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Congressional Summer Wrap-Up

August 08, 2022

Over the weekend—by a 51-50 vote—the Senate approved the Inflation Reduction Act (H.R. 5376); the bill now moves to the House for approval. Additionally, during the past month Congress worked on several bills from annual appropriation bills to emergency COVID-19 funding. Below are summaries and an outlook on various pieces of legislation.

Inflation Reduction Act of 2022

On August 7—by simple majority vote—the Senate approved the Inflation Reduction Act of 2022, which includes new energy and climate spending, deficit reduction, an extension of Affordable Care Act premium subsidies for three years through 2025, prescription drug reform, and significant tax changes.

The full text of the bill is available for review.

Outlook

The House is expected to approve the Inflation Reduction Act this week and President Biden will sign it into law.

It is important to note this current bill does not include additional funding to support the response to COVID-19 or monkeypox. However, according to media reports, the Biden administration has been in constant communication with congressional leaders about the need for additional funding for both. However the path forward to garner approval by Congress on emergency supplemental funding for public health is unclear to the ASTHO government affairs team.

Specific provisions of the Inflation Reduction Act that may be of interest to state and territorial health officials:

  • Extension and expanded eligibility for Affordable Care Act premium tax credits, that were enacted as part of the American Rescue Plan, from 2023 to 2025.
  • Permits the Secretary of HHS to negotiate prices of high-cost medicines currently covered under Medicare.
  • Permits the Secretary of HHS to require drug companies to pay additional rebates if drug prices rise faster than inflation.
  • Cap insulin out-of-pocket costs for Medicare beneficiaries at $35 per month.
  • Creation of a $2,000 out-of-pocket cap for Medicare Part D beneficiaries.
  • Provisions for eliminating financial barriers to vaccines in Medicare Part D and Medicaid:
    • Coverage of adult vaccines that are recommended by the Advisory Committee on Immunization Practices (ACIP) under Medicare Part D.
    • Improving access to vaccines under Medicaid and CHIP.

Environmental and Climate Justice Block Grants

  • Appropriates $2.8 billion, to remain available until September 30, 2026, to award grants for activities that include:
    • Community-led air and other pollution monitoring, prevention, remediation, and investments in low zero-emission and resilient technologies and related infrastructure and workforce development that helps reduce greenhouse gas emissions and other air pollutants.
    • Mitigating climate and health risks from urban heat islands, extreme heat, wood heater emissions, and wildfire events.
    • Climate resiliency and adaptation.
    • Reducing indoor toxins and indoor air pollution.
    • Facilitating engagement of disadvantaged communities in state and federal public processes, including facilitating such engagement in advisory groups, workshops, and rulemakings.
  • Requires the Administrator for the EPA to appropriate $200 million to remain available until September 30, 2026, to provide technical assistance to grantees receiving funding for environmental and climate justice block grants.
  • Eligible entities include Indian tribes, local governments, institutes of high education, community-based nonprofit organizations, community-based nonprofit organizations, or a partnership of community-based nonprofit organizations.

Funding to Address Air Pollution at Schools

  • Appropriates $37.5 billion, to remain available until September 30, 2031, for grants and other activities to monitor and reduce air pollution and greenhouse gas emissions at schools in low-income and disadvantaged communities.
  • Appropriates $12.5 million, to remain available until September 30, 2031, for providing technical assistance to schools in low-income and disadvantaged communities to address environmental issues, develop school environmental quality plans, and identify and mitigate ongoing air pollution hazards.

Funding to Address Air Pollution

  • Appropriates $117.5 million, to remain available until September 30, 2031, for grants and other activities to deploy, integrate, support, and maintain fence line air monitoring, screening air monitoring, national air toxics trend stations, and other air toxics and community monitoring.
  • Appropriates $50 million, to remain available until September 30, 2031, for grants to expand the national ambient air quality monitoring network with new multipollutant monitoring stations; and replace, repair, operate, and maintain existing monitors.
  • Appropriates $3 million, to remain available until September 30, 2031, for grants and other activities to deploy, integrate, and operate air quality sensors in low-income and disadvantaged communities.
  • Appropriates $15 million, to remain available until September 30, 2031, for grants and other activities for testing and other agency activities to address emissions from wood heaters.
  • Appropriates $20 million, to remain available until September 30, 2031, for grants and other activities for monitoring emissions of methane.
  • Appropriates $25 million, to remain available until September 30, 2031, for Clean Air Act grants.
  • Appropriates $45 million, to remain available until September 30, 2031, to carry out activities concerning greenhouse gases.
  • Appropriates $5 million, to remain available until September 30, 2031, to provide grants to states to adopt and implement greenhouse gas and zero-emission standards for mobile sources.

