Zika Funding: One Step Forward, Two Steps Back

By: Michaela Keller

In the early morning hours on Thursday, amidst a Democrat led sit-in to protest the House Republicans resistance to vote on gun safety measures, a conference report bill to address the Zika virus was introduced in the House, voted on favorably and sent to the Senate.  The report came after negotiations within a bipartisan conference committee in both the House and Senate, which sought to reconcile the various funding measures proposed to fight Zika, broke down. The conference report package that House members ultimately voted on did not have bipartisan support and the vote, 239-171, was largely along party lines.

In the hours and day that followed, details of the bill emerged, including rhetoric from both parties as to how the bill should proceed. The major pieces of the bill include a top line funding level of $1.1 billion, which is equal to the Senate agreed upon number and higher that the House passed number of $622 million, yet lower than the Administration’s request for $1.9 billion. The package includes $476 million to the CDC for mosquito control, $230 million to NIH for vaccines, $227 for the Public Health Social Services Emergency Fund and $165 million to the State Department and USAID to respond to outbreaks overseas.

While many agreed that the House’s willingness to accept the Senate passed number of $1.1 billion was a step in the right direction, the details of how that money is allocated, and under what provisions, caused immediate backlash from most Democrats. One of the first points of contention is that $750 million of the funding is offset by redirecting funding from unspent Ebola and Affordable Care Act funds as well as about $100 million from HHS’s administration fund. As you may recall from this post, the funding that both the Administration and Senate proposed did not include any offsets. Second, there is concern that the funding provided through Social Service Block Grants for primary care services in areas most affected by Zika is prohibited from being used for contraception and other reproductive health services. Lastly, policy riders related to pesticide use were also raised as red flags for Democrats.

Despite the aforementioned areas of disagreement, NACHC was pleased to see that the bill included $40 million to expand primary care services for health centers in Puerto Rico and other territories as well as $6 million to assign National Health Service Corps members to Puerto Rico and other territories.

By the end of the day on Thursday, Senate leadership proceeded to call for a vote on the conference package, which is scheduled for next week. The Senate will need 60 votes in order to pass the conference report; however, given that Democrats have harshly criticized the funding measure, it is unlikely that the conference report will pass. Additionally, President Obama announced that he would veto the funding measure if it came to his desk in its current form.

When all is said and done next week, Congress will likely be back where it started more than four months ago, without an agreed upon funding mechanism to prevent and respond to the Zika virus.  With the House currently on recess until after the 4th of July and only a few days of regular business scheduled for both chambers before the summer recess period begins on July 15th, there is great uncertainty as to what the path forward is from here. Many speculate that a deal will not be reached in the coming weeks, meaning that the summer will pass before Congress passes a funding bill to address the Zika virus. For additional updates, stay tuned to the Health Centers on the Hill blog.

Senate Appropriations Committee Approves FY2017 LHHS Bill

Last week, the Senate Appropriations Committee approved the first bipartisan Labor, Health, and Human Services (LHHS) Appropriations bill in 7 years. The legislation contained the full health center funding request for fiscal year 2017 (FY17) of $5.1 billion in funding for health centers. This is level funding compared with FY16 and composed of $1.5 billion in discretionary funding from the Appropriations Committee and $3.6 billion in funding from the mandatory Health Centers Fund, which was extended last year by H.R.2, the Medicare Access and CHIP Reauthorization Act of 2015. A copy of the Appropriations Committee press release and bill summary can be viewed here.

Additionally, the Committee directed that within the $5.1 billion available to health centers, the legislation would invest $100 million in funding for expanded mental health as well as opioid prevention and treatment services at health centers nationally. The Committee proposes providing $50 million in funding to prevent and treat opioid abuse and $50 million to expand mental health services. This funding could assist health centers in addressing these increasing public health problems in underserved communities. The NACHC press release on the Senate FY17 LHHS bill can be viewed here.

We haven’t heard anything definitive on when the House LHHS Subcommittee could begin consideration of their version of the FY17 legislation. There were rumors the House could move this week, but thus far no LHHS Subcommittee action has been scheduled. The House will only be in session for 3 more weeks until they break for the August recess and once they return in September they will only have 17 scheduled days in session until the end of the fiscal year. We will keep you posted on any movement in the House on the LHHS bill.

