Carrie Levine is typical of the Money & Politics team’s approach — dogged, determined and leaving no stone unturned. Her work also speaks to one of Chuck Lewis’ original missions for the Center: exposing the impact of money in politics.

Carrie tracked one of the most influential conduits for money in politics to an ordinary suburban address outside Cincinnati. It’s the home to a little known law firm behind $22 million spent by shadowy conservative groups to influence ballot initiatives and state elections. He wasn’t pleased when Carrie turned up at his door: “You’re not welcome here,” he said, calling approaching him at his home “unbelievably unprofessional.”

Importantly, the Carrie story, was a good example of the partnership strategies being developed by our communications expert William Gray. The Phantom story was beautifully presented on Politico and more conservatively in the Columbus Dispatch.

Also on the Money & Politics beat, managing editor Alison Fitzgerald marked the passing of former Attorney General Eric Holder’s deadline for prosecutions arising from the 2008 financial crisis. Answer: none.

The Chicago Sun-Times ran a version of  our piece on transparency and corruption in Illinois on its Op Ed page. And check out the lovely headline on the Jeff Kelly Lowenstein piece for us which kicked it off: Illinois and integrity: a strange tale and curious mix.

HSBC Swiss Leaks and Lux Leaks roll on

ICIJ Director Gerard Ryle notes the impact of the huge #swissleaks story rolls on: HSBC’s Swiss branch agreed to pay a record-breaking $43 million without admitting guilt to settle criminal action taken by Swiss authorities as a result of our story in February.

"Amazon has begun to pay taxes in Europe and not hide behind structures in Luxembourg. This largely results from our stories last year.”

Here is the #swissleaks package and here’s #luxleaks. More in the What we’re reading category, the US Justice Department showed why it and HSBC were reluctant to explain its money laundering methods because it was still open to abuse.

Backing our Buffett story

In an earlier note I mentioned the ruckus about the story of Dan Wagner and The Seattle Times' joint report on Clayton Homes, an arm of Warren Buffett’s Berkshire Hathaway, and the way it treated poor mobile home owners. Buffett attacked our coverage and made some unpleasant and incorrect assertions about our former staff member and the way he went around reporting the piece. It’s nice to have had the New York Times Editorial Board weigh in a second time on that story.

National Security drum beat

R. Jeffrey Smith, our managing editor for National Security keeps up a steady drum beat on the hideous waste from the campaigns in Afghanistan and Iraq. His piece on a spanking new military base in Afghanistan that was never used is a great case in point. 

Too many things to know about too many candidates

Many folks on the team including Dave Levinthal, Carrie, Michael Beckel and Kimberley Porteous, with major assists from our social maestro John Ketchum and digital editor Jared Bennett,  have done a nice job on highly shareable and informative “listicles” regarding the ever-growing list of presidential candidates. Theese attractive efforts keep us nicely current and amazingly don’t have any cat pictures in them. Here’s Rick Perry and here is a shorter list for Lincoln Chafee. 

What we’re reading — mostly me this week:

• Michael Massing in the New York Review of Books has done the second of a three-part series on digital journalism. Inside baseball for some of you perhaps but a valuable analysis.
• The Nation’s Eric Alterman wrote a nice bleat about the risks to investigative journalism though I am tempted to recall some words of Kara Swisher in my presence: “Can you give me the precise date when the old media is going stop complaining about the new media."

Thanks for reading this far and I welcome any feedback. 

The 2016 presidential election has already unleashed more than $1 million in negative ads, according to a Center for Public Integrity review of federal campaign finance filings.

Only 515 more days until Election Day. In the meantime, expect the price of presidential mudslinging to rapidly hit eight, then eventually nine figures, as the already crowded race for the White House escalates.

To date, nearly all of the negativity has been directed at Democratic Party frontrunner Hillary Clinton, who announced her candidacy in mid-April.

This month alone, Clinton has been attacked by the Republican National Committee and a host of other conservative groups, including the Stop Hillary PAC and the Citizens United Super PAC.

“Getting in early was the only way to go given the enormity of the opposition,” said Dan Backer, treasurer of the Stop Hillary PAC.

“That strategic move will ultimately help defeat her,” Backer continued. “A lot of groups have recognized the coming storm and are getting themselves and their audiences ready.”

Clinton campaign staffers did not immediately respond to a request for comment, although Clinton supporters have launched a massive, rapid-response operation called Correct the Record.

And other left-leaning political groups, including the Democratic National Committee, have turned Clinton’s embattlement into fundraising opportunities of their own.

Johanna Dunaway, an associate professor of political science and mass communication at Louisiana State University, said early advertisements are important for several reasons, including fundraising and establishing a candidate's reputation.

"Early ads are critical to defining candidates and what they are all about — from their personal bio to their policy positions," she said.

So far, just one Republican candidate — former Arkansas Gov. Mike Huckabee — has been targeted by attack ads, according to reports filed with the Federal Election Commission by party committees, nonprofits, political action committees and super PACs.

Not captured by these reports: so-called “issue ads” that cast candidates and their policy positions in a negative light that are not disclosed to federal election regulators this early in the campaign process.

Huckabee has witnessed about $100,000 spent against him so far — all by the conservative Club for Growth, an anti-tax organization that has played a prominent role in the careers of several of Huckabee’s Republican rivals, including Sens. Ted Cruz, Rand Paul and Marco Rubio.

Earlier this year, David McIntosh, president of the Club for Growth, warned that his group would “make sure that Republican primary voters thoroughly examine [Huckabee’s] exceptionally poor record.”

In an email, Club for Growth spokesman Doug Sachtleben stressed that the Club for Growth had not officially endorsed anyone in the race but praised Cruz, Paul and Rubio for having “walked the talk.”

Huckabee has long feuded with the Club for Growth, which he says has “utterly misrepresented, distorted and outright lied” about his record as governor.

Huckabee could also face trouble from a new super PAC, Truth Squad 2016, which was formed this week by 2012 Republican presidential also-ran Fred Karger. The committee’s organizational paperwork specifically names Huckabee as a candidate it exists to oppose.

Some political groups, however, are opting to introduce their preferred candidates in a positive light.

Paul, the libertarian-leaning senator from Kentucky, for instance, has benefited from super PAC Concerned Voters for America spending more than $250,000 on field organizers to promote his campaign.

Concerned Voters for America has, in the past, received the bulk of its funding from a nonprofit organization that grew out of the failed 2008 presidential campaign of his father, former Republican Rep. Ron Paul of Texas.

Meanwhile, Rick Perry, the former governor of Texas who announced his presidential run on June 4, has been praised in more than $200,000 worth of TV ads in Iowa this month by a supportive super PAC called the Opportunity and Freedom PAC.

Jordan Russell, a spokesman for the group, said the ad buy was a “chance to reintroduce Gov. Perry’s record to voters” and was a way to help Perry “build momentum.”

Furthermore, Cruz, the Texas senator beloved by many tea party activists, has been lauded to the tune of about $50,000 to date by a political action committee called Make DC Listen, a name that stems from a popular phrase in his speeches.

Make DC Listen is led by John Drogin, who managed Cruz’s 2012 U.S. Senate campaign, when he unexpectedly prevailed over GOP establishment favorite David Dewhurst.

Overall, groups not controlled by the candidates have spent about half as much on positive ads so far this year — roughly $575,000 — as negative ones, according to the Center for Public Integrity’s analysis.

Most presidential candidates will file their first campaign finance reports with the FEC next month.

This story was co-published with TIME. 

Republican Jeb Bush is finally going to answer to "candidate."

After months of playing a coy, will-he-or-won't-he game over declaring a formal bid for the presidency, Bush is set to formally announce today.

Since December, when he said he would "actively explore" running, Bush has built a formidable operation that includes a roster of well-known campaign operatives, a super PAC named Right to Rise and an accompanying nonprofit group that will reportedly concentrate on policy.

His heavy involvement with these groups, which are legally prohibited from coordinating their expenditures with his official campaign committee once he is an official candidate, has earned him criticism from both the left and the right. Some campaign finance reform advocates have even urged the attorney general to appoint a special counsel to investigate whether Bush violated campaign finance laws, something he maintains he has not done.

To be sure, Bush, the son and brother of former presidents, has tapped his rich Rolodex over the past six months. Estimates of the amount he's raised by his fledgling operation range as high as $100 million.

But despite the big war chest, though, the former Florida governor has had some high-profile stumbles, and his undeclared campaign went through a shakeup earlier this month.

Here's more on Bush's political and financial history:

Sources: Center for Public Integrity reporting, as well as the Center for Responsive Politics, Miami Herald, Politico, Yahoo News and U.S. Senate.

Image sources:AP

If you think costs would come down if hospitals were all owned and operated by big for-profit corporations like Hospital Corporation of America, you might want to take a look at a study published last week by the journal Health Affairs.

Of the 50 U.S. hospitals that mark up prices the most, 49 of them are part of for-profit hospital chains, according to the study’s authors, Ge Bai of Washington & Lee University and Gerard Anderson of the Johns Hopkins Bloomberg School of Public Health.

Using 2012 data provided by 4,483 hospitals to the Centers for Medicare and Medicaid Services, Bai and Anderson found that those 50 had an average markup of 1,013 percent over what Medicare pays for the thousands of items on hospitals’ “chargemasters.” (Chargemasters are lists of all the items and services hospitals bill for. Hospitals set their own charges. Few states set any limits on what hospitals can charge.) That’s almost three times the average markup at the other 4,433 hospitals. The average markup for all those other hospitals—most of them nonprofits—was 340 percent.

Of those high-markup 50, more than a fourth of them are owned and operated by Nashville-based Hospital Corporation of America (HCA). But with 14 hospitals on the list, HCA was just in second place. A full half of the top 50 are owned by HCA’s biggest rival, Community Health Systems, a Franklin, Tennessee company that operates 199 hospitals in 29 states.

At the very top of the markup list was North Okaloosa Medical Center in Crestview, Florida. That hospital, in the Sunshine State’s panhandle, had the distinction of marking up its costs an average of 1260 percent. The Atlantic’s Olga Khazan took a look at North Okaloosa’s markups. She found, for example, that the hospital charged $79,350 to treat a hemorrhage. That’s compared to Medicare’s reimbursement of $5,177.

As the authors noted in their Health Affairs article, “Collectively, this system (of giving hospitals free rein to mark up their costs) has the effect of charging the highest prices to the most vulnerable patients and those with the least market power.” Those who are the most vulnerable, of course, are the uninsured and under-insured. Bai and Anderson pointed out that even when (or if) the Affordable Care Act is fully implemented, there will still be 30 million people without insurance. When those folks get sick or injured and wind up in the hospital, they’ll be on the hook to pay whatever the hospitals decide to charge. This means that even with the ACA, thousands of families will still find themselves in bankruptcy court every year because of medical bills they can’t possibly pay.

(Note to the uninsured: it’s in your best interest to find out which hospitals near you are nonprofit and which ones are for-profit. And that’s not just because the for-profits’ markups are higher. The ACA requires nonprofit hospitals to provide discounts to eligible uninsured patients. There are no such requirements for for-profits.)

Most of the high-markup hospitals are in the South. And of the top 50, 20 are in for-profit-hospital-friendly Florida, whose governor is former HCA CEO Rick Scott.

Scott has a long history in the world of for-profit health care. When I worked for Humana in the early 1990s, the company decided to sell its hospital division, and Scott and one of his business partners at the time, David Vanderwater, bought them. Soon after that, Scott negotiated a merger with HCA and became the combined company’s chief executive. He resigned from HCA in 1997 after the government launched an investigation into whether the company had committed Medicare fraud.

Two years before Humana decided to get out of the hospital business—and while I was on the public affairs team—the company was the subject of a series of investigative reports by ABC TV’s Sam Donaldson. In 1991, Donaldson found that Humana’s hospitals were charging patients several thousand percent more for medicines and other items than their actual cost. In one of his reports, he showed that Humana charged patients $143.25 for needles it bought for 80 cents—a markup of 17,806 percent.

One of Humana’s executives at the time was Wayne Smith. Soon after Humana sold its hospitals, Smith became the company’s president—and my boss. I was reporting to him when I left the company to join Cigna.

A few years later, Smith was named president of Community Health Services, the company that owns half of the high-markup 50.

Isn’t it a small world?  

When Bai and Anderson’s study was published last Monday, Community Health Services shareholders apparently were spooked for a New York minute. The volume of shares traded that day was almost triple the volume the preceding Friday. The share price fell $1.39, to $52.76. By the end of the week, though, the share price had largely recovered.  That’s because very few states have any power to control hospital price markups. Only Maryland and West Virginia, in fact, set hospital rates. Bai and Anderson found that hospitals in Maryland had markups of less than 1.5 percent, lower than those of hospitals in any other state.

Community Health Services and HCA’s shareholders might get worried if other states were to follow Maryland’s lead. But considering the amount of money the hospital industry spends to influence campaigns and public policy, the chances of that happening are pretty slim.

Wendell Potter is the author of Deadly Spin: An Insurance Company Insider Speaks Out on How Corporate PR is Killing Health Care and Deceiving Americans and Obamacare: What’s in It for Me? What Everyone Needs to Know About the Affordable Care Act.

As President Obama prepares for the last of the global summits he organized to lock down or eliminate nuclear explosive materials around the globe, his aides are hoping for modest achievements rather than pressing for broad new measures to help protect the world from a nuclear terror attack, according to current and former administration officials.

