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LEGISLATIVE UPDATE FOR JULY 7, 2010:

Budget/Appropriations and Policy Update


Budget Resolution: Congressional Spending Blueprint for FY 2011

On July 1, the House adopted a one year spending plan (H. Res. 1493) that was passed as part of a resolution establishing rules for the debate of the FY 2010 War Supplemental.  The House plan would set a limit of $1.121 trillion for FY 2011 discretionary spending which is $7 billion less than the Administration’s Budget Request.  The Senate Budget Committee approved a $1.838 trillion Budget Resolution for FY 2011 on April 22 which is $4 billion less than the Administration’s request.  With these spending ceilings in place the Appropriations Committees now has the “green light” to establish separate ceilings for each subcommittee and to start marking up the individual appropriations bills. 

Due to the sharply more partisan Congressional environment that exists now prior to the November elections, the leadership in both the House and Senate have decided not to advance the Budget Resolutions in either chamber beyond the efforts made to date (as described above).

FY 2011 Appropriation Bills

Now that the spending ceilings have been established for FY 2011, the House and Senate Appropriations Subcommittees have begun marking up their individual bills.  Below are summaries of FY 2011 bills that the House has marked up and reported out of the various subcommittees as of this writing.

• Commerce, Justice and Science:  Marked up June 29 for a total of $60.5 billion ($3.9 billion below FY 2010).

• Agriculture: Marked up June 30 for a total of $23 billion ($204 million below FY 2010).

• State and Foreign Operations: Marked up June 30 for a total of $56.7 billion ($3.89 billion above FY 2010).

• Transportation/HUD: Marked up July 1 for a total of $67.4 billion ($500 million below FY 2010).

• Legislative Branch: Marked up July 1 for a total of $3.7 billion ($6.8 billion below FY 2010).

While the Appropriations subcommittees will continue to markup bills it is likely that only a small number of them will see action in either the full committee or on the House or Senate floor before the November elections.  A Continuing Resolution will therefore need to be passed by September 30, 2010.  There is speculation that most of the FY 2011 appropriation bills will be rolled into an omnibus bill after the elections with final action occurring after the November elections.


FY 2010 War Supplemental

Although the Senate passed the $60 billion bill in late May, the House passed a $79.8 billion war supplemental to fund the Iraq and Afghanistan war effort by a vote of 239-182 on July 1, 2010.  The House bill includes $58.8 billion for the wars plus an additional $21 billion for domestic spending.  The House plan would use the funding to avert teacher layoffs and Pell grant shortfalls.  With the added domestic spending the bill will now go back to the Senate.  Republican leaders have already criticized the House for adding domestic sending items to the bill.  As a result the prospect for a quick agreement in both chambers is poor.

The Administration wanted to have the funding in place prior to the July 4th recess and has issued a veto threat due to funding being cut in the House bill for the President’s “Race to the Top” education initiative.  This reduction was made to help fund the other provisions in the bill.  Chairman Obey has argued that even with the cut over $3.2 billion remains to fund the “Race to the Top” initiative.

Prevention and Wellness Update

Implementing Health Care Reform: The Prevention and Wellness Fund

The month of June was a busy one in the area of prevention and public health.   The Administration took its first steps towards implementing the Prevention and Public Health title of the Affordable Care Act (ACA).  Late in June, HHS Secretary Sebelius announced the release of $500 million in Prevention and Public Health Investment funds, $250 million for work force activities and $250 million for prevention funds.  The President also announced by Executive Order, the establishment of the National Prevention, Health Promotion and Public Health Council.  This Council, chaired by the Surgeon General will provide coordination and leadership at the Federal level with respect to prevention, wellness, and health promotion practices, the public health system, and integrative health care in the United States.  The Council is also charged with the development of a national prevention, health promotion, public health, and integrative health-care strategy that incorporates the most effective and achievable means of improving the health status of Americans and reducing the incidence of preventable illness and disability in the United States. The Council’s first report was released on June 30, 2010.

Prevention and Public Health Investment Fund

The Prevention and Public Health Fund, created in Title IV of the Health Care Reform legislation, was established to provide for expanded and sustained national investment in prevention and public health programs to improve health and help restrain the rate of growth in private and public sector health care costs.  The legislation appropriated $500 million for fiscal year 2010; $750 million for fiscal year 2011; $1 billion for fiscal year 2010; $1.25 billion for fiscal year 2013; $1.5 billion for fiscal year 2014; and, $2 billion for fiscal year 2015 and each year thereafter.  As the bill passed after the FY 2010 appropriations were finished, the Administration has the responsibility of distributing the FY 2010 Prevention Trust Fund dollars.  The FY 2011 and beyond Prevention Trust funds will, for the most part, be appropriated by Congress.

