APHA Legislative Update - July 2013

House rejects farm bill reauthorization

In a surprising defeat for the House Republican leadership, the House of Representatives defeated the House version of the farm bill by a vote of 195-234 on June 20. The House bill, H.R. 1947, as currently written would cause nearly 2 million people to lose their Supplemental Nutrition Assistance Program benefits entirely, 210,000 children to lose free school meals and 850,000 households to see their benefits cut by an average of $90 per month. It would also slash SNAP nutrition education funding that helps low-income families stretch limited resources to maximize nutrition. APHA joined more than 65 national, state and local organizations in sending a letter to the full House of Representatives urging members to defeat the bill unless the cuts to nutrition programs are restored. In addition, the White House issued a statement threatening to veto the House version of the bill prior to its defeat.

On top of the significant cuts to SNAP contained in the bill, the House also adopted an additional harmful amendment offered by Rep. Steve Southerland, R-Fla. Southerland’s amendment would allow states to require most adults who receive or apply for SNAP — including parents with children as young as 1 and many people with disabilities — to work or participate in a work or training program for at least 20 hours a week or else have their entire family’s SNAP benefits cut off. At the same time, the amendment provides no jobs and no funds for work or training programs, and it does not require states to make any work opportunities available.

It is unclear what will happen next after the defeat of the bill in the House. While some have floated the idea of the House taking up and passing the Senate bill, it is unlikely that the House has the votes to pass the Senate bill, S. 954, which was passed overwhelmingly by the Senate in June. Senate Majority Leader Harry Reid, D-Nev., has stated that the Senate will not pursue another short-term extension of the farm bill.

Senate passes immigration reform

On June 27, the Senate passed the comprehensive immigration reform bill, S. 744, by a vote of 68-32. The bill would provide a pathway to citizenship to more than 10 million undocumented people and would direct billions of dollars to strengthen security measures along the southern U.S. border. In terms of opportunities for aspiring citizens to access health-related programs, S. 744 would bar most lawfully present immigrants from accessing federal health coverage, nutrition assistance, and premium tax credits and cost-sharing reduction that would allow them to participate in the new health insurance marketplaces established under the Affordable Care Act. Lawfully present individuals including those with registered provisional immigrant, blue card and V visa status would be denied access to these important programs during the entire period they are in provisional status. This means that many legal status immigrants would have to pay into programs for 10 to 15 years before they have the opportunity to access these programs that are critical for good health.

APHA sent a letter to the Senate in advance of the vote to oppose any amendments that would deny, delay or hinder access to care or other health-related benefits for aspiring citizens. The letter also asked the Senate to support Sen. Mazie Hirono’s, D-Hawaii, amendment that would restore taxpayer fairness to immigrants who are lawfully present, employed and have satisfied their federal tax liability.

House Speaker John Boehner, R-Ohio, has indicated that he will require a majority vote of House Republicans to pass any immigration reform bill, including a House-Senate compromise.

Senate Appropriations Committee adopts FY 2014 spending allocations

On June 20, the Senate Appropriations Committee adopted its FY 2014 302(b) allocations for the 12 annual appropriations bills. The Senate allocation for the Labor, Health and Human Services, Education and Related Agencies Appropriations bill, which funds CDC, HRSA and other federal public health agencies, was set at $164.3 billion, a $7.7 billion increase over the FY 2013 pre-sequestration level of $156.6 billion. This compares with the House Appropriations Committee level of $121.8 billion for FY 2014, by putting the Senate allocation $43 billion higher than the allocation adopted by the House Appropriations Committee.

The Senate Labor, Health and Human Services, Education and Related Agencies Subcommittee is expected to take up the health spending bill on July 9 and the full Senate Appropriations Committee is expected to consider the bill on July 11.

President outlines comprehensive plan to combat climate change

On June 25, President Barack Obama unveiled an ambitious and comprehensive Climate Action Plan to address climate change during a speech at Georgetown University. APHA’s executive director, Dr. Georges Benjamin, MD, who issued a statement praising the president’s proposal, was among the guests attending the president’s speech. One of the cornerstones of the plan is a directive to the U.S. Environmental Protection Agency to develop new standards for reducing carbon emissions from both new and existing coal- and gas-fired power plants, a major contributor to carbon emissions, which contribute to climate change. The plan also calls for a doubling of renewable energy generation by 2020, increasing fuel efficiency standards for heavy trucks and establishing stricter energy efficiency standards for common household appliances. In addition to reducing carbon emissions, the plan also calls for reducing other greenhouse gases including hydrofluorocarbons (which are primarily used in refrigerators and air conditioners) and methane.

The plan includes several proposals to help the nation to adapt to the current impacts of climate change. The proposal includes an effort by the U.S. Department of Health and Human Services to identify best practices to ensure the nation’s medical facilities are prepared for and resilient to the impacts of climate change. It will also seek to build upon the work at the CDC to train public health professionals to prepare for the unique impacts their communities will face from climate change. APHA will continue to advocate for increased funding for CDC’s Climate and Health Program to ensure that resources are available to achieve these goals.

Over the past several years, APHA has developed a number of resources on the health impacts of climate change including a climate change and health guidebook and a webinar series. The White House also recently released state-by-state fact sheets on the effects of climate change, highlighting the consequences of pollution and extreme weather in each state.