Obama set a high bar five months after his election when he said that nuclear armed terrorism was “the most immediate and extreme threat to global security” and promised that he would lead an effort to lock down all vulnerable nuclear material around the world within four years. But more than six years later, there is a consensus inside and outside the government that such a sweeping achievement remains out of reach.

Over the course of his presidency, Obama has scaled back his goals in this area and settled for what a senior White House official publicly described in 2012 as “the incremental nature of success," rather than throwing his full weight behind the creation of global security standards for nuclear materials that independent experts say could have a more lasting and significant impact.

The administration’s focus on what its officials depict as the art of the possible has provoked grumbling from outsiders that progress achieved so far could be undermined after Obama departs in 2017, unless the government mounts a last-minute push for a more sweeping agreement — even one involving only a few dozen like-minded nations instead of a global pact.

“I completely understand that putting forth ambitious ideas is putting your hand into a buzz saw,” said Kenneth Luongo, senior advisor to the secretary of energy during the Clinton administration and former director of arms control and nonproliferation at the Energy Department, referring to opposition by several nuclear-weapons states and some others to a new system of nuclear material controls.

“But you have to do it, so you can show people the scar,” he said, and demonstrate to the world that the United States is prepared to take political risks  to reduce this threat.

The Obama administration since 2009 has hardly slighted nuclear security: According to the Nuclear Threat Initiative, a nonprofit group in Washington that advocates tighter control of nuclear explosive materials, the administration has invested more than $5 billion in it. That figure includes funds given to Russia and other countries to help secure their nuclear weapons arsenals, to convert research reactors so they burn fuel that cannot be used in weapons, and to improve the physical protection and accounting of nuclear explosive materials such as plutonium and highly-enriched uranium.

The summit meetings Obama led in in 2010, 2012 and 2014 about associated nuclear perils — in Washington, South Korea and the Netherlands — included 53 nations and were attended by 46 sitting presidents, prime ministers or other heads of state. Some of those leaders brought what the administration called “gift baskets” meant to highlight their commitment to nuclear security, including offers to ship nuclear explosive materials to the United States or Russia for destruction.

But Luongo, who now directs a nonprofit group called Partnership for Global Security, said the meetings left “gaps and fissures” in the patchwork of domestic regulations and international agreements designed to protect nuclear materials from falling into the wrong hands. And he urged that the United States lead an effort to transform the current system, where it is up to individual countries to decide how seriously to take the protection of their nuclear materials, into one with enforceable international standards. 

Laura Holgate, the senior director for WMD Terrorism and Threat Reduction at the National Security Council and a leader of the efforts to prepare for next year’s summit, declined to address planning for the final summit. Shortly after the second summit in March 2012, however, Holgate said the administration had not sought new nuclear security treaties because too many other countries were opposed to such measures.

Instead, she said, the summit process reflected “the incremental nature of success,” adding: “That’s just the way it is in this field. You don’t have giant thunderclaps and then the world is different.”

Asked for further comment last week, a White House spokesman forwarded a copy of a speech last July in which Holgate said the summits had “built up an impressive track record in meaningful progress” and helped make it “harder than ever for terrorists to acquire nuclear weapons.” In the speech, she said “we have not yet done all that we can or need to do,” but a “comprehensive” arrangement for controlling both civilian and military stocks of nuclear explosives would be promoted “over time.”

“We also need,” Holgate said then, “to reflect the principle of continuous improvement.”

In advance of the 2014 summit, however, the Department of Energy’s National Nuclear Security Administration, in a document labeled “Official Use Only,” said that while U.S. initiatives had made the world safer, there are still “serious threats that require urgent attention.” The May 2013 report, which was obtained by the Center for Public Integrity, said that terrorists were still seeking nuclear weapons, and plenty of raw materials to build them are still scattered around the world.

Hundreds of pounds of weapons-usable uranium are being stored at civilian sites, including in South Africa and Belarus, the document said. Scores of research reactors, where security is generally lower than at military sites, still operate with fuel composed of weapons-grade explosives, it said, including more than 60 in Russia alone. Meanwhile, global plutonium stocks are rising, the report said, with more than 100 metric tons produced since 1998, enough it said to build at least 20 thousand nuclear weapons.

The loss of even a small amount of this material from any of the hundreds of sites where they are stored could have catastrophic consequences, the report said. “In today’s global environment, a nuclear … device would not just impact one city or one country; it would gravely damage us all.”

The report’s depiction of the threat as an urgent problem has found resonance in a coalition of more than 80 arms control, academic, and philanthropic organizations known as the Fissile Materials Working Group. It plans to release a 16-page report Tuesday proposing what it calls “bold, new actions” to advance nuclear security at the final summit beyond what the Obama administration is presently considering, including creating a pathway toward "universal, mandatory...standards."

The group’s membership spans the political spectrum, and includes the Arms Control Association, the Cato Institute, the Federation of American Scientists, the Stimson Center, Physicians for Social Responsibility, and the Center for Strategic and International Studies, as well as independent groups in Russia, India, Denmark and elsewhere. One of its members, the Stanley Foundation, has financially supported foreign travel by staff at the Center for Public Integrity. The working group has already given copies of its report to diplomats heading for a preparatory conference scheduled to be held in Lithuania the week of June 28.

The Working Group report calls on the nuclear weapons states to share more information about security practices and expenditures, and to support visits by foreign experts who could review the security arrangements for their fissionable materials (not the weapons themselves) — the way U.S. scientists helped their Russian counterparts in the 1990s, when the collapse of the Soviet Union left huge stores of such materials poorly guarded.

The Working Group report also calls for summit leaders, including the United States, to seek an agreement that highly-enriched uranium will no longer be used as fuel in civilian nuclear reactors, and that all research reactors should be modified so they only burn non-explosive fuel. Previous summits have called on countries to minimize -- not end -- their use of highly-enriched uranium reactor fuel.

The report further urges countries to agree to work towards halting the use of weapons-grade uranium to power ship-board or submarine reactors, a sensitive issue for the United States, Russia, the United Kingdom, and India. A task force convened by the Federation of American Scientists in March recommended development of a propulsion reactor using reactor-grade uranium, although the Navy has expressed concern that such reactors would not be as powerful or efficient.     

Holgate attended a closed meeting of nonproliferation experts at the Carnegie Endowment in Washington in March, several of the experts said, and raised doubts about parts of the plan. According to two of those present, Holgate noted that the idea of one state having a legitimate interest or stake in the security of another’s nuclear weapons materials was still controversial. This makes it unlikely that nuclear weapons states would accept any security standards set by outsiders, including international bodies, she suggested.

Countries should instead consider proposing “a menu of steps” allowing the nuclear weapons states to demonstrate that their protections for military-related fissionable materials are effective, Holgate said, according to the source and a copy of notes she provided to members of the group. National Security Council spokesman Mark Stroh responded that “I have no comment on whatever alleged handwritten notes you think you have.”

Gary Samore, who served from 2009 to 2013 as the White House coordinator for arms control and weapons of mass destruction and led preparations for the 2010 and 2012 nuclear summits, said he considers Holgate’s approach reasonable.

He said that some non-nuclear countries fear the United States has a hidden agenda, aimed at limiting their access to nuclear technology under the guise of security, or at highlighting shoddy security practices. They are especially worried, he said, that the United States might want to give the International Atomic Energy Agency or another group the power to set and enforce security standards, infringing on their sovereign rights.  

Overcoming suspicions among the summit partners, he said, required constant reassurance and compromise. “We were always very prudent,” Samore said. “I always tried to make it clear that we were not trying to do something that was strongly opposed by key countries.”

Samore said that efforts to set and enforce security standards for fissionable materials related to military programs would be particularly problematic. Most non-nuclear weapons states at the summits would support such an agreement, he said, but Russia and France are opposed. “I think if we had tried to go down that road, we would have met resistance from almost everybody else — the Indians, the Chinese, the Pakistanis,” he said, “to say nothing of the U.S. nuclear establishment.”

“That isn’t to say that nothing can be done about nuclear security,” he said. “It just means that it can’t be done through a nuclear treaty,” but instead through bilateral discussions, such as those between the United States and Russia, Pakistan, the United Kingdom and France.

Those who favor a more ambitious U.S. agenda note that one of the major achievements of the 2014 summit was something very much like a treaty. Thirty-five of the 53 leaders in attendance agreed in writing to adopt the International Atomic Energy Agency’s guidelines on nuclear security into their national rules and regulations. They also agreed to periodic reviews by outside experts and to improve the training of their nuclear security personnel.

Four nuclear weapons states — France, the United Kingdom, the United States and Israel — signed the document, titled “Strengthening Nuclear Security Implementation.” Four others in attendance, Russia, China, Pakistan and India, declined to join. Samore said there was hope two years ago that Russia, the world’s largest nuclear power, might sign the statement, putting pressure on the other three countries to do likewise. But he said that given the conflict between the United States and Russia over Ukraine, chances are that Russia will not sign the document.

Luongo nonetheless called the joint statement a “first step” toward the kind of comprehensive nuclear security agreement that he and others envisage. A group of 23 nuclear security experts, including Luongo and Kenneth Brill, U.S. ambassador to the International Atomic Energy Agency from 2001 to 2004 and director of the U.S. intelligence community’s National Counterproliferation Center from 2005 to 2010, proposed a draft of such an agreement in March.

It would be open to any state that wished to join, and require they establish and maintain a system for protecting nuclear materials that conformed to a series of legislative, regulatory, transparency and other standards to ensure those materials were secure. The language of the proposal describes those standards only in broad terms, but Luongo said the draft was merely the basis for the beginning of a discussion of the agreement.

But so far Brill, Luongo and others in the group haven’t found any nation — including the United States — willing to promote it as part of their political agenda.

Luongo said the reason that the idea hasn’t caught on yet is not because it’s unachievable but because no one is pushing it hard enough.  By suggesting these goals are unattainable, he said, Samore and others underestimate the growing support for nuclear security — support generated in part by the administration’s own summits.

“Countries recognize there is a problem,” Luongo said. “But there hasn’t been the requisite leadership yet to move toward solving that problem. We have been moving in the right direction. But the stars are not yet aligned.”

This story was co-published with Politico Magazine.

Donald Trump built a real estate empire.

He’s owned an eponymous airline, luxury vodka brand and clothing line.

Reality television show? Check.

He’s has even grappled his way into the WWE Hall of Fame, before trying, and failing, to buy the National Football League’s Buffalo Bills.

But never — despite cryingpoliticalwolfmoretimes than, perhaps, any other modern American — has Trump officially run for political office.

Until now.  

Here’s more on Trump’ political and financial history as he strides (seriously!) into the Republican party’s claustrophobic presidential candidate field:

Sources: Center for Public Integrity reporting, Center for Responsive Politics, Federal Election Commission, Forbes, National Institute on Money in State Politics.

Image sources:AP, Flickr

When the U.S. Food and Drug Administration ruledonTuesday that artificial trans fats are not safe to eat, it stripped the food additives of their “generally recognized as safe” status.

Such a move is rare: In April, the Center for Public Integrity reported on how the food industry, not the federal government, largely determines whether food additives are safe for consumption. When the food industry declares an additive to be “generally recognized as safe,” or GRAS, the FDA allows food companies to avoid an extensive safety evaluation.

Food companies, many of which have recently chosen to replace trans fats with other oils, have three years to completely remove the additives from their products, according to the FDA.

From now on, companies seeking to add trans fats to food must submit a formal petition to the FDA and undergo a thorough safety assessment.

The FDA’s ruling today on trans fats — or partially hydrogenated oils — cites a wealth of scientific research linking trans fats to chronic health problems such as heart disease, stroke and Type 2 diabetes.

The move “demonstrates the agency’s commitment to the heart health of all Americans," Stephen Ostroff, the agency’s acting commissioner, said in a statement. "This action is expected to reduce coronary heart disease and prevent thousands of fatal heart attacks every year.”

The Grocery Manufacturers Association, which represents the food industry, said it will work with regulators to ensure that food manufacturers comply with the law within the time frame laid out in the ban.

“GMA is pleased that FDA has acted in a manner that both addresses FDA's concerns and minimizes unnecessary disruptions to commerce. GMA will work in collaboration with FDA to further reduce [trans fats] in foods,” the association’s statement reads.

Trans fats are among many ingredients that public health groups and consumer advocates have pointed to as examples of how potentially unsafe additives can enter the largely industry-regulated food supply with little to no government oversight.

Because the GRAS system is so opaque, critics say, it’s impossible to know whether companies secretly adding ingredients to foods and beverages are monitoring long-term health effects similar to those posed by trans fats.

Trans fats have been used in fried foods, cake mixes and microwave popcorn for decades. But they have long been vilified by public health officials for contributing to the deaths of thousands of Americans.

The ban on trans fats is a victory for public health advocates who have long battled the powerful food industry, which has fought to keep the ingredient in the food supply.

Georges Benjamin, executive director of the American Public Health Association, says the public’s health will greatly benefit from the FDA’s ban on trans fats.

“This is an example of success in terms of people identifying an unhealthy food additive and pushing the FDA, despite enormous industry resistance, to do the right thing in terms of protecting public health,” he said.

Today’s announcement finalizes a preliminary ruling issued two years ago by the FDA concluding that trans fats are no longer safe to eat.

Erin Quinn contributed to this report

Federal officials spent years locked in a secret legal battle with UnitedHealth Group, the nation’s biggest Medicare Advantage insurer, after a government audit detected widespread overbilling at one of the company’s health plans, newly released records show.