The Secretary announced $250 million of the FY 2010 funds would be going for work force activities, and the remaining $250 million would go towards the following prevention activities (see below). 

FY 2010 Prevention Funding
 
Work force Activities:
• Create additional primary care residency slots ($168 million);
• Support physician assistant training in primary care ($32 million)
• Encourage students to pursue full-time nursing careers ($30 million)
• Establish new nurse practitioner-led clinics ($15 million)
• Encourage states to address needs of the health professional workforce ($5 million)

Community and Clinical Prevention ($126 million)
• Putting Prevention to Work ($74 million).  This will basically be $30 million to fund remaining unfunded ARRA grants and $44 million for HIV related activities in the President’s National HIV/AIDS Strategy. 
• Primary and Behavioral Health Integration ($20 million). 
• Obesity Prevention and Fitness ($16 million).  These activities will support the First Lady’s “Let’s Move!” initiative and help implement recommendations of the President’s Childhood Obesity Task Force.
• Tobacco Cessation ($16 million). Implement anti-tobacco media campaigns showing the negative health consequences of tobacco use, telephone-based tobacco cessation services, and outreach programs targeting vulnerable populations.


Public Health Infrastructure ($70 million)
• Public Health Infrastructure ($50 million). 
• Epidemiology and Laboratory Capacity Grants ($20 million). Build state and local capacity to prevent, detect, and respond to infectious disease outbreaks.


Research and Tracking ($31 million)
• Surveillance ($21 million).
  Fund data collection and analysis to measure the impact of health reform and support strategic planning.
• Community Preventive Services Task Force ($5 million).  Strengthen CDC’s Community Guide by supporting the Task Force on Community Preventive Services’ efforts to identify and disseminate additional evidence-based recommendations on important public health decisions to inform policymakers, practitioners, and other decision makers.
• Clinical Preventive Services Task Force ($5 million). Expand the development of recommendations for clinical preventive services, with enhanced transparency and public involvement in the processes of the Task Force.


Public Health Training ($23 million)
These funds support the training of existing and next generation public health professionals.
• Public Health Workforce ($8 million).  Expand CDC public health workforce programs to increase the number of fellows trained and placed in public health positions.
• Public Health Training Centers ($15 million).  Support training of public health providers to advance preventive medicine, health promotion and disease prevention, and improve the access and quality of health services in medically underserved communities

National Prevention, Health Promotion and Public Health Council

On June 10, 2010, the President put out an Executive Order establishing the National Prevention, Health Promotion and Public Health Council to be chaired by the Surgeon General.  The purpose of the Council is to provide coordination and leadership at the Federal level with respect to prevention, wellness, and health promotion practices, the public health system, and integrative health care in the United States.  The Council is also charged with the development of a national prevention, health promotion, public health, and integrative health-care strategy that incorporates the most effective and achievable means of improving the health status of Americans and reducing the incidence of preventable illness and disability in the United States. 

The Council has started meeting, and they are putting together an Advisory Group on Prevention, Health Promotion, and Integrative and Public Health.  The Advisory Group will be composed of 25 members or representatives from outside the Federal Government appointed by the President and shall include a diverse group of licensed health professionals, including integrative health practitioners who are representative of or have expertise in: worksite health promotion; community services, including community health centers; preventive medicine; health coaching; public health education; geriatrics; and rehabilitation medicine. 

The Council has also started working on the National Prevention and Health Promotion Strategy.  The Strategy is due out in March of next year, but an interim report was released on June 30, 2010.  The Strategy will set specific goals and objectives for improving the health of the United States through federally supported prevention, health promotion, and public health programs, consistent with ongoing goal setting efforts conducted by specific agencies; establish specific and measurable actions and timelines to carry out the strategy, and determine accountability for meeting those timelines, within and across Federal departments and agencies; and make recommendations to improve Federal efforts relating to prevention, health promotion, public health, and integrative health-care practices to ensure that Federal efforts are consistent with available standards and evidence.

A copy of the Council’s first report, as well as a fact sheet on the report, can be found at: http://www.healthreform.gov/forums/blog/preventioncouncil.html

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