2018 brought a whirlwind of activity for public health advocates and your NACCHO government affairs staff were in the thick of it. On issues across the spectrum of public health, NACCHO members and staff continued to advocate with Congress and the administration to improve the public’s health and safety and advanced keypolicy proposals here in Washington.
Thank you to all NACCHO members who told their stories and shared information with policymakers to help inform public health policy. Here is a roundup of some of the highlights from the past year.
Public Health Funding
For the first time in two decades, funding for the Labor, Health and Human Services and Education Appropriations bill was completed ahead of the October 1 start of the new fiscal year.
Then-NACCHO Interim Executive Director Laura Hanen testified before the House Labor, Health and Human Services, and Education Appropriations Subcommittee about key funding for local public health priorities. This was important to help Congress understand the programs and what they fund.
In the end, Congress rejected most cuts proposed by the White House in their FY2019 budget proposal, including significant cuts to public health programming. In the end, most programs remain flat funded at the same levels as FY2018:
- The Prevention and Public Health Fund received $844 million for infectious disease and chronic disease prevention.
- The Public Health Emergency Preparedness Program at the Centers for Disease Control and Prevention (CDC) received a small $5 million increase from FY2018.
- Creation of a new allocation of $10 million to support surveillance activities at CDC to monitor mothers and babies impacted by the Zika virus during pregnancy in the highest risk jurisdictions.
- Creation of a new provision of $50 million for an Infectious Disease Rapid Response Fund to provide resources quickly in the event of an emergency related to an infectious disease.
In addition, NACCHO was successful in one of its key priorities to ensure that funds set aside to address the opioid epidemic can be accessed at the local level. Thanks to our efforts, appropriators included language in the FY2019 bill designating local health departments as eligible for direct opioid funding.
Another key NACCHO priority for 2018 was to ensure a strong reauthorization of the Pandemic and All Hazards Preparedness Act, which Congress must revisit every five years. The House and Senate each worked on their own versions of the legislation, with NACCHO staff providing technical advice and feedback on their products. During this process, then-NACCHO President Umair Shah MD, MPH testified before the House Energy and Commerce Health Subcommittee in a hearing entitled “Examining the Reauthorization of the Pandemic and All-Hazards Preparedness Act” to share the important leadership role local health departments play in national preparedness.
On December 20, the House passed a five-year reauthorization bill, Pandemic and All-Hazards Preparedness and Advancing Innovation Act of 2018 (H.R. 7328.) The bill is very close to a previous version passed by the House this year and supported by NACCHO. It would reauthorize the public health emergency preparedness and hospital preparedness programs for five years. It would also codify the make up of the Public Health Emergency Medical Countermeasures Enterprise (PHEMCE), which coordinates Federal efforts to enhance chemical, biological, radiological and nuclear threats and emerging infectious diseases preparedness from a medical countermeasure (MCM) perspective.
The Senate passed a continuing resolution (CR) that included language to extend until February 8 just two PAHPA provisions that have expired – the limited antitrust exemption for medical countermeasures and BARDA contracting for medical countermeasures. Unfortunately, the CR did not extend other PAHPA provisions that have already expired, including the National Advisory Committee on Children and Disasters and temporary reassignment of state and local public health workers.
The Senate has indicated a willingness to take up the House-passed bill, but it is unclear if there will be an opportunity for a vote before Congress adjourns for the year.
Opioid Epidemic Response
After passing extensive and varied legislation in both chambers, Congress came together on a final legislative package to address the opioid epidemic. NACCHO was very active in this process: NACCHO staff and members advocated with Congress for provisions that would benefit local health departments responding to the opioid crisis, and NACCHO Board member Dr. Michael Kilkenny, Medical Director, Cabell-Huntington (WV) Health Department, testified before the House Energy and Commerce Health Subcommittee about his community’s strategy to reducing opioid overdoses.
The SUPPORT for Patients and Communities Act (H.R. 6) contained provisions to authorize $40 million in grants to states to address the infectious disease consequences of the opioid epidemic. It also accelerates research to find non-addictive painkillers and eases restrictions on medication-assisted treatment, as well as increases state prescription drug monitoring programs to prevent abuse. The law will also help prevent illicit opioids such as heroin and fentanyl from being shipped through the mail, provide grants to substance abuse prevention programs, and make numerous small changes to Medicare and Medicaid, such as allowing Medicaid funding for individuals seeking treatment at inpatient rehab facilities with more than 16 beds. NACCHO endorsed the opioid legislation.
