August 2008

While summer in Washington is usually a slow time, we do have a lot of public health activity to report to you this month.

Victory for Public Health! Tobacco Bill Clears the House of Representatives
On July 30, the U.S. House of Representatives cast a historic vote to reduce smoking and save lives by overwhelmingly approving the Family Smoking Prevention and Tobacco Control Act (HR 1108) granting the U.S. Food and Drug Administration authority to regulate tobacco products.

A broad coalition of public health and anti-smoking groups, including NACCHO, have worked on this effort for more than 10 years and this is the first time the House has ever approved such legislation. The bill passed by a clear veto-proof margin of 326 to 102 which underscores the broad, bipartisan support for this legislation and provides powerful momentum for enacting it into law this year. Click here to see how your Member of Congress voted on this legislation. 

In September, attention moves to the Senate, where the bill (S. 625) has already passed the Health, Education, Labor and Pensions Committee. Congress likely will adjourn at the end of September after returning from the August recess, which means there is only a short time left to pass the bill this year. With 57 sponsors and several other senators who have committed to supporting the bill, it appears that the Senate has the votes to pass this legislation this year.

However, Health and Human Services Secretary Michael Leavitt has recommended a veto of the bill by the President. The White House cites its opposition to the bill because it would “potentially lead the public to mistakenly conclude some tobacco products are safe.” In addition, according to the Bush Administration, the bill would mandate significant added responsibilities for the Food and Drug Administration (FDA) that conflict with FDA’s mission of ensuring the safety and effectiveness of drugs, biologics, and medical devices. The White House also objects to the fees imposed on tobacco companies by the bill.

If the bill doesn’t pass the Senate this year, the legislative process would start over again next year. However, the strong vote in the House provides a precedent for future action if the bill is not passed by the Senate this year.

Thank you to NACCHO members who contacted Members of Congress to urge their support for this bill. NACCHO staff also made calls to more than 40 Capitol Hill offices asking Members of Congress to support for the bill. Click here for contact information and talking points for use in urging your Senators to support the bill this year.

Public Health Funding Update
As Congress left town for its August recess, appropriations for FY09 continued to be stalled over partisan issues regarding energy policy, specifically off-shore drilling.

Appropriations Committee Chairman David Obey (D-WI) has announced that he does not plan to bring up any appropriations bills in committee this year, preferring to wait until the next Congress convenes after the fall elections. If Congress fails to pass its appropriations bills, government programs will continue to be funded through a continuing resolution, perhaps through February or into March. Details of a continuing resolution have not yet been made public, but NACCHO will provide more information as it becomes available.

Key Senate Committee Staff Briefed in Advance of Health Reform Debate
On July 25, NACCHO staff, along with staff from the Association of State and Territorial Health Officials, the American Public Health Association, Trust for America’s Health, Partnership for Prevention, March of Dimes, and the Bazelon Center for Mental Health Law participated in an invitation-only roundtable involving a group of key Senate staff from the Health, Education, Labor and Pensions Committee, Budget Committee, and Finance Committee. The focus of this roundtable was preparing for health reform. One of the messages that emerged from the group of public health advocates was to focus on population-based prevention and public health, not just access to health care.  Senate staff in attendance were open to the idea of addressing prevention as part of health reform, but some stressed the importance of finding a funding mechanism that does not depend on discretionary appropriations.

Click here for NACCHO's policy statement on creating a United States Health System for the 21st Century.

Mental Health Parity Law Poised for Final Passage
This year may see a final victory in the effort to achieve parity for mental health services with other health care services. NACCHO has been a part of the Mental Health Liaison Group pushing for passage of this legislation. House and Senate negotiators have come to agreement on a reconciled bill after passage of different versions of mental health parity legislation (HR 1424/S. 558). The reconciled version now awaits passage by the Congress in order to be sent to the President for his signature. The new federal parity law would —

• Completely end insurance discrimination against mental health and substance use disorder benefits for over 113 million Americans, requiring full parity coverage with physical health benefits;
• Extend to all aspects of plan coverage, including day/visit limits, dollar limits, coinsurance, copayments, deductibles and out-of-pocket maximums;
• Preserve strong state parity and consumer protection laws while extending parity protection to 82 million more people who cannot be protected by state laws; and
• Ensure parity coverage for both in-network and out-of-network services.

For more information, go to the Mental Health Liaison Group at www.mhlg.org.

Indian Health Care Improvement Act Reauthorization Stalled in the House
NACCHO has joined a coalition of groups led by the National Indian Health Board calling for reauthorization this year of the Indian Health Care Improvement Act (IHCIA).

The Senate bill (S 1200) passed by a wide margin on February 26, but the House has not yet considered its bill (HR 1328). Congress is expected to recess for the year at the end of September. There is limited time remaining to pass this legislation before a new President and new Congress take office in 2009.

Since its passage in 1976 the IHCIA has provided the framework for carrying out the federal government's trust responsibility for Indian health. The IHCIA is the law under which health care is administered to American Indians and Alaska Natives.

It has been 16 years since the Congress last performed a comprehensive review of the IHCIA (since 1992). The IHCIA contains a number of provisions that authorize appropriation of funds to support the programs set forth in the law; however, these provisions expired in fiscal year 2001. Fortunately, the Snyder Act of 1921 provides permanent authority for the appropriation of funds for Indian health, so Congress can and does continue to appropriate funds for these programs. Nonetheless, reauthorization is needed to officially extend the life of the IHCIA authorization and to update the bill to reflect both current needs of Indian health and the current methods of health care delivery and systems enjoyed by most Americans.

There is also a critical need for health promotion and disease prevention activities in Indian country and provisions of the IHCIA reauthorization would address this need. Indians are 630 % more likely to die from alcoholism, 650 % more likely to die from tuberculosis, 318 % more likely to die from diabetes, and 204 % more likely to suffer accidental death compared with other groups. The IHCIA would update and modernize health delivery services, such as cancer screenings, home- and community-based services, and long term care for the elderly and disabled and establishes a continuum of care through integrated behavioral health programs—both prevention and treatment—to address alcohol/substance abuse problems and the social service and mental health needs of Indian people.

Click here to contact your Member of Congress regarding reauthorization of the IHCIA.