April 2008

Underneath the never-ending clamor associated with the political campaigns, the U.S. Congress has quietly advanced several important public health bills. Medicaid, tobacco control, workforce, and VC bills, among others, are on the burner. Although this year’s Congressional session will be foreshortened by the political conventions and the election, progress made this year is indispensable in setting up important public health issues for action in 2009.

There is so much going on that we are offering you quick and easy ways to take action on any or all of the pending legislation described below. NACCHO’s Legislative Action Center enables you to edit and fax letters to your Representatives and Senators directly from the web site in a few easy keystrokes. Please visit that site at http://capwiz.com/naccho/home/ and let your voice be heard on Capitol Hill. If you can take the time to place letters on your own letterhead and fax them from your offices that would be even better.

Medicaid Regulations. The House Energy and Commerce Committee unanimously passed a bipartisan bill imposing a one-year moratorium on implementation of seven different Medicaid regulations on April 16, 2008. All of them would impose large additional burdens on state Medicaid programs. The cumulative effect would cost the states from $18 billion (according to the Congressional Budget Office) to $50 billion (according to the states) over five years. The next step is the full Committee, then the House floor. It has been reported that the ranking GOP member of the Committee, Rep. Joe Barton (R-TX) concurs with the legislation and is attempting to broker an agreement with the White House, which is otherwise likely to veto any measure passed. The fate of the measure remains uncertain in the Senate, which has not yet achieved a bipartisan agreement on the measure, although a comparable bill has been introduced by Senators Kennedy (D-MA), Rockefeller (D-WV) and Snowe (R-ME).

NACCHO filed comments opposing one of the seven regulations in particular that would severely limit reimbursement for Targeted Case Management. Full implementation of the regulation, which took effect March 1, 2008, will adversely affect local health departments that receive Medicaid reimbursement for case management services. The comments are available here. A report on the regulations and their projected impact produced by the House Government Reform and Oversight Committee is available at http://www.amchp.org/policy/Downloads/Waxman%20Med%20Regs%20Report%203-08.pdf. NACCHO supports both House and Senate measures to delay all seven regulations, as does a broad coalition that includes the National Association of Counties and the nation’s governors.

Tobacco Control. The House Energy and Commerce Committee (a very busy group of people at the moment) also passed landmark legislation granting authority to regulate tobacco products to the U.S. Food and Drug Administration (FDA). This is the first time a committee of the House has ever succeeded in passing such a measure, which follows comparable action by the Senate Health, Education, Labor and Pensions Committee last August. All major national public health organization, including NACCHO, were among the 630 organizations, representing public health, health care providers, faith communities, and others, that supported the measure. The next steps are floor votes on both House and Senate, which have not yet been scheduled. Tobacco control advocates will be working to gain veto-proof majorities in both chambers. 

Public Health Workforce. We reported last month on the introduction of a House version of the Public Health Preparedness Workforce Development Act (HR 5496) by Representative Doris Matsui(D-CA). This is a companion bill to S. 1882, introduced last year by Senators Hagel (R-NE) and Durbin (D-IL). This legislation would build upon the National Health Service Corps model and provide scholarships and loan repayment to encourage individuals to enter careers in health departments working on public health preparedness. The legislation would authorize $35 million per year for student scholarships and $195 million per year for loan repayments. The bill would also support mid-career training for public health professionals to join the preparedness or biocides workforce. If the bill is passed and signed into law, appropriations would have to be passed through the regular budgeting process to fund these programs.

This information is being repeated because NACCHO, as well as our other public health partners, are working to build support for the bill by increasing the number of co-sponsors in both House and Senate.

Vaccines for Children (VFC). The ineligibility of local health departments to be VFC providers for underinsured children (those with private health insurance that does not cover vaccines) has long been an obstacle to many local immunization programs. Some states and localities have entered into arrangements with community health centers, which are eligible providers for underinsured children, whereby public health departments vaccinate such children as delegates of the health center. A bill introduced in both House and Senate early this year would render such arrangements unnecessary. Representatives Waxman (D-CA) and Roybal-Allard (D-CA) and Senator Kennedy (D-MA) have introduced HR 4702 and S. 2465, the Vaccine for Children Access Act of 2008. These bills would give the approximately 1.8 million children who are currently underinsured for one or more vaccines access to VFC vaccines in public health clinics.

In order for all these bills to move forward, it is important to build support. You can help by using NACCHO’S Legislative Action Center to fax letters to your Senators and Representatives.