Senate HELP Committee pushes for vote on compounding

Sens. Tom Harkin, D-Iowa, and Lamar Alexander, R-Tenn., introduced the Pharmaceutical Compounding Quality and Accountability Act, S. 959, in response to the fungal meningitis outbreak associated with medical products from the New England Compounding Center that led to 745 illnesses and 58 deaths last year. The bill would give the U.S. Food and Drug Administration the authority to oversee high-volume compounding facilities to ensure safe manufacturing practices at these facilities. Some of these facilities package and ship thousands of units of medicines to clinics across the country, with no federal oversight. Therefore, a single point of contamination can endanger patients nationwide. The bill would also protect the traditional role of pharmacists to compound individual medicines for one patient at a time. The bill passed the Senate Health, Education, Labor and Pensions Committee by voice vote in late May. Most recently, Harkin and Alexander sent a letter to Senate leadership urging them to bring the legislation before the full Senate in July. APHA and Trust for America’s Health sent a joint letter to Senate HELP Committee leaders in support of the bill and urged them to include federal regulation of large-scale compounding facilities that work and ship products within a single state and large, non-sterile compounding facilities.

APHA summer advocacy campaign underway

In June, APHA launched its annual Public Health Action, or PHACT, Campaign to mobilize its members, affiliates and other advocates to educate their members of Congress on important public health issues that help to build and maintain healthy communities. Throughout the summer, advocates are encouraged to reach out to their members of Congress and meet with them when they are at home during the August congressional recess, which stretches from Aug. 3-Sept. 8. Advocates are encouraged to express support for increasing critical federal funding for public health agencies, protecting the Prevention and Public Health Fund and passing comprehensive legislation to reduce gun violence.

The PHACT Campaign toolkit offers sample questions for town hall meetings, sample emails and scripts for sending messages to or calling congressional offices, tips for setting up meetings with congressional district staff and tips for using social media to publicize your advocacy activities. Advocates can also send messages to their members of Congress expressing the importance of public health funding, the prevention fund and gun violence prevention. Also, visit the PHACT website for information on where your state ranks on public health issues. The PHACT website will be updated throughout the summer with a list of town hall meetings in your community and other helpful resources to use in advocacy efforts. APHA is also requesting that advocates and affiliates share their advocacy success stories by emailing us at [email protected].

Registration now open for APHA’s Annual Meeting

Registration is open for APHA’s 141st Annual Meeting and Exposition to be held Nov. 2-6 in Boston. The meeting, which has a theme of "Think global, act local,” will present an opportunity to discuss best practices around the world and learn how other nations have improved population health outcomes while keeping costs in check. Register by Aug. 22 to receive special savings. Visit APHA’s website for more information.

Policy watch: State and international updates

New York City launches bike-sharing program

In early June, New York City launched its bike-sharing program, Citibike, with positive results. On the first day alone, members took more than 6,000 trips covering 14,000 miles. As of June 24, nearly 45,000 people have signed up for an annual membership with Citibike. It is part of a growing trend in cities around the U.S., both large and small, to adopt this type of cost-effective transportation and physical activity promotion program. Since 2010, more than 30 cities have created a bike-share system, with more set to begin operating this summer in cities such as Chicago and San Francisco. Bike-sharing allows customers to pick up a bike at one docking station and conveniently drop it off at a different docking station near their destination. In Washington, D.C., Capital Bikeshare was one of the first start-ups in the U.S. and has grown since its inception in September 2010, providing commuters with an alternative to driving or using the metro and has helped many members meet their daily recommended levels of exercise.

Montana releases new health initiative

On June 20, Montana Gov. Steve Bullock, in collaboration with the Montana Department of Public Health and Human Services and the Association of Montana Public Health Officials, released a plan to help get state residents healthy. "Big Sky. New Horizons. A Healthier Montana: A Plan to Improve the Health of Montanans" consists of six major priorities: prevent and manage chronic disease; promote health for mothers, children and infants; prevent and control communicable diseases; prevent injuries and reduce exposure to environmental health hazards; improve mental health and reduce substance abuse; and strengthen the public health and health care system. Officials compiled data for more than a year to establish these health priorities. The department will monitor 27 health indicators such as access to care, obesity and tobacco use. The plan includes strategies to improve the health indicators within five years. Department Director Richard Opper explained that while the plan should be used to guide educational programs, it will take a collective effort by the citizens of Montana to see these goals through.

WHO pushes for stricter food marketing to children

On June 18, the World Health Organization’s Europe office announced it would encourage efforts to further restrict the marketing of unhealthy food to children to help fight childhood obesity. Young children spend, on average, more than two hours watching television daily. At this developmental stage, children are typically unable to distinguish between advertisements and the regular TV program. Additionally, there has been a new and rapid expansion of media channels that are available to larger numbers of children and offer low-cost means for directly marketing to them. All 53 members of the European region have agreed to restrict unhealthy food advertising to children. But most do not have fully implemented regulatory approaches and are struggling to comply with the commitment to restrict food marketing. WHO released a comprehensive report about the trends, regulations and problems with food marketing, focusing on television, new media, mobile marketing, schools, "Advergames” and sponsorships. The organization will discuss the findings, as well as strategies to curb the childhood obesity epidemic, at its European Ministerial Conference on Nutrition and Noncommunicable Diseases in the Context of Health 2020 on July 4 and 5 in Vienna.

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