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Legislative Update - green

July 2018

Join us for the Legislative Update call on
Monday, July 9, at 1 p.m. (ET)

APHA's legislative staff will provide an update on
congressional activity and Q&A

Call (800) 442-5794
Passcode: 141930


  1. APHA urges administration to end child separation at the border, demands immediate family reunification 
  2. APHA joins public health leaders on a friend of the court brief opposing efforts to weaken the Affordable Care Act 
  3. Farm Bills advance in Senate and House 
  4. House and Senate appropriators pass FY 2019 health spending bills 
  5. House-passed rescissions legislation blocked in the Senate

APHA urges the administration to end child separation at the border and demands immediate family reunification

In the last two months, more than 2,300 children have been taken from their parents as part of the Trump administration’s “zero tolerance” policy, in which adults are prosecuted for crossing the U.S.-Mexico border illegally and their children are taken from them and held in separate facilities. APHA and Trust for America’s Health released a statement calling this practice inhumane and a threat to the public’s health, citing the significant body of research that highlights the importance of  family structure, stability and environment as key social determinants of a child’s and a community’s health. Soon after, President Trump issued an executive order that the White House said was intended to reverse the administration’s policy of separating families, but the order did not include a strategy for reuniting the families. In response, APHA and leading public health organizations sent a letter to Secretary Kristjen Nielsen of the Department of Homeland Security and Secretary Alex Azar of the Department of Health and Human Services urging immediate action to reunite the families that have been separated. The groups also encouraged the secretaries to direct significant resources to provide health and mental health services to mitigate any long-term effects of adverse childhood experiences. Finally, the groups urged the administration to focus on implementing alternatives that do not entail what could amount to the long-term detention of families, including children, in prison-like conditions.

In the following days, DHS and HHS released a statement outlining a plan to reunite children with their parents, but only after their parents’ immigration proceedings are complete. In the meantime, children will remain in HHS custody.

APHA joins public health leaders on a friend of the court brief opposing efforts to weaken the Affordable Care Act 

In 2012, the Supreme Court ruled that the Affordable Care Act’s individual mandate was constitutional as a tax penalty under Congress’ taxing power. That penalty was eliminated as a part of the sweeping tax reform bill that the president signed into law late last year. Now, a coalition of 20 conservative states is using the elimination of the tax penalty as their core argument in a lawsuit filed against the federal government alleging that the ACA is unconstitutional. The pending lawsuit, Texas v. United States, claims that because the tax bill changed the penalty from $695 to $0, the mandate requiring individuals to purchase health insurance is still in effect, which exceeds Congress’ power under the Commerce Clause. If this argument prevails, it will upend major provisions of the ACA including the protections that ban insurers from charging individuals with pre-existing conditions more for health insurance coverage.

On June 14, APHA and deans, chairs and faculty of leading schools of public health submitted a friend of the court brief urging the court to maintain the ACA, highlighting the law’s many public health benefits including the Prevention and Public Health Fund.

The Trump administration announced it will not defend the health care law in court, causing concern among proponents of the law. The administration’s announcement came during the time when insurers are proposing individual market premiums for next year, which skeptics worry will destabilize the already fragile health insurance marketplaces. A coalition of 16 state attorneys general will defend the ACA in place of President Trump and U.S. Attorney General Jeff Sessions.

Farm Bills advance in Senate and House

On June 28, the Senate passed its version of the Farm Bill by a vote of 86-11. The Farm Bill, an $868 billion legislation package that subsidizes agriculture and food assistance programs, requires reauthorization every four to five years. The Senate bill has been predominately well-received by APHA and the public health community. Counter to the efforts of their colleagues in the House, Senate Agriculture Committee Chairman Pat Roberts, R-Kan., and Ranking Member Debbie Stabenow, D-Mich., led a clear effort to develop a Farm Bill that would receive strong bipartisan support. The Senate bill includes a nutrition title that would improve the Supplemental Nutrition Assistance Program’s integrity and operations, including efforts to better support seniors, people with disabilities and Indian Tribes participating in SNAP.

On June 21, the House narrowly passed its version of the Farm Bill by a vote of 213-211, with all Democrats opposing the bill. The bill failed to pass last month when a group of conservative Republicans voted against the measure due to a disagreement with their leadership over immigration legislation. The House’s 2018 Farm Bill has drawn harsh criticism from the nutrition, hunger and public health community, largely due to the proposed changes to SNAP. The House plan would impose strict requirements on between 5 million to 7 million SNAP recipients, and would push another 400,000 recipients out of the program by tightening eligibility requirements. The bill also threatens to weaken key conservation programs and laws that protect the public from the harmful effects of pesticides. Following the passage of the House bill, President Trump congratulated the House for passing the bill and praised the inclusion of work requirements.

