July 2012

I. Supreme Court upholds Affordable Care Act
II. Senate passes farm bill reauthorization
III. Congress passes transportation reauthorization legislation
IV. Senate Appropriations Committee passes FY 13 Labor-HHS-Education Appropriations bill
V. Environmental Protection Agency proposes stronger protections against soot
VI. Senate votes to uphold mercury and air toxics rule
VII. Comprehensive dental reform bill introduced in Senate
VIII. APHA summer advocacy campaign underway
IX. Registration now open for APHA’s Annual Meeting
X. Updates from the states

Supreme Court upholds Affordable Care Act

On June 28, in 5-4 decision, the U.S. Supreme Court ruled that the Affordable Care Act is constitutional. The majority opinion was authored by Chief Justice John Roberts and was joined by Justices Elena Kagan, Ruth Bader Ginsburg, Stephen Breyer and Sonia Sotomayor. The ruling represents a major victory for public health advocates who worked tirelessly over the past two years in support of the law.

Specifically, the court upheld the individual mandate requirement of the law, ruling that Congress can impose a penalty on individuals who fail to purchase insurance through its authority to tax.

The court also upheld the act’s expansion of coverage through the Medicaid program; however, it limits the Secretary of Health and Human Services’ enforcement powers by ruling that the federal government cannot withhold states’ existing federal Medicaid payments in an effort to require states to participate in the expansion of Medicaid coverage to new beneficiaries as outlined in the law.

“Today’s historic ruling by the nation’s highest court marks a significant milestone in our national efforts to improve the delivery and financing of health services in the U.S. and to promote health and wellness rather than disease treatment,” said Georges C. Benjamin, MD, FACP, FACEP (E), executive director of APHA in a statement released by the Association following the court’s decision.

Since its enactment, the ACA has already provided many new benefits, and additional benefits will continue to take effect over the next several years. Among the benefits:

• 31 million Americans are projected to gain health coverage by 2019 due to critical upcoming reforms, including the exchanges, exchange subsidies, minimum coverage provision and Medicaid expansion;
• 54 million U.S. families have additional benefits, including greater access to preventive health care services recommended by the U.S. Preventive Services Task Force, such as vaccines and preventive care and screenings for women;
• 2.5 million young adults up to age 26 are able to stay on their parents’ health insurance plans;
• nearly 18 million children with pre-existing conditions are protected from insurance coverage denials;
• 3.6 million seniors received 50 percent discounts on their drugs in 2011 as an initial step in closing the “donut hole;” and
• nearly 33 million seniors accessed preventive services now available without cost-sharing through Medicare.

For additional information about the court’s decision, visit the Supreme Court’s website or SCOTUSblog.

For background on key provisions in the ACA, including the Prevention and Public Health Fund, visit APHA’s health reform website. For an overview of the law as well as state-specific fact sheets on how your state is benefiting from the ACA, visit the Healthcare.gov website.

Senate passes farm bill reauthorization

On June 25, the U.S. Senate passed S. 3240, Agriculture Reform, Food, and Jobs Act of 2012, legislation to reauthorize federal farm programs over the next five years, by a vote of 64-35. The bill makes a number of changes to current farm programs. The biggest disappointment for many public health advocates was the bill’s reduction in the Supplemental Nutrition Assistance Program, commonly known as food stamps, by $4.5 billion over the next 10 years. An amendment by Sen. Kirsten Gillibrand, D-N.Y., supported by APHA and other advocates, to restore the cuts was defeated by a vote of 33-66.

The Senate also rejected a number of amendments that would have made additional reductions to the SNAP program, including an amendment by Sen. Rand Paul, R-Ky., that would have turned the SNAP program into a block grant to states and would have cut the program by $322 billion over 10 years. Also rejected by a vote of 43-56, was an amendment by Sen. Jeff Sessions, R-Ala., that would have restricted categorical eligibility for SNAP to recipients of cash assistance under other state and federal aid programs.

The House Agriculture Committee released its draft of the bill earlier this week. The proposal would cut the SNAP program by more than $16 billion over 10 years, more than three times the cuts contained in the Senate-passed bill. The Committee is scheduled to take up the bill on July 11. APHA members are encouraged to send a message to their representative urging them to protect important nutrition and other public health-related provisions in the House version of the bill.

