Heart on the Hill - February 2018

Stroke Telemedicine and Cardiac Rehab Legislation Pass Congress

A two-year budget deal, approved by Congress in early February, included provisions the association has been advocating for over the past several years that will expand telestroke and cardiac rehabilitation services.

Under the budget legislation, Congress approved the Furthering Access to Stroke Telemedicine (FAST) Act, which would require Medicare to reimburse hospitals for telestroke services nationwide, regardless of where a patient lives.

The Improving Access to Cardiac and Pulmonary Rehabilitation Act was also included as part of the agreement. The bill passed by Congress will allow physician assistants, nurse practitioners and clinical nurse specialists to supervise cardiac and pulmonary rehabilitation on a day-to-day basis under Medicare and hopefully encourage more use of these very effective programs. The provision will go into effect in 2024 – due to budgetary constraints – but the association hopes to get it moved forward in subsequent legislation.

Also, contained in the budget bill was a provision which repealed arbitrary Medicare payment caps for outpatient therapy services. The caps have seriously limited treatment options for millions of Americans, especially those recovering from a stroke.

Lastly, this budget deal contained a commitment for a $2 billion increase over two years for the National Institutes of Health (NIH). This serves as the floor not the ceiling for NIH funding in 2018 and 2019. Earlier this year for 2018, the Senate Appropriations Committee's legislation contained a $2 billion increase for the NIH (for the third year in a row) and the House Appropriations Committee's bill contained a $1.1 billion increase for the NIH. These numbers must be reconciled in conference. The association expects to see the final 2018 funding level for the NIH by the end of March.

CEO Nancy Brown thanked Congress following the vote and said, “This game-changing bill could not come at a better time. In the next two decades, 45 percent of the total U.S. population will have cardiovascular disease with costs expected to reach $1.1 trillion. We hope to find more health care strategies like these to help wipe out the burden of heart disease and stroke.”

Contact: Katie Berge

Health Advocates, Lawmakers Discuss Nation's Obesity Problem

After decades of sharp increases, the rise in obesity rates among both children and adults has slowed in recent years, according to a “State of Obesity” report discussed during a Congressional briefing on February 14th.

Despite these promising statistics, the report, released last August by the Trust for America's Health and the Robert Wood Johnson Foundation, found that obesity remains a top-of-mind concern in communities across the country. Nationally, the obesity rate among children ages 2-19 has remained stable in recent years, at about 17 percent.

Factors related to racial and socioeconomic inequities in obesity rates are still an issue. Rates are higher among Latino (21.9 percent) and African-American (19.5 percent) children than among white (14.7 percent) and Asian (8.6 percent) children, the report said.

CEO Nancy Brown described how the association and Voices for Healthy Kids is working with community leaders in every state to advocate for health and wellness policies that create greater access to healthy foods and places to be active.

“We are committed to improving heart and brain health for everyone, regardless of race, ethnicity, gender, income or ZIP code,” she said.

Across the country, states are increasingly implementing or evaluating the impact of nutrition and physical activity policies to provide greater accessibility for underserved communities.

However, the weakening of school nutrition standards and funding cuts to obesity prevention programs, among other efforts, could stall this progress, health advocates told lawmakers.

Contact: Kristy Anderson

Women in Congress Go Red

Nearly 40 women lawmakers from the House of Representatives participated in this year's “Congressional Women Go Red” photo event on February 14th.

Co-chairs of the Women's Caucus, Representatives Susan Brooks (R-IN) and Lois Frankel (D-FL) assisted in arranging the photo. In the Senate, Senator Mazie Hirono (D-HI) organized the photo. In addition, Senators Hirono and Lisa Murkowski (R-AK) introduced and passed a resolution recognizing February 2018 as American Heart Month and February 2, 2018 as National Wear Red Day.

To celebrate American Heart Month and support women's heart health the photos were widely disseminated on the representatives' social media channels. Lastly, Representative Chris Smith (R-NJ) introduced a resolution on February 27th to acknowledge the ever-growing burden of CVD in the U.S. and around the world. This resolution also recognized February 2018 as American Heart Month.

Contact: Alison Council

FDA and Congress at Odds Over Menu Labeling

To help chain restaurants, movie theaters, sports arenas, grocery and convenience stores meet the new May 7, 2018 deadline for posting calorie information, the Food and Drug Administration (FDA) recently released supplemental guidance. The draft guidance document addresses concerns raised by some retail food establishments and provides additional options for complying with the menu labeling requirements.

