Last night, Congress released a bipartisan agreement to fund the federal government for the remainder of the fiscal year after the current continuing resolution expires on Dec. 20. Also included in the agreement is a two-year extension of Medicaid funding for the U.S. territories and increased federal medical assistance percentages (FMAP). The bill also raises the federal tobacco purchasing age from 18 to 21 years old, but does not ban flavored e-cigarette products. The House of Representatives passed the spending package on Dec. 17 by a vote of 297-120, and the bill now moves to the Senate for consideration.

ASTHO issued a press statement applauding the bipartisan legislation and encouraged swift enactment of the bill.

Below is a summary of the outlook for the agreement and an analysis of appropriations levels across public health agencies. It is important to note these bills are thousands of pages long, and accordingly, it is likely that ASTHO’s government affairs team missed provisions during our first reading.

If you have any questions or concerns, please contact a member of ASTHO’s government affairs team: Carolyn McCoy, Carolyn Mullen, or Jeffrey Ekoma.

Outlook

These are bipartisan and bicameral bills and as such they are expected to be approved by Congress this week.

FY20 Appropriations

The FY20 Labor, Health and Human Services, and Education (LHHS) Appropriations bill provides federal funding for NIH, CDC, SAMHSA, AHRQ, and HRSA. The bill text can be found here and explanatory statement for the LHHS section can be found here.

ASTHO’s funding summary can be found here.

Important public health provisions in the bill include:

CDC

The bill provides $7.97 billion in CDC funding, which includes $6.99 billion in budget authority and $854 million in transfers from the Prevention and Public Health (PPH) Fund. This results in a $636 million increase above the 2019 enacted level. This topline funding level exceeded ASTHO and one hundred national organizations’ 22x22 advocacy request for CDC and brings public health advocates one step closer to achieving a total topline CDC allocation of $8.8 billion by FY22. Included within this allocation are the following:

• Chronic disease prevention: $1.2 billion, an increase of $53 million, to invest in continued chronic disease prevention and surveillance.
• Public health data modernization: $555 million, an increase of $51 million, in new resources to modernize public health data collection at the CDC and Prevention and across the country.
• Tobacco and e-cigarettes: $230 million, an increase of $20 million.
• HIV elimination: $140 million to support CDC’s efforts to reduce new HIV infections by 90 percent in 10 years.
• Infectious Disease Rapid Response Fund: $85 million, an increase of $35 million, to respond to infectious disease emergencies in the United States and the ongoing Ebola crisis in the Democratic Republic of Congo.
• Injury prevention: $30 million increase for the National Center for Injury Prevention and Control, including:
• $12.5 million for firearm injury and mortality prevention research
• $10 million for suicide prevention
• $4 million for adverse childhood experiences prevention
• Diabetes prevention: $27 million, an increase of $2 million, for the Diabetes Prevention Program.
• Food safety: $63 million, an increase of $3 million.
• Public health research: $225 million for a new CDC building to enhance public health research collaboration.
• Global health security: $173 million, a $75 million increase, to continue CDC’s global health efforts.

Assistant Secretary for Preparedness and Response (ASPR)

The bill provides $2.7 billion to ASPR, an increase of $106 million above the 2019 enacted level. The total funding level includes:

• Strategic National Stockpile: $705 million, an increase of $95 million.
• National Ebola Training and Education Center and ten regional Ebola and other special pathogen treatment centers: $11 million.

Health Resources and Services Administration (HRSA)

The bill includes $7.3 billion for HRSA, which is $172 million above the 2019 enacted level. The total funding level includes:

• Ryan White HIV/AIDS program: $2.4 billion, an increase of $70 million and a $50 million increase for health centers to reduce new HIV infections by 90 percent in 10 years.
• Maternal and child health: $944 million, an increase of $17 million, for programs to improve maternal and child health, including an additional $5 million to reduce maternal mortality.
• Title X family planning: $286 million or level funding.

Substance Abuse and Mental Health Services Administration (SAMHSA)

The bill provides $5,882,496,000 in total program-level funding for SAMHSA, which includes $12,000,000 in transfers from the Prevention and Public Health Fund.

• Mental health resources for children and youth: $102 million for Project AWARE, an increase of $31 million; $69 million for the National Child Traumatic Stress Initiative, an increase of $5 million.
• Suicide prevention: $16 million for the Zero Suicide program, an increase of $7 million; $19 million for the Suicide Lifeline, an increase of $7 million.
• Substance abuse treatment: $3.8 billion, an increase of $19 million, including continued funding for opioid prevention and treatment.
• Substance abuse prevention: $206 million, an increase of $1 million above the 2019 enacted level.

Health Extenders and Tobacco Purchasing Age

Among other key changes, this funding agreement:

• Raises the federal minimum age to purchase tobacco products from 18 to 21 years old. This provision can be found on page 1492 of the bill text. Unfortunately, this bill does not include a ban on flavored e-cigarettes. Click here to read ASTHO’s summary and analysis of the tobacco-21 provision.
• Extends Medicaid funding for fiscal years FY20 and FY21 at a federal matching rate of 76% for Puerto Rico and 83% for the other territories. The bill includes program integrity requirements for Puerto Rico’s Medicaid program. ASTHO will provide additional information in the new year with further details. The table below includes the funding for each territory by fiscal year.

• Extends mandatory funding for community health centers through May 22, 2020, which is intended to create pressure for a Memorial Day deal on legislation to reduce prescription drug prices and address surprise out-of-network medical billing.
• Extends, for a decade, the Affordable Care Act’s Patient-Centered Outcomes Research Institute, which researches the effectiveness of clinical treatment.
• Delays the reduction in the allotments for Medicaid disproportionate share hospitals (DSH) until May 22, 2020.
• Reauthorizes the national poison center network program through FY2024. This authorizes control centers to use other communication technologies in addition to the national toll-free number and requires the program to include toxic exposure (in addition to poisoning) in nationwide media campaigns.
• Requires HHS to ensure the development and implementation of a national strategy for vector-borne diseases, including tick-borne diseases, and to identify strategic goals and address gaps and unnecessary duplication in federal activities related to vector-borne diseases. Codifies and continues regional centers of excellence in vector-borne diseases. Authorizes grants to health departments in areas at high risk of vector-borne diseases to increase capacity to identify, report, prevent, and respond to such diseases and related outbreaks.
• Provides access to 3,000 additional foreign labor permits in the Northern Mariana Islands under the existing Commonwealth-only Transitional Worker visa program (48 U.S.C. 1806) for a three-year period to speed typhoon recovery. All protections for workers currently in law remain in force.