August 2006

Senate Committee Passes All-Hazards Preparedness Bill and HHS Funding Measure
In mid-July, the week before NACCHO’s annual conference in San Antonio, the heat of debate on Capitol Hill matched the ambient air temperature – over 100 degrees. Stem cell research was the issue generating the heat. Coolly and quietly, however, the Senate addressed two measures with significant implications for local public health. The first was the FY2007 funding bill for health and education. The second was bipartisan legislation reauthorizing the public health preparedness and medical response activities of HHS.

Public Health Funding for FY 2007 – Up in the Air
The Senate Appropriations Committee reported its version of the bill funding the Departments of Labor, Health and Human Services and Education for FY 2007. The House Appropriations Committee did the same thing in June. On the Senate side, the total amount for all programs in the bill was 0.89% above the current fiscal year and 3.6%, or $5 billion, more than the President’s request. The extra $5 billion for discretionary (non-entitlement) programs was the direct result of the success of Senators Arlen Specter (R-PA) and Tom Harkin (D-IA) in gaining an increase of that amount in the overall budget cap earlier this year, an effort supported by the entire community of advocates for public health, education and labor funding. This is an era when holding the line constitutes a victory, in light of great pressures to reduce federal spending.

NACCHO advocates strongly for all programs that contribute to local health department funding streams. Our two top priorities this year were the CDC cooperative agreements for public health preparedness, which took a nasty cut in FY2006, and the Preventive Health and Health Services block grant, which the Administration has twice proposed to eliminate. Both House and Senate Appropriations Committees have proposed level funding for these programs, $824 million and $100 million, respectively. It can reasonably be assumed that these levels will stand, although all programs are still vulnerable to additional small across-the-board cuts to which Congress has resorted the last several years. NACCHO will remain vigilant. The full details of both House and Senate Appropriations Committee action can be found at http://thomas.loc.gov/home/approp/app07.html

Final action on HHS spending will likely not take place until after the November election. Congress will be on a month-long recess in August and has very little time before a scheduled early-October adjournment to act on a large amount of pending legislation. A lame duck session is a near-certainty.

Public Health Preparedness Legislation Passes First Hurdle
The legislation that authorizes, or sets the terms and conditions, for HHS public health preparedness programs (including the CDC and HRSA cooperative agreements) that passed originally in 2001, expires this year. It is important to note at the outset that, even if the authorizing legislation is not renewed in time, that will have no effect on the FY 2007 appropriation, which will move forward in any event.

Sen. Richard Burr (R-NC), chair of the Subcommittee on Bioterrorism and Public Health Preparedness, spearheaded a months-long examination of preparedness programs and consulted widely about public health needs. NACCHO leaders met with the Senator and/or his staff on multiple occasions to discuss the most pressing local needs. The ranking minority member, Sen. Edward Kennedy (D-MA) and Sen. Burr shared a commitment to producing a bipartisan bill.

The final version of the bill, produced after extensive negotiations between Senators from both sides of the aisle and the Administration, is S. 3678, the “Pandemic and All-Hazards Preparedness Act.” The Senate Health, Education, Labor and Pensions Committee passed it unanimously. It can be found by searching for S. 3678 at http://thomas.loc.gov. Senate Majority Leader Bill Frist (R-PA) was a co-sponsor, so there is a reasonable chance that the bill will pass the Senate before the year is out. Its future in the House, which has produced no comparable bill, remains unknown.

The bill would establish once and for all an “all-hazards” approach to public health preparedness, rather than focusing exclusively on acts of bioterrorism. The bill codifies much that is already existing or planned practice with respect to the CDC cooperative agreement program. In addition, it establishes penalties for states (and the three direct urban grantees) that fail substantially to meet performance benchmarks or that exceed carryover limits that the HHS Secretary would establish. There is a strong emphasis on performance measurement and fiscal accountability and a new requirement for a state match beginning in 2009 (which would include in-kind contributions).

The bill would establish a modest new federal public health workforce program, in the form of grants to states that establish state loan repayment programs for public health professionals who go to work in state or local health departments. It is important to note, however, that this new program would not be useful until Congress appropriated new funds for it and a state established a loan repayment program.

The bill also would open the hospital preparedness program (which it moves organizationally from HRSA to a new Assistant Secretary for Preparedness and Response) to direct funding by HHS of partnerships that include a group of hospitals and a state or local health department, rather than passing all the funding through the state. The HHS Secretary would have the discretion to determine what proportion of hospital preparedness funds would be used in this new fashion.

The bill codifies into law the requirement for local concurrence with state spending allocations that has existed for several years in the CDC cooperative agreement guidance. It also requires activities undertaken under both CDC and the hospital preparedness cooperative agreement programs to be consist with the activities of local health departments and local emergency plans. This reflect NACCHO’s consistent advocacy for the proposition that public health response to a disaster takes place in the context of local emergency management plans.

The bill ensures some additional local flexibility in spending preparedness funds by explicitly permitting their use to pay salary and expenses for any health department personnel carrying out preparedness activities, even if that is not their primary assignment. NACCHO proposed and advocated strongly for both provisions.

RWJ Foundation and Research!America Train NACCHO Members to Advocate for Public Health
NACCHO is fortunate to have established partnerships that have enabled us to offer some expert training in public health advocacy to NACCHO members. Research!America, a Washington, DC-based organization that specializes in health advocacy, offered a well-received day-long workshop in advocacy on July 25, in conjunction with the NACCHO Annual meeting in San Antonio, Texas. The Texas Association of Local Health Officers (TALHO) organized the event with NACCHO collaboration and Research!America contributed the resources for the workshop, attended by over 50 persons.

The Robert Wood Johnson Foundation (RWJF) CONNECT project provided an intensive three-day Washington, DC experience July 12-14 for 15 two-person teams. NACCHO identified the teams and provided ongoing consultation as the project evolved. The teams consisted of one local health official or senior health department staff member and one person representing a community organization with which the health department works in partnership. The purpose of the CONNECT project is to help people who work at the local level addressing health and public health problems build relationships with their Members of Congress and other policymakers.

The participants came to Washington at the Foundation’s expense, received intensive training from personal “coaches” provided by RWJF, developed fact sheets and specific “asks,” or requests, for their Members and Senators to assist them back in their communities, and rehearsed in advance. The teams were then escorted around Capitol Hill for two half-days of meetings with staff of their Representatives and Senators (and, in a few cases, with the Representatives or Senators themselves). Following the visits, the participants worked with their RWJF coaches to develop strategies for building on the experience.

The event was the first time that the Foundation has offered the long-established CONNECT program to local public health officials and it was a resounding success. Not only did the program assist the participants to develop a new set of advocacy skills, but it also helped strengthen the community partnerships themselves. One important lesson was that, although the use of foundation funds for “lobbying” is prohibited, and many local health department personnel also cannot “lobby”, there is much non-legislative advocacy and education about public health that is fully permissible and highly effective in generating the support of policy makers for public health.

***Remember to visit http://capwiz.com/naccho/home/ for all the latest legislative news from Washington.***