The audit, completed in 2012, found that Medicare had paid too much for nearly half of a sample of patients enrolled at PacifiCare of Washington State, a subsidiary of UnitedHealth Group. The heavily redacted audit was part of a cache of documents recently released to the Center for Public Integrity through a court order in a Freedom of Information Act lawsuit.

Matt Burns, a UnitedHealth spokesman, declined comment. However, during more than three years of confidential — and previously undisclosed — negotiations, the insurer argued the audit was unfair and the results were flat out wrong.

These audits are called Risk Adjustment Data Validation, or RADV. They test the accuracy of a billing tool called a “risk score.” Medicare uses risk scores to pay health plans higher rates for sicker people and less for those with few medical needs. But federal officials concede that some health plans may overstate how sick their patients are, a practice known as “upcoding,” that wastes billions of tax dollars every year. The RADV audits are designed to recover any overcharges.

Officials have done these audits at least since 2008. But they haven’t released any findings from them, so the PacifiCare experience offers a rare look at government oversight of the popular — and fast growing — Medicare Advantage industry. These privately-run alternatives to the basic fee-for-service Medicare program treat more than 17 million Americans at a cost topping $150 billion a year and are facing calls for greater transparency — including recent criticism from two U.S. senators.

The secrecy surrounding Medicare Advantage — CMS officials blacked out large chunks of the PacifiCare audit and related documents — prompted a stern rebuke from one of those senators, Judiciary Committee Chairman Charles Grassley.

“The public’s business ought to be public, with few exceptions. An agency shouldn’t withhold internal deliberations unless there’s a really good reason for it, like a risk to national security. It seems to me that a discussion of a Medicare overpayment problem and what to do about it ought to be public,” the Iowa Republican said in a statement.

“What is CMS worried about disclosing and why?” Grassley added. Last month, Grassley wrote to Attorney General Loretta Lynch and CMS administrator Andrew Slavitt asking how many of the risk score fraud audits had been launched over the past five years and their results.

In a separate letter, Sen. Clare McCaskill, the senior Democrat on the Senate Aging Committee, asked CMS officials what’s being done to curb billing fraud and abuse alleged by Medicare Advantage whistleblowers, calling it “an issue that must be investigated further.”

Congress authorized the use of risk scores starting in 2004. It’s essentially an honor system in which health plan doctors assess every patient’s health risks (and thus the associated payments) based on specific medical conditions they have, such as diabetes. Exactly what’s permissible under the billing rules, however, remains confusing even to many health plan professionals.

“I think there’s really not a very good understanding of how this works,” said Holly Cassano, a medical coding consultant in Florida.

It is clear CMS officials knew years ago that risk scores rose much faster among Medicare Advantage plan members than for people who remained on traditional Medicare, a worrisome signal of creeping billing abuse. A major 2009 government study that was not made public suggested some plans “gamed” the system by exaggerating how sick patients were, for instance.

In June 2008, officials picked five health plans, including PacifiCare of Washington, Inc., for pilot RADV audits. Details on the four other audits appear to have been redacted in records released to the Center for Public Integrity. CMS would only say the pilot audits “recovered” $3.4 million.

Under the audit rules, two sets of auditors combed over medical records for 201 patients to confirm they had the illnesses the government paid to treat. If these conditions are not properly documented in the medical charts, Medicare asks for a refund. By contrast, plans can get credit when underpayments are discovered.

Among the PacifiCare audit findings:

• Medicare paid the wrong amount for 128 of the 201 patients, an error rate of nearly two-thirds. Payments were too high for 98 of the patients, too low for 30 of them. In total, the plan was overpaid by $381,776 during 2007.
• One in five medical conditions could not be confirmed and most of these errors triggered higher payments than justified. CMS officials redacted the names of the medical conditions.
• Auditors cited a “lack of sufficient documentation of a diagnosis” most often as the cause for either denying or slashing payments. However, in more than a third of the errors, payment was denied because the medical file was missing the required signature of the doctor who treated the patient.

CMS records show that the audit dragged on for years because officials changed some rules in the middle of the game and set up a lengthy and bureaucratic appeals process for health plans to follow.

CMS shared “preliminary” audit findings with the company in December 2010, but took nearly two years more to present a final version.

In a letter on Aug. 21, 2012, CMS officials said UnitedHealth owed the government $381,776. CMS said that it would deduct the money from upcoming payments to the plan, and reminded the company it could appeal.

But the flap didn’t end there, for reasons that are not explained in the exchange of testy letters between the company and government.

Scott Theisen, UnitedHealth Group chief financial officer, filed an appeal in a Sept. 20, 2012 letter. He argued that the sample was too small and that the insurer didn’t give the company enough time to secure sufficient medical records to justify its billing

“Thus the amount of the overpayment claimed to be due by CMS cannot be accurate,” Theisen wrote

On March 14, 2014, a CMS hearing officer remanded the case to the agency for further negotiations.

CMS wouldn’t say what happened next. In a statement, the agency wrote: “CMS takes seriously program integrity and payment accuracy in Medicare Advantage, and is taking steps to protect taxpayers, Medicare beneficiaries and the Medicare program. CMS is exploring how to make RADV hearing officer decisions public in such a way that safeguards the protected health information of Medicare Advantage enrollees.”

UnitedHealth Group and the other health plans audited, clearly dodged a financial bullet.

CMS had announced in June 2008 that it would start applying penalties known as “extrapolation,” which have been widely used in other types of Medicare fraud investigations.

This meant that the billing error rate found in the sample of 201 patients would be applied to the PacifiCare of Washington plan. That could have dramatically boosted the penalty.

But somewhere between 2008 and 2012, officials changed their mind and let Medicare Advantage plans off the hook.

CMS officials have never explained fully why they decided against extrapolating the audit findings.

But a confidential CMS presentation dated March 30, 2011 perhaps offers more than a clue. Each of 15 slides states “for internal government use only,” and notes that “unauthorized disclosure may result in prosecution to the full extent of the law.”

One slide estimates payment errors in Medicare Advantage at $13.5 billion for 2010 and notes that health plans “have an incentive to submit more diagnoses” in order to raise their payments.

But when CMS sought opinions on the audits in December 2010, it received more than 500 comments.

“These comments express significant resistance to the implementation of the RADV audits and payment recovery based on extrapolated payment error estimates,” CMS said in the presentation. The presentation went on to say: “Successful payment recovery based on payment error identified in these RADV audits will depend on CMS’ ability to address the challenges raised.”

CMS said it was “expecting to respond to the comments and finalize the payment error calculation methodology and overall strategy shortly.”

As of last month, more than four years later, that still hasn’t been done.

This story was co-published with NPR.

Peter Bale, chief executive officer of the Center for Public Integrity, was elected president of the Global Editors Network at the organization’s board meeting in Barcelona Wednesday.

Global Editors Network is a cross-platform community of editors-in-chief and media executives aimed at creating sustainable, high-quality journalism and empowering newsrooms through a variety of programs designed to inspire, connect and share.

“The Global Editors Network is arguably the most forward-looking journalistic industry group in the world,” Bale said. “It isn’t rooted in ‘old’ media but in a commitment to the future of journalism using the most advanced technology and storytelling methods available.”

Bale said he is proud to have been a member of the organization since its foundation and looks forward to working with its “indefatigable and imaginative director general Bertrand Pecquerie.”

The organization’s board also elected Paul Steiger, executive chairman of ProPublica’s board of directors, as treasurer.

Read more in the Global Editor’s Network news release.

The earliest donors to Republican Jeb Bush’s pre-presidential campaign machine include prominent Florida politicians, the state’s chamber of commerce and even a labor union, according to a Center for Public Integrity review of Florida campaign finance filings.

Together, these Sunshine State lawmakers and special interests have donated nearly $250,000 to a controversial super PAC that Bush, a former Florida governor, controlled prior to his formal presidential announcement on Monday.

The pro-Bush Right to Rise super PAC has not yet filed reports with the Federal Election Commission detailing its funders, and it won’t until next month.

The state campaign finance disclosures reviewed by the Center for Public Integrity offer a preview, however limited, of who in a crowded presidential election field has already committed cash to Team Jeb.

Among the most generous Florida-based political groups already backing Bush: The Committee for a Stronger Florida, which is associated with former Florida House Speaker Will Weatherford.

To date, it has given $75,000 to Bush’s Right to Rise super PAC. Weatherford has praised Bush for having “one of the most successful records as governor of anybody I've ever seen.”

In February, Weatherford was also among the hosts of a fundraiser for the Right to Rise super PAC staged at the Grand Hyatt in Tampa, Florida, according to a copy of an invitation obtained by the Sunlight Foundation, a nonprofit group that advocates for government transparency.

Weatherford’s Committee for a Stronger Florida, in turn, has collected most of its money since its inception last July from the Florida Republican Party.

Meanwhile, the Treasure Coast Alliance, operated by influential Republican state Sen. Joe Negron — who is vying to be the next Senate president — has donated $51,000 to Bush’s Right to Rise super PAC, records show.

And the PAC of Florida’s current GOP House Speaker Steve Crisafulli — known as Growing Florida’s Future — has donated $25,000.

Other Florida Republicans whose PACs have donated to Bush’s Right to Rise super PAC during the year’s first five months include:

• state Rep. Seth McKeel ($13,000)
• Florida Agriculture Commissioner Adam Putnam ($10,000)
• state Sen. Jack Latvala ($5,000)
• state Sen. Wilton Simpson ($5,000)
• state Rep. Dana Young ($5,000)
• state Rep. Brad Drake ($1,000)  
• and state Sen. Anitere Flores ($1,000)

Additional donors to the pro-Bush super PAC include political groups run by the Florida Chamber of Commerce, the Florida Professional Firefighters labor union and the health care industry.

Prior to his presidential announcement, Bush for months traveled the country raising money for his Right to Rise super PAC — which last week was renamed Right to Rise USA — and a companion political action committee also called Right to Rise.

People on both the left and right have criticized Bush for working too closely with these purportedly independent groups, which are now prohibited from coordinating their expenditures with Bush since he officially declared his candidacy. The groups are run by close Bush surrogates who are familiar with his campaign plans and objectives.

The Associated Pressrecently reported that an internal firewall between the campaign and the super PAC went into effect on June 4.

The Sunlight Foundation has obtained invitations for more than three-dozen fundraisers for the Right to Rise super PAC, which reportedly hopes to raise as much as $100 million by the end of June. Officials with the super PAC have derided that figure as inaccurate but stressed that the group's first campaign finance filing next month will show “very formidable numbers.”

By law, super PACs are allowed to accept contributions of unlimited size from individuals, companies, labor unions and other groups.

Bush’s official presidential campaign committee, in contrast, is barred from accepting direct contributions from labor unions and companies, while contributions from individuals are capped at $2,700 and donations from PACs are capped at $5,000.

This story was co-published with TIME. 

COLUMBUS, Ohio — Thousands of hastily scribbled signatures fill boxes in the basement of Ian James’ 7,800-square-foot restored Victorian home in the historic Franklin Park neighborhood. James needs these names to win a place on Ohio’s November ballot for a measure to legalize medical and recreational marijuana.

But the political consultant isn’t just gathering the signatures. He came up with the idea for the measure. And he recruited a lawyer to draft a constitutional amendment that would put Ohio’s future marijuana market in the hands of only 10 growers — an arrangement that critics are calling a monopoly.

Meanwhile, he plans to pay his own firm nearly $6 million to run the campaign.

Though James is an extreme example, he’s a member of a much larger and little-known class of professionals that form what could be called Ballot Measure Inc.:  a powerful electoral-industrial complex funded by moneyed interests that belies the quaint notion of “citizen democracy” that such efforts are assumed to represent.

Active in the 26 states that have citizen-initiated ballot measures, the network of pollsters, direct mail specialists, lawyers, consultants, signature gatherers and voting data whizzes were paid at least $400 million for 85 statewide measures across the country in 2014, according to a Center for Public Integrity analysis of state records.  In presidential election years, state and local measures are a billion-dollar industry, said ballot initiative expert David McCuan.

The growth of the industry means that often only those with money can afford to get into the game.  In some big states, such as California, where political consultant David Townsend estimates a controversial measure costs at least $25 million to pass, paid signature gatherers are now virtually a requirement to get on the ballot.

And this process of direct democracy sometimes appears to directly benefit only special interests: such as the Native American tribes who gave $107 million in 2008 to win measures expanding their slot machine operations in California; the agribusiness giant Monsanto, which gave $10.7 million last year to block labeling of genetically modified foods in Colorado and Oregon; or the plastics industry, which is currently fighting a plastic bag ban in California.   

“The process has been captured by interests,” said McCuan, a Sonoma State University professor. “It’s been professionalized. It’s expensive.”

This has created a market filled with the promise of profits for those willing to work as mercenaries for a cause — or even come up with their own cause. James isn’t the only one known to have done so. The California lottery was famously created by signature gatherers in 1984, and a Nevada political consulting firm came up with and successfully campaigned for anti-union measures in multiple states, beginning in 2010.

“The honest and most easy response is: I am going to profit from this,” James told the Center for Public Integrity. “If people are upset about me making money, I don’t know what to say other than that that’s part of the American process. To win and make this kind of change for social justice, it does cost a lot of money.”

James’ initiative has drawn considerable heat. The measure would root the 10 marijuana growth sites to particular land parcels, which happen to be controlled by the mysterious companies funding the initiative. They would function as Ohio’s only wholesale suppliers of marijuana, selling to separate retail shops and nonprofit medical dispensaries.

