Heart on the Hill - August 2018
Administration Chips Away at the Affordable Care Act
This summer, the administration finalized several proposed rules that expand access to subpar insurance policies. These plans contain fewer patient protections than the options offered by the Affordable Care Act (ACA), including several that are important to patients with cardiovascular disease. These include the ten essential health benefits, bans on annual and lifetime limits and caps on out-of-pocket costs.
On August 1, the Department of Health and Human Services released the final version of its controversial rule on short-term, limited duration (STLD or short-term) plans. This new rule expands the availability of STLD plans from three months to one year. It also gives consumers the option to renew these plans. Despite broad and strong opposition from almost all healthcare stakeholders, including hospitals, providers, patient groups and insurers, the administration moved forward with few changes to the original rule.
Short-term policies are not required to provide comprehensive coverage, including hospitalization, emergency room visits, preventive care, prescription drugs, maternity coverage and many other essential services. These polices have a history of retroactively rescinding coverage, or denying it, which can cause high rates of medical bankruptcy, and leave consumers’ lives and finances in jeopardy. In addition, healthier individuals tend to select these plans causing premiums to rise significantly for those with preexisting conditions that require more comprehensive coverage.
The potential impact on patients with heart disease and stroke is significant. Individuals who choose these plans could be left out in the cold if their insurer decides that their cardiovascular event was “preexisting” and those left on the exchange could be priced out of coverage altogether. To help protect our patients, the association, in conjunction with more than 30 patient and provider advocacy partners, will turn their attention to regulating these plans through state legislatures.
Contact: Katie Berge
House and Senate Seek Farm Bill Compromise
Last month, the Senate passed their version of the farm bill, the Agriculture Improvement Act, with a strong bipartisan vote of 86-11. The Senate legislation ensures that vulnerable populations, including children, the elderly and the disabled still have access to benefits and strengthens the integrity and accountability of the Supplement Nutrition Assistance Program (SNAP). Unlike the Senate, the House-passed a version, H.R. 2, the Agriculture and Nutrition Act, would decrease benefits for or cut millions from the program.
The association was pleased to see that priorities such as the Food Insecurity Incentives Program (FINI), improving the SNAP Electronic Benefits Transfer (EBT) system and a fruit and vegetable prescription program pilot in the Senate bill. The legislation also makes commonsense changes to nutrition education that will strengthen the program. Compared with the House bill, the Senate proposal does not contain language that would undermine the integrity of the Fresh Fruit and Vegetable Program (FFVP). In a statement, CEO Nancy Brown indicated the association’s support for the Senate bill, while noting that the bill does not go far enough to improve diet quality.
The House and Senate have convened a conference committee to work out the differences between the two bills. It is difficult to say whether conferees will be able to reach an agreement. The chairs and ranking members of the respective committees seem optimistic that they can produce and pass a bill before the September 30 expiration date.
In addition to ensuring that those who need SNAP remain on the program, the association will continue to advocate through every step of the process for policies that improve diet quality and for healthy and affordable food access.
Contact: Kristy Anderson
Agriculture Funding Bills Could Put Nutrition Policies in Jeopardy
The Senate and House Appropriations Committees passed their respective agriculture funding bills this spring and early summer. As in previous years, both bills 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 delaying 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,” which would allow the definition to be 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.
On a positive front, both bills contained funding for the promotion of the upcoming update of the Dietary Guidelines for Americans (DGAs). This is the first time the DGAs have received a line-item allocation. In addition, language previously included in the agriculture funding legislation, which would roll back science-based nutrition standards for sodium, whole grains, and fluid milk in school meals, are no longer in either bill – though in part due to USDA reopening this rule.
Unfortunately, the House bill this year included new attacks on nutrition policy. There is a rider on the DGAs that requires additional reporting to Congress on changes to the process, which could be problematic as the update process for the DGAS moves further along. There is also a rider on the Nutrition Facts Label that would prohibit the update from advancing unless the final rule does not require products such as maple syrup and honey to have an added sugars label. It is bad precedent to legislate nutrition labels that should be based in science and handled through the regulatory process.
The association will continue to push for agriculture appropriations legislation without riders that are detrimental to science-based nutrition policy.
