ASPPH’s legislative agenda continues to focus on advocating for adequate appropriations for academic public health’s priority agencies and programs, and to oppose the Trump Administration’s policy proposals regarding health care access, immigration, the elimination of the Fogarty International Center and cutting Facility & Administrative (or indirect) Costs on NIH extramural awards. Final fiscal year 2018 appropriations action was expected in December, but due to the tax reform debate, another short term Continuing Resolution is likely. Executive orders imposing arbitrary restrictions on citizens from selected countries Immigration reform proposals continue to be subject to litigation and the Speaker of the House is assuring members that legislation restoring the Deferred Action for Childhood Arrivals (DACA) will be included in a final budget agreement. A bipartisan agreement on sustaining the Affordable Care Act may also be included in a final deal. The proposals to eliminate Fogarty and impose a cap on indirect costs have been successfully rebuffed.
Temporary Funding and Debt Level Extension Enacted; Expires on December 8
Congress in early September gave final approval to a temporary deal (H.R. 601) to continue funding the government, provide initial funding for Hurricane Harvey recovery operations, and extend the debt limit. The Continuing Resolution and debt limit expire on December 8.
ASPPH’s FY 2018 Program Priorities Funded by the Senate Appropriations Committee; Elimination of Fogarty and Cap F&A Costs Rejected
The Senate Appropriations Committee in early September approved the fiscal year 2018 Labor-HHS Education Appropriations measure (bill/report). The panel’s bill fully funds all of ASPPH’s appropriations priorities. The panel also rejected two Administration proposals that the Association actively opposed: the elimination of the Fogarty International Center and placing a 10 percent cap of Facilities and Administrative (or indirect) costs. The Association organized letters signed by many deans and program directors on both issues earlier this year (FIC letter/F&A letter). The letters were cited several times in the legislative debate on the proposals. ASPPH’s updated talking points and funding chart on its FY 2018 funding priorities are available online.
The Senate bill provides NIH with a $2 billion increase in funding, $900 million more than provided in the House’s version of the bill, which cleared the House Appropriations Committee in July and received full House approval in August. The Senate bill provides a modest increase in funding for the Fogarty International Center.
CDC was provided with an appropriation of $7.18 billion in the Senate, down slightly (-1.1% or $80 million) from FY 2017. The Prevention Research Center program and the Centers for Public Health Preparedness were funded at the same level as in FY 2017. The NIOSH Education and Research Centers and the Agriculture, Forestry and Fishing Centers received modest increases. HRSA received a $4 million increase over the FY 2017 level. The HRSA Public Health Training Centers (PHTC) Program was level funded in the senate. The PHTC Program was not funded by the House.
ACA Repeal Efforts Fail (Repeatedly); Further Repeal Efforts Certain
Faced with another defeat, the Senate GOP leadership in early October withdrew the proposed Graham-Cassidy amendment that would have repealed the Affordable Care Act. The move came after the Congressional Budget Office released a preliminary score for the amendment. It estimated that between 2017 – 2026, the measure would reduce federal spending by $133 billion. This is the same projected savings as the ACA-repeal bill that passed bill House in May. Additionally, CBO estimated that “millions” would lose health insurance coverage under the proposal.
In late October, Senators Lamar Alexander (R-TN) and Patty Murray (D-WA), chair and ranking member respectively of the Senate Health, Education Labor and Pensions Committee, announced that they had reached agreement on legislation to sustain the Affordable Care Act. Specifically, the bill would restore cost sharing reduction payments, fund outreach and enrollment activities, and make the state waiver process easier while maintaining ACA-mandated patient protections. The agreement was introduced with 12 GOP sponsors and 12 Democratic sponsors. The bill language is here and a section-by-section summary is here. Even those in Congress who are not enthusiastic about the agreement believe there is a fair chance it will be included in a final budget agreement.
Trump Administration Releases New Immigration Ban
The Trump Administration issued a revised immigration ban in late September. According to the White House, most citizens of Iran, Libya, Syria, Yemen, Somalia, Chad and North Korea will be indefinitely banned from entering the United States. The policy is more detailed than Trump’s earlier executive order. This time, according to the White House, “each country has its own set of restrictions, and citizens of Iraq and some Venezuelans who seek entry will also face restrictions or heightened scrutiny.” Sudan, included in the earlier policy, is not included in this version. The Administration released the announcement, a fact sheet, and a set of FAQs on the new policy.
The Supreme Court was scheduled to hear oral argument on the earlier Executive Order on October 10, but postponed the hearing and subsequently dismissed the cases. ASPPH joined in an amicus brief filed with the Supreme Court in opposition to the earlier executive order. The new policy was scheduled to go into effect on Oct. 18. However, U.S. District Judge Derrick Watson, a federal judge in Hawaii, blocked the Trump administration from enforcing its latest travel ban, just hours before it was set to take effect. He granted Hawaii’s request to temporarily block the policy. He said Trump’s new order ‘‘suffers from precisely the same maladies as its predecessor’’ in that it ‘‘plainly discriminates based on nationality in the manner that the 9th Circuit has found antithetical to … the founding principles of this nation.’’ A Federal judge in Maryland, Theodore Chuang, issued a slightly more limited ban on the new restriction a day later.
ASPPH Calls on Congress to Restore DACA Program
ASPPH joined more than 70 other associations in a letter to Congress urging legislative action on the Deferred Action for Childhood Arrivals (DACA) policy. The letter responded to the Administration’s September 5 decision to rescind DACA. The letter stated, “[W]e urge you to ensure that all members of the health care workforce with [DACA] status are able to continue their employment, education, training, and research, with passage of a permanent legislative remedy, such as the bipartisan, bicameral Dream Act of 2017 (S. 1615, H.R. 3440). By providing a legal pathway to permanent residency for undocumented Americans brought to the U.S. as children, Congress can help our country produce a diverse and culturally responsive health care workforce to meet the needs of underserved populations, improve cultural awareness, and promote health equity.” ASPPH also sponsored a webinar in September featuring experts on the legal, regulatory, and legislative status of the DACA policy and the implications of its potential repeal. The session also considered what the leaders, faculty, and students of academic public health can do to support affected students.
ASPPH Calls on FEMA to Expend All Available Resource to Restore Essential Services in Puerto Rico and the Virgin Islands
In a September 29 letter to Brock Long, Administrator, Federal Emergency Management Agency, the ASPPH’s leadership said it is increasingly concerned about the situation in the Commonwealth of Puerto Rico and the U.S. Virgin Islands. ASPPH called on FEMA “to expend all available resources to restore essential services to the affected populations. Any delay in meeting the needs of the citizens of Puerto Rico and the Virgin Islands is unacceptable.” The letter, signed by ASPPH Board Chair Dr. Donna Petersen and ASPPH President Dr. Laura Magaña, also called on FEMA and the Administration to “focus resources on expeditiously meeting the needs of the University of Puerto Rico so that it can again provide essential services to the island’s citizens. Of particular concern is the ability of the University of Puerto Rico Graduate School of Public Health to function effectively. In addition to providing essential educational services to graduate students who will become future public health leaders, the school provides critical services to the Commonwealth and its citizens… In the island’s current situation, the School’s services are essential.”