2003 and Feb. 2004).

[^35]: *Id.*

[^36]: Lobbying Disclosure Midyear and Year End Reports filed by
    Alexander Strategy Group with the Senate Office of Public Records
    (Aug. 14, 2003 and Feb. 17, 2004).

[^37]: Defendant's Plea Agreement, *U.S. vs. Jack Abramoff*, D.D.C., 7-8
    (Jan. 3, 2006). *See also, Foundation Funds Diverted From Mission,*
    Washington Post (Sep. 28, 2004).

[^38]: *Lobby Firm Is Scandal Casualty, supra* note 18.

[^39]: *As the Revolving Door Turns,* BusinessWeek (July 11, 2005).

[^40]: Democrats have made a number of efforts to get these Committees
    to investigate the illegal withholding of the Medicare cost
    estimates. In the House, Democrats introduced H. Res. 776, which
    would have required the Administration to turn over information
    relating to the Medicare cost estimates. This resolution was
    rejected by the House Committee on Energy and Commerce and the House
    Committee on Ways and Means. (House Committee on Energy and
    Commerce, *Adverse Report to Accompany H. Res. 776* (Oct. 8, 2004)
    (H. Rept. 108-754); (House Committee on Ways and Means, *Adverse
    Report to Accompany H. Res 776)* (Oct. 7, 2004) (H. Rept. 108-754)).
    The Chairman of the House Government Reform Committee also turned
    down a request by the Ranking Member for an investigation (Letter
    from Rep. Henry A. Waxman to Government Reform Committee Chairman
    Tom Davis (Mar. 17, 2004)). In addition, the Republicans on the
    House Ways and Means Committee voted down motions to subpoena two
    key witnesses, including Mr. Scully, who refused to appear
    voluntarily (House Committee on Ways and Means Democrats, New
    Release, *Ways and Means Republicans Allow Scully and the White
    House to Avoid Answering Questions on Medicare Estimate Coverup*
    (Apr. 1, 2004)). In the Senate, the Senate Finance committee never
    held hearings on this issue, despite two letters from Democrats
    requesting public hearings. (*E.g.,* Letters from Senators Tom
    Daschle, Bob Graham, and Kent Conrad to Senate Committee on Finance
    Chairman Chalres Grassley and Ranking minority Member Max Baucus
    (Jan. 30, 2004); Letter from Senators Tom Daschle, Bob Graham, John
    Kerry, Jay Rockefeller *et al*. to Senate Committee on Finance
    Chairman Charles Grassley and Ranking Minority Member Max Baucus
    (Mar. 26, 2004)).

[^41]: Lobbying Disclosure Midyear Report filed by Alexander Strategy
    Group with the Senate Office of Public Records (Aug. 15, 2005).

[^42]: *Id.*

[^43]: Center on Budget and Policy Priorities, *Assessing the Effects of
    the Budget Conference Agreement on Low-Income Families and
    Individuals* (Jan. 9, 2006).

[^44]: Minority Staff, House Committee on Budget, *Summary and Analysis
    of Reconciliation Conference Report* (Dec. 22, 2005), at 4 (online
    at http://www.house.gov/budget_democrats/
    analyses/06reconciliation_conference_report.pdf). The total cost was
    derived by adding the provisions for increasing cost-sharing and
    premiums, eliminating federal benefit standards, and tightening
    asset rules and other changes to long-term care, then subtracting
    the cuts that already existed in the Senate version of the bill.
    *See also,* Center on Budget and Policy Priorities, *supra* note 43.