Contact: Kristy Anderson
Legislative Actions Threaten New Menu Labeling Regulations
Opponents are still trying to roll back the new menu labeling law that went into effect in May. Under the regulations, restaurants and other retail food establishments with 20 or more locations are required to post calories and provide nutrition information to consumers upon request.
The latest legislative effort to undermine the law would exempt restaurant chains with at least 75 percent of sales off premises, such as pizza and other major take-out chains, from labeling calories for their menu items. In addition, the proposal would weaken menu labeling enforcement and consumer protection measures. Efforts to “hotline” the bill in the Senate, or approve it without an actual vote, were defeated in June and July. We anticipate that the anti-menu labeling community will continue to look for ways to move their agenda forward, which we will fight as we work for the law’s successful implementation.
Contact: Kristy Anderson
Association Submits Comments on Flavored Tobacco and Calls on FDA to Stop Sale of Some E-cigarettes
In July, the association submitted comments in response to the Food and Drug Administration’s (FDA) request for information on flavored tobacco. The FDA asked for data on the role that flavors play in the initiation, use and cessation of tobacco products. The agency plans to use the information to determine how to regulate flavored tobacco products.
Our letter called on the FDA to ban characterizing flavors, including menthol, from all tobacco products. The letter discussed the significant increase in flavored tobacco products on the market; the high rates of initiation and continued use among youth and young adults; and the lack of evidence supporting their use as a cessation tool. The letter also raised concern about the number of toxins found in some flavorings. We suggested that the only possible circumstance in which a flavor should be allowed is when the manufacturer proves that a specific flavor: 1) will help smokers quit tobacco altogether or switch completely to a less risky “noncombustible” product, 2) that the flavor does not attract youth or lead to increased initiation, and 3) that the flavor is safe, non-toxic, and does not cause developmental abnormalities.
In addition to the association’s detailed comments, almost 800 You’re the Cure advocates wrote letters to the FDA in support of a flavor ban.
In related news, on August 7, the association joined five other public health and medical organizations in calling on the FDA to stop the sale of new e-cigarettes that have been illegally introduced in recent months without the agency’s review. The products are similar to Juul e-cigarettes, which have become widely popular with teens. These new products are sleek, high-tech, easy-to-hide, come in kid-appealing flavors, and deliver a powerful dose of nicotine. Our efforts to remove these products from the market was covered by ABC’s Good Morning America.
Contact: Susan K. Bishop
Volunteer Speaks at FDA Event on Nutrition Innovation
On July 26, Anne Thorndike, M.D., represented the association at a Food and Drug Administration (FDA) meeting on nutrition innovation. Dr. Thorndike is vice chair of the association’s nutrition committee, a general internist at Massachusetts General Hospital, and an assistant professor of medicine at Harvard Medical School.
In her remarks, Dr. Thorndike discussed the increase in consumer demand for healthier foods and offered support for a standard “healthy” icon on food packages. An icon could help consumers easily identify healthy products and encourage the food industry to make a wider variety of healthy options available. However, Dr. Thorndike urged the FDA to first update and strengthen the definition of what can be labeled “healthy”. She also recommended several steps that the FDA could take to encourage innovation by the food industry and encouraged the agency to quickly finalize voluntary sodium reduction targets.
The public meeting was part of the FDA’s new Nutrition Innovation Strategy that was launched in March to find new ways to reduce the burden of chronic disease through improved nutrition. The FDA plans to implement the strategy over several years, including updating health claims, improving ingredient labels, modernizing standards of identity, reducing sodium, and educating consumers about menu labeling and the revised Nutrition Facts label.
Contact: Susan K. Bishop
STATE UPDATES
Tobacco 21 Advances Across the Country
From coast to coast, more municipalities are creating a future free of smoking by passing policies that set the legal age of sale for tobacco to 21.
Communities across the Northeast, including Massachusetts, New York and New Hampshire have passed formal policies to raise the legal age to buy cigarettes, protecting over 3 million people from the harms of tobacco.
Momentum for Tobacco 21 continues to build across the Midwest. Recently, Aurora, Gurnee, Peoria, Skokie, and Wheaton, Illinois, Minneapolis and Shoreview, Minnesota, and Topeka, Kansas all voted in favor of the policy. These actions have already shown positive results, with teen smoking rates dropping by over 35 percent in two Illinois cities. It is also predicted to lower overall smoking rates by 12 percent.
