Heart on the Hill - August 2017

Hundreds of Advocates Rally for Health Care, Research

On June 26-27, more than 330 American Heart Association volunteers and staff from 46 states trekked to Washington, D.C. as part of the biennial You’re the Cure on the Hill to advocate for the protection of health care coverage, federal research support and key legislation that will benefit Americans with cardiovascular disease (CVD).

 The date of our Lobby Day this year proved to be timely. Senate Majority Leader Mitch McConnell (R- KY) had planned to vote on the Senate’s health care repeal legislation during this week. The association opposed the Better Care Reconciliation Act (BCRA) and our volunteers asked their lawmakers to reject the legislation or any other bill put forward by either party that would reduce health care coverage for Americans. Unable to assemble the support needed for passage of the BCRA, Leader McConnell announced he would delay the vote the day our advocates were on Capitol Hill.

Heart disease and stroke researchers and survivors also met with legislators to stress the urgent need for more National Institutes of Health (NIH)-funded heart and stroke research, particularly in light of the association’s recent report showing CVD will continue to be America’s most burdensome disease. Advocates urged their congressional members to prioritize NIH funding for heart and stroke research and to increase the NIH’s budget by $2 billion in fiscal year 2018.

Volunteers also asked lawmakers to support a cardiac rehabilitation supervision bill (H.R. 1155/S. 1361) and the Furthering Access to Stroke Telemedicine (FAST) Act (H.R. 1148/S. 431).

Contact: Amy Shope-Manzi

Health Care Reform Stalls as Cries for Bipartisanship Grow Louder

July marked the culmination of many months of intense work on health care reform in both the House and Senate. In a dramatic vote held in the early hours of Friday, July 28 the Senate narrowly voted down a series of proposals that sought to repeal and replace portions of the Affordable Care Act, including the Health Care Freedom Act, also known as the “skinny repeal.” Republican Sens. Collins (ME), McCain (AZ) and Murkowski (AK) voted with Democrats to block the legislation. In a statement following the vote, AHA CEO Nancy Brown said that the pursuit of market stabilization, affordability reforms and bipartisanship should be the next steps in the health care debate.
 
Several analyses released by the nonpartisan Congressional Budget Office estimated that these bills would have had significant and far-reaching negative impacts on patients. The proposals included many problematic provisions, including weakening of patient protections, large cuts to the Medicaid program and coverage losses for tens of millions of individuals and families.

The rejection of these measures, however, is not the end of the conversation on health care reform. Important decisions by the administration and Congress, such as cost-sharing reduction payments (CSRs) and tax reform, will significantly impact patients’ ability to access coverage.

The association and its coalition partners have pressed Congress to return to bipartisan discussions and regular order to reach long-lasting solutions to the issues that currently plague our nation’s health care system.

Contact: Katie Berge

House Labor-HHS Appropriations Rejects President’s Proposed Cuts

The House Appropriations Labor, HHS, Education and Related Agencies Subcommittee wrapped up work last month on the FY 2018 funding bill that contains many of our health priorities.

In response to intense lobbying by the association and other medical research and prevention partners, the committee rejected the Trump administration’s proposals to cut funding for the National Institutes of Health (NIH) by $7 billion, eliminate money for the Centers for Disease Control and Prevention’s (CDC) Million Hearts program and fold most CDC chronic disease programs into a block grant.

Instead, the House Appropriations Committee bill includes $1.1 billion in funding for the NIH, which is a 3.2 percent increase. The increase represents a 1.6 percent bump for the National Heart, Lung and Blood Institute and a 1.5 percent increase for the National Institute of Neurological Disorders and Stroke.

The House rejected the proposed block grant funding for the CDC's chronic disease programs. Instead, the CDC’s Heart Disease and Stroke Prevention Program received a $6 million increase, while WISEWOMAN and the Million Hearts program were flat funded at $21 million and $4 million, respectively. The committee rejected the president’s proposal to terminate the Million Hearts program.

AHA President John Warner, M.D., commended the committee’s investment in the CDC because it will “help ease the toll of chronic diseases, along with spending on related health care services.” He added, “This funding supports the important work being done across the country to prevent cardiovascular disease – the no. 1 and most costly killer in the United States – and save lives.”

The association was successful in securing language in the report accompanying the bill in the sections on the NIH and the CDC, highlighting the need for more funding for cardiovascular disease research and prevention to curb the burden of heart disease and stroke.

The Senate Appropriations Committee is expected to act on its version of this legislation in September.

Contact: Claudia Louis

Senate Nixes House’s Harmful Tobacco Riders

Also in July, the House Appropriations Committee advanced two bills that would negatively impact the tobacco cessation and prevention landscape.

The Labor-HHS subcommittee appropriations bill included a $50 billion cut to the CDC’s Office of Smoking and Health (OSH), which would negatively impact OSH’s quit lines and the successful Tips From Former Smokers campaign. Despite an emotional plea and amendment offered by Rep. Debbie Wasserman Schultz (D-FL) during the full committee markup, the cut remained in the bill.