Grants to Reduce Air Pollution at Ports

  • Appropriates $2.25 billion, to remain available until September 30, 2027, to award rebates and grants to eligible recipients to:
    • Purchase or install zero-emission port equipment or technology for use at or to directly serve one or more ports.
    • Conduct relevant planning or permitting in connection with the purchase or installation of such zero-emission port equipment or technology.
    • Develop qualified climate action plans.
  • Appropriates $750 million, to remain available until September 30, 2027, to award rebates and grants to states to eligible recipients, including:
    • A port authority.
    • State, regional, local, or Tribal agency that has jurisdiction over a port authority or a port.
    • An air pollution control agency.

Diesel Emissions Reductions

  • Appropriates $60 million, to remain available until September 30, 2031, for grants, rebates, and loans to identify and reduce diesel emissions resulting from goods movement facilities, and vehicles servicing goods movement facilities in low-income and disadvantaged communities to address the health impacts of such emissions on such communities.

Funding for Renewable Fuel Standards at EPA

  • Appropriates $5 million, to remain available until September 30, 2031, to support:
    • The development and establishment of tests and protocols regarding the environmental and public health effects of a fuel or fuel additive.
    • Internal and extramural data collection and analyses to regularly update applicable regulations, guidance, and procedures for determining lifecycle greenhouse gas emissions of a fuel.
    • The review, analysis, and evaluation of the impacts of all transportation fuels, including fuel lifecycle implications, on the general public and low-income and disadvantaged communities.

Funding for Enforcement Technology and Public Information

  • Appropriates $18 million, to remain available until September 30, 2031, to update the Integrated Compliance Information System of the EPA and any associated systems, necessary information technology infrastructure, or public access software tools to ensure access to compliance data and related information.
  • Appropriates $3 million, to remain available until September 30, 2031, for grants to states, Indian tribes, and air pollution control agencies to update their systems to ensure communication with the Integrated Compliance Information System of the EPA and any associated systems.

Environmental and Climate Data Collection

  • Appropriates $32.5 million, to remain available until September 30, 2026, to support data collection efforts, track disproportionate burdens and impacts of such data, and support efforts to ensure that any mapping tool is accessible to the community-based organizations.

Neighborhood Access and Equity Grant Program

  • Appropriates $1.9 billion, to remain available until September 30, 2026, to the Administrator of the Federal High Administration for competitive grants:
  • To improve walkability, safety, and affordable transportation access through construction projects.
  • Mitigate or remediate negative impacts on the human or natural environment resulting from a facility in a disadvantaged or underserved community.
  • For planning and capacity-building activities in disadvantaged communities.
  • Eligible entities include states, territories, units of a local government, or political subdivisions of a state.

Improving Energy Efficiency or Water Efficiency or Climate Resilience of Affordable Housing

  • Appropriates $837.5 million, to remain available until September 30, 2028, for the cost of providing direct loans and grants to fund projects that improve energy or water efficiency, indoor air quality or sustainability, implement the use of low-emission technologies, address climate resilience, or building electrification of an eligible property.

Senate FY23 LHHS Appropriations Bill & COVID Supplemental Funding Bills

On July 28, the Senate Committee on Appropriations released its Labor, Health and Human Services, Education and Related Agencies (LHHS) FY23 appropriations bill. Included in the package of bills is $21 billion in emergency COVID-19 and other emerging diseases supplemental funding. The proposed funding levels included within the bill are subject to change as both chambers of Congress are expected to negotiate on their respective pieces of legislation.

Available for review are the text of the full LHHS committee draft bill, the draft report, and a Senate-drafted summary of the appropriations bill.

A summary of the COVID-19 and other emerging disease emergency supplemental funding request is also publicly available.

Outlook

Funding levels in the Democrat’s Senate bill are lower than those proposed levels in the House and were not negotiated in a bipartisan manner, creating hurdles for future work on FY23 appropriations. Significant policy differences remain between the two parties and must also be addressed. The Senate bills are not likely to be even considered by the respective appropriation committees anytime soon. It is also important to note that the House did not include any additional COVID-19 supplemental funding in their package of appropriation bills.

Considering that we are in an election year, it is expected that Congress will need to pass a short-term continuing resolution that funds the federal government at FY22 levels before September 30, 2022, to avoid a government shutdown and provide certainty through the midterm election cycle. It is unclear if Congress will approve a long-term continuing resolution or a final FY23 appropriations bill after the midterm elections. Moreover, the proposed emergency supplemental funding for COVID-19 needs to garner 60 votes necessary to advance in the Senate therefore it is unclear if Congress would add emergency supplemental funding as an “anomaly” to the continuing resolution.

