Congressional Corner

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Sept. 7, 2017

Congress returned from August recess on Sept. 5. Below please find highlights on issues ASTHO is closely monitoring. 

Senate LHHS Bill

Today, the full Senate Appropriations Committee approved the fiscal year 2018 (FY18) Labor, Health and Human Services and Education (LHHS) Appropriations bill by a 29-2 vote. The total for the Senate bill is $164.1 ($3 billion higher than FY17 bill, but represents $800 million less in total discretionary funding than FY2017) billion versus the House bill that is a total of $156 billion, an $8.1 billion difference. 

On Monday ASTHO will release a more detailed legislative analysis of the Senate LHHS bill.

According to a Senate majority summary and Senate minority summary the bill provides:

  • Overall HHS
    • $1.7 billion increase over FY17 at $79.4 billion.
     
  • Overall Centers for Disease Control and Prevention (CDC)
    • $7.18 billion a decrease from the FY17 level of $7.2 billion.
      • Maintains separate funding for chronic disease prevention programs.
      • Rejects the Administration’s proposed “America’s Health” block grant to states.
       
    • $160 million for the Preventive Health and Health Services Block Grant. 
    • $606.8 million for the immunization program which is level with FY17. 
    • $660 million for the Public Health Emergency Preparedness (PHEP) to allow states to prepare, respond, and recover from emerging threats such as natural disasters, disease outbreaks, and chemical, biological, radiological, and nuclear threats.
     
  • Opioid abuse prevention and treatment
    • A total of $816 million across all of HHS funds for opioid abuse prevention and treatment. 
      • The bill continues $126 million for CDC opioid prevention programs.
      • $50 million for Community Health Centers treatment and prevention.
      • The bill maintains funding for previously funded SAMHSA opioid prevention and treatment programs.
       
    • $15 million for a new SAMHSA opioid prevention program for community prevention.
    • $500 million in state opioid abuse crisis grants authorized in 21st Century Cures Act (CURES).
    • $1.9 billion to continue the Substance Abuse Prevention and Treatment Block Grant.
    • $94 million in mandatory funds to Community Health Centers. 
    • An additional $22.6 million to the NIH National Institute on Drug Abuse.
     
  • Other highlights
    • $287 million for the Title X program, the same level as FY17.
    • $108 million for the Teen Pregnancy Program. This is level with fiscal year 2017. The program was proposed for elimination in the President’s budget. The bill also includes new bill language directing HHS to administer the program as it was during the Obama Administration.
    • Maternal and Child Depression – $5 million for a new Screening and Treatment for Maternal Depression program as authorized in CURES. This funding will create grants for states to establish, expand, or maintain programs for screening and treatment of women who are pregnant or who have given birth within the preceding 12 months for maternal depression. 
     

House Vote on FY18 Omnibus Appropriations bill:

The House passed four appropriations bills called the “security minibus” before the August recess. This week, the House will consider the remaining eight appropriations bills (H.R. 3354) for FY18. They are: Interior & Environment; Agriculture; Commerce, Justice, Science; Financial Services; Homeland Security; Labor, Health and Human Services, Education; State and Foreign Operations; and Transportation-Housing and Urban Development. A summary of the eight measures can be found here. After these are passed, they will bundled together with the four that passed in August and sent to the Senate as one complete omnibus appropriations bill. These bills do not match and will need resolution. ASTHO will monitor progress of these bills.

Debt Ceiling and Harvey Relief

On Sept. 6, President Trump made a deal on a continuing resolution (CR) that extends current funding levels for three months as well as suspend the debt limit until December. The measure will be attached to a $7.85 billion aid package that passed the House on Wednesday for Hurricane Harvey relief. 

Today, Senate Appropriations Chairman Thad Cochran added $7.4 billion in Community Development Block grants (CDBG) to the package, bringing its total price tag to $15.25 billion. CDBG funds often used to rebuild infrastructure, schools, and other business. The Senate also changed the dates of the CR and debt ceiling boost to Dec. 8 rather than Dec. 15.

In addition, CMS approved Texas's request to waive CHIP co-pays and enrollment fees, and the state also could waive or modify various federal requirements governing Medicaid providers, making it easier for providers enrolled with another state Medicaid agency to offer help in Texas, too.

ASTHO will continue to monitor progress on appropriations and debt ceiling legislation, as it will arise again in December.

Senate Hearings

Health, Education, Labor and Pensions Committee Hearing on Market Stabilization

The Senate held a series of hearings on stabilizing the health insurance markets that included state insurance commissioners yesterday and governors today. Witnesses in today’s hearing included Gov. Bill Haslam (TN), Gov. Charlie Baker (MA), Gov. Steve Bullock (MT), Gov. Gary Herbert (UT), and Gov. John W. Hickenlooper (CO.). There was strong agreement on the need to stabilize the markets through funding the cost sharing reduction payments to insurance companies, allow more state flexibility at the state level to design coverage and payment schemes that work for each unique jurisdiction and spur innovation, as well as lower healthcare costs. In addition, there was consideration discussion related to phase two, after this initial stabilization is underway and there is room to continue to improve on ACA.

Chairman Alexander (TN) concluded his opening remarks by saying: “What more can be done to encourage wellness? What can be done to prevent more serious illness and disease and the high costs that come from being ill? We should be looking at the real ways to bring down cost of health care, which is the best way to reduce cost of health insurance.” Additionally, Gov. Hickenlooper stated: “And we can’t stabilize the market without funding health priorities that reduce health care costs like weight management, tobacco cessation, family planning and injury prevention, just to name a few.”

Finance Committee Hearing on CHIP

The Children’s Health Insurance Program (CHIP) was also on the schedule today for the Senate Finance Committee. Federal funding is set to expire at the end of this month for the program. Central questions that still remain are how long the plan should be extended and what to do about the federal funding increase created by ACA—a 23 percent boost in federal payments. Sen. Wyden (OR) urged action before the end of the month rather than December as some have proposed. Sen. Hatch (UT) said that there might not be enough time given the amount of work on the Senate’s plate to “give full and fair consideration to CHIP reforms prior to the expiration of federal funding.”

ASTHO will continue to monitor these issues and provide timely updates.

Health Emergency Declared in Puerto Rico, Virgin Islands

HHS Secretary Tom Price declared a health emergency in Puerto Rico and Virgin Islands in the wake of Hurricane Irma. HHS has already deployed approximately 70 people to areas affected by Hurricane Irma. Additional staff are on standby. For more information, see HHS's webpage on Hurricane Irma.

ASTHO Letters

On Sept. 6, ASTHO sent a letter supported by 33 organizations encouraging the Senate to provide increased top line funding for CDC and HRSA in the FY18 LHHS Appropriations bill. In addition, partnering with NACCHO, ASTHO sent a letter reminding lawmakers of the importance of the Public Health Emergency Preparedness and Hospital Preparedness Programs, particularly following the devastation of hurricanes Harvey and Irma.

ASTHO also signed onto a letter opposing an amendment offered by Rep. James Comer that would prohibit FDA from finalizing a product standard to reduce N-Nitrosonornicotine, a carcinogen found in smokeless tobacco products. Shortly after signing on to this letter, the amendment was withdrawn.