In comments submitted to the FDA Jan. 8, the association recommended several small modifications to the guidance, but expressed overall support for the document and encouraged the agency to finalize it quickly. The association also met with FDA Commissioner Scott Gottlieb, M.D., the same day to voice our strong support for menu labeling and to urge the agency not to weaken the existing requirements.

Unfortunately, the House of Representatives recently passed a bill that would weaken parts of the menu labeling law. The “Common Sense Nutrition Disclosure Act” would, among other things, allow food establishments to determine their own serving sizes; make it difficult to find calorie information while at the establishment; and weaken enforcement and consumer protection.

The association has strongly opposed this bill over the past few years and recently sent a letter to Congress asking representatives to vote against the bill. The association also activated our volunteers and around 300 advocates wrote to their House members asking them to oppose the legislation.

We are working hard to keep the Senate from following the House's lead and instead, respond to the consumers' need to make healthier, informed choices about what they and their families eat. The vast majority of Americans back the FDA's menu labeling requirements and updates to the Nutrition Facts panel, according to a new poll commissioned by the Center for Science in the Public Interest.

Contact: Susan K. Bishop and Kristy Anderson

USDA Reverses School Meal Standards

Late last year, the U.S. Department of Agriculture (USDA) released an interim final rule (IFR) that would roll back the evidenced-based nutrition standards for sodium, whole grains, and milk in child nutrition programs.

Their action came at a time when nearly 100 percent of schools are in compliance with the standards. Evidence shows that the schools increased whole grains, fruit, and vegetable consumption, changes that have the potential to improve health outcomes and save money down the road. The association has been a leading advocate in opposing changes to the school foods nutrition standards.

Currently, all grain served must be 100 percent whole grain-rich, meaning grain products must be at least 51 percent whole grains and the rest of the grains enriched. The IFR would permanently allow schools to submit waivers for products that don't meet the whole grains standards.

Sodium levels, which vary based on age and the type of meal, are currently at target one of three. The IFR has extended the time for implementation of target two, which was supposed to go into effect last year, with no clear path forward or reassurance that they will continue with sodium reduction. The IFR would also now allow 1 percent flavored milk with no calorie limits, which could increase the amount of calories and saturated fat a child consumes.

In our comment letter to the USDA, the association opposed these changes, reiterated the science and the need to keep the standards strong for the sake of children's health, and offered suggestions on how to help programs to achieve these goals.

The advocacy community collectively submitted nearly 100,000 letters against the roll back of child nutrition standards, including 4800 letters from You're the Cure volunteers.

While the program may need to be fine-tuned occasionally, and some schools might need extra technical assistance to help them get across the finish line, reopening the school meals nutrition regulation is a dangerous and unprecedented step.

The science-based nutrition standards are working, and kids are healthier because of them. The association will continue to put children's health first and strongly advocate to protect these standards.

Contact: Kristy Anderson

President's 2019 Budget Cuts NIH, CDC

On February 12th, President Donald Trump submitted his FY 2019 budget to Congress. Despite the president's proposed budget, the government will continue to operate under the 2017 funding levels. Final decisions on 2018 appropriations are still in limbo.

Our review of the President's 2019 proposal focused, as usual, on how it funds the association's top priorities, including the National Institutes of Health (NIH) and Centers for Disease Control and Prevention's (CDC) heart disease and stroke prevention programs.

The Trump administration's proposal flat-funds the NIH and requires it to absorb the costs of three other federal departments – the Agency for Healthcare Policy and Research, the National Institute of Occupational Safety and Health and the National Institute on Disability, Independent Living, and Rehabilitation Research. The association has expressed concerns about this proposed change and funding.

“This budget will do little to help us combat the burden cardiovascular disease will place on this nation's financial and health care systems in the coming years," said American Heart Association President John J. Warner, MD. "The association calls on Congress to instead boost the NIH's budget by at least $2 billion in both FY 2018 and FY 2019."

The president is also proposing to consolidate the CDC's chronic disease programs into an America's Health block grant and to zero out funding for Million Hearts 2022. The CDC translates prevention research into public health practice to improve the nation's cardiovascular health. Million Hearts is a public-private partnership designed to prevent 1 million heart attacks and strokes over the next five years. The White House made the same recommendations last year, but each were soundly rejected by the House and the Senate Appropriations Committees.

