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September 2011


Congress returned from  summer recess and resumed work in number of issues relevant to local health departments.

Federal Funding Update

FY2012 Funding

The 12 spending bills to fund the government in FY2012 have not yet been passed by Congress. The House Labor-HHS-Education Subcommittee has delayed mark-up of its FY12 bill indefinitely. The Senate FY2012 Labor-HHS-Education bill was marked up by the Appropriations Committee on September 21. (Details can be found here.) Passage of a final bill in the near term will be challenging due to the differing allocations for the bills between the House and Senate. 

The House allocation for Labor-HHS-Education is $18 billion (11.5 percent) less than the FY2011 funding level of $157.4 billion. The Senate allocation taken from the Budget Control Act (BCA) cuts Labor-HHS-Education spending by approximately $11 billion. The BCA restores about $9 billion in Pell Grant funding.  Because all 12 bills will not pass before the end of the month a continuing resolution will be passed by the end of September to continue government operations. A proposed continuing resolution (CR) released by the House Appropriations Committee would keep the government running from October 1 to November 18. The bill contains $1.043 trillion, the total amount agreed to by the Congress and the White House in the recent debt-ceiling legislation and $3.65 billion in disaster relief funding to provide assistance to the thousands of people affected by Hurricane Irene, recent wildfires, floods and tornadoes in the Midwest and South, the mid-Atlantic earthquake, and other natural disasters. On September 21, the House failed to pass the CR, which means it will be altered to allow for passage before September 30 to avert a government shutdown.

FY2013 Funding

Development of the FY2013 President's Budget Request is about to get underway. In an August 17 memo, the Office of Management and Budget directed federal departments and agencies to develop their FY2013 budget requests at least 5 percent below fiscal 2011. Departments and agencies were directed to also identify additional cuts that would put their requests 10 percent below FY2011.


A 5 percent cut in discretionary appropriations, carried out across the government, would amount to significantly less than the amount established through BCA enacted spending caps for each of the next 10 years. The new budget caps allow a total of $1.047 trillion for discretionary appropriations in fiscal 2013, excluding costs for the wars in Iraq and Afghanistan.

Special Joint Committee on Deficit Reduction

Members of the special joint committee for deficit reduction have been appointed and have begun meeting. The committee must put forth recommendations for deficit reduction of at least $1.2 trillion by November 23, 2011. 

Key Dates for the Special Joint Committee:

October 14, 2011:  House and Senate committees put forward recommendations to the special joint committee.

November 23, 2011:  Deadline for vote by special joint committee on a 10-year deficit reduction package of at least $1.2 trillion.

December 2, 2011: Deadline for special joint committee to formally report proposals.

December 23, 2011:  Deadline for vote by House and Senate on $1.2 trillion deficit reduction package.

 January 15, 2012:  Deadline for enactment of deficit reduction package or across-the-board cuts triggered to reduce spending by at least $1.2 trillion or remainder of what is not enacted by Congress.  Half to come from defense spending and half to come from non-defense and 2 percent cut to Medicare providers.

January 2, 2013:  If triggered, across-the-board cuts take effect.

Health Reform Implementation

Prevention and Public Health Fund Announcements

In August, HHS made a number of grant announcements that included funds from the Prevention and Public Health Fund (the Fund). On August 15, CDC awarded $49 million to the fifty states, two territories, and six cities (Chicago, Washington, D.C., Houston, Los Angeles, New York City, and Philadelphia) to strengthen health department epidemiology and laboratory work, detect and prevent healthcare-associated infections (HAIs) and support immunization programs. The funding breaks down as follows:  $39.6 million to increase epidemiology, laboratory and health information systems capacity at health departments; $9 million to coordinate their HAI prevention activities, implement multifacility, multidisciplinary prevention efforts, improve monitoring of antimicrobial use and enhance electronic reporting of HAIs; and $600,000 to strengthen the evidence base for immunization programs and policy.

On August 25, HHS awarded $137 million, partly supported by the fund, to states to strengthen the public health infrastructure and provide jobs in core areas of public health. Awarded in nearly every state, 3 territories, and the city of Houston, the grants enhance tobacco cessation services, strengthen public health laboratory and immunization services, prevent healthcare-associated infections, and provide comprehensive substance abuse prevention and treatment.

On August 31, HHS awarded $40 million for the second year of funding for the National Public Health Improvement Initiative to state, tribal, local, and territorial health departments and several schools of public health. The funding, which partially comes from the fund, is intended to enhance the nation's public health infrastructure and strengthen the public health workforce and support 10 public health training centers.

On September 9, HHS announced $700 million in renovation and construction grants for community health centers and on September 15, awarded $10 million in planning grants to organizations preparing to become community health centers. Several local health departments were among the awardees.

Insurance Exchanges

On August 12, HHS awarded $185 million to help states continue to set up their insurance exchanges, which are to be operational in January 2014. The exchanges will enable small businesses and individuals to buy insurance, receive premium tax credits, or enroll in Medicaid or the Children's Health Insurance Program. On August 17, HHS, Labor and Treasury departments issued proposed rules for health insurers and group health plans to provide consumers with consistent and comparable information about health plan benefits and coverage, along with a uniform glossary of terms, for shoppers and enrollees upon request and before they buy coverage.

Essential Health Benefits (EHB) Package

On August 29, the Institute of Medicine (IOM) released its Perspectives on Essential Health Benefits - Workshop Report.  Under the Affordable Care Act, health plans for individuals and small businesses, both in the exchange and outside of the exchange, are required to cover the EHB package, which fall under 10 general categories including emergency services, behavioral health treatment, and preventive services and chronic disease management. HHS requested that the IOM recommend the criteria and methods for determining and regularly updating the EHB package. The IOM will release a final report with recommendations in the early fall of 2011.

Emergency Preparedness

President Obama issued a proclamation declaring September as National Preparedness Month.  The president stated that, "Preparedness is a shared responsibility, and my administration is dedicated to implementing a 'whole community' approach to disaster response.  This requires collaboration at all levels of government, and with America's private and nonprofit sectors." The Federal Emergency Management Agency also has a website dedicated to the National Preparedness Month Coalition and its resources.

Now that Congress is back in session, action is expected on the Pandemic and All-Hazards Preparedness Act which expires on September 30, 2011. On July 25, the House Energy and Commerce Committee passed the "Pandemic and All-Hazards Preparedness Reauthorization Act of 2011" (H.R. 2405).  In the Senate, Senators Burr (R-NC), Casey (D-PA), Enzi (R-WY) and Harkin (D-IA) are drafting reauthorization legislation to be considered in the Senate Health, Education, Labor and Pensions committee. We expect that the Senate bill will be more comprehensive than the House bill, ensuring a more complicated path to passage. NACCHO continues to press for reauthorization this year and for appropriators to hold the line on cuts to preparedness funding in the FY12 funding cycle.