The passage of these funding bills in the Appropriations Committees is the first step in a lengthy appropriations process and the limited number of days in session could slow down final compromises on the appropriations bills or omnibus package until after the November elections. If that is the case, the most likely scenario is a series of short term funding extensions if Congress does not finalize the appropriations process by September 30th, dragging the process until much later in the year or even into 2017. Please stay tuned to Health Centers on the Hill for updates on the LHHS bills as information becomes available.

Zika Funding Negotiations Set to Begin

By: Michaela Keller

This past week, the Senate named its conferees on the Zika spending package to join the already-named House conferees, signaling a formal start to negotiations on the differing measures put forth by the House and Senate to combat the Zika virus. Chief among those differences is the funding level that both chambers agree is appropriate to address the virus. As detailed in this post, last month the Senate approved $1.1 billion, while the House approved $622 million to fight Zika, both levels below the Administration’s original request of $1.9 billion.

Apart from the funding levels, another significant difference between the House and Senate passed measures is whether or not the funding is offset. In the Senate passed bill, the funding is considered an emergency appropriation, meaning that it is not tied to any offset, or cuts to other programs. In contrast, the House offsets the full $622 million by repurposing emergency Ebola funding as well administrative funds within HHS.  Whether or not to offset any agreed upon funding will certainly be one of the key decisions of the conference committee.

Among other things, the conference committee will also be tasked with determining whether to provide funding until the end of September 2017, as agreed upon in the Senate, or to provide funding until the end of September of this year, as agreed upon in the House. House conferees have stated that they plan to include Zika funding in the yet-to-be-unveiled Labor-Health and Human Services funding bill, which is expected later this month.  However, whether that funding will get approved through the regular appropriations process and under what time frame, remains a question that conferees will need to consider.

Congress Comes Home Part II- To Iowa, California, Minnesota, and Washington

Since our last  “Congress Comes Home”  blog, we have had more and more health centers share stories of their recent Member visit(s). HUGE thank yous to those who’ve already shared their stories! Inviting a Member of Congress for an in-person visit is a great advocacy tool and a great way to strengthen a relationship that could potentially last for decades. Keep in mind that next week, from May 30th to June 3rd, both House and Senate will be out of session so right now is a great time to reach out. Here are short excerpts from a few health center experiences so far this year:

In mid- February, Congressman Rod Blum (R-IA) visited Eastern Iowa Health Center and Congressman David Loebsack (D-IA) visited both Community Health Centers of Southeastern Iowa and River Hills Community Health Center. These visits were scheduled when the House was out of session. To coordinate efforts, the health centers notified the Iowa Primary Care Association of the visits who then relayed the information to NACHC.

Tip #1 and #2: Be sure to let NACHC and your state’s PCA know about the health center visit ahead of time. They can provide you with background information on the Member as well as help compile any statistics or information needed to illustrate your concerns. Feel free to email federalaffairs@nachc.org for some up-to-the-minute insight.  Also, check the 2016 Congressional calendar to see when your Member is likely to be back home in the district. Friendly reminder that the next recess is May 30th to June 3rd. Don’t forget 2016 health center visits by your Rep., Senator, and/or delegate are one criteria used to determine 2017 NACHC Congressional Awards.

In April, Congresswoman Betty McCollum (D-MN) organized a roundtable discussion with various community leaders regarding health disparities within the Asian American and Pacific Islander community at United Family Medicine in St. Paul, Minnesota. Participants involved included the Minnesota Association of Community Health Centers, MN Department of Health, St. Paul-Ramsey County Public Health, and Council of Asian Pacific Minnesotans. The discussion was featured in Congresswoman McCollum’s newsletter as well as posted on her Twitter account.

Rep. McCollum with United Family Medicine and other community partners to discuss health equity.

Rep. McCollum with United Family Medicine and other community partners to discuss health equity.

Tip #3 and #4: Inviting a member to your health center doesn’t always have to mean you conduct a tour. It can also include community events, like this roundtable discussion with stakeholders. This is an opportunity to address your concerns or current issues or barriers impacting your community’s access to healthcare. However, make sure to work with the Member’s office to ensure an appropriate amount of time for the event. If possible, coordinate with the Member’s communications staff when posting on social media (Twitter, Facebook, etc.).

On April 28th, Family HealthCare Network (FHCN) celebrated the opening of their newest Community Health Center in Traver, CA. In attendance were local government and school leaders, a field representative from Congressman Devin Nunes’ office (R-CA), FHCN board and staff, and Traver community members. Not only did they celebrate with a ribbon cutting but also conducted guided tours of the new health center, and had live entertainment on hand from students of Traver Elementary School’s band and folkloric dance team. Sounds like a fun time!