The association is calling on Congress to reject the block grant proposal and increase funding for Million Hearts, as it did in 2017.

Contact: Claudia Louis

New NASEM Study on E-Cigarettes

In late January, the National Academies of Sciences, Engineering and Medicine (NASEM) released a new comprehensive study on the “Public Health Consequences of E-Cigarettes.”

The report found that e-cigarettes are not without health risks, but are likely to be less harmful than conventional cigarettes. It also stated that using e-cigarettes may help adults move away from conventional cigarettes. However, more research is needed, especially to determine the long-term health effects, according to the study's authors.

Health experts who wrote the report were particularly concerned when they found that teens and young adults who use nicotine-containing e-cigarettes are more likely to try conventional cigarettes. Use of e-cigarettes among U.S. high school students is on the rise, jumping from 1.5 percent in 2011 to 11.3 percent by 2016.

The researchers who wrote the study have theorized that one reason for the high usage among teens is the way e-cigarettes are marketed, often by promoting flavors like strawberries and cream that are popular among younger users.

Yet there is still not enough long-term evidence to conclusively determine whether young people are just experimenting with e-cigarettes or becoming habitual smokers, according to the report.

The report supports many of the recommendations made in the association's 2014 e-cigarette policy, which advocated for further research to fully understand the potential benefits and harms of e-cigarettes. In a statement, CEO Nancy Brown called the NASEM report a timely contribution to the ongoing debate about e-cigarettes. She said that this report demonstrates the need for further research.

“Until we have sufficient scientific data, we must have strong FDA regulation of these products and any new versions that come on the market,” she said.

Contact: Susan K. Bishop

Tobacco and Prevention Fund Appropriations

Unfortunately, there have yet to be any updates on tobacco appropriations due to the absence of a final FY2018 appropriations bill. However, the association remains vigilant to the threat of riders that would impede the Food and Drug Administration's (FDA) ability to oversee harmful tobacco products, like e-cigarettes and cigars.

The association also remains concerned about the final funding level of the Center for Disease Control's (CDC) Office of Smoking and Health (OSH). CDC's OSH operates the successful Tips from Former Smokers Campaign that has spurred over a half a million Americans to quit smoking. It is important that as the Senate and House finalize FY18 appropriations, legislators continue to remain aware of the important work undertaken by OSH.

Unlike tobacco, appropriations for the Prevention and Public Health Fund (PPHF) have been affected significantly because of recent Continuing Resolutions (CRs).

Although the final Children's Health Insurance Plans (CHIP) package did not use PPHF dollars as a pay for, as was originally proposed, the PPHF did take a $750 million cut under the December 8 CR. In addition, the February 8 CR, known as the Bipartisan Budget Act of 2018, included a $1.35 billion cut over the next 10 years.

The PPHF is responsible for the funding of several important public health and heart disease-related programs, including Million Hearts and the CDC's Division for Heart Disease and Stroke. As with tobacco, it is crucial that these public health programs remain funded.

Contact: Alison Council


Four States Fund Biking and Walking

Raleigh residents will benefit from a bond measure that recently passed, which secures $35 million for pedestrian and biking infrastructure, greenways, and Safe Routes to School infrastructure funding. The funding under this bond builds upon the city's past investments in pedestrian and biking infrastructure. Most recently, Raleigh's 2018 budget approved $2,002,00 for bicycle and pedestrian improvements, and $285,000 to fund the city's BikeShare program.

Down the coast in Florida, Pinellas County voted to dedicate an estimated $412 million of their budget to transportation infrastructure, including walking and biking, impacting the nearly one million residents who rely on safe sidewalks and streets.

Denver residents will have more physical activity spaces under the Denver GO Bond which secured more than $115 million for walking and biking infrastructure in the state. Historically, Denver has lacked sidewalks, but under this bond, $30 million will be used for sidewalk improvements.

Finally, Travis County Texas has approved a transportation bond that will have a significant impact on walking and biking in the area. Sixty-five million dollars has been dedicated over the life of the bond to several of these projects. In addition, walking and biking infrastructure will be built into the other transportation projects funded and incorporated into the overall design. In Dallas, the 2017 Capital Bond program secured tens of millions of dollars for walking and biking infrastructure within the city. Among the projects that will be funded are $6.24 million for system-wide sidewalk improvements and ADA Pedestrian ramp upgrades. Additional transportation projects within each district, as well as system-wide, will also incorporate walking and biking improvements within the project design.