James, a 49-year-old Ohio political veteran, has succeeded at this before. In 2009, he persuaded Ohioans to approve four casinos, also rooted to particular plots of land. For Responsible Ohio, as his marijuana effort is called, James wrangled together investors who are willing to bankroll a $20 million campaign, sink in an additional $20 million to buy the land and $300 million more to build facilities.

The investors have contributed through limited liability corporations with vague names such as Verdure GCE LLC and NG Green Investments LLC, offering few clues as to who’s behind them. Their hoped-for payoff? Guaranteed ownership of a wholesale marijuana market potentially worth more than $1 billion, according to a prospectus to investors outlining the Responsible Ohio campaign budget and obtained by the Center for Public Integrity.

And once the measure passes, James said he plans to open a consulting company helping launch marijuana retail stores.

Investing in pot

Just off Interstate 71 in Franklin County, Ohio, a 19-acre field on a two-lane road will become an oasis of legal pot if Responsible Ohio’s measure passes.

The field’s owner, Kenneth Campbell, said he signed a contract early this year to take the plot off the market and give an unknown buyer the exclusive right to purchase the field by the end of 2015. When Campbell’s name and plot of land started showing up in news reports on marijuana legalization, he was as surprised as anyone.

“People saw my name,” Campbell said. “They said, ‘Hey Ken, you’re growing some pot!’ And I said, ‘I am?’ ”

Around the state, at least four other sections of land were reserved in the same way — to LLCs that paid for the exclusive right to buy the land by the end of the year or early into 2016. All 10 land parcels will be written into the state constitution should Responsible Ohio get its way.

The Responsible Ohio campaign has trumpeted some of the investors, including minor celebrities such as Nick Lachey, former 98 Degrees boy-bander and ex-husband of singer Jessica Simpson; fashion designer Nanette Lepore; and Arizona Cardinals defensive end Frostee Rucker. Others — such as Chicago investor Ben Kovler and Dayton pain specialist Dr. Suresh Gupta — can only be found after digging through documents. These investors declined or did not respond to requests for comment for this story. James said he’s not an investor.

Responsible Ohio investor Alan Mooney, a financier who specializes in off-shore corporations, said the limited set of investors would ensure Ohio’s marijuana market has the capital to get off the ground.

“I don’t want to throw open the doors like they did in California,” he said. “I know a lot of the street people, the hippies and stoners would love that. This has got be professional business people.”

The pre-arranged, limited list of investors doesn’t sit well with some Ohioans. Words such as “monopoly,” “cartel” and “oligopoly” appear frequently in critics’ speeches and newspaper columns.

Responding to such concerns, some state legislators are working on a counter ballot measure that would block initiatives benefiting only a small group. As lawmakers, they can refer an item to the ballot without gathering signatures. 

Major pro-legalization groups such as the Marijuana Policy Project and the Drug Policy Alliance also have distanced themselves from the initiative, despite supporting legalization measures in other states including Colorado, where the number of pot cultivators was not capped.

And some longtime supporters of marijuana in Ohio are actively opposing Responsible Ohio, alongside anti-drug activists.

“This is egregious to me on many levels,” said Marcie Seidel, an anti-drug activist who opposes all forms of legalization and heads Ohio’s Drug Free Action Alliance. “This is basically wealthy individuals, the 1 percent that we always hear about, that are wanting and asking us as Ohio citizens to guarantee in the constitution that they are going to make millions and millions more dollars so they can become even more wealthy.”

Behind the money

It’s not uncommon in the U.S. for moneyed interests who will benefit financially from the outcome of ballot measures to back their campaigns or opposition movements. Corporations and business trade groups gave more than three-quarters of the $266 million contributed by top donors to ballot measure groups in 2014, according to a Center for Public Integrity analysis published earlier this year.

For example, in Colorado, competing casinos gave more than $36 million in a fight over a 2014 measure to expand gaming at racetracks.

And Monsanto and other food-company allies raised $36 million to successfully block measures last year to label genetically modified foods in Colorado and Oregon, while pro-labeling groups fueled by money from natural foods businesses raised $7.5 million in the two states.

Ballot measures were the darling of early 20th century progressives, who saw them as a way to circumnavigate corrupt legislatures. South Dakota became the first state to add initiatives and referenda to its constitution in 1898, borrowing from the ideas behind robust ballot measure politicking in Switzerland. By 1918, 24 states and many more cities had adopted ballot measures, according to the University of Southern California’s Initiative and Referendum Institute.

But the provisions played a minor role in American political life until 1978 when Proposition 13, California’s anti-tax initiative, heralded the “taxpayer revolt” and new popularity for ballot measures. Now, measures promoted with expensive TV ad campaigns often bankrolled by wealthy interests or activist groups are a way of life in California, where the ballot measure is most popular, followed closely by several other western states, such as Oregon, Washington and Arizona. Ohio typically sees one or two statewide measures per year.

Moneyed interests don’t always win ballot measure fights, of course. In 2010, voters rejected California’s Proposition 16 that would have made it harder for municipalities to create their own power companies, despite $46 million spent by Pacific Gas & Electric in support, and less than $100,000 spent by opponents. But if big business is going to win, it needs help to create the network that a true grassroots movement would have at the ready. That’s where the pros come in.

‘Not a process for amateurs’

At Responsible Ohio’s headquarters in James’ Victorian home, July 1 looms. That’s the day the campaign must turn in its signatures to the secretary of state — at least 305,591 to get the measure on the ballot. The team has already surpassed that number, but James is hoping to obtain 800,000 signatures and register thousands of new voters — then remind them all to go to the polls in November.

To do this, James has assembled a cadre of professionals. The prospectus for potential Responsible Ohio investors outlines a preliminary $20 million budget for the campaign: $5.6 million for signature gathering, canvassing and operations, paid to James’ firm; $702,000 for lawyers and bookkeepers; $278,000 for polling; $350,000 for public relations; $1.5 million for data analysis by veterans of Barack Obama’s two presidential campaigns; $4 million for direct mail and a vote-by-mail program; $7.1 million for TV and radio advertising; and $440,000 for lobbying.

In Ohio, this is what it takes to run a ballot measure campaign: more than 500 people working full-time, and election pros running the whole show.

“This is a business,” James said. “What we’re doing in changing the constitution to legalize marijuana will lead to more than 10,000 people working in the state, billions of dollars being generated in new revenue. That money is also going to flow into local communities. But no one creates an industry of that magnitude without being paid for it.”

James has worked on eight state and local ballot measures in Ohio.  He got his taste for politics as a kid going to union meetings with his mother, a teacher. Starting in high school, he volunteered or worked on about a dozen candidate campaigns, he said, and later took jobs in the Ohio statehouse and as a lobbyist for the late entertainer and casino mogul Merv Griffin. He focuses now on ballot measures and said he works 80 hours a week on Responsible Ohio’s campaign.

Many other politicos also work exclusively on ballot measures for hefty price tags. Barry Fadem, a California-based attorney, has spent his three-decade career writing ballot measure language. His clients typically need to spend $100,000 even before the measure is filed with the state, he said, just to conduct opinion polls, hire consultants to start organizing the campaign and pay him to craft the legalese.

“The initiative process is just not a process for amateurs,” Fadem said. “It’s really not. Because it’s so hard to win.”

Some industry members claim only to work for causes they care about, but most combine work that supports their political principles with work that lines their pocketbooks, taking on gambling, land-use or other types of measures that pay well.

But industry members said they aren’t getting rich. Michael Arno leads a major signature gathering company, Arno Petition Consultants, that has been paid more than $9.5 million since 2010, according to data from the Lucy Burns Institute and state records.

“If I had a nickel for every nickel people thought I’d had, I’d be retired by now,” he said. “We go through long stretches we don’t have any work.”

Foot soldiers

With clipboards and pens in hand, Donnie Dawson stood on the sidewalk outside the Franklin County Government Center on a recent afternoon, calling to people shuffling into the revolving doors to pay speeding tickets and lawyers leaving to catch a smoke break.

“Legalize marijuana, bro?” he called out to a man in bright red pants.

“I don’t smoke,” the man said as he kept walking. “I sell.”

The man had a point: His current illegal business would be doomed under Responsible Ohio’s initiative, because only the 10 for-profit companies that are also funding the campaign would be allowed to grow and sell pot wholesale, though others could set up retail shops.

But voters may not know that from listening to Dawson try to collect their signatures. “Basically the 10 companies are for the nonprofit medical marijuana, for research for the medical marijuana,” said Dawson when asked what he tells potential signers curious about the alleged monopoly. "They're there to do the research and invent different strands of weed to help."

That leaves out a piece of the picture. Though it’s true the 10 wholesalers would supply nonprofit medical dispensaries, the wholesalers are presently organized as for-profit LLCs and would also supply for-profit retailers. “While maybe not artful, it is accurate,” James said of Dawson’s words.

A stream of Ohioans signed Dawson’s petition. None of them read the entire 24-page measure; many of them didn’t seem bothered by the wealthy investors behind it. 

"It goes hand in hand. It's kind of like Philip Morris and cigarette companies,” said 36-year-old warehouse employee Jorrel Carse, who also said he didn’t know much about the petition when he signed it. “It's all just a part of business."

Josh Sword, a construction worker and self-described “street pharmacist,” said he has grown marijuana in the past and would grow it again if Responsible Ohio’s measure passed.

Ohio’s potential marijuana market even inspired a copycat measure. But the Better for Ohio group seeks to authorize 40 growth facilities instead of just 10. The right to operate those sites would go to owners of certain $100 bills, with their serial numbers listed in the ballot measure. Better for Ohio said it would assign ownership of the bills at a later date.

The backers of the measure aren’t joking — they hired Arno’s California-based firm to gather signatures but will be aiming for the 2016 ballot after running out of money to pay Arno to qualify this year. 

Massive signature drives, though fraught with claims of fraud and deception over the years, remain the hallmark of the initiative process. Though some measures can still rely on volunteers for the labor-intensive job, at least $20 million was paid to 21 firms gathering signatures for the 2014 ballot, according to data from the Lucy Burns Institute and state records. 

But Dawson, a professional signature gatherer, isn’t making millions. The 42-year-old father of five did not say how much he makes, but James said signature gatherers are paid a base rate of $9.50 per hour, with the chance to earn more if they bring in many valid signatures.

Voices unheard

Responsible Ohio is attracting a motley crew of opponents, from anti-drug activists to pro-pot voters hoping to get other, less restrictive versions of marijuana legalization on the ballot.

Mary Smith, a marijuana activist and the former owner of what she called a “run-of-the-mill hippie department store” in Toledo, said she isn’t backing it because she doubts Responsible Ohio’s wealthy investors have genuine empathy for medical marijuana patients.

“This is completely about greed,” she said.

But so far opponents are without a broad coalition and have yet to muster significant funding to go up against the $20 million campaign from Responsible Ohio. Anti-drug activist Seidel said she thinks some sort of opposition group will form but doesn’t know where the money will come from.

Vermilion resident Aaron Weaver and about 20 other pro-pot critics of Responsible Ohio are trying to put up a fight. In April, they formed a new nonprofit, Citizens Against Responsible Ohio.

So far the group exists as a website, Facebook pages and Twitter feeds. And they are paying out of their own pockets to promote Facebook posts criticizing the measure. Encouraged solely by a tweet from comedian Drew Carey, an Ohio native who voiced skepticism about Responsible Ohio’s plan, Weaver drafted a letter asking him for money. “With your assistance, we can turn the tide and put a stop to these well-polished thugs in their tracks,” Weaver’s letter reads.

In an initiative process intended to be the voice of the people, the people are struggling to find the money to get their voices heard, while moneyed interests can afford to pay top dollar for the ballot professionals. It’s an irony not lost on the professionals themselves.

“To be quite honest, it’s a lucrative business, but there are certainly questions we all have about the efficiency, and what’s good for democracy and what’s not,” said Paul Maslin, a pollster who has worked on initiatives for 20 years. “Because let’s face it: Sometimes ballot measures can be the purview of special interest groups that may not be linked up with the public interest.”

Others are unmoved, even upon hearing that Ian James plans to pay his own firm $5.6 million to promote the idea he created.

“It's America,” said David Bruno, an Akron-based consultant who has helped James attract investors. “Good for him. And for the people that want to criticize that, it's a shame they didn't try to do it first.”

But for Weaver, Responsible Ohio would crush his version of the American dream: opening a marijuana farm that would double as his business and a retirement plan for his parents if legalization ever came to Ohio.

“It’s an absolutely unfair fight,” the 28-year-old administrative assistant said. “It’s a perversion of our process in the state of Ohio and I think any state, really. I mean putting your business plan into the constitution of a state? That’s unheard of. That’s ridiculous.”

Data reporter Ben Wieder contributed to this story.

This story was co-published with TIME. 

Nils Kauffman, who served as an education officer for the U.S. Agency for International Development in Afghanistan, said he noticed irregularities at a vocational training institute the agency was funding during his visits to its campus in downtown Kabul in 2012 and 2013. He recalls being surprised not to see any students in the institute’s laboratories, where volt meters and scientific equipment remained in their original packaging.

Though Kauffman spied students elsewhere, he said he could never get a reliable account of how many were actually enrolled at the school. He also could not verify that the institute had addressed what a 2011 external audit called a host of “deviations” from sound practices, including a lack of accounting software, a cash-based payment system, and $118,000 in spending by the school over a five month period on weapons, international travel, and salary supplements.

