Heart on the Hill - November 2017

Administration/Congress Target ACA

Efforts to repeal the Affordable Care Act (ACA) stirred up political turmoil, wreaking havoc on the congressional calendar, and scuttling many other legislative priorities as summer ended and fall began.

Earlier attempts to repeal and revamp the ACA under budget reconciliation rules were narrowly defeated in July. Senators Susan Collins (R-ME), Lisa Murkowski (R-AK) and John McCain (R-AZ) voted with Democrats, blocking the Health Care Freedom Act also known as the "skinny repeal." Despite this very public defeat, Senate Republicans made another last-ditch attempt at health care reform after returning from the August recess.

On September 13, Senators Lindsey Graham (R-SC) and Bill Cassidy (R-LA) introduced the "Graham-Cassidy" proposal. Under their plan, states would have been given the ability to waive important patient protections, including portions of the essential health benefits package. The legislation would also have made drastic cuts to Medicaid, a critical safety net program that provides treatment and care for millions of Americans with cardiovascular disease and stroke.

The association and several other patient and provider groups held a press conference and fly-in on September 25 to raise awareness of how Graham-Cassidy would impact the health care community. Patients from several states explained how they would be negatively affected by the legislation and met with key members of the Senate Finance Committee. Despite a frenzied effort by leadership and the bill sponsors, the proposal stalled in the Senate after Senators McCain and Collins publicly opposed the bill, allowing budget reconciliation procedures to expire on September 30.

The failure of these attempts to repeal the ACA did not end the discourse over health care reform. In mid-October, President Trump signed an executive order, which will further destabilize the ACA, and then almost immediately moved to terminate cost-sharing reduction payments. The fallout from these actions could be catastrophic to Americans wrestling with heart disease and stroke.

One effort that holds promise is the Senate Health, Education, Labor and Pensions (HELP) Committee's exploration of bipartisan fixes to our current health care system. The committee’s bipartisan negotiations on stabilization were temporarily stalled while the drama surrounding the Graham-Cassidy proposal unfolded, but have recently been reignited in the wake of its failure. However, significant challenges still lie ahead. In late October, Senator Orrin Hatch (R-UT) and Congressman Kevin Brady (R-TX) introduced another stabilization bill, which again casts a shadow of uncertainty over both the process and the outcome. These dueling legislative packages, in conjunction with the recent moves by the White House, will continue to significantly impact patients’ ability to access affordable and adequate coverage.

The association is encouraged and supportive of the ongoing bipartisan discussions in the HELP Committee and urges Congress to continue to utilize regular order to find long-lasting solutions to the issues that currently plague the nation’s health care system.

Contact: Katie Berge

Increasing Focus on State Medicaid and ACA Waivers

2017 has also been a busy health care year for governors and state legislators. Many states, including Iowa, Wisconsin, Massachusetts, Maine, Oklahoma, Arkansas and others have actively pursued changes to both the Medicaid program and the Affordable Care Act (ACA) through state innovation waivers.

The "1332" and "1115" waivers affect two distinct health care populations: ACA enrollees and Medicaid participants, respectively. While different and unique, these waivers can have overlapping impacts on the patient populations and the underlying programs they are intended to serve, either directly or indirectly.

The association has been both encouraged and concerned by some of the policies included in these waivers. For example, Alaska used 1332 waivers to implement a reinsurance program that has been successful in improving affordability, maintaining access to high-quality care and addressing the unique needs of state residents. In more recent proposals, including those from Iowa and Oklahoma, provisions were included that could result in fewer individuals enrolling in insurance due to cost, while also reducing access to critical services. Iowa recently withdrew their waiver request, citing concerns regarding the Department of Health and Human Services' (HHS) delay in acting on their request in advance of the 2017 open enrollment period.

1115 waivers have been used by states for decades to develop, test and implement novel approaches to providing health care services and reducing costs in the Medicaid program. There are concerns that provisions within some waivers will result in excessively restrictive drug formularies, barriers to those seeking emergency care, drastic changes in eligibility requirements and implementation of work requirements that would pose substantial barriers to care for cardiovascular disease patients.

We anticipate an increasing volume of waivers from states in the coming years and months. The association will continue to carefully assess and work to influence submissions that contain problematic provisions. While allowing states to make constructive modifications to better meet the needs of their citizens who rely on Medicaid and ACA is laudable, we must be diligent to ensure that waivers are not used to undermine coverage for those who rely on the exchanges and Medicaid, patient protections and the long-term stability of the individual market. We will continue to work with our coalition partners at the federal and state levels to shine a light on how these waivers would impact our patients both positively and negatively.

Contact: Katie Berge

ACA Open Enrollment Push

The new administration has taken steps to undermine the Affordable Care Act (ACA) and the upcoming open enrollment period, including reducing the amount of time consumers will have to seek or renew their coverage, dramatically cutting funding and support for navigator services to assist individuals in understanding their coverage options, virtually eliminating all advertising and awareness campaigns, and scheduling planned outages of the exchange website at crucial times during open enrollment. To fill this void, the association, along with our coalition partners from across the health care field, will promote outreach and enrollment to all of our patient populations. Through our collaboration, we hope to ensure that Americans understand the changes to the enrollment period, where to find in-person and online resources, and how to comparison shop for insurance.

The connection between health insurance and health outcomes is clear and well-documented. Americans with cardiovascular disease (CVD) who lack health insurance, or are underinsured, have higher mortality rates and poorer health outcomes than their insured counterparts. As one of the country’s largest and oldest patient advocacy and research organizations, we remain committed to connecting with patients who have CVD and stroke to let them know where and how to enroll in health care coverage, including through the exchanges, Medicare and Medicaid.