Affordable Care Act
The Affordable Care Act (ACA) remains the law of the land, though efforts to weaken the law continued in 2018. Last week, a federal judge in Texas ruled the ACA unconstitutional in a lawsuit that had been brought by several state attorneys general. The ruling in Texas v. United States stated that because Congress repealed the penalty associated with the individual mandate—an action they took as part of a tax bill package—the entire law should be invalid. The ruling did not immediately invalidate the law and the appeals process is expected to be set in motion shortly. Larger Congressional attempts to repeal the entire law, however, failed.
In May, long-awaited menu labeling regulations mandated by the ACA went into effect, modelled after policy pioneered in several cities like New York and Seattle. FDA rolled out educational resources to help consumers and nutrition advocates increase uptake of the new information.
Legislation to reauthorize the Farm bill for five years was signed into law after months of negotiations. We are happy to report that the final law did not include harmful provisions passed by the House in their version of the bill and opposed by NACCHO and other public health organizations, which would have reduced access to the program for families by adding work requirements to the Supplemental Nutrition Assistance Program. The final law also included authorization of substance abuse prevention and treatment programs for rural America and the Healthy Food Financing Initiative which helps to address “food deserts” in underserved communities.
The FDA signaled it intends to take action against youth use of e-cigarettes. FDA Commissioner Scott Gottlieb, MD announced in November that he is recommending changes to protect kids by having all flavored e-cigarettes sold in age-restricted, in-person locations and, if sold online, under heightened practices for age verification. He also announced plans to ban menthol flavoring in tobacco products and flavors in cigars.
Similarly, this week the Surgeon General issued an Advisory on E-cigarette Use Among Youth, prompted by recent skyrocketing rates of e-cigarette use by this population. A recording of the announcement is available. The Surgeon General urges immediate action to protect the nation’s young people from the addiction to nicotine. E-cigarette use has recently surged among youth, fueled in part by new e-cigarette types that look like a USB flash drive. New resources were also released this week in collaboration with the CDC’s Office on Smoking and Health to help with education efforts around the dangers of e-cigarettes.
Last month, the Fourth National Climate Assessment was released by the federal government. The report details the effects of climate change on various sectors of society, including energy supply, transportation, the environment, and human health. It found that climate change is already producing detrimental impacts in all these areas, but that it can still be reversed if swift action is taken. The report also provides data on the impact on underserved populations such as people of color, people living in poverty, children and older adults. NACCHO remained active on efforts to combat climate change, including opposing the rollback of regulations meant to clean up power plant emissions.
In 2018, HHS sought to dial back key funding for reproductive health at the local level. For example, HHS attempted to end teen pregnancy prevention program (TPPP) grants early, impacting several local health departments that receive TPPP funds. After successful litigation by grantees and advocacy by NACCHO with other national partners, this action was reversed and grantees received their funding.
The Administration also proposed changes that would harm the Title X Family Planning Programs. Since its inception almost 50 years ago, Title X has been a bedrock, cost-effective health care program helping ensure that poor and low-income individuals have access to critical family planning care including contraception; sexually transmitted infection testing and treatment; and screening for breast and cervical cancer. The administration released new vision and requirements for applying to participate in the Title X program, announcing future funding decisions would heavily favor applicants that emphasize ideologically driven priorities including promoting abstaining from all sex outside of marriage. Furthermore, their proposal failed to mention “contraceptive care” and added language that promotes natural family planning methods. NACCHO sent comments to HHS opposing the changes. Several reproductive health groups have sued to stop the changes.While a long list, these are just some of the many public health issues where NACCHO has been active to promote public health. On each of these issues, the input of NACCHO members through the Board of Directors and advisory groups has been vital to guiding the organization’s advocacy efforts. NACCHO members have also reached out personally to educate policymakers about the impact of policy decisions on people in their communities. In 2019, NACCHO looks forward to continuing to work with local health departments across the country to ensure that policy decisions are attentive to the health needs of people in communities large and small.