Kauffman didn’t have the authority to demand a new, broader audit of the institute, but he reported his concerns to his superiors at USAID. They never acted, he said, and he recalls an official in the agency’s Office of Afghanistan-Pakistan Affairs expressing worry that canceling the institute’s funding would create what the official called “bad press.”

“Every time something came up, they jumped to keep this guy [the institute’s leader] happy, despite the problems, despite the lack of financial transparency,” said Kauffman, who is now a private development consultant based in the San Francisco Bay Area. In fact, USAID continued giving the institute funds, totaling at least $12.3 million through last Sunday, according to USAID spokesman Sam Ostrander.

Kauffman’s experience is only a small part of the controversy suddenly surrounding the long-running U.S. effort to promote the education and training of the largely illiterate population in Afghanistan. More than three-quarters of a billion dollars in U.S. funds have been used to finance the effort, and USAID has repeatedly depicted it as one of its signal accomplishments there.

Last month, Afghanistan’s newly-appointed education minister raised questions about the veracity of that claim when he told his country’s parliament that some aid funds had flowed to so-called “ghost schools, which are only on paper,” according to several Afghan media accounts of the May 27 session. The minister, Assadullah Hanif Balkhi, said that officials in the previous government — in power from 2004 to 2014 — lied about the number of schools to obtain more foreign funds.

“It is a fact that there are no schools in some parts of the country, but all the expenses — including teachers’ salaries — are being paid, and now we will bring reforms to this waste,” Balkhi told the parliament, according to Tolonews, a publisher and broadcaster based in Kabul.

Asked to provide more detail, a spokesman for the ministry, Kabir Haqmal, later told NBC News — the Center for Public Integrity's publication partner for this article — that the matter is still under investigation. In some cases, he said, schools may have been closed due to fighting while “permanent absentees” were kept on the books for years, following a requirement of Afghan law.

“There could be schools that do not exist, but we [are] assessing all our records and so far have not found any such instances,” Haqmal said. “That does not mean there are no ghost schools, but we just do not have that information yet. We are taking this very seriously and will share our finding with public very soon."

The new minister’s claims have provoked the top federal auditor for U.S. reconstruction efforts in Afghanistan, John F. Sopko, to express concern that “U.S. and other donors may have paid for schools that students do not attend and for the salaries of teachers who do not teach.”

In a June 11 letter to acting USAID administrator Alfonso E. Lenhardt, released by Sopko on June 18, Sopko said the allegations about “ghost schools, ghost students, and ghost teachers call for immediate attention,” and asked the agency to explain within two weeks what it is doing to investigate the reliability of its data and the potential misuse of its funds.

Accurate data, Sopko said, “is essential for gauging progress in USAID’s education programs and for making future funding decisions.”

USAID spokesman Ostrander, in an emailed response to questions, said the agency will provide a detailed reply to Sopko by the June 30 deadline. According to a written statement Ostrander provided to the Center for Public Integrity from Larry Sampler, assistant to the USAID administrator for Afghanistan and Pakistan, the agency has already asked the Afghan Education Ministry for more information. USAID currently has a full-time employee assigned to help the ministry improve the reliability of its data, according to Sampler’s statement.

Like all the agency’s projects in Afghanistan, “USAID-implemented education projects adhere to the Agency’s strict practices for monitoring their performance and success,” Sampler wrote.

USAID has repeatedly boasted about its role in raising enrollment rates in Afghanistan, citing Afghanistan Education Ministry data. More than eight million Afghan students were enrolled in 2013, compared to just 900,000 in 2002, according to data that Sopko cited in his most recent quarterly report. He said USAID had acknowledged these figures could not be independently verified, however.

At the Afghanistan Technical Vocational Institute, where Kauffman said he observed irregularities, 4,529 students have so far graduated “with the support of USAID and other sponsors,” Ostrander said. But the institute’s founder and director, Sardar Roshan, reached by cell phone in Kabul, told the Center for Public Integrity that the total number was “close to 7,000.” Ostrander told the Center for Public Integrity he could not explain the discrepancy.

Roshan's tight connections to Washington

Roshan served as Afghanistan’s ambassador to Pakistan from 1992 to 1994, as the country’s minister of education from 1990 to 1992, and as a “rebel commander” liaising between “anticommunist forces and the U.S. government” in the National Islamic Front of Afghanistan during the 1980’s, according to his Linkedin profile.

Roshan denies that the institute has ever misreported its student population, saying the “ghost schools” are in rural provinces, but that his institute in downtown Kabul “could not fake students even if we wanted to.” He says he is highly proud of the institute. “When I’m in the international airport, when I walk into a bank in Kabul, when I look at the provincial governments, I see my graduates in every corner,” he said.

Rajiv Shah, the administrator of USAID from 2010 until February, singled the vocational institute out for special praise in a July 2013 speech at the U.S. Institute of Peace in Washington. “Today, we have more than 8 million children in schools with over 30 percent of who are girls. These investments have resulted in over 30,000 young women finishing secondary school and more than 40,000 young women seeking to earn university degrees today,” Shah said. “I’ve had the chance to meet some of these young women on visits to places like the Afghan Vocational Training Institute, watching them come in from around the country to develop marketable skills so they can triple or quadruple their earning potential upon graduation.”

But Kauffman, the former USAID education officer, was not alone in in voicing concerns about the institute’s achievements. In early 2012 – more than a year before Shah’s speech — USAID’s inspector general had reported there was “little evidence” that the agency’s support of the school, known as the Afghanistan Technical Vocational Institute, had strengthened its “overall technical capacity” or empowered Afghan youth. It said the project that included the institute “lacked clearly defined goals, objectives, and priorities.”

The institute began receiving USAID funds in 2007, according to Roshan and Ostrander. The funds were initially for scholarships, and were paid under USAID’s Afghanistan capacity-building program, Roshan said. But the financing was switched to the agency’s education department in 2010, under a subcontract with Education Development Center, Inc., a Massachusetts-based non-profit organization. Students were supposed to be trained in business management, construction, horticulture, information and communication technology, and automotive repair, according to the USAID webpage about the institute.

After the 2011 audit by accounting firm Grant Thornton’s Afghanistan office, USAID staff twice came to inspect the institute. But Kauffman said the institute obstructed efforts by USAID teams to dig deeper into its records, a claim supported by a copy he provided of USAID’s internal report about its site visits in July and August 2011.

The report states that the inspectors were “unable to meet all technical staff, check the systems, or gather sample documentation,” partly because the staff “were instructed by their headquarters not to disclose any documents” to them. It complained that Roshan and his ex-finance officer only met with them for 50 minutes, and said that as a result they were unable to learn whether the Institute had addressed key concerns the audit raised, including many involving its handling and disbursement of donor funds.

One person was, inappropriately, still responsible for handling petty cash, writing checks, and entering financial data into the computer, the report said.  And the “most important gap” identified by the auditors — the fact that the institute paid its employees’ salaries in cash rather than traceable bank transfers — was still a problem, the inspectors wrote. Multiple reports by Sopko have described this as a frequent practice in Afghanistan.

Roshan denied making any attempt to obstruct the inspection. He told the Center for Public Integrity that many of these problems were resolved by the institute directly after the audit appeared, though he acknowledged that the institute had continued to use a cash-based payment system until 2013. Ostrander similarly said the institute had made progress since undergoing a separate assessment of its business model.

Roshan sent the Center for Public Integrity a lengthy rebuttal to the Grant Thornton audit, accompanied by documents including templates for payment vouchers, time sheets, a 19-page accounting manual, and its personnel policy. He defended the spending on weapons, saying the institute needed shotguns for the protection of its staff and students. The international travel was for his own visits to the U.S., he said. And the salary supplements were “necessary,” he said, to keep American teachers at the institute.

“I admit shortfalls in the finance/procurement systems,” Roshan told the Center for Public Integrity in an emailed statement, but some were “nothing but symptoms of failure of the counterpart/donor to deliver technical and financial assistance” in a timely and consistent manner.

Roshan said further that the issues raised in the audit stemmed from friction between Education Development Center, Inc. and USAID. Indeed, the agency’s 2012 inspector general report said the two entities had disagreed about “key elements of the design” of the larger educational project that Washington was financing, and said that this had hampered progress. “We were just caught in the tug of war,” Roshan said.

Alison Cohen, a spokeswoman for Education Development Center, Inc., said in an emailed statement that her firm “did as it was required,” and USAID found no mismanagement of its funds “on the part of EDC.” She said the firm is “fully committed to achieving the highest level of compliance” with its contracts, a quality recognized by “dozens of federal agencies, state and local governments, and private organizations” that have given it funds.

Finding various ways to keep the funds flowing

A few months after the USAID site visits, the agency stopped funding the institute through Education Development Center and found what Kauffman described as an alternative path: It modified one of its ongoing funding agreements with the United Nations Human Settlements Programme (UN Habitat) to add continuing technical and financial support for the institute.

But UN Habitat leaders raised their own concerns about the institute’s accounting and spending practices, informing USAID staff at an April 2012 meeting that Roshan’s salary and benefits package was $17,600 per month, according to a memo five months later from the director of USAID’s Office of Social Sector Development, Carol Horning, to the agency’s Afghanistan mission director. Annual per capita gross national income in Afghanistan was $1,940 that year, according to World Bank data.

Roshan denied he was paid $17,600 but declined to say what his salary was at the time. He said he had salaries that “were not on an Afghanistan scale” because he was an American citizen, and lived in Maryland for periods during the early 2010s. “I singlehandedly created the institute from scratch,” he said. “I was compensated less than half of what I should have received.” Roshan stepped down as the CEO this year, according to both Roshan and Ostrander, but Roshan said he remains the president until its board selects a new one.

The UN Habitat funding method worked for most of 2012, but on November 19, 2012, as it was drawing to a close, Roshan wrote directly to Shah, suggesting that “urgent funding be continued through an appropriate USAID mechanism for a period of time to avoid an abrupt closure” of the institute, according to an email that Roshan provided the Center for Public Integrity.

Shah responded less than four hours later, according to a second email that Roshan provided the Center for Public Integrity, thanking Roshan for his note and sending a copy to USAID’s assistant administrator for Afghanistan and Pakistan “so we could explore this issue and get back to you.” McKenzie Stough, a spokesperson at Georgetown University, where Shah is now a distinguished fellow at the School of Foreign Service, said that she had conveyed a request for comment to Shah’s personal assistant, but no response was forthcoming.

Eleven days after Roshan’s email exchange with Shah, Afghanistan’s then-education minister Farooq Wardak signed a letter to U.S. Ambassador James B. Cunningham — identical in wording to the email that Roshan had sent Shah.

USAID’s Afghanistan mission director at the time, Ken Yamashita, met with Roshan on December 10, 2012, and proposed that USAID continue supporting the institute but disburse the funds as a part of an overall USAID financial support to the Education Ministry, according to an email from USAID official Kerry Pelzman to several colleagues, which was obtained by the Center for Public Integrity. Yamashita, who is now a regional director at the Peace Corps, told the Center for Public Integrity by email that he did not dispute this account.

Twelve days later, Yamashita met with Wardak to seal the deal, according to a December 29, 2012, letter from him to Wardak. In it, Yamashita thanked him for his “receptivity to inclusion of support for ATVI as part of USAID’s on-budget support to the Ministry of Education,” and promised to let Cunningham know that Wardak’s November letter had “borne fruit.” Cunningham, who is now a senior fellow at the Atlantic Council, did not respond to phoned and emailed requests for comment.

Yamashita’s optimism was premature. Funding for the institute did not end up going through the Education Ministry, according to Kauffman, who said he heard the USAID finance department had objected to providing such general support. But in June 2013, USAID began providing another million dollars in direct funding for the institute, good for the next two years, according to the statement it posted on the Web. That funding expired on June 14, 2015.

Ostrander said the direct grant would not be renewed, but said USAID expects to start funding the institute again soon, this time through The Asia Foundation. The funding is meant to improve administrative functions and — subject to compliance with what Ostrander described as “certain requirements and standards” — cover its operating expenses. Ostrander said he could not immediately tell the Center for Public Integrity how much funding would be transmitted to the institute under the new agreement.

Roshan said however that he expects The Asia Foundation funding to net his institute $300,000 over the next six months. Two spokeswomen for The Asia Foundation did not reply to phoned and emailed requests for comment.

There’s “no way” the institute could continue to exist without international support, Kauffman said.

If there ever was a piece of legislation influenced by campaign contributions and lobbyists, the bill to repeal a 2.3 percent excise tax on medical device manufacturers, which the House passed last Thursday, would be it.

Forty-six Democrats joined 234 Republicans to repeal the tax, which was authorized by the Affordable Care Act as one of the ways to pay for the expansion of health insurance to millions of uninsured Americans. The tax went into effect on Jan. 1, 2013, and is expected to generate between $26 billion and $29 billion over 10 years, according to Congress’s Joint Committee on Taxation.

Even though the medical device makers are gaining financially now that more Americans can afford their products, most of them hate the tax — so much so that the industry has spent $109.7 million lobbying in Washington since the it went into effect, according to MapLight, a nonprofit group that tracks and reports on money’s impact on politics.

In addition to all that money, MapLight found that the biggest medical device makers and their trade group have donated $19.5 million to House members since Oct. 1, 2012, most of whom voted for the repeal.