FHCN Traver Grand Opening Ceremony

FHCN Traver Grand Opening Ceremony. Photo courtesy of Family HealthCare Network.

Tip #5, #6 and #7: There are elected officials at multiple levels of government who have a stake in the healthcare system so it is beneficial to make an effort to build relationships with all elected officials. The more the merrier. In addition, add some fun activities to the schedule and demonstrate how essential your health center is to the surrounding community. Also, create and publicize a press release of the event to attract more attention from local media and community members.

Earlier this month, Senator Maria Cantwell (D-WA) visited Community Health Association of Spokane’s (CHAS) Health’s Maple Street Clinic where she held a press conference with a fellow WA state representative to urge Washington to implement the Federal Basic Health Plan and afterwards toured the facility. Combined CHAS and Senator Cantwell’s office did a fantastic job of disseminating the event via Facebook, Twitter, press releases, and blogs. To keep the conversation flowing, CHAS staff made sure to invite Senator Cantwell and her staff to visit again in the near future, especially during the August recess and National Health Center Week (NHCW).

CHAS Health's blog post on Senator Cantwell's visit. Photo courtesy of CHAS Health.

CHAS Health’s blog post on Senator Cantwell’s visit. Photo courtesy of CHAS Health.

Tip #8 and #9: Do your best in promoting the visit(s) via social media, blogs, press releases etc. If you would like some technical support, please feel free to reach out to us at NACHC. We have lots of helpful resources at your fingertips. Invite your member to visit in August, particularly during National Health Center Week  (August 7th through 13th). Friendly reminder that the whole month of August, both chambers will be out of session meaning they should be back in their states and districts. This year’s theme is “Celebrating America’s Health Centers: Innovators in Community Health.” Time to shine and show off the innovative programs and services your health center provides in order to meet the unique needs of your community. Sky’s the limit!

Lastly, late last year Congressman Jim Costa (D-CA) visited Livingston Community Health’s (LCH) Hilmar Health Center in Hilmar, California. Rep. Costa congratulated and commended LCH staff on establishing their dental center. LCH has built a strong, positive relationship with Rep. Costa as he visits the three locations often.

Rep. Costa with Hilmar Health Center staff. Photo courtesy of Livingston Community Health.

Rep. Costa with Hilmar Health Center staff. Photo courtesy of Livingston Community Health.

Tip #10: Be flexible with your time requests. Members’ schedules can change, length of recesses differ, and things come up so make sure to allocate more than enough time during the visit. As the visit approaches, keep in contact with Member’s office for any updates or changes with his or her schedule.

For more how-to’s on inviting your Member of Congress and meeting tips, visit our Grassroots Advocacy website or email federalaffairs@nachc.org.  Don’t forget, August 7th through 13th is National Health Center Week (NHCW) and another opportune time to invite your member to tour your health center.

Do you also have a story to share? What tips and tricks have you learned in the process of scheduling and organizing Congressional visits? Do you alert the local press or utilize social media? Let us know by emailing your story, photos if available, and tips for fellow health centers to federalaffairs@nachc.org.

Senate Moving Forward With Zika Package

By: Michaela Keller

Last week, the Senate announced a bipartisan agreement to provide $1.1 billion in emergency funding to combat the Zika virus. This agreement, brokered by Senators Roy Blunt (R-MO) and Patty Murray (D-WA), will be one of three Zika funding amendments offered during debate on an unrelated appropriations bill, scheduled to begin on Tuesday.  The amendment includes several provisions of interest to health centers .

The Senate proposal includes $51 million in resources for HRSA: $40 million for Health Centers in Puerto Rico and other territories; $6 million for National Health Service Corps placements and loan repayment in Puerto Rico and other territories; $5 million for Maternal and Child Health Block Grant funds to Puerto Rico and other territories.

On Monday, the House Appropriations Committee, led by Chairman Hal Rogers (R-KY), introduced legislation to provide $622.1 million to respond to the Zika virus through the duration of the current fiscal year, or until the end of September. The House proposal does not call for funds to HRSA. The funding is offset by repurposing $352.1 million from unobligated and unspent resources left over from the Ebola outbreak in 2014 and $270 million in unused administrative funding within HHS. Floor action on the bill is expected later this week.