Key Public Health Funding Proposal Highlights

ASTHO members' priorities saw proposed increases or level funding in the bill:

  • $600 million, a $400 million increase from FY22 for public health infrastructure and capacity nationwide.
  • $200 million, an increase of $100 million to modernize public health data surveillance and analytics at CDC and State and local health departments.
  • $100 million, an increase of $92 million, for the CDC's social determinants of health programs.
  • $740 million, an increase of $25 million for Public Health Preparedness Cooperative Agreements.
  • $325.6 million, an increase of $30 million, for the ASPR Hospital Preparedness Program (HPP).
  • $160 million, or level funding for the Preventive Health and Health Services Block Grant.

Review the comprehensive subcommittee summary for information about other funding levels and policy proposals for CDC, HRSA, SAMHSA, and additional public health programs.

COVID-19 Emergency Supplemental Funding

This bill proposes $16 billion in emergency supplemental funding through the Public Health and Social Services Emergency Fund (PHSSEF), including:

  • $9 billion for the Biomedical Advanced Research Development Authority for advanced research and development, manufacturing, production, purchase, and distribution of medical countermeasure against COVID-19 including vaccines, therapeutics, tests, diagnostics, and medical products and supplies.
  • $6.25 billion in flexible funding to allow the Department of Health and Human Services to purchase and distribute vaccines, therapeutics, and diagnostics to ensure a sufficient supply to meet demand if and when a new variant or surge of infections emerges.
  • $750 million for research and clinical trials for vaccines focused on emerging coronavirus strains and to support domestic manufacturing capacity.

The bill also provides $5 billion in emergency funding to support the global response to COVID-19.

Child Nutrition Reauthorization (Healthy Meals, Healthy Kids Act)

The Healthy Meals, Healthy Kids Act (H.R. 8450) recently advanced out of the House Committee on Education. The bill reauthorizes critical child nutrition programs including the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), the Child and Adult Care Food Program, school meals, and summer feeding programs. The bill is now headed to the House floor where a timeline for consideration is unclear. Key highlights include:

  • Extension of postpartum eligibility from six months (non-breastfeeding) and one year (breastfeeding) to two years for 900,000 participants.
  • Permits remote certifications beyond the COVID-19 pandemic to ensure greater access to WIC services.
  • Increases the investment in WIC’s Breastfeeding Peer Counselor Program (from $90 million per year to $180 million).
  • Provides regulatory relief to facilitate WIC’s transition to online shopping options, with a target of scaling up nationally by 2025.

Telehealth Rules Extension

The Advancing Telehealth Beyond COVID-19 Act of 2022 (H.R. 4040) was passed by the House on July 27 with broad bipartisan support (416-12) and is currently under consideration by the Senate, where it is expected to receive bipartisan support. Key highlights of the bill include:

  • Removal of geographic requirements and an expansion of originating sites for telehealth services for two years ending on December 31, 2024.
  • Extends practitioner eligibility to furnish telehealth services for two years ending on December 31, 2024.
  • Extends telehealth services for federally qualified health centers and rural clinics for two years ending on December 31, 2024.
  • Delays requirements for mental health services furnished through telehealth until after January 1, 2025.
  • Extends the furnishing of audio-only telehealth services ending on December 31, 2024.
  • Expands the use of telehealth services for recertification of hospice care eligibility ending on December 31, 2024.

Reauthorization of Mental Health and Substance Use Programs

The Restoring Hope for Mental Health and Well-Being Act of 2022 (H.R. 7666) was passed by the House on June 22 with broad bipartisan support (402-20) and is currently under consideration by the Senate. The bill seeks to reauthorize key programs that support prevention, treatment, and recovery services at SAMHSA, expand access to medications for addiction treatment, bolster the behavioral health care workforce, eliminate the need for practitioners to apply for a waiver to administer scheduled drugs, expand pediatric mental health care, and increase treatment services for maternal mental health amongst other important things. A full analysis of the bill will be completed and released in the coming weeks.

CHIPS and Science Act

The CHIPS and Science Act of 2022 (H.R. 4346) was approved by Congress on a bipartisan basis and was signed into law by President Biden. While this bill primarily focuses on research and technology, some of the provisions may impact public health knowledge. A fact sheet of the bill is available, as are a section-by-section summary and the bill text. Specific provisions of the bill that may be of interest to state and territorial health officials include:

  • Expands the National Institute of Standards and Technology's greenhouse gas measurement activities to help governments and organizations accurately measure emissions at all scales.
  • Supports research at the National Science Foundation on risk assessment, predictability, and development of tools for increased societal resilience in the face of catastrophes like national disasters.
  • Supports social and behavioral science research on the impact of social media and consumer technology on mental health, particularly on the health of children and adolescents.