At this stage, the outlook for the Farm Bill is unclear as the Senate and House will need to meet in a conference to try to work out the differences between the two vastly different bills before the current Farm Bill expires on Sept. 30. If a new Farm Bill is not passed and signed by the president before it expires, Congress will need to pass a short-term extension of the current bill or risk jeopardizing vital public health programs. As the bill moves to conference, APHA will continue to urge Congress to oppose any amendments that threaten public health, including measures that would weaken or cut SNAP benefits.

House and Senate appropriators pass FY 19 health spending bills

On June 28, the Senate Appropriations Committee passed its version of the FY 2019 Labor-HHS-Education spending bill. The bill funds most federal public health agencies and programs including the Centers for Disease Control and Prevention and the Health Resources and Services Administration. The Senate Appropriations Committee provided a $2.2 billion increase in the allocation for the health spending bill for FY 2019. Unfortunately, even with the increase, many programs under CDC and HRSA saw level funding. And the bill once again fails to provide any funding for CDC to conduct public health research into firearm morbidity and mortality prevention. APHA and other health advocates have urged Congress to provide CDC with $50 million in FY 2019 for this research. The bill would also cut $15 million from CDC’s Racial and Ethnic Approaches to Community Health program, a crucial element of the national effort to reduce racial health disparities. On the positive side, the bill contains increases to programs that address emergency preparedness, maternal and child health, opioids, and health workforce and rural health. The bill also rejects the inclusion of controversial policy riders and ideological funding cuts to important programs, such as Title X funding for family planning services and CDC’s Climate and Health program. Following the vote, APHA issued a statement thanking the chair and ranking member for working in a bipartisan manner on the bill but also urging them to work to further improve the funding in the bill for CDC and HRSA programs.

The full House Appropriations Committee will consider its version of the Labor-HHS-Education spending bill after the July 4 recess. The draft bill was approved by the Labor-HHS-Education appropriations subcommittee on June 15.  Unfortunately, the allocation of funding for the House version of the bill is flat funded when compared to FY 2018. In its current form, the House bill contains a number of unacceptable cuts to important public health programs. The bill would completely defund HRSA’s Title X, which helps ensure that millions of individuals can access quality family planning and sexual health services. The bill also eliminates funding for the Department of Health and Human Services’ Teen Pregnancy Prevention Program, which provides critical resources to organizations across the country that work to implement evidence-based programs to prevent teen pregnancy. The bill would also eliminate the Centers for Disease Control and Prevention’s Climate and Health Program, which is providing important resources to 16 states and two cities to develop ways to anticipate the health effects of climate change and preparing programs to protect their communities. The House bill also fails to provide any resources for CDC to conduct public health research into firearm morbidity and mortality prevention. In addition, the bill would block any discretionary funding from being used to implement the Affordable Care Act. On a positive note, the bill did provide increases and new funding to CDC programs related to emergency preparedness, as well as increases to other programs to address chronic diseases such as heart disease and diabetes, opioid overdose prevention and immunizations. The vast majority of CDC programs are level funded in the bill when compared to FY 2018 levels.

House-passed rescissions legislation blocked in the Senate

On June 7, the U.S. House of Representatives passed H.R. 3, the Spending Cuts to Expired and Unnecessary Programs Act, by a vote of 210-206. The bill would rescind $14.7 billion in previously approved spending, including $7 billion from the Children's Health Insurance Program. Of the $7 billion rescission, the bill would cut $2 billion from the Child Enrollment Contingency Fund, which provides payments to states if they experience an unexpected surge in enrollment. The fund ensures that eligible children can continue to get covered. The House legislation would also rescind $5 billion from the Children’s Health Insurance Fund. APHA joined hundreds of other state and national organizations in sending a letter to all members of Congress to opposing the proposed CHIP cuts that originated from a proposal sent to Congress from the Trump administration. The original recessions proposal from the administration would have also cut more than $252 million in funding intended to bolster overseas infrastructure to prevent future outbreaks of the Ebola virus, but that provision was later dropped after it receive significant push back in the face of a new Ebola outbreak in the Republic of Congo. On June 20, a vote in the Senate to discharge the bill from committee and bring it to the full Senate for consideration failed by a vote of 48-50 with all Democrats and Republican Senators Susan Collins and Richard Burr opposing the measure. It is unclear whether the Republican leadership will try to bring the bill back up for consideration now that the time for a simple majority vote has expired and any vote to move the proposal forward would require 60 votes for passage.

Additional APHA Advocacy News

Given the rapid pace in Washington, D.C., we wanted to highlight additional issues we have weighed in on recently. Those include:

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