June 2008

Congress grappled with a large array of health-related measures in June.  As of mid-month, the path to passage for any of them remained unclear, as Senate, House, and White House juggled priorities among each other, but all remained airborne.

The Money Wars
A supplemental spending bill to provide funds for the wars in Iraq and Afghanistan for the remainder of this fiscal year is a “must pass” measure, but Democrats in both Senate and House have endeavored to use it as a vehicle for some domestic spending priorities, as well.  The Senate version contains a moratorium on seven Medicaid regulations that would restrict federal Medicaid spending in many ways, including one that imposes various limits on Medicaid financing for case management.  The White House has threatened a veto.  The House previously passed a stand-alone version of that moratorium, but is trying to negotiate a war supplemental that the White House will sign, recognizing the difficulty of achieving a veto-proof majority.  Some of the Medicaid rule moratoria, including that postponing the rule affecting case management, were in jeopardy as of June 16 and time was running out.

Another health issue for which time was running out is a scheduled cut in Medicare physician reimbursement.  It will take effect July 1 without Congressional action. The Senate is considering at least two different bills to address this, but their connection with the war supplemental and its health aspects is close.  That entanglement arises from the fact that new domestic spending proposed in the war supplemental is to be offset by certain other cuts in Medicare that may also be implicated in the separate Medicare bills.  The possible permutations are numerous and yet another variable is the possible inclusion of mental health parity legislation in the Medicare bills.

Both House and Senate are on track to begin action on FY 2009 funding for health programs.  The House Subcommittee on appropriations for the departments of Health and Human Services, Labor, and Education is scheduled to consider its funding bill June 19, with full Appropriations Committee action the following week.  The Senate is planning to act soon thereafter.  NACCHO will report on the funding levels for public health programs as soon as that information becomes public.  However, there is little doubt that these measures will draw a veto if Congress sends a final version to the President, because both House and Senate are planning domestic spending that exceeds the President’s budget.  No one, on or off Capitol Hill, is sure what course funding bills will take as the Presidential election approaches.  NACCHO’s testimony submitted to both House and Senate appropriators earlier this year can be found at  www.naccho.org/advocacy/action/upload/Testimony-SenateAppropsFY09.doc

One area in which the White House has recently proposed additional domestic spending is food safety at the Food and Drug Administration.  In an early-June supplemental request, the President asked $275 million more for FDA, with little detail on the proposed uses of the additional funds.  This request was accompanied by some other unrelated spending increases, as well as by proposals for reductions elsewhere to ensure the request as a whole is budget-neutral.  Among the proposed offsets is a $260,000 reduction in the Social Services Block Grant program.

Health Reform
Both House and Senate have inaugurated a series of hearings and forums to explore various issues associated with health care reform.  Alameda County, CA Health Officer Dr. Tony Iton (also NACCHO Metro Forum chair) testified before the House Ways and Means Subcommittee on Health, which conducted a hearing on health disparities on June 10, 2008.  Iton received the invitation from Subcommittee Chair Pete Stark, who represents portions of Alameda County.  The Ways and Means Committee has jurisdiction over both Medicare and taxes, and will therefore be an essential player in healthcare or health system reform.  Iton reminded the Subcommittee that “health” is not the same as “healthcare” and that healthcare disparities are just a subset of health disparities, which are rooted in larger issues of social inequity.  Iton’s statement can be found at http://waysandmeans.house.gov/hearings.asp?formmode=view&id=7051.

The Senate Finance Committee, which has jurisdiction over Medicare, Medicaid, and taxes, kicked off its discussions of healthcare reform with a day-long summit entitled “Prepare to Launch” on June 16, 2008.  That event focused on the healthcare delivery system and its financing.  A varied roster of speakers included Federal Reserve Chairman Ben Bernanke and prevention specialist Dr. Dean Ornish.  Bernanke told Senators that healthcare spending is the single largest component of personal consumption, more than food or housing, and suggested that the question is whether we are getting our money’s worth. 

The Housing Crisis and Public Health
Mahoning County, Ohio Health Commissioner Matthew Stefanak testified at a hearing in Cleveland conducted by the House Financial Services Committee Subcommittee on Housing and Community Opportunity.  The hearing addressed foreclosure problems and solutions in Ohio. Stefanak, NACCHO board member and chair of NACCHO’s Environmental Health Essential Services Committee, discussed the public health problems caused by foreclosures that have hit his county hard and resulted in numerous blighted, condemned housing units.  His written testimony can be found at http://www.house.gov/apps/list/hearing/financialsvcs_dem/stefanak061608.pdf

On Your Behalf
On behalf of local health departments, NACCHO continued its participation in advocacy with respect to a number of public health matters that were on the “front burner” in June.  These included childhood immunization and vaccine safety, where a Capitol Hill rally led by immunization opponent actress Jenna McCarthy garnered attention that immunization advocates countered with a letter and scientifically accurate information.  NACCHO joined others in continued communication to the Hill on: 1) support of FDA regulation of tobacco, for which legislation remains viable; 2) funding related to the health effects of climate change, which failed along with the energy bill; and 3) funding for all of CDC.  NACCHO also encouraged letters by local health departments in selected jurisdictions affected by the Medicaid targeted case management rule to write the House leadership urging passage of a moratorium on its implementation (see discussion above). 

NACCHO also conducted a press briefing by teleconference to provide background to reporters on the local health department response to measles outbreaks.  The May 19, 2008 event featured presentations by three NACCHO members who discussed how the controlled measles outbreaks in their communities.  The speakers were:  Paul A. Biedrzycki, Director of Disease Control & Environmental Health for the City of Milwaukee Health Department, WI; Dr. Wilma J. Wooten, Public Health Officer for the County of San Diego Health and Human Services Agency, CA; and  Dr. Jane Zucker, Assistant Commissioner at the New York City Department of Health and Mental Hygiene Bureau of Immunization, NY. A written transcript and an MP3 audio file can be found at http://www.naccho.org/press/.