OpenSecrets, another watchdog group, found that 27 of the 32 Democrats who co-sponsored the bill received money from the medical device industry.

The House member who has received the most in donations is Rep. Erik Paulsen, the Minnesota Republican who has been the industry’s go-to guy in its effort to kill the tax. MapLight says Paulsen, the chief sponsor of the Protect Medical Innovation Act of 2015 — the official name of the repeal bill — has received $109,049 from the industry. Coming in second is Democratic Rep. Ron Kind of Wisconsin, who has taken in $55,400.

The focus will now be on the Senate, where passage is less certain but where five Democrats, including both of Minnesota’s senators, Al Franken and Amy Klobuchar, have signed on as co-sponsors of that chamber’s repeal bill. In fact, says OpenSecrets, the industry has been more benevolent to those two recently than anybody else on that side of the Capitol. Franken has received $47,249 in contributions while Klobuchar has received $39,900. 

If you’re wondering why the industry is so generous to the Minnesotans it’s because the Land of 10,000 lakes is also the land where a lot of medical devices are made.

One of the biggest companies, Medtronic, is headquartered there. Or at least it was until it realized that it could avoid billions of dollars in U.S. taxes by claiming to be based overseas. Last year Medtronic announced plans to relocate its headquarters to Europe when it completed its acquisition of an Irish company.

The deal became final on Jan. 26., according to a Medtronic press release from Dublin, the company’s new legal headquarters (although the company’s CEO is staying at Medtronic’s “operational” headquarters in Minnesota).

But foreign-based companies like Medtronic can still dole out campaign contributions to get what they want on this side of the Atlantic, especially if they think there’s a chance they can avoid even more U.S. taxes.

As soon as the House passed the repeal bill Thursday, several members were quick to send out their own press releases to say what a great idea it was.  One of them was GOP Rep. Jackie Walorski of Indiana, who wrote, “It is time to stop propping up Obamacare with a tax on the medical device industry at the expense of the Hoosier economy.”

As Elkhart Truth reporter Tim Vandernack noted, Walorski singled out the “adverse impact” the tax has had on Mishawaka-based orthopedic instrument maker Complexus Medical, “forcing the firm to cut its research and development budget.”

Maybe so, but on its website, Complexus Medical has a link to a 2013 South Bend story about the company’s big expansion plans.

The story quoted company CEO David Behrens as saying that Complexus Medical had made more than $1 million in capital investments, such as precision machining, in 2012, and was planning to increase its workforce from 70 to 100 people once its 15,000-square-foot expansion was completed in the spring of 2013 — an expansion made necessary because of an increase in business.

This is how the South Bend paper reported Behrers comments:

"’It's hard to keep this busy," he said, noting growing is not easy. "It's tough to sleep when you've got more work than you can do. And when you don't have enough," he said. "So either way you wake up in the middle of the night thinking about it.’"

As Consumers Union reported after an extensive study of the industry’s profitability, the vast majority of medical device makers are doing very well financially and are thriving even with the tax. It quoted the accounting firm Ernst and Young as saying the leading U.S. medical device makers have been logging record profits in recent years.

They just don’t want to give up a penny of the new Obamacare revenue they’re getting to help more people get access to the care they need.

The millions they’re spending to get the tax repealed is just a tiny fraction of their revenue and profits, but it’s an investment that will pay off bigtime for shareholders if they’re successful.

And Democrats, many of whom voted for Obamacare, are pocketing much of the industry’s cash.

Wendell Potter is the author of Deadly Spin: An Insurance Company Insider Speaks Out on How Corporate PR is Killing Health Care and Deceiving Americans and Obamacare: What’s in It for Me? What Everyone Needs to Know About the Affordable Care Act.

One of the nation’s largest dental management chains, Aspen Dental, violated New York law by making decisions that should have been left to dentists and sharing profits with dental clinics, according to a settlement with the state’s attorney general.

New York Attorney General Eric T. Schneiderman launched an investigation of the chain in 2013 after an investigative report by the Center for Public Integrity and PBS Frontline. The news report found that Aspen Dental, which targets low-income patients, pressured dentists to increase revenue by using high-pressure sales techniques. Many patients complained of being overcharged or given unnecessary treatments.

The attorney general investigation reached the same conclusions. He cited 300 consumer complaints since 2005 and internal company documents. The settlement calls for Aspen Dental to pay a $450,000 civil penalty and to overhaul the way it does business in New York.

Aspen Dental, based in East Syracuse, New York, serves nearly 500 dental practices in 30 states and reported annual revenue of $645 million. Forty of those clinics are in New York.

The company says it provides back-office support for dentists, who own the practices. But the attorney general found that Aspen Dental was coaching dentists on patient care issues and pressuring the offices to push additional treatments. Office managers and hygienists were paid bonuses to sell more treatments.

If offices didn’t meet revenue targets, they were scolded by Aspen Dental. One internal Aspen Dental document released by the attorney general showed the company complaining that hygienists were falling short of their revenue targets and instructing them to sell more products and services to patients.

Aspen Dental chief executive officer Robert Fontana signed the settlement, which outlines the findings of the attorney general.

However, Aspen Dental issued a statement last week criticizing Schneiderman for saying in a press release that the settlement “bars company from making decisions about patient care in New York clinics.”

The company contends that it never made decisions about patient care, or that the dentists who own Aspen Dental clinics were mere puppets.

“The Attorney General demonstrates how unfriendly the business climate can be in New York State by mischaracterizing in their press release the very nature of the business we’ve built over the past 20 years,” Fontana said in the statement.

This isn’t the first time Aspen Dental has settled with a state attorney general. The Pennsylvania attorney general sued the chain in 2010, alleging that it advertises “free” exams but still charges patients’ insurance companies. The state also alleged that Aspen Dental failed to reveal that the “no-interest” credit cards it pushes have steep penalties – 29.9 percent interest on the entire amount of the original loan — if a patient misses payments. Aspen Dental settled, paying $175,000 in restitution without admitting wrongdoing.

In December, Aspen Dental settled a case with the Massachusetts attorney general, agreeing to pay at least $990,000. The attorney general found that Aspen Dental engaged in deceptive advertising and marketing practices and failed to give refunds to patients charged for services that were never provided.

Center for Public Integrity reporter Michael Beckel appeared on C-SPAN's popular "Washington Journal" program on June 20 to detail the money already flowing into the 2016 presidential election and who is behind the election's first campaign ads.

Election Day 2016 is still more than 500 days away, but political ads are already starting to appear— especially in Iowa and New Hampshire, where the first presidential nomination contests will be held early next year.

Democratic Party frontrunner Hillary Clinton has already been targeted by nearly $1 million in negative ads by a host of conservative groups, including the Republican National Committee, as the Center for Public Integrity recently reported.

Meanwhile, super PACs and other groups not controlled by the candidates themselves have begun ad campaigns to introduce voters to candidates in the crowded GOP presidential field.

Beckel discusses these trends, and he outlines the differences between candidates' official campaigns and the super PACs and politically active nonprofits that are also supporting most major 2016 presidential contenders.

Beckel is part of a team of Center for Public Integrity reporters covering the influence of money in both federal and state elections.

Alleged Charleston gunman Dylann Roof wrote that he was never the same after discovering a website with “pages upon pages of these brutal black on white murders.”

The pages that left Roof in disbelief were the product of a white-nationalist group subsidized by American taxpayers.

The Council of Conservative Citizens Inc. is listed by the Internal Revenue Service as a nonprofit organization that promotes social welfare, also known as a 501(c)(4). Such groups pay no federal taxes, a form of government subsidy.

The council is now under fire for allegedly inspiring racial hatred in Roof, a 21-year-old high school dropout. He is charged with nine counts of murder.

Tax-exempt social welfare groups are supposed to “primarily promote the common good and general welfare of the people of the community as a whole,” according to IRS documents.

The Council of Conservative Citizens explains on its website that its members believe “that the American people and government should remain European in their composition and character…. We also oppose all efforts to mix the races of mankind.”

Groups that espouse hate can be stripped of their tax-exempt status, said Marcus Owens, who ran the IRS’s exempt organizations division in the 1990s. That happened to the neo-Nazi group National Alliance in 1982. The Council of Conservative Citizens has been identified by the Southern Poverty Law Center as a “notorious, racist hate group.”

However, Owens says Republicans in Congress have made it virtually impossible for the IRS to revoke the tax-exempt status of political groups after the recent, so-called tea party scandal. Republicans criticized the IRS for what they said was inexcusable targeting of conservative 501(c)(4)s. And the Treasury Inspector General for Tax Administration said the agency had employed “inappropriate criteria” in scrutinizing some groups’ tax-exemption applications. 

The Council of Conservative Citizens has had tax exempt status since 1985. In its most recent tax filing in 2013, the group reported revenues of $67,000.

Owens said the small amounts of money involved may also deter the IRS from taking action.

“The ability of the IRS to deal with organizations that are not a significant revenue drain is very limited these days,” he said.

A spokesman for the IRS did not respond to requests for comment.

The Council of Conservative Citizens said in a statement that it “unequivocally condemns Roof’s murderous actions.” Its spokesperson, Jared Taylor, said, “I think it would be a big mistake to say that he was inspired (by the group’s website.) He was informed.”

Taylor said the group is not racist, does not promote hate and educates the public about a variety of issues. One of those issues is black-on-white crime. Roof allegedly told the black victims in the church, “You rape our women.”

That’s a theme pushed by the website. Even after the shootings, the Council of Conservative Citizens reported, “Every year, there are some 20,000 rapes or sexual assaults (including threats) of white women by blacks.” The group claims that crimes in which white men rape black women are virtually nonexistent.

Taylor, who has written books on black-on-white crime, cites data from the Justice Department’s National Crime Victimization Survey to say there is an epidemic of white women being raped by black men.

However, the data Taylor cites is not reliable, said Rachel Morgan, a statistician who specializes in the survey at the department’s Bureau of Justice Statistics. The last survey presenting data on race was in 2008. While more than 160,000 people were surveyed, no more than ten black women said they were either raped, sexually assaulted or threatened with sexual assault by a white offender. That’s too few cases to draw any conclusions, Morgan said.

Taylor runs his own white-nationalist organization and website called American Renaissance. And he has his own tax-exempt organization, called the New Century Foundation. Since 1994, the IRS has granted New Century Foundation public-charity status, meaning even contributions made to it are tax exempt.  The group has assets of nearly $1.6 million.

This story was co-published with the Daily Beast. 

Republican Bobby Jindal’s resume includes more accomplishments than most people will experience in their lifetimes.

The current governor of Louisiana is a former Rhodes Scholar, former McKinsey & Co. consultant and former congressman.

He also once served as the secretary of Louisiana's Department of Health and Hospitals and was a top advisor at the U.S. Department of Health and Human Services during the George W. Bush administration.

But Jindal, who turned 44 earlier this month, is hoping that he’ll be able to add another title to that list — 45th president of the United States.

Today in a New Orleans suburb, Jindal is set toannounce his 2016 White House bid.

In doing so, he’ll be joining a crowded field that already includes four sitting U.S. senators and several current and former governors.

Here’s more about Jindal’s political and financial history:

Sources: Center for Public Integrity reporting as well as Bloomberg, the Center for Responsive Politics, Federal Election Commission, Fox News Radio, Gambit, National Institute on Money in State Politics, New York Times and Newsmax.

Image sources:AP, Flickr

Today’s U.S. Supreme Court ruling means 6.4 million people won’t lose subsidies that helped them afford health insurance.

But the historic ruling in King v. Burwellmay be far from the last word on health reform.

Bills to advance, or cripple the law in statehouses — and the accompanying partisanship — didn’t come to a halt in the months that lawmakers awaited the Supreme Court decision, and may well linger on.

“I think we should continue to do everything we can to opt out of Obamacare,” said Mike Ritze, a Republican member of the Oklahoma House of Representatives and staunch foe of the law.

A multi-front war

The high court’s decision inKing v. Burwell was anxiously awaited by both backers and supporters of the Affordable Care Act, who agreed that a decision invalidating the subsidies would have created chaos for Obamacare.

Plaintiffs in the case, four residents of Virginia, argued that they should not be forced to buy health insurance and shouldn’t receive tax credits under the law. Their argument rested on wording in the law that was vague on whether the tax credits applied to residents of states using a federal insurance marketplace, or “exchange,” rather than an exchange established specifically by a state; 34 states are using the federal exchange. But the justices ruled in a 6-3 decision that siding with the plaintiffs might well destroy insurance markets.

“The combination of no tax credits and an ineffective coverage re­quirement could well push a State’s individual insurance market into a death spiral. It is implausible that Congress meant the (Affordable Care) Act to op­erate in this manner,” Chief Justice John Roberts wrote for the majority.

But in statehouses around the country, fighting over the act will likely continue. The Center for Public Integrity reported on the heated war over Obamacare in state legislatures earlier this year, finding more than 700 health reform-related bills introduced during 2014 or carried over from 2013 in states where legislatures allow that. Five states—California, Hawaii, Illinois, New York and Washington— saw 50 or more health bills each, according to data from the National Conference of State Legislatures, or NSCL.

Whether some diehard opponents will stand down amid greater public acceptance of the law is not clear. One who says he won’t is Ritze, an osteopathic physician who chairs the Oklahoma House Public Health Committee.

“We’ll continue to introduce bills and legislation to take bites out of the ACA,” said Ritze.

The NCSL has tracked more than 170 new state bills filed in 2015 relating to health issues, including some direct assaults on the Affordable Care Act. A list is here.

