Congressional Corner

Congressional Corner



 May 25, 2017

Federal Budget

Trump Administration Releases FY18 Budget Request

On May 23, President Trump released his proposed budget for FY18. ASTHO released a statement and detailed analysis in response. It is important to remember that this is the first step in the budget process. Congress holds the power to authorize and appropriate federal funds. While this is an important message document, ASTHO will focus efforts on working with Congress to understand the importance of federal funding for state and territorial public health.

Sequestration Returns

On May 23, President Trump issued a sequestration order for FY18 mandating that on October 1, “direct spending budgetary resources for fiscal year 2018 in each non-exempt budget account be reduced by the amount calculated by the Office of Management and Budget (OMB) in its report to the Congress of May 23, 2017.” This order essentially means that OMB will enforce current law. Without a bipartisan act of Congress to adjust the caps on discretionary spending established by the Budget Control Act of 2011, these sequester cuts could happen automatically. In the past, Congress reached an agreement that provided some relief from the sequester level caps. However, it is unclear whether they will develop a bipartisan agreement for FY18. This is an important priority for ASTHO and we will continue to encourage members of Congress to raise the non-defense discretionary spending caps.



American Health Care Act (AHCA)

Yesterday, the Congressional Budget Office (CBO) releasedits score for the version of AHCA that passed the House of Representatives. CBO calculates that AHCA (H.R. 1628) would reduce the federal deficit by $119 billion between 2017-2026. Most of these savings would come from cuts to Medicaid and private insurance subsidies. However, it would leave approximately 23 million more people uninsured during this same time. This is a slight improvement over the March 23rd score, which estimated 24 million people would be left uninsured. This new score reflects amendments to the law that would allow states to seek waivers from regulations that set minimum benefit standards. It also allows states to change how insurance companies charge people based on health status and how prices are set by age. The estimate also states that Medicaid would be cut by $834 billion over 10 years.

The Senate continues to work on their own version of a healthcare reform bill.

Energy & Commerce Subcommittee Hearing on Zika

On May 23, the House Energy and Commerce Subcommittee on Investigations and Oversight held a hearingthat examined “challenges and concerns with the U.S. public health response to the Zika virus outbreak, including the ability to determine the link between Zika and other illnesses, the efficacy and limits of available diagnostic testing, the status of vaccine development, and the federal government’s plan to respond to the potential future spread of the virus.” The hearing was in response to a Government Accountability Office report entitled “Emerging Infectious Diseases: Actions Needed to Ensure Improved Response to Zika Virus Disease Outbreaks.” The report states that “since Zika virus disease was a newly emerging disease threat in the United States, the Centers for Disease Control and Prevention (CDC), and the states were not fully equipped with needed information and resources at the beginning of the outbreak.” Many unknowns remain, according to the report, which recommends that “CDC establish a transparent process for providing test manufacturers access to diagnostic tests for comparison purposes and FDA and CDC provide information to help ensure that users of diagnostic tests can compare performance.”

Witnesses included:

  • Timothy Persons, PhD, chief scientist at the U.S. Government Accountability Office.
  • Lyle R. Petersen, MD, MPH, director of CDC’s Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases.
  • Luciana Borio, MD, acting chief scientist at FDA.
  • Anthony Fauci, MD, director of the National Institutes of Allergy and Infectious Diseases at the National Institutes of Health.
  • Rick A. Bright, PhD, director of Biomedical Advanced Research and Development Authority and deputy assistant secretary of the Office of the Assistant Secretary for Preparedness and Response at HHS.

ASTHO monitored the hearing, which focused primarily on vaccine creation, testing, and surveillance, as well as vector control. The hearing highlighted the fact that follow-up monitoring on babies possibly exposed to Zika virus in utero might not be feasible due to budget constraints on state and local public health.

ASTHO Zika Letters

ASTHO submitted a letter to the Energy and Commerce Subcommittee on Investigations and Oversight thanking the committee and its members for their hearing on the public health response to the Zika virus and the challenges ahead. In the letter, ASTHO also emphasized the importance of continued federal funding. In addition, ASTHO signed on to a letter written by the Zika Coalition, which was then sent to the March of Dimes.


Federal Agencies

SAMHSA Report on Protecting our Infants Act

Earlier this week, the Substance Abuse and Mental Health Services Administration (SAMHSA) released a report entitled “Protecting Our Infants Act: Final Strategy.” The Protecting Our Infants Act (Public Law 114-91), enacted in 2015, mandates that HHS:

  • Conduct a review of planning and coordination of HHS activities related to prenatal opioid exposure and neonatal abstinence syndrome (NAS).
  • Develop recommendations for the:
    • Prevention of prenatal opioid exposure.
    • Treatment of opioid use disorder.
    • Prevention, identification, and treatment of NAS, as well as any long-term consequences thereof.
    • Develop a strategy to address these issues, gaps, overlap, and duplication among federal programs, as well as coordination of federal efforts to address NAS.


SAMHSA submitted the “Protecting Our Infants Act: Report—2017” to Congress on Jan. 19. The strategy proposed in this report was revised to reflect public comment.


HHS Report on Average Health Insurance Premiums

On May 23, HHS released a new analysis showing that premiums have doubled for individual health insurance plans since 2013. The analysis is based on data compiled by the previous administration. The Office of the Assistant Secretary for Planning and Evaluation produced the report. Data from the report states that:

  • Average exchange premiums were 105 percent higher in the 39 states using in 2017 than average individual market premiums in 2013. The median state premium increased 108 percent.
  • Average monthly premiums increased from $232 in 2013 to $476 in 2017. Sixty-two percent of those states had 2017 exchange premiums at least double the 2013 average.
  • There is substantial variation in the percent increase by state.
    • All 39 states using experienced an increase in individual market premiums from 2013-2017.
    • Across the states, the lowest premium increase was 12 percent (New Jersey). The highest premium increase was 222 percent (Alabama).
    • Sixteen states had premium increases below the national average of 105 percent, 20 states experienced premium increases between 105 percent and 200 percent, and three states saw premiums triple, with increases of 200 percent or more.

In the report, HHS was not able to determine the contributions that various ACA provisions—such as benefit mandates, guarantee issue, and rating rules—played in the overall premium increases.