Congressional Priorities for the Summer that Impact Public Health

August 17, 2023 | Jeffrey Ekoma

Federal lawmakers have a long list of public health priorities to address before the current fiscal year ends on September 30, including must-pass annual appropriations, reauthorizing the Pandemic and All-Hazards Preparedness Act, and taking on emerging challenges such as the opioid epidemic and drug shortages. Below is a summary of the legislation that might be approved by Congress during the fall.

Fiscal Year 2024 Appropriations

House appropriators marked up the Labor, Health and Human Services, Education, and Related Agencies (LHHS) bill in subcommittee. It's important to note that all bills have been marked up about $119 billion below the $1.59 trillion funding level set in the Fiscal Responsibility Act (FRA) of 2023 resulting in a $1.6 billion proposed cut below FY23 for CDC, a cut of $234 million for SAMHSA, and a cut of more than $700 million for HRSA.

Senate appropriators have taken a different path concerning their process and developed their bills at levels greater than the House and the spending caps set by the FRA. The Senate is further along, having marked up its bill out of the full appropriations committee, while the House marked up out of its subcommittee. Funding for the federal government expires on September 30, and there are hurdles that appropriators will have to overcome to prevent a government shutdown.

There is also the possibility for a 1% across-the-board if Congress is unable to pass all 12 appropriation bills before the end of the calendar year, as stipulated in the FRA. There is some optimism that Congress will pass a continuing resolution to avoid a shutdown, however, that cannot be fully ruled out with limited legislative days after the August recess period.

Reauthorizing the Pandemic and All-Hazards Preparedness Act (PAHPA)

Reauthorizing PAHPA has seen significant activity in both the House and Senate since the current authorization expires on September 30. The House has marked up two separate pieces of legislation (H.R. 4421 and H.R. 4420) that would reauthorize PAHPA as well as other bills, specifically:

• H.R. 4529—Public Health Guidance Transparency and Accountability Act of 2023: Would require CDC to develop, establish, and maintain good guidance practices setting forth the policies and procedures of the centers for developing, issuing, disseminating, and using such guidance documents. It would require that the public participates in developing guidance the documents and ensures that guidance documents under the jurisdiction of Centers within CDC do not create, confer, restrict, or revoke any rights, responsibilities, or liabilities for individuals.
• H.R. 4381—Public Health Emergency Congressional Review Act: Grants Congress the authority to terminate a public health emergency starting six months after it has been established by HHS and every six months afterward. It also requires that the Secretary of HHS inform Congress of a public health emergency renewal in writing, no later than 48 hours after such a determination.
• H.R. 3813—CDC Leadership Accountability Act of 2023: This would require Senate confirmation for a CDC Director and designates any appointee after June 1, 2023, as an “acting” Director.

Similarly, the Senate marked up a discussion draft out of the full Senate Health, Education, Labor, and Pensions Committee last month. ASTHO submitted feedback to the committee highlighting the importance of reauthorizing critical preparedness programs such as the Public Health Emergency Preparedness Program, Epidemiology and Laboratory Capacity Program, and the Hospital Preparedness Program at funding levels that are higher than its current authorization.

ASTHO also expressed gratitude to the committee for considering specific language revisions to the current statute that would strengthen the Public Health Emergency Medical Countermeasures Enterprise and require the GAO to evaluate the impact of regional stockpiling to name a few. It is important to note that there are vast differences between both versions of the legislation, and it will require reconciliation prior to full passage in Congress.

Addressing Drug Shortages

The impact of drug shortages is being felt across the country and the impact on public health is profound. Recognizing this, Representative Cathy McMorris Rodgers (R-WA) and Senator Mike Crapo (R-ID) requested feedback from stakeholders on solutions to address the increase in drug shortages. ASTHO provided feedback, highlighting how a shortage of Rifapentine is affecting care for those with tuberculosis and a shortage of critical chemotherapy medications such as Carboplatin, Methotrexate, and Cisplatin has forced hospitals in some states to implement contingency and or conservation strategies that directly impact patient care.

Due to an overwhelming response to their request, both members introduced a discussion draft that would address market flexibility of drugs on the market, increase transparency from group purchasing organizations, and require additional information to address shortages to name a few. Both members are seeking input on their draft before the end of the month and ASTHO is working to further emphasize the impact of shortages on public health departments.

Opioid Epidemic

According to CDC, the number of people who died from drug overdose was nearly the same in February 2023 as it was in February 2022. The impact of drug overdoses and the opioid epidemic continues to be an issue of interest for Congress. The House Energy and Commerce Committee is also working to reauthorize provisions included as part of the Substance Use-Disorder Prevention that Promote Opioid Recovery and Treatment for Patients and Communities Act or the SUPPORT Act, which was originally signed into law in 2018. Specifically, the committee advanced legislation that would expand treatment and response options to the epidemic. Also included in the bill is a provision that would address xylazine by classifying the sedative as a Schedule III controlled substance, among other important reauthorizations.

The sprint to wrap up these priorities is in full effect right now. ASTHO will continue to monitor these important public health issues and provide updates as they become available.