The National Academy for State Health Policy, an independent group, has taken notice of bills to create exchanges or to junk them. 

As of June, 11 states are considering bills to now establish their own exchanges or designate the federal exchange as the state's own. On the flip side, lawmakers in ten states introduced bills this year to block creation of an exchange or to scrap one that’s in place, according to the academy. Here’s a state-by-state list tracking the bills. How states might link up to the federal site isn’t entirely clear at this point.

Not-so-hidden agendas

Some bills are the handiwork of political groups that push agendas on a range of hot-button topics across the country.

The conservative American Legislative Exchange Council, or ALEC, works to “advance limited government, free markets and federalism at the state level.” It has long championed “model” bills that gum up enforcement of the health reform law.

It’s liberal foil is the State Innovation Exchange,  that sees itself as the “legislative wing of the progressive movement.”

The  Tenth Amendment Center, which considers  Obamacare unconstitutional, wants to see legislators pull levers of state government in ways that will obstruct the law. One such step: threaten to revoke the licenses of insurance agents who agree to sell Obamacare policies. Another tactic: enact laws that tie the hands of state insurance department officials, who are largely responsible for regulating health coverage.

“The federal government needs states to be complicit to pull this off,” the group says on its website.

The ACA’s backers tend to dismiss these sorts of bills as fringe politics or gimmicks that will ultimately be struck into oblivion by the courts. But the impact of multiple legal tussles over Obamacare is not known. Some states have recently taken the first steps down that trail.

In April, Arizona Gov. Doug Ducey, a Republican, signed HB2643, which prevents the state “from using any personnel or financial resources to enforce, administer or cooperate with the Affordable Care Act.”

Ritze, the Oklahoma lawmaker, cited a recent bill in his state that tightens oversight of Obamacare “navigators,” who help walk uninsured people through the complexity of picking a plan and signing up. ACA supporters have attacked these bills as thinly veiled ploys by insurance agents to scare off competition.

The Oklahoma bill, (SB 236), for instance would require criminal background checks for navigators and require them to register with the state. It was signed into law in April.

According to Ritze, navigators “were not giving consistent answers” when people had questions about insurance policies. He said: “we felt they should be certified or have some oversight.”

In Montana, SB 350 became  law in April and will also require licensing of navigators.

The great unknown

Tracking how much is being spent in the states to lobby lawmakers to pass these sorts of bills can’t be done with any certainty, said Denise Roth Barber, managing director of the National Institute on Money in State Politics in Helena, Montana.

Barber said half the states don’t require companies and lobbyists to report money that is paid to lobbyists.

“If you don’t have that piece of the puzzle you are missing a significant chunk,” she said. “It’s an amazingly important question that can’t be answered.”

This story was co-published with NPR.

It is clear from both the first paragraph and closing comments in the Supreme Court’s decision upholding Obamacare subsidies that the justices listened more closely to the insurance industry than perhaps any other party.

In an amicus brief it filed with the court in King v. Burwell, America’s Health Insurance Plans, the industry’s main trade group, painted a dire picture of what would happen to the private health insurance market—and to people who cannot enroll in an employer-sponsored health plan—if the court ruled in favor of the plaintiffs.  According to AHIP, under that scenario, you could pretty much kiss the private health insurance industry goodbye in two-thirds of the states.  

The plaintiffs argued that because of the way the Affordable Care Act was worded, the government was unlawfully providing financial help to millions of people in 34 states— the states that had defaulted to the federal government to operate their health insurance marketplaces, or exchanges, rather than set one up on their own.  

A sentence in one section says the subsidies will be made available through the exchanges “established by the state.” Members of Congress who wrote the law insisted they never intended for the subsidies to be available in just the states that set up their own exchanges. But attorneys for the plaintiffs insisted that the justices should interpret those four words literally (and out of context).

They asked the Court to strike not only the subsidies in the 34 states that didn’t set up their own exchanges —but also the law’s requirement that most Americans must buy coverage or pay a penalty.  The plaintiffs, however, did not ask the court to strike another provision: one that makes it illegal for insurance companies to refuse to sell a policy to any applicant willing to pay.  

A victory by the plaintiffs would have created a situation in which many of the newly insured—especially low- and moderate-income individuals in good health—would have dropped their coverage. Without the subsidies many of them have been getting from the federal government since January 2014, they wouldn’t be able to afford the premiums.  Had the plaintiffs prevailed, the only people who could be expected to continue buying coverage in the individual market in those 34 states would be those with conditions requiring expensive care.

AHIP wrote in its brief that without the mandate to buy insurance, young and healthy people would once again opt to go uninsured, leaving the marketplace to sicker and older consumers. AHIP wasn’t just blowing smoke; the trade group noted what happened a few years back  when New York and several other states tried to force insurance companies to accept all applicants without a mandate to buy coverage. Premiums in every one of the states spiked dramatically and almost immediately. Most insurers quit selling policies in those states because of this developing  “death spiral.”  

Cigna, where I worked, was one of many insurers worried that Congress might consider doing what New York did. Back then, I wrote a policy brief stressing the necessity of requiring people to buy coverage if insurance companies were required to take all comers.

Roberts, for one, paid keen attention to AHIP’s brief. Here’s how he began the majority decision:

“The Patient Protection and Affordable Care Act grew out of a long history of failed health insurance reform. In the 1990s, several States sought to expand access to coverage by imposing a pair of insurance market regulations—a ‘guaranteed issue’ requirement, which bars insurers from denying coverage to any person because of his health, and a ‘community rating’ requirement, which bars insurers from charging a person higher premiums for the same reason. The reforms achieved the goal of expanding access to coverage, but they also encouraged people to wait until they got sick to buy insurance. The result was an economic ‘death spiral’: premiums rose, the number of people buying insurance declined, and insurers left the market entirely.”

He went on to note that in 2006, “Massachusetts discovered a way to make the…  requirements work—by requiring individuals to buy insurance and by providing tax credits to certain individuals to make insurance more affordable. The combination of these three reforms—insurance market regulations, a coverage mandate, and tax credits—enabled Massachusetts to drastically reduce its uninsured rate.”

What Roberts didn’t say was that those three reforms came straight out of the Republican reform playbook, or at least their pre-Obamacare playbook.  It was former GOP presidential nominee Mitt Romney who helped devise the Massachusetts plan when he was governor there.

Roberts also did not claim he was saving Republicans from themselves, but that is  what he did. The reality is that, despite their insistence on repealing and replacing Obamacare, Republican lawmakers have not been able to offer a workable  alternative. They boxed themselves in by condemning their best reform ideas because Obama and Congressional Democrats adopted them. The fact is, they’ve got nothing new that will help to bring down health care costs and expand coverage.

Roberts summed up his rationale for agreeing with the government with this sentence toward the end of his decision:

“Congress passed the Act to improve health insurance markets, not to destroy them.”

Exactly.  And he knew that, despite the GOP Sturm und Drang about Obamacare, if they actually got what they wished for, they would, indeed, destroy those markets.

Wendell Potter is the author of Deadly Spin: An Insurance Company Insider Speaks Out on How Corporate PR is Killing Health Care and Deceiving Americans and Obamacare: What’s in It for Me? What Everyone Needs to Know About the Affordable Care Act.

America’s flimsy workplace health and safety protections are no accident.

Problems that contribute to the daily toll of illnesses, injuries and deaths — from outdated chemical-exposure standards to tiny fines for major violations — come after decades of concerted efforts to delay fixes and weaken the Occupational Safety and Health Administration’s authority.

It’s jammed the gears of the regulatory system to the point that they hardly turn. OSHA issued seven health standards in the last two decades — one of which was revoked by Congress — compared with six in 1978 alone. As a result, most of the agency’s exposure limits are more than 40 years old. And tens of thousands of chemicals, including some that the federal government has known for years are hazards, have no limits at all.

There’s plenty of blame to go around. Business interests, lawmakers, federal agencies and the White House have all played a role.

Industry

The metal hexavalent chromium, emitted as a fume during chrome plating and certain welding operations and used in products such as specialty paints, can cause cancer. The risk at OSHA’s original exposure limit was so extreme — as many as one worker in three would likely get cancer from inhaling that much chromium over their entire careers — that advocacy group Public Citizen and a union sued in 2002 to get the agency to act.

Companies, sensing a threat, had mobilized years earlier. They argued there was no significant risk, criticized studies that suggested otherwise and lobbied to keep the standard unchanged.

This is how industries typically react. It’s playing out again as OSHA tries to update its limit for lung-damaging silica. Thousands of lives have been lost to such delays.

What makes the chromium case stand out: Advocates and federal officials eventually got their hands on the chromium lobby’s internal documents. They offer a revealing look at how companies work to beat back protections meant to keep people from dying.

In 1996, according to the minutes of one Chrome Coalition meeting, companies and their consultants discussed how they might “forestall the rulemaking.” The plan included attacking health studies showing harm and preparing for a lawsuit.

No one made even a passing mention of what would be best for workers’ health. Another industry document said only a comparatively modest cut in the chromium limit would be acceptable because it could be handled by modern facilities “without major additional investment.”

According to testimony in an enforcement action later filed by the U.S. Environmental Protection Agency, the coalition spent an estimated $500,000 on a lung-cancer study of chrome workers to call into question earlier research. But the results provided “strong support for the inadequacy of the current standard” and even raised questions about whether the limit OSHA proposed was protective enough, according to a 2006 paper co-authored by David Michaels, an occupational health expert who since 2009 has headed OSHA.

The Chrome Coalition withheld that study from federal agencies. Instead, Michaels wrote, it massaged the data and released certain parts that seemed to support its position.

The coalition no longer exists, but the chromium companies did get something for their efforts. OSHA feared that certain firms couldn’t afford to reduce exposures to the proposed limit of 1 microgram per cubic meter of air — as the chromium industry argued — so in 2006 the agency set the new standard at 5 micrograms.

That means workers can still legally be exposed to chromium levels that, by OSHA’s reckoning, would give up to one in 22 of them cancer over a working lifetime. That’s far less protective than OSHA typically aims for.

Adam M. Finkel, who worked on the chromium rule while directing OSHA’s health standards program from 1995 to 2000, calls the adopted limit “shamefully weak.”

The fact that it got through at all qualifies as a rare victory. Few of OSHA’s 470 exposure limits have been changed since they were adopted in 1971.

Trade groups have played an outsize role in that, too. They challenged rule after rule in court, leaving OSHA hemmed in by decisions that contribute to an expensive, years-long slog to update a single health standard.

One turning point came in 1980.

After federal officials concluded that benzene can cause leukemia, OSHA lowered its exposure limit in 1977 from 10 parts per million to 1. The American Petroleum Institute, which three decades earlier conducted an internal toxicological review that concluded “the only absolutely safe concentration for benzene is zero,” sued to get the new standard overturned.

A divided Supreme Court did so, finding that OSHA had not demonstrated that the standard remedied a “significant risk.” The decision — opposed by four of the justices, who contended it endangered workers and disregarded the law — affected more than just benzene. OSHA could no longer declare that carcinogen exposure must be as low as possible. Ever since, the agency has spent time on complex analyses that estimate the number of workers at risk.

OSHA’s later benzene analysis estimated that for every 1,000 people exposed over a working lifetime to concentrations at the original standard, 95 would likely fall ill with leukemia as a result — nearly 1 in 10. Prodded by unions, the Reagan administration adopted a 1 part-per-million standard in 1987 that stuck.

The decade-long wait came at a cost. A former OSHA official and two occupational medicine experts separately estimated that several hundred workers would die of cancer as a result.

The American Petroleum Institute did not respond to requests for comment. But in a statement after the Supreme Court ruling, the group’s then-president, Charles J. DiBona, said the case demonstrated the importance of regulators relying on “scientific facts rather than pure speculation.”

“The issue was never whether benzene is toxic,” he said. “The petroleum industry itself identified it as toxic years ago and imposed its own protective standards long before the government showed any interest in regulating it.”

In the 1980s, frustrated with the slow pace of health rule revisions, Reagan-appointed officials tried to fix everything in one fell swoop.

Most of OSHA’s exposure limits from 1971 were carbon copies of ones recommended by the American Conference of Governmental Industrial Hygienists, a group of experts that regularly updates its numbers. OSHA decided to launch a rulemaking to adopt the nonprofit’s most recent recommendations.

OSHA’s 1989 rule added new limits or tightened existing ones for 376 chemicals and won praise from big industry groups, including what is now the American Chemistry Council. The early criticism came almost entirely from unions, which contended that standards remained too lax.

But other trade groups, including the American Iron and Steel Institute and the Society of the Plastics Industry, ultimately filed suit to overturn some of the new limits.

The AFL-CIO filed suit, too, but to get OSHA to toughen some of the rules, not toss them.

Business interests upset about tighter limits won that battle in a big way. The U.S. Court of Appeals in Atlanta vacated everything. The agency’s economic-impact analysis and other studies, prepared with less detail so all 376 chemicals could be handled at once, weren’t sufficient, the judges ruled.

“It may well be, as OSHA claims, that this was the only practical way of accomplishing a much needed revision of the existing standards and of making major strides towards improving worker health and safety,” the judges wrote in their 1992 decision. But the 1970 Occupational Safety and Health Act doesn’t allow that flexibility, they added.

As the congressional Office of Technology Assessment noted three years later, “Arguably, OSHA faces rulemaking requirements among the most demanding of all federal agencies with health, safety and environmental regulatory responsibilities.”