Congress passes transportation reauthorization legislation

In late June, the House and Senate passed the conference agreement on H.R. 4348, the Moving Ahead for Progress in the 21st Century Act, also known as MAP-21. The legislation reauthorizes federal transportation programs mostly at current levels through Sept. 30, 2014.

Unfortunately, the final conference report failed to include several provisions that APHA and other public health groups had advocated for. The final bill eliminates the Transportation Enhancements, Safe Routes, Recreational Trails and Scenic Byways programs and establishes a new Transportation Alternatives program – which cuts funding compared to these programs by one-third. While the bill does include the so-called “Cardin-Cochran” language allowing for local control of Transportation Alternatives funding, it does so at a reduced level of funding. The agreement fails to provide dedicated funding for repairing roads and bridges. Finally, the bill does not include any provisions to encourage the inclusion of health impact assessments into proposed transportation policies, plans and projects.

Visit APHA’s transportation and health webpage for additional information about the links between transportation policy and public health.

Senate Appropriations Committee passes FY 2013 Labor-HHS-Education Appropriations bill

One June 14, the Senate Appropriations Committee approved S. 3295, the FY 2013 Labor-HHS-Education appropriations bill, which would provide a $1.4 billion increase over fiscal year 2012 levels. The bill would provide an increase of $32 million over the FY 2012 program level for the Health Resources and Services Administration and a $61 million increase for the Centers for Disease Control and Prevention. The bill would provide $1 billion for the Prevention and Public Health Fund, including $280 million for the Community Transformation Grant Program, a $54 million increase over FY 2012 and a $135 million increase over the president’s budget. The detailed committee report can be found here. The bill will now be reported to the full Senate for its consideration. The House has proposed about $8 billion less than the Senate’s level for the fiscal year 2013 Labor-HHS-Education allocation in its budget resolution. The House Appropriations Committee has yet to schedule a markup of its version of the bill.

Environmental Protection Agency proposes stronger protections against soot

On June 15, the Environmental Protection Agency proposed new national air quality standards for fine particulate matter that would reduce dangerous pollution in communities and save thousands of lives. Overwhelming evidence now shows that there are negative health impacts at lower levels of pollution than previously thought. Fine particulate matter, or PM2.5, one of the most dangerous forms of air pollution, can penetrate deep into the lungs and possibly cause premature death, heart attacks, strokes and childhood asthma. EPA’s proposal would strengthen the annual standard for PM2.5 to a range of 13 micrograms per cubic meter to 12 micrograms per cubic meter. The current annual standard is 15 micrograms per cubic meter. Recent Clean Air Act rules that cut pollution are projected to meet these new proposed standards without taking additional action in 99 percent of U.S. counties.

APHA applauded EPA for taking a step in the right direction to reduce particulate matter exposure and safeguard public health, and the Association looks forward to the agency setting strong final standards to protect people from this dangerous pollution.

Senate votes to uphold mercury and air toxics rule

In another major victory for public health, the U.S. Senate on Jun 20 voted 53-46 to block a resolution by Sen. James Inhofe, R-Okla., to reverse the U.S. Environmental Protection Agency’s Mercury and Air Toxics Standards for power plants. The resolution would not only nullify these lifesaving standards, but would permanently block EPA from issuing any “substantially similar” mercury and air toxics protections in the future without express congressional authorization.

The new standards will dramatically reduce more than 80 toxic air pollutants from the more than 600 coal- or oil-fired power plants operating in the United States. EPA estimates that this vital public health protection will have enormous health benefits, preventing up to 11,000 premature deaths, 130,000 asthma attacks, 4,700 heart attacks and 5,700 hospital visits each year starting in 2016. According to EPA, these new standards will eliminate more than 90 percent of mercury emissions from power plants — a significant step forward in protecting public health from the debilitating effects of mercury, especially in unborn children. Consumption by pregnant women of food containing mercury — even at low levels — can impact fetal neurodevelopment causing delays, learning disabilities and birth defects. Power plants are the largest industrial source of mercury found in the United States.

APHA and other public health and medical advocates have actively lobbied against the resolution since its introduction.

Comprehensive dental reform bill introduced in Senate

On June 7, Sen. Bernie Sanders, I-Vt., introduced S. 3272, the Comprehensive Dental Reform Act of 2012. APHA sent a letter in support of the legislation, saying that it would improve access to safe and high-quality oral health care for vulnerable and underserved populations. In addition to expanding coverage by creating new access points and enhancing the workforce, the bill would fund new research and raise the public’s awareness of the importance of oral health.

APHA summer advocacy campaign underway

In May, APHA launched its annual Public Health Action (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. During August (Aug. 4-Sept. 9) congressional recess, we are asking APHA members and affiliates to reach out to their congressional delegation in their states to express support for increasing critical funding for public health agencies and protecting the Prevention and Public Health Fund.

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 a message to their members of Congress expressing the importance of public health funding. The PHACT website will be updated throughout the summer with a list of town hall meetings in your community, information on public health funding and other helpful resources to use in advocacy efforts. APHA is also requesting that advocates and APHA affiliates share success stories about how public health funding is effecting their state or community by emailing us at phact@apha.org.

Registration now open for APHA’s Annual Meeting

Registration is open for APHA’s 140th Annual Meeting and Exposition, “Prevention and Wellness Across the Life Span,” to be held Oct. 27-31 in San Francisco. The meeting will present an opportunity to discuss the impact prevention and wellness have on health, both physical and mental, at all ages. Register by Aug. 16 to receive special savings. Visit APHA’s website for more information.

Update from the states

New York proposes ban on the sale of large sodas

On May 30, New York City Mayor Michael Bloomberg’s (I) administration introduced a proposal that would ban the sale of large sodas and sugary beverages at movie theaters, restaurants, street carts and sports arenas. Under the proposed ban, the sale of sweetened drinks in cups or bottles larger than 16-fluid ounces would be prohibited. Sugary beverages ranging from energy drinks to pre-sweetened teas would be included, but the ban would not apply to fruit juices, dairy-based drinks, diet sodas, alcoholic beverages, or other drinks with fewer than 25 calories per 8-fluid ounce. Beverages sold in grocery stores and vending machines would not be regulated, nor would the ban restrict the purchase of additional drinks or free refills. This initiative follows 30 years of rising obesity rates, which is partly attributed to one-third of New Yorkers consuming one or more sugary drinks per day. The proposal is pending approval by the city’s board of health.

California voters reject tobacco tax

In June, California voters rejected a measure that would have added a $1 tax on a pack of cigarettes. Known as Proposition 29, it was estimated the measure would bring in $735 million in new tax revenue to be directed toward tobacco-related disease research and tobacco prevention and control programs. Despite efforts by the American Cancer Society and cancer survivor Lance Armstrong the proposition was narrowly defeated by a vote of 50.3 percent. Public support for the measure fell significantly after the tobacco industry spent $47 million on an ad campaign that cast doubts on how the new revenue would be spent. Health groups supporting the proposal spent $12 million. The proposition mirrored a 2006 attempt at increasing the tobacco tax, which also failed after an industry-sponsored ad campaign.

Kansas hospitals launch quality initiative

As part of a federal campaign to reduce rates of hospital-acquired infections and injuries, the Kansas Healthcare Collaborative launched its own initiative calling for best practices and the development of standards for quality care. Federally, a goal has been set to reduce hospital infections by 40 percent and lower hospital readmissions by 20 percent by the end of 2013. A report from the Centers for Disease Control and Prevention found that 1.7 million patients acquired an infection while hospitalized in 2002, leading to 98,987 deaths. Nationwide, these infections cost hospitals $45 billion a year. Founded by the Kansas Medical Society and Kansas Hospital Association, and with the leadership of 100 nurses, physicians and hospital administrators, the collaborative will strive to reduce 10 common hospital-acquired conditions. These include surgical site infections, injuries from falls, catheter-associated urinary tract infections and adverse drug events to name a few. More than 70 percent of Kansas state hospitals are participating in the initiative.

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