We look forward to working with internal and external partners to guarantee that our patients have access to the lifesaving and sustaining care they need to live healthier, happier lives.

Contact: Katie Berge

FDA Proposal Would Delay Updated Nutrition Facts Label

On September 29, the Food and Drug Administration (FDA) proposed delaying the compliance deadline for the revised Nutrition Facts label by 18 months. Under the proposal, food manufacturers would have until January 2020 or January 2021, depending on company size, to begin using the new label on their food products.

The FDA suggested the delay after receiving requests from the food industry for more time. According to the agency, the additional time will help manufacturers update and print new product labeling, reduce industry production costs and give the FDA more time to provide further guidance to manufacturers on implementation. However, the FDA did acknowledge that the delay will decrease benefits to consumers since they will have to wait longer for updated nutrition information.

In a statement, the association’s CEO Nancy Brown expressed disappointment with the proposed delay. She called it unnecessary since many companies are already using the revised label on their products, and urged the FDA to keep the original compliance deadlines (July 2018 for larger companies and July 2019 for smaller ones).

The association repeated these concerns in detailed comments submitted to the FDA, and launched a grassroots campaign to generate letters to the agency opposing the delay.

Contact: Susan K Bishop

2018 Health Appropriations Bills Advance

In early September, the Senate Appropriations Committee joined their House counterparts in rejecting the Trump Administration's recommended $7 billion cut to the National Institutes of Health’s (NIH) budget. The Senate panel, however, gave the NIH a $2 billion increase for the third year in a row, compared to the $1.1 billion increase proposed by House Appropriations Committee. Under the Senate funding, the National Heart, Lung, and Blood Institute would receive $3.323 billion and the National Institute of Neurological Disorders and Stroke would get $1.905 billion.

We joined with the rest of the medical research community in advocating for the $2 billion increase for the NIH. In a statement, the association’s President John Warner said "To advance life-saving research into heart disease and stroke, funding for the NIH must continue to grow. Now, more than ever, it is critical that this research be made a national priority because the burden of cardiovascular disease is growing faster than our ability to combat it."

The association has activated both its Scientific Council and You’re the Cure network to contact their congressional members and ask them to include the Senate Appropriations Committee’s funding recommendation for the NIH in the final bill.

Both the House and Senate Appropriations Subcommittees also rejected the White House’s proposal to fund the Centers for Disease Control and Prevention’s (CDC) chronic disease programs, including heart disease and stroke prevention, via a block grant. This plan would have greatly undermined the CDC’s focus and resources needed to stem the tide of cardiovascular disease. The association and other groups strongly advocated against a block grant and are pleased that the Senate and the House abandoned the idea. However, unfortunately, the Senate did not follow the House’s lead when it came to support for the CDC’s Division for Heart Disease and Stroke Prevention. The House allotted $6 million more for the division than in FY 2017, while the Senate level-funded it.

Finally, both the Senate and the House Appropriations Committees rebuffed President Trump's request to end the Million Hearts program and instead allocated $4 million to the program. The Senate also agreed with the House on level funding for the WISEWOMAN program, which helps women ages 40-64, who are low-income, uninsured or underinsured, avoid heart disease and stroke.

The final bill will not likely reach the president’s desk until at least sometime in December.

Contact: Claudia Louis

Tobacco and Prevention Appropriations

Unfortunately, appropriations for tobacco and the Prevention and Public Health Fund (PPHF) faced some funding challenges in early September.

Unlike the House, which cut the Centers for Disease Control and Prevention’s (CDC) Office on Smoking and Health (OSH) by $50 million, the Senate Appropriations Committee approved $205 million for OSH – the same as FY17. The OSH conducts the successful “Tips from Former Smokers” campaign that has influenced half a million Americans to quit smoking. We are hopeful that when the House and Senate conference their bills in the coming months they will not include the House’s $50 million cut and instead opt for the Senate’s level funding.

Despite repeated attempts by Congress to repeal and replace the Affordable Care Act and the associated PPHF, the PPHF is still authorized and appropriated. However, the House Energy and Commerce Committee marked up and passed a Children’s Health Insurance Program (CHIP) reauthorization bill, titled the CHAMPION Act on October 4. This bill takes money from the PPHF to pay for other public health programs, including CHIP and community health centers. Though we do agree that Congress needs to support the programs that are included in the CHAMPION Act, we think that cutting $6.35 billion from the PPHF over the next ten years will only worsen public health outcomes. The PPHF supports many other vital programs focused on preventing heart disease and stroke, including Million Hearts, and also provides assistance for the “Tips” campaign. At the time of publication, the bill has not passed the House.

Contact: Alison Council

FAST Act Passes Senate

The association’s Furthering Access to Stroke Telemedicine (FAST) Act passed the Senate unanimously at the end of September. The bill had broad bipartisan support in the Senate Finance Committee and was included in the CHRONIC Care Act, legislation that focuses on improving health outcomes for individuals with chronic conditions in the Medicare program.

The House also took meaningful steps toward enacting the FAST Act into law by reporting the sister bill to the FAST Act in the Senate out of the Energy and Commerce Committee. That bill also enjoyed strong bipartisan support and is up for consideration on the floor of the House this fall.

Contact: Katie Berge

Cardiac Rehab Gaining Momentum

The association's legislative priorities to expand the access and utilization of cardiac rehabilitation services have also been gaining steady momentum, adding nine additional cosponsors from both parties in recent months. The Senate bill, "Improving Access to Cardiac and Pulmonary Rehabilitation Act of 2017," sponsored by Senators Amy Klobuchar (D-MN), Debbie Stabenow (D-MI) and Mike Crapo (R-ID) and its House counