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I. Congress continues to mull over Affordable Care Act repeal
II. APHA speaks out against executive order limiting federal rules
III. Health groups oppose bill that would undermine health rules
IV. Groups urge Senate committee leaders to ensure HHS nominee’s commitment to vaccine science
V. Health groups oppose roll-back of methane rule
VI. APHA joins health and scientific groups denouncing immigration executive order
VII. Policy watch: State and international updates
Congress continues to mull over Affordable Care Act repeal
Congress passed a budget blueprint in January to clear the way for fast action to repeal major provisions of the Affordable Care Act. The budget resolution tasked the Senate Health, Education, Labor and Pensions and Finance Committees and House Energy and Commerce and Ways and Means Committees with developing reconciliation legislation that would only need a simple majority to repeal portions of the ACA. The committees were given a deadline of Jan. 27 to report the legislation to their respective Budget committees, which would then package the legislation into a bill or bills before moving to the full House or Senate for a vote. However, all four authorizing committees missed the deadline. House committee recommendations are now expected in mid-to-late February, and the timeline for the Senate committees to act is unclear. President Donald Trump has put pressure on members of Congress calling for repeal and replace to happen simultaneously. Lawmakers are currently struggling with developing a replacement plan, recognizing that repealing the law without a viable replacement plan in place could result in millions of people losing their health care coverage and destabilization of insurance markets. The delay provides advocates with more time to put pressure on Congress and oppose repeal of the health law.
Critical mandatory funding for community-based prevention and public health activities through the Prevention and Public Health Fund, created under the ACA, is also at risk for elimination as part of the larger effort to repeal the health law. Over the next five years, states would lose more than $3 billion from grants and programs supported by the prevention fund. Visit Trust for America’s Health for state-specific information regarding programs that the fund is supporting and what is at risk in your state if the fund is eliminated.
APHA continues to strongly oppose any effort to repeal or otherwise weaken the ACA. Join us in this effort by sending an action alert or calling your members of Congress by using these talking points to urge your members of Congress to oppose any effort to repeal this historic public health law. Contact us at email@example.com to request an opinion editorial template opposing elimination of the Prevention and Public Health Fund.
And for inspiration, check out the great op-eds recently published by APHA members and Affiliates.
APHA speaks out against executive order limiting federal rules
On Jan. 30, Trump signed an executive order that would require federal agencies to identify two existing rules for elimination every time they seek to put a new rule into place. Federal rules play a key role in protecting the public from a variety of health threats, including deadly air pollution, toxic substances, workplace injuries and food contamination. APHA issued a statement opposing the executive order stating that the order threatens to weaken the federal government’s role in protecting the public from serious health threats.
Health groups oppose bill that would undermine health rules
APHA joined the American Lung Association, the American Heart Association and others in sending a letter to the U.S. House of Representatives opposing H.R. 5, the Regulatory Accountability Act of 2017. The bill would undermine proven public health protections by requiring federal standards to be based on industry cost estimates, not what best protects the public. For example, H.R. 5 would force the U.S. Environmental Protection Agency and the Food and Drug Administration to prioritize the historically overstated estimates of costs to industry over scientific evidence and public health when seeking to craft rules to protect the public from health threats such as air pollution and tobacco products. The bill would also impose dozens of procedural requirements that would increase costs of critical safeguards, or worse, delay or completely block lifesaving protections before they can be implemented. Federal rules already go through extensive review, expert input and public comment before they are finalized. The numerous additional analyses, reporting and planning requirements imposed by this bill, some of which duplicate existing requirements, would hinder agencies from setting safeguards under the law to protect the public.
The bill passed the House by a vote of 238-183. It is unclear whether the Senate plans to take up the bill, and Trump has not indicated whether he would sign the bill should it pass the Senate.
Groups urge Senate committee leaders to ensure HHS nominee’s commitment to vaccine science
On Jan. 17, more than 100 public health and medical organizations sent a letter to Senate Health, Education, Labor and Pensions Committee and Senate Finance Committee leaders urging them to ensure that Rep. Tom Price, R-Ga., who has been nominated to lead the U.S. Department of Health and Human Services, is committed to vaccine science. In the letter, the groups stated: “As the nominee for the Secretary of Health and Human Services it is our hope that Chairman Tom Price will support our nation’s public health infrastructure by fostering investments in the science and technology that informs our national immunization policy, providing a safety net to uninsured poor adults for vaccine purchases, monitoring the safety of vaccines, educating providers and performing community outreach, and conducting surveillance, laboratory testing, and epidemiology to respond to disease outbreaks.”
During the hearing, Sen. Robert Menendez, D-N.J., asked Price if he believed that vaccines cause autism. Price responded that the science shows that they do not.
Health groups oppose roll-back of methane rule
On Feb. 1, APHA joined the American Lung Association, Physicians for Social Responsibility and other leading health organizations in sending a letter to the U.S. House of Representatives opposing H.J. Res. 36, a resolution of disapproval using the Congressional Review Act to permanently block actions by the Bureau of Land Management to reduce dangerous and wasteful methane leaks from the oil and gas industries. Use of the Congressional Review Act would not only block current actions to solve manageable problems, it would also prevent the Bureau of Land Management from moving forward with substantially similar actions in the future. Methane fugitive emissions, or leaks, occur from oil and gas wells, drilling-related infrastructure and natural gas pipelines. Estimates of the amount of methane lost to leakage range from 9.3 percent to about 12 percent. Not only are these leaks wasteful, but they also create dangerous threats to health, including the release of volatile organic compounds, many of which are toxic and carcinogenic, and are also a precursor to ground-level ozone formation. In addition, methane, a powerful heat-trapping gas, is a highly potent driver of climate change. The resulting higher temperatures mean longer and hotter heat waves and more ground-level ozone; these in turn contribute to asthma attacks, cardiovascular disease, heart attacks and premature death. Climate change also increases the frequency and intensity of storms, droughts, wildfires and flooding.
Unfortunately, the bill passed the House by a vote of 221-191. The U.S. Senate may take up the bill as soon as next week.
APHA joins health and scientific groups denouncing immigration executive order
On Jan. 27, Trump signed an executive order that would restrict the admission of certain foreign nationals and refugees to the United States under the guise of protecting the nation from foreign terrorists. APHA joined other professional scientific and engineering societies in sending a letter urging the administration to rescind the executive order. In the letter, groups expressed profound concern that the executive order will reduce U.S. science and engineering output by discouraging “the best and brightest international students, scholars, and scientists from studying and working, attending academic and scientific conferences, or seeking to build new businesses in the United States.” APHA also joined other groups dedicated to promoting a diverse and culturally competent health and biomedical workforce in expressing concern regarding the impact that the executive order would have on patient care, health education and medical research.
Policy watch: State and international updates
Iowa looks to defund health care providers that perform abortions
For the first time in two decades, Iowa Republicans have control of the House and Senate. Chief among their goals is a plan to cease all state funding to health care providers that perform abortions. While these health care providers — the most recognizable example being Planned Parenthood — do offer abortions, these procedures account for only 2.5 percent of the services delivered. Halting state funding to these health providers will also result in patients losing access to critical gynecological and obstetrical services, contraceptive services, treatment of sexually transmitted diseases and prenatal care. Low-income women and women living in rural areas of Iowa with few or no other health care providers to offer comparable services would be most affected in large part due to socioeconomic restraints, inability to travel to a different health care provider, or a lack of similar reproductive services offered by other providers. According to a 2016 report published by the University of Iowa, for every $1 spent on family planning services offered at organizations like Planned Parenthood, Iowa saves $3.40. Over nearly an 11 year period, the state has saved $345 million as a result of reduced Medicaid costs for deliveries and birth, and first year of life costs. Defunding family planning clinics would instead result in an increase in Medicaid spending in response to a worsening of birth outcomes, and an increased number of unintended and unwanted pregnancies.
Virginia health officials call for legalization of syringe services programs
In November, the Virginia health commissioner, Marissa Levine, MD, declared the state’s opioid addiction crisis a public health emergency. The Virginia Department of Health has been working to combat the health consequences of the opioid epidemic, including identifying solutions to mitigate deadly infections caused by the use of contaminated needles and syringes. Specifically, the state health department is looking to work with lawmakers to pass a bill legalizing needle exchange programs in the state. By providing clean needles to drug users, bloodborne pathogens responsible for spreading HIV and hepatitis C would not be shared, avoiding potential outbreaks of these two deadly infections. The syringe services programs would also help get people into addiction treatment and treatment for people who already have HIV or hepatitis C. Studies have shown that syringe exchange programs help decrease drug use by connecting people to treatment who would have otherwise not entered drug treatment. Nongovernmental organizations would provide the funding for the programs, which would provide cost savings to the state by preventing new cases of HIV and hepatitis C.
The department of health proposed similar legislation last year that failed to make it through the House Courts of Justice Committee.
State of emergency declared in Brazil in response to yellow fever outbreak
Gov. Fernando Pimental of Minas Gerais, a state in southeastern Brazil, declared a state of emergency on Jan. 13 in response to an outbreak of yellow fever suspected to have killed 10 people and infected at least 100. Yellow fever, an acute viral hemorrhagic disease that causes fever, headache, muscle pain, nausea and vomiting, can be deadly. By declaring the outbreak a public health emergency, Pimental was able to secure better access to treatment and services. Minas Gerais, a high-risk area for yellow fever, has received over 700,000 vaccines from Brazil’s Ministry of Health. The hope is to inoculate enough people against the disease in these rural areas to prevent a spread of the outbreak to larger cities. If the virus, spread by mosquitos, reaches cities infested with Aedes aegypti mosquitoes — the same species that carries the Zika virus — the result could be outbreaks that spread faster than can be contained.
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