Osceola County, FL Passes CPR in Schools Policies

Osceola County joins the growing list of large school districts in Florida that have enacted formal policy around CPR training in schools. This means that over 10 thousand students every year in Osceola County will be trained in guideline-based CPR.

Contact: Douglas Dunsavage

Complete Streets in Kansas City and Oklahoma City

New Kansas City infrastructure/road projects will now have to include complete streets components that are context-appropriate for the area; leading to active living for the 481,000 residents of the city. The complete streets policy, which passed in December 2017, should make it easier for residents to get more exercise and the data illustrates that 43 percent of residents with safe places to walk within 10 minutes of home meet recommended activity levels compared to just 27 percent of those without safe places.

In January 2018 the city council and mayor in Oklahoma City adopted a new livable streets (complete streets) policy which will ensure that more people have access to safe walking and biking opportunities in their respective neighborhoods. Studies show people who reside in walkable neighborhoods are typically more active, which reduces the risk of many chronic diseases, such as diabetes and heart disease. More than 32 percent of Oklahoma adults are classified as obese, according to 2016 data by Centers for Disease Control and Prevention. Livable Streets will help provide the opportunity for everyone to walk or bike to their destination.

Contact: Tim Vaske

CPR Passes in Florida and Kansas

Pinellas County joins the growing list of large school districts in Florida that have enacted formal policy around CPR training in schools. As a result, close to 7,000 additional students every year in Pinellas County will now be trained in guideline-based CPR. Five thousand more students in Brevard County will also receive annual training in guideline-based CPR. These two counties add to the over 2.4 million students already getting this training across the country.

Kansas has become the 38th state to enact policy requiring CPR training for graduation. This means that more than 31,000 students in Kansas will now be trained each year in guideline-based CPR.

Contact: Douglas Dunsavage

Three States Vote to Improve Early Care and Education

North Carolina has adopted rules and regulations that will positively impact both center and home-based childcare settings. Over 200,000 children will now have access to better food, improved learning and play environments in childcare homes and centers across the state.

Across the country, more than 400 licensed early care and education centers and more than 1,400 licensed home-based early care and education providers in Utah will now offer more nutritious food, increased physical activity opportunities and limited screen time. This new rule will ensure that the children in their care will be provided the best environment to learn and grow.

Finally, over 30,000 children who are enrolled in center-based childcare programs in Rhode Island will be positively impacted by improvements made in the state's childcare wellness policies.

Contact: Tim Vaske

Sugary Beverages are Taken off the Menu in Long Beach, California

On November 14, the City of Long Beach adopted the final reading of the Kids First Choice policy, removing sugary drinks from kids' meals in the city's restaurants. The policy, first introduced on October 17, received unanimous support from the council members in attendance. Long Beach has over 470,000 residents and 1,200 restaurants.

Contact: Katie Bishop Kendrick

Smoke-Free in Forth Worth and East Baton Rouge Parish

The city of Fort Worth passed a comprehensive smoke-free ordinance, making it the last major city in Texas to go smoke-free. This historic win comes after a two-year campaign that capped nearly 10 years of work to make this a reality for Fort Worth residents.

The residents of East Baton Rouge can now breathe a little easier. The Parish Council voted to go smoke-free which will protect the nearly 450,000 residents who live in the parish.

Contact: Lucy Culp

Tobacco 21 Passes in Onondaga County, New York

Residents in Onondaga County, New York will now have to wait until they are 21 to purchase tobacco products. This new regulation, which raises the legal age from 18, will protect nearly 470,000 individuals from ever beginning to smoke.

Contact: Lucy Culp

Seattle Helps to Close the Food Security Gap

Seattle took proactive steps to close the “food security gap” by allocating $2,404,359 from the Seattle sugary drink tax to expand the Fresh Bucks program. These funds will be distributed to help those families that do not qualify for SNAP benefits but remain food insecure. This provision also expands program eligibility, increases the number of retail locations where participants can use Fresh Bucks, boosts community-based outreach and promotion efforts, adds to the number of clinics and patients that receive Fresh Bucks incentives through their healthcare providers and supplies funding for seven federal training educators to support this expansion.

Contact: Kim Milbrath