The House Labor-HHS bill will not be marked up until September, and it remains unclear if it will include the same cut to OSH.

The House Appropriations Committee also marked up the agriculture appropriations bill, including two riders that would impede the Food and Drug Administration’s (FDA) ability to conduct oversight of tobacco products.

The first rider exempts so-called “large and premium cigars” from FDA oversight. Unfortunately, the language in this bill provides a loophole that would also exempt cheap, flavored cigars, which are often marketed to youth.

The second rider changes the grandfather date under which products are subject to the FDA’s pre-market review process. The rider changes the date from 2007 to 2016 for newly deemed tobacco products, resulting in significantly fewer e-cigarettes undergoing the pre-market review process. Without this review, products that could have a negative impact on public health, like those with flavors that attract children and those that contain harmful chemicals, could be allowed on the market.

Luckily, when the Senate Appropriations Committee marked up the agriculture appropriations bill, the riders were not included. It remains unclear whether these riders will ultimately be included when the two chambers conference their appropriations bills.

In other tobacco news, the House passed legislation requiring Veterans Administration (VA) health facilities to be smokefree. The bill, if enacted, would require the indoors of VA facilities to be smokefree within 90 days after passage. VA community living centers, or nursing homes, would be required to be smokefree by December 31, 2018. The outdoor smokefree policy would become effective on October 1, 2021, a year earlier than what was originally proposed. This legislation is a significant public health win for all veterans and we look forward to its passage.

Contact: Alison Council

FDA Announces New Plan to Address Tobacco and Addiction

The Food and Drug Administration (FDA) Commissioner Scott Gottlieb announced a new plan for tobacco regulation on July 28. The approach places nicotine, and the issue of addiction, at the center of the FDA’s tobacco regulation efforts.

According to the announcement, the FDA will examine how nicotine is delivered and the relative risk of each type of delivery mechanism. Because traditional cigarettes pose the highest risk to users, the agency intends to lower the amount of nicotine in cigarettes so they are less addictive. At the same time, the FDA will encourage the development of “innovative tobacco products that may be less dangerous than cigarettes” to help smokers move to a lower risk product. This could include non-combustible products like e-cigarettes and vape pens.

As part of this plan, the FDA also announced several changes to the tobacco deeming rule released last year. Under the policy, manufacturers of newly regulated products will have additional time to submit tobacco product review applications to the FDA. Applications for cigars, pipe tobacco and hookah tobacco must be submitted by August 8, 2021; applications for e-cigarettes now have until August 8, 2022. These products will also be allowed to remain on the market while the agency reviews the applications.

The FDA also intends to examine several other issues, including the role of flavors in tobacco products; whether premium cigars should be exempt from FDA regulation; and what actions the agency can take to increase access to FDA-approved nicotine replacement therapy products.

AHA CEO Nancy Brown praised the FDA  for its plan to lower nicotine levels and examine how flavors attract kids. However, she expressed disappointment with the agency’s decision to delay portions of the deeming rule, and for raising the possibility that premium cigars may be exempt in the future.

Contact: Susan K. Bishop

Agriculture Appropriations Bills Threaten Nutrition Policy Gains

The FY 2018 Senate and House agriculture appropriations bills included many of the same policies that were in the 2017 omnibus funding bill, including several damaging riders that threaten progress made in nutrition policy.

Both bills still contained a rider that would prohibit the voluntary sodium targets from moving forward until the Dietary Reference Intake (DRI) update is published. While the association welcomes a DRI update, tying the targets to them is simply a delay tactic giving those who oppose the targets more time to raise questions about the science behind sodium.

Also included in both bills was a rider requiring the U.S. Department of Agriculture (USDA) to reopen the Supplemental Nutrition Assistance Program (SNAP) retailer standards rule to redefine “variety” so that the definition is more permissive. This rider potentially opens the door for unhealthy foods to qualify as staple foods, and the USDA is prohibited from implementing other parts of the regulation until this action is completed.

There were continued attempts to roll back science-based nutrition standards for school meals in the House bill. A familiar rider in the legislation would extend the whole grains waiver another year, permanently freeze the sodium standards at target one and expand milk to one percent flavored with no calorie limits. The bill also retains a provision that prohibits the USDA Food and Nutrition Service from conducting new research without prior congressional approval. The removal of the service’s autonomy is cause for concern given ongoing attacks on nutrition science. Finally, the report that accompanied the House bill contained non-binding language that would delay menu labeling implementation and Nutrition Facts label compliance to align with the new GMO food labeling law.

Surprisingly, the rider to roll back nutrition standards for school meals was not in the Senate bill. Some speculate this could be because the USDA is currently in the process of reopening the rule, but that remains to be seen.

The association will continue to push back on these riders and advocate for agriculture appropriations legislation without riders that are detrimental to science-based nutrition policy.

Contact: Kristy Anderson

CMS Creates New Medicare Benefit for Patients with PAD 

At the end of May, the Centers for Medicare and Medicaid Services (CMS) announced that Medicare will now cover supervised exercise therapy (SET) for patients with peripheral artery disease (PAD).
 
To qualify for the new benefit, Medicare beneficiaries must first have a face-to-face visit with a physician to obtain a referral for SET, as well as information about cardiovascular disease and PAD risk factor reduction. Then, Medicare will cover 36 sessions over a 12-week period, with each session lasting 30 to 60 minutes. Beneficiaries may also be eligible for an additional 36 sessions over an extended period of time.

CMS’ decision to provide Medicare coverage of SET was triggered by a formal request the American Heart Association filed last September. AHA asked CMS to consider providing Medicare coverage for SET because the association has long recommended SET as a first-line, non-invasive, low-risk therapy for PAD patients who experience fatigue, discomfort, cramping or pain in the leg muscles when walking or exercising. The association was concerned that the lack of Medicare coverage for SET was limiting patients’ access to a safe and effective treatment for PAD.

CMS agreed to provide Medicare coverage of SET after reviewing AHA’s request and supportive comments from hundreds of health care providers, patients and other members of the cardiovascular community.

AHA CEO Nancy Brown praised CMS’ decision, saying that the association “couldn’t be more thrilled with [the] decision that will give more Americans the access they need to this important treatment option.”

Contact: Susan K. Bishop

Bipartisan Praise for FAST Act

On July 20, the House Energy and Commerce Subcommittee on Health held a hearing on bipartisan legislation aimed at improving the Medicare program.

The FAST Act was touted as a bipartisan achievement by both the Chairman, Rep. Michael Burgess (R-TX), and the Ranking Member, Rep. Frank Pallone (D-NJ). The subcommittee will reconvene after the August recess and consider moving the bill on to the full committee.

Contact: Katie Berge

Cardiac Rehab Update

In June, Sens. Mike Crapo (R-ID), Amy Klobuchar (D-MN.) and Debbie Stabenow (D-MI) introduced S.1361, the Improving Access to Cardiac and Pulmonary Rehabilitation Act of 2017.

The bill was a centerpiece of this year’s You’re the Cure on the Hill efforts, and has been gaining bipartisan support in both chambers. S. 1361 would expand access to cardiac rehabilitation programs by removing the requirement that a physician be physically located within 250 yards of a program. While the program would still be overseen by a physician, other specialist medical professionals -- including physician assistants, nurse practitioners and clinical nurse specialists -- would directly supervise participating patients.

In the House, the bill is led by Reps. Lynn Jenkins (R-KS) and John Lewis (D-GA).

Contact: Katie Berge

STATE UPDATES

Nationwide Tobacco Policy Wins

The AHA and our tobacco prevention partners continue to see great progress in the effort to raise the age to purchase to tobacco up to 21. Oregon, New Jersey and Maine, as well as communities across the country, have recently passed new laws that will significantly reduce the number of youth who ever start using tobacco. Now, five states and more than 250 communities have passed tobacco to 21 laws.

Meanwhile, in Texas, 20 cities have gone smokefree over the last year. This means an additional 800,000 residents will be protected from harmful secondhand smoke. In August, the Parish Council of East Baton Rouge voted to go smokefree, protecting the nearly 450,000 people who live in the parish.

South Carolina will now provide tobacco cessation coverage to all one million Medicaid enrollees in the state. Medicaid enrollees often smoke at higher rates than the rest of the population but are less likely to have access to this important benefit to help them quit.

Contact: Lucy Culp

CPR in Schools Gains Momentum

With the passage of a formal CPR training in schools policy in four Florida counties – Duval, Palm Beach, Pascal and Orange – more than 30,000 students will be added to the over two million students already being trained every year across the country.

In addition, Nevada has become the 37th state to enact policy requiring CPR training for graduation. Likewise, the community of Omaha, Nebraska will now require CPR training before graduation. 

Contact: Douglas Dunsavage

New York and Texas Pass PE Quality and Appropriations Bills  

Texas legislators have approved a bill that strengthens the existing School Health Survey, a state-required report administered by the Texas Education Agency. The survey collects information on physical activity and health education from more than five million students in all the state’s school districts. 

Data from the survey will be publicly shared with the state, education authorities, health stakeholders and parents to better assess the quality of physical education programs in their schools.

Meanwhile, New York City’s Phys Ed 4 All coalition -- led by the American Heart Association -- worked with the New York City Council and Mayor Bill de Blasio to ensure the continuation of the PE works initiative for FY 2018. This initiative aims to ensure all schools have a certified PE teacher moving forward. It is expected that $30.6 million will be devoted to this cause this year, with additional funding provided in the next two years.

Mayor de Blasio also introduced the Universal PE Initiative to improve capital and ensure every school has PE infrastructure by 2021.

Contact: Tracy Weldon

Sugary Drink Tax Passed in Seattle