With a solid reputation for progressive public health values, Minneapolis recently enacted an ordinance banning menthol and flavored tobacco from any stores that allow anyone under 18 to shop. This action effectively removes these products from all convenience and grocery stores. In addition, this momentum for better tobacco policies led to a fast-paced campaign to pass Tobacco 21. The goal is to implement Tobacco 21 at the same time as the menthol ban.
Contact: Lucy Culp
Wisconsin and Louisiana Enact T-CPR Policy
Wisconsin has become the second state this year to pass legislation around High Quality Telephone CPR. The legislation requires that all 911 telecommunicators that answer emergency medical condition calls are trained to provide telephone CPR which incorporates recognition protocols and at minimum compression only CPR for calls with a suspected OHCA. This legislation will ensure that close to 6 million people in Wisconsin will be more likely to receive high quality CPR in an acute event.
Louisiana has also taken positive steps to expand access to High Quality Telephone CPR. A state Senate bill will ensure that 4.5 million people in Louisiana will be more likely to receive high quality CPR in an acute event.
Contact: Douglas Dunsavage
New York City and Howard County, Maryland Make Bike Paths More Accessible
New York City’s 8.5 million residents will benefit from city funding for the Hudson River Greenway. Manhattan’s Hudson River Greenway is the most heavily used bikeway in the United States—nearly 7,000 people ride a bike there every day. While the West Side of Manhattan enjoys this popular, well-maintained space for safe walking, running, and bicycling, residents on the East Side are not as fortunate. The waterfront of Manhattan’s East Side is a patchwork of pathways and esplanades of varying widths and quality with three significant gaps. This year, the association advocated to close the gap that makes the Greenway continuous to East Harlem, from 125th Street to 135th Streets. East Harlem continues to be one of New York City’s more vulnerable communities and has persistent health challenges, which makes this a particularly important achievement.
Down I-95 in Maryland, Howard County public officials announced their intention to create a community where walking is a viable transportation option for all residents with the addition of safe and connected bicycle network. The goal of the project is to foster equity by connecting underserved areas of the county, while also making it easier for residents to achieve a healthy weight and reduce their risk for heart disease and stroke. Health disparities are persistent throughout the county: 72 percent of African Americans, 67 percent of Hispanics and 59 percent of Whites do not have a healthy weight. In addition, 20 percent of residents do not engage in physical activity, 26 percent have high blood pressure and 31 percent have high cholesterol.
Contact: Katie Bishop Kendrick
CalFresh Pilot Project Puts Fruits and Vegetables Within Reach for SNAP Recipients
California’s state legislature, recently appropriated 9 million for the CalFresh Fruit and Vegetable EBT Pilot Project to increase the purchase and consumption of California-grown fruits and vegetables that are financially out-of-reach for low-income residents. The project incentivizes CalFresh shoppers by offering a dollar-for-dollar match for this state-grown produce.
Contact: Kim Milbrath
Virginia and Maine Work to Close the Coverage Gap
After years of tireless advocacy, Virginia has moved to close the coverage gap by expanding Medicaid. This decision is expected to provide coverage to over 300,000 Virginia residents. Currently, 138,000 individuals do not have access to affordable coverage.
In November, Maine voters approved a ballot measure to expand the state’s Medicaid program. Now, affordable health insurance will be available to over 70,000 Mainers. The state will now begin to implement the new law.
Contact: Lucy Culp
Three States Vote in Favor of Stroke and STEMI Facility Designations
South Carolina took proactive steps to create a more comprehensive stroke system of care with under a new regulation. Now all stroke facility tiers must provide a certificate of recognition by the Department of Health, and all EMS authorities must develop and implement protocol plans for stroke patients. In addition, the regulation requires that all hospitals that have a certification of recognition by the state report data to a statewide stroke registry (using GWTG-Stroke as the platform). Close to 13,000 stroke patients will have better access to stroke care, as a result.
In Tennessee a new policy campaign established by state Senate legislation, through requires that the Department of Health Designate nationally accredited STEMI Receiving and Referring Centers. EMS are also required to develop and implement protocol plans for cardiac patients. Close to 17,000 cardiac victims every year will now live in a state with a more comprehensive cardiac system of care.
Further south in Mississippi, a similar policy campaign, requires that the state Department of Health Designate nationally accredited STEMI Receiving and Referring Centers and requires EMS to develop and implement protocol plans for cardiac patients. This is a positive step for the over 6,000 Mississippi residents who experience a cardiac event annually.
Contact: Douglas Dunsavage
Arkansas and New Jersey Vote to Create STEMI Registries
Arkansas has the fifth highest stroke mortality rate and highest STEMI mortality rate in the country. Fortunately, funding for the Stroke and STEMI Registry programs, respectively, will positively impact all Stroke and STEMI patients in Arkansas. The additional funding for the stroke and STEMI registries will not only help ensure that processes are developed for the timely and quality treatment of patients but will also help educate all Arkansans about the signs of a stroke and heart attacks and what to do.
With the passage of New Jersey’s budget bill, $500,000 was appropriated for the development of a statewide stroke registry. This new comprehensive system will help to create a more centralized system of care for stroke patients.
Contact: Douglas Dunsavage
States Act to Combat Obesity
In late June, the City of San Francisco passed an interim budget that includes nearly $20 million in revenue generated from the sugar sweetened beverage tax. A portion of this funding ($3,228,000) will be provided to the San Francisco Unified School District to support physical activity, food access and educational programs provided by Community-Based Organizations, school nutrition, hydration stations and oral health.
Additionally, the Oakland City Council adopted a resolution authorizing the City Administrator to allocate funds to combat the health impacts of sugary drinks. The association worked with many partners to ensure the revenue from the sugar-sweetened beverage tax was allocated to issues around chronic disease and prevention, including hydration stations for schools, broad community education and marketing around the health impact of sugar consumption and evaluation and impact studies for funded efforts.
Governor Kim Reynolds of Iowa signed state legislation which includes $494,993 for Obesity Prevention Programming. Funds will be allocated to expand community obesity programs, such as 5-2-1-0. This program was designed to help central Iowa kids and families make healthy choices and recommends four daily health habits that kids can adopt with the support and encouragement of adults. The dollars appropriated for obesity prevention will help in its reduction and positively impact more than 3.1 million people throughout the state, of which more than 730,000 are under the age of 18.
Contact: Jill Ceitlin
Rhode Island Protects Children from Unhealthy Foods and Beverage Marketing
Children in Rhode Island will now be protected from the lure of unhealthy food and beverage marketing in school. A new policy mandates that foods and beverages marketed in schools must now meet minimum nutrition standards as defined by the USDA within the Healthy, Hunger-Free Kids Act of 2010, the Rhode Island Board of Education and local district wellness committees. The policy will positively impact over 140,000 Rhode Island students. This is the third state to enact legislation to protect children and prohibit the marketing of unhealthy foods and sugary drinks in schools.
Contact: Katie Bishop Kendrick
New York City Steps Up to Fund Physical Education
The New York City Department of Education – which is the largest school district in the country, serving over 1.1 million students – has voted to support PE Works. This city program hires s and trains certified physical education partners. The program also works with every school across the city to complete a needs assessment to ensure effective PE for grades K-12. Initially piloted at $6.6 million in FY16, the program was established as an official city initiative with FY17 funding. Current FY18 funding is $30.63 million and new FY19 funding increases this investment to $39.8 million. The goal of these dollars is to make sure that every school employs at least one certified PE teacher by the year 2020.
Contact: Katie Bishop Kendrick
New York City Launches Hypertension Initiative
Also, in New York City, the Department of Health and Mental Hygiene launched a Hypertension Initiative. The association serves on the initiative’s Steering Committee, Treatment Adherence Committee, Get Out the Message Committee and Healthy Lifestyles Committee. This effort intends to promote blood pressure screening, clinical guidelines and community education. The association prioritized hypertension funding within the New York City advocacy agenda at the beginning of FY 17-18. In addition to serving on the Steering Committee, the team also included hypertension appropriations as one of the lobby day asks and provided testimony at a city council budget hearing. As part of these efforts, New York City will spend $1.8 million over three years to install 100 blood pressure kiosks annually. The kiosks will be stationed in city buildings and pharmacies throughout the five boroughs.
Contact: Jill Ceitlin
