Fall continues to be a busy time in Washington on the public health and health reform front.
NACCHO and ACPM Congressional Briefing
NACCHO co-convened a congressional briefing on October 4 with the American College of Preventive Medicine entitled "The New Paradigm for Public Health and Preventive Medicine: Working Smarter in Today's Economy." Speakers included Andrew Rein, Associate Director for Policy at CDC; Lillian Shirley, NACCHO President and Director of the Multnomah County Health Department; and Miriam Alexander, ACPM President and Director of Preventive Medicine Residency Training at the Johns Hopkins Bloomberg School of Public Health. Bobby Pestronk moderated the well attended briefing. Slide presentations for the speakers can be found here.
Federal Funding Update
The FY2012 appropriations process is still in process, with none of the annual appropriations bills completed by the start of the fiscal year on October 1. Of the 12 appropriations bills, the House has passed six and the Senate has passed one. On October 4, the second continuing resolution (CR) of FY2012 was signed into law to keep the government funded until November 18. The CR, to comply with the budget cap for FY2012 included the Budget Control Act, includes a 1.503 percent across the board reduction in spending for the duration of the CR. The CR also includes $2.6 billion for Federal Emergency Management Agency disaster relief.
The House and Senate appropriations committee leadership are meeting to establish overall funding levels for the 12 spending bills so that negotiations on the individual bills can begin. The 12 bills could be completed through an omnibus measure, a series of "mini-buses," or a year-long continuing resolution. There is a strong desire by House and Senate leaders to finish the bill before November 18 prior to the release of the super committee deficit reduction recommendations due November 23.
On September 21, the Senate Appropriations Committee passed its FY2012 Labor-Health and Human Services (HHS)-Education Appropriations bill that includes funding for state and local public health programs. On September 29, House appropriations chairman Harold Rogers (R-KY) released a draft FY2012 Labor-HHS-Education spending bill. The draft was issued to serve as a marker for the House when negotiating with the Senate on final funding amounts. The Senate total spending for the bill is $158 billion, $308 million below FY2011. The House total is $153 billion, $4 billion below FY2011. The House eliminates funding for the Affordable Care Act, including the Prevention and Public Health Fund, and includes a number of contentious healthcare-related riders, which will make reconciling the differences between the two bills all the more challenging.
More information about FY12 funding bills is available here.With regard to the Senate bill, NACCHO is also concerned about the elimination of the Preventive Health and Health Services Block Grant; Advanced Practice Centers for preparedness; and the Healthy Homes and Lead Poisoning Prevention Program at CDC which has been moved to HRSA with no dedicated funding. There is also concern that the Senate continues to reduce CDC budget authority for particular programs and replace the funding with Prevention and Public Health Fund dollars. This leaves these programs particularly vulnerable should the fund be eliminated.
In terms of the House bill, NACCHO is concerned about the $8.6 billion rescission in ACA funding, including $1 billion for the Prevention and Public Health Fund; a deep cut to CDC of $863 million; a deep cut of $26 million to Public Health and Preventive Medicine Training Programs, including the Public Health Training Centers; elimination of the Title X Program, and the reinstitution of the federal funding ban on syringe access programs.
Debt Reduction Efforts
The Joint Select Committee on Deficit Reduction or super committee continues to work on a deal to reduce the debt by at least $1.2 trillion to be made public by November 23.
To add to the super committee's deliberations, President Obama released a deficit-reduction plan that uses entitlement cuts, tax increases and war savings to reduce government spending by more than $3 trillion over the next 10 years. The president's plan also includes a $3.5 billion reduction to the Prevention and Public Health Fund and $320 billion in healthcare cuts over a decade; $248 billion of the reductions would come from Medicare and $73 billion from Medicaid. NACCHO has expressed its opposition to the proposed cut in the Prevention and Public Health Fund.
Job Creation Agenda
In an effort to address job creation, the president sent the American Jobs Act to Congress and requested immediate passage. The proposal includes a variety of provisions including a payroll tax cut, tax credits for hiring veterans and long-term unemployed, and funding for teachers, firefighters and police. The President's deficit reduction proposal includes offsets to pay for the American Jobs Act, one of which is higher taxes on individuals' income above $200,000 and married couples that earn mote than $250,000.
The Senate Democrats have not embraced all elements of the president's package and are putting together a proposal of their own. The Senate Democrats have announced that their package will include 5.6 percent surtax on household income above $1 million which will raise $450 billion over 10 years and offset the cost of the president's package of tax cuts and spending initiatives to revive the flagging economy.
NACCHO continues to educate congressional staff on job losses experienced by LHDs and the need for inclusion in job creation legislation.
Health Reform Implementation
IRS Community Health Needs Assessment Requirement
NACCHO submitted comments on a notice from the Internal Revenue Service (IRS) regarding the Community Health Needs Assessment (CHNA) requirements for tax-exempt hospitals. Hospitals must conduct a CHNA every three years and adopt an implementation strategy. The requirements are effective for taxable years beginning after March 23, 2012. NACCHO recommended that the IRS require hospitals to partner with local health departments in developing their CHNA and implementation strategies as part of a collaborative process. For more information, go to NACCHO's Community Health Assessment and Health Reform webpage.
Essential Health Benefits Package
On October 6, the Institute of Medicine (IOM) released its recommendations to HHS for the essential health-benefits package under the Affordable Care Act. The IOM panel recommendations stress affordability as a major objective in the process of determining coverage elements. The panel proposed that the law be interpreted to require that the scope of benefits be equivalent to a typical small-employer plan. HHS will have to determine what the national average premium of small-employer plans would be in 2014 and ensure that the benefits they require do not cost more than the premium target. HHS plans a series of listening sessions with consumer and industry groups, with the goal of releasing a draft rule by the end of the year.
Affordable Care Act Grant Announcements
Recently, awardees of the following grants funded by the Affordable Care Act were announced:
More information is available here.