OSHA had estimated that the 1989 update would save 683 lives a year at an annual cost of $6,000 per affected plant. The Court of Appeals judges offered a tip: “Before OSHA uses such an approach, it must get authorization from Congress.”

A generation later, Congress has yet to give OSHA that authority. In fact, it’s hobbled the agency even further.

Congress

When Republicans gained control of Congress after the 1994 election, Rep. Cass Ballenger of North Carolina gleefully took the reins of the House Subcommittee on Workforce Protections. Raising funds in the election campaign had been easy, he told The Washington Post: “This was my sales pitch: ‘Businessmen, wouldn’t you like to have a friend overseeing OSHA?’ ”

Ballenger, who died in February, owned a plastics packing company and saw OSHA as a menace. He was part of a growing tide in Congress. Rep. John Boehner of Ohio, now House speaker and then chairman of the House Republican Conference, said at the time that most employers “would describe OSHA as the Gestapo of the federal government.”

The debate then and throughout OSHA’s history centered on whether the agency treated businesses as adversaries rather than potential partners. Ballenger said OSHA inspectors felt “pressured to issue citations in order to look good.”

His overhaul legislation in 1995, which would have sharply cut back OSHA’s enforcement authority and abolished the country’s workplace-hazard research institute, didn’t make it out of committee after the Clinton administration threatened to veto it. But OSHA spent years on the defensive, battling budget-cut proposals and congressional efforts that delayed the ergonomics rule begun by a Republican labor secretary in 1990.

Businesses hated the rule, which would have affected broad swaths of industry because it was supposed to protect against disabling injuries caused by repetitive movements. In 2001, shortly after OSHA issued the standard, Congress revoked it — the first (and so far only) regulation undone by the Congressional Review Act.

Eric Frumin, former health and safety director for the Amalgamated Clothing and Textile Workers Union, pushed hard for a standard and remains distraught about its demise.

“Tens of millions of workers who are not covered by a union contract would have had a grievance procedure for abusive workloads,” said Frumin, now with Change to Win, a labor consortium. “The biggest single safety and health problem [could have been] wiped off the agenda.”

There’s no sign that OSHA will get congressional help anytime soon. Worker-safety advocates in Congress are focused on the Protecting America’s Workers Act, which would add teeth to enforcement with tougher civil and criminal penalties. Now, OSHA bemoans, companies can get into far more trouble for killing fish than killing workers. The typical employer penalty after an OSHA fatality investigation last fiscal year came to about $5,000, the AFL-CIO calculated.

Lawmakers have proposed the bill this year and for each of the last six Congresses. It made it as far as hearings only once, in 2010 — when Democrats were in control — and couldn’t get traction that year.

The measure faces deep skepticism among Republicans.

“Policies that impact our workplaces virtually always carry with them a cost, and we must be mindful not to impose any unnecessary or unnecessarily costly new requirements,” Rep. John Kline, R-Minn., now chairman of the House Committee on Education and the Workforce, said at one of the 2010 hearings.

Kline’s campaign contributions from business interests in 2009-2010 totaled about $930,000, according to the Center’s analysis of data from the Center for Responsive Politics. He took in nearly 90 percent more from such sources in 2013-2014, as committee chairman.

But Public Citizen doesn’t see wide differences between Democrats and Republicans over the last two decades when it comes to improving worker health.

“Both parties are essentially corporate-funded,” said Dr. Sammy Almashat, a researcher with Public Citizen’s Health Research Group. “In addition to the donations, the actual donation itself, it’s infused a culture in the regulatory process of extreme deference to industry.”

Still, businesses aren’t uniformly opposed to more protections. Jim Thornton, a manufacturing safety and health professional active with the American Society of Safety Engineers, said many employers already keep exposures lower than OSHA requires because they don’t want to sicken their workers.

Industry groups as well as unions came to the table when the American Industrial Hygiene Association, which represents occupational-health professionals, tried to develop a better standards system about 15 years ago. They got as far as writing draft legislation before the effort petered out, said Aaron Trippler, the association’s director of government affairs.

“There has been some talk about, ‘Maybe we could put a group together again,’ ” he said. “But I don’t think you could get anywhere unless you have Congress behind it.”

Rep. Joe Courtney, a Democrat from Connecticut who’s sponsoring the House version of the Protecting America’s Workers Act this year, thinks reform will come eventually.

“There’s this narrative that OSHA is an impediment to job creation and economic growth,” said Courtney, whose biggest single source of campaign contributions is labor, though industry sectors have donated more combined. “My experience is that more enlightened employers out there understand that it’s to their advantage to protect workers from preventable illnesses and accidents — that it actually increases productivity, that it works for both sides. But still, there’s this sort of kneejerk opposition to anything the federal government touches.”

Office of Management and Budget

OSHA has tried, in fits and starts, to reduce its exposure limit for silica since the 1970s. But its long-awaited proposal, ready in OSHA officials’ eyes in 2011, had to go to another agency for review before the public could weigh in.

And there it sat for 921 days — 2 ½ years.

The White House's Office of Management and Budget is supposed to complete its reviews in 120 days, unless the rulemaking agency asks for more time. Critics say OSHA rules frequently languish during review while business interests work to undermine the proposals. The OMB can demand changes from agencies.

The OMB did not respond to repeated requests for comment about its review process. But Cass R. Sunstein, who headed the OMB office responsible for reviews from 2009 to 2012, said in written congressional testimony that the process helps improve rules, ensure that benefits outweigh costs and make “agencies ‘look before they leap.’ ”

Susan Dudley, Sunstein’s immediate predecessor, wasn’t involved with the silica-rule review but has followed the issue as director of the George Washington University Regulatory Studies Center. Vetting details such as health risks under current law and how much the proposal will help is a highly complex affair, she said. Even so, the length of time strikes her as “a sign that there was a lot of controversy on it.”

“There clearly was some debate about the right way to go,” she said.

The latest delay involves a rule for beryllium, which is used in industries ranging from defense to golf-club manufacturing and can trigger a deadly lung disease. It’s a rare case in which a big company has championed better protections after decades of efforts to impede them.

OSHA sent a proposal for a tighter limit to the OMB after the substance’s major producer, Materion, and the United Steelworkers union joined together to urge such an action. The OMB has had the proposal since September — nearly 10 months — despite that agreement and the fact that the U.S. Department of Energy has required stronger protections for its contractors’ workers since 2000.

Four members of Congress wrote the OMB in April to ask that it turn the proposal loose in light of the “public health urgency.”

The members, all Democrats, noted in their letter that any concerns people might have about the proposal could be raised during the hearings OSHA would hold.

Those are public. OMB meetings are not. All that can be gleaned from them is who attended — and what documents were shared, if any.

Silica is a fairly typical example. Not counting government representatives, 80 percent of the people who attended the 11 OMB meetings on that proposal were affiliated with companies and trade groups — far outnumbering attendees there to advocate for worker health. (It’s agency policy to accommodate everyone who wants to meet.) The American Chemistry Council came with a document that predicted the rule would “eliminate countless jobs and small businesses.”

The OMB’s key charge in reviews, handled by its Office of Information and Regulatory Affairs, is to delve into costs and benefits. Industry generally argues that the expense will be far higher than OSHA expects. As it happens, OSHA usually does get it wrong — by overestimating.

That’s what the Office of Technology Assessment found in 1995 when it analyzed OSHA rules, five of them health standards. Some of the overestimates were huge: The vinyl chloride rule ultimately cost about a quarter of what OSHA’s consultant expected; the cotton-dust standard cost less than a third of what the agency had estimated.

Delays have happened in Democratic and Republican administrations alike, though Public Citizen says they’ve worsened under President Barack Obama. Celeste Monforton, who worked at OSHA in the 1990s, sees OMB gridlock as a statement on the low priority presidents assign to worker health.

When OSHA is faced with deadlines set by judges or Congress, it’s able to meet them, Monforton said — perhaps because the deadline operates as a battering ram through executive-branch logjams. She thinks the agency could do better if it had more White House support.

“There’s certainly procedural issues and outside parties … that play a role and have played a role in delaying protections for workers, but you also don’t have the strong political desire to issue these regulations,” said Monforton, a lecturer at George Washington University’s School of Public Health.

Centers for Disease Control and Prevention

Information on how chemicals are used in the workplace — which occupations handle what, the number of people exposed, the ways they’re exposed — is surprisingly hard to come by. Yet these are the details officials need to protect health and prioritize standard-setting.

“There are no systems that capture it,” said Julia Quint, a toxicologist who ran California’s Hazard Evaluation System and Information Service before retiring in 2007.

Workplace-hazard research is the purview of the Centers for Disease Control and Prevention’s National Institute for Occupational Safety and Health. The problem isn’t that NIOSH hasn’t conducted a national survey of workplace exposure across industries — it’s that the agency hasn’t done it for more than 30 years.

From 1981 to 1983, NIOSH collected information by visiting nearly 4,500 workplaces, updating a survey conducted a decade earlier. That produced rich data that regulators and health researchers relied on for years. But the data are old, and NIOSH doesn’t have funding to do that work again.

Health advocates say NIOSH has few champions in Congress — it was even targeted for closure in the 1990s — and is an afterthought at its parent agency. Founded as the Communicable Disease Center in 1946 to fight malaria, the CDC must respond to public-health crises as varied as tornadoes and bioterrorism.

NIOSH’s funding tells the tale. It equated to 20 percent of the CDC’s budget in the late 1970s but has hovered around 5 percent for the last decade.

The American Industrial Hygiene Association and American Society of Safety Engineers have called on Congress to consider other parent agencies for NIOSH, whose budget they said in a 2013 letter “continues to fall short of its commitments to occupational safety and health research and education as an ever-increasing amount … is forced to be given back to CDC for administrative costs.”

The CDC would not make its director, Tom Frieden, available for an interview. In a statement, the agency said its public-health responsibilities and budget have ballooned in the last generation, but NIOSH’s funding rose, too — nearly sixfold since 1983. (That doesn’t account for inflation, which ate a substantial chunk of the increase. Much of the rest was earmarked for tasks the agency didn’t have 30 years ago, such as miner-health research.)

The CDC believes NIOSH is fulfilling its mission.

“CDC supports NIOSH’s work in leading strategic surveillance of injury and illness on the job, allocating its resources for maximum return,” the CDC said.

NIOSH, for its part, would love to conduct an updated workplace survey. Roughly 15 years ago, officials had discussions with OSHA about sharing the cost, estimated at $21 million to $33 million in today’s dollars. But NIOSH Director Dr. John Howard said that idea was unraveling by the time he arrived in 2002.

“Our NIOSH folks couldn’t figure out what was going on,” he said. “I remember sort of forcing the issue with [then-OSHA Director John] Henshaw about are we going to do this or not? ‘No, we’re not going to do it.’ ”

Henshaw said he doesn’t recall discussions about OSHA co-funding a new survey, but he thinks it’s possible such an idea reached less-senior officials and they nixed it.

“I think probably one of the reasons why it never came to my level, why I don’t recall it, is it was thought to be a NIOSH responsibility, not an OSHA responsibility,” he said. “The agency may have communicated [that] to NIOSH.”

NIOSH can’t shoulder the cost alone, Howard said, so the agency decided to focus its survey efforts on one big and growing industry — health care. It’s also spent the last decade and about $90 million delving into the complex health implications of nanotechnology, making recommendations for the burgeoning field of materials made at a scale far smaller than the human eye can see.

Given OSHA’s difficulties regulating old hazards, Howard said, NIOSH recommendations could be all that workers have to protect themselves from new ones.

“We lament like everybody else, ‘It’s a broken system,’ … but it doesn’t stop us,” Howard said. “We have to go on. Because if we don’t go on, there’s nothing there.”

OSHA

The driving force that pushed the chromium standard to completion in 2006 wasn’t OSHA but a court order. Though the agency knew in 1975, thanks to NIOSH’s work, that the exposure limit needed to be dramatically tightened, the U.S. Court of Appeals in Philadelphia noted in 2002 that OSHA had dragged its feet “in the face of an admittedly grave risk to public health.”

“Indeed, at oral argument, OSHA's counsel admitted the possibility that OSHA might not promulgate a rule for another ten or twenty years, if at all,” the court wrote in its decision.

Forces outside OSHA’s control make its job much harder. But the agency could do more, its critics say.

“They’ve sort of given up,” said Rena Steinzor, a University of Maryland law professor who is a past president of the Center for Progressive Reform, a left-leaning think tank. “They’re suffering from battered-agency syndrome.”

In the 1990s, despite the benzene court decision and other challenges, OSHA issued 11 health rules. In the 15 years since, it’s issued four — one during the Obama administration, one during the George W. Bush administration and two at the end of the Clinton administration. That includes the overturned ergonomics rule.

Finkel, the former OSHA director of health standards, said the mid-1990s were more productive because the agency’s leaders supported his division’s work and didn’t back down when the OMB or industry groups applied pressure. Even so, he said, there was a pervasive fear of lawsuits within the agency.

“There’s something about OSHA through all its history — it’s been too deferential,” said Finkel, now executive director of the Penn Program on Regulation at the University of Pennsylvania Law School.

Monforton, the former Labor Department official, said OSHA keeps asking the public for input about what it should do — what chemicals to focus on, how to streamline the standard-setting process — and then seemingly does nothing with the information.

“There are obstacles for OSHA, but in some ways, they’re their own worst enemy,” she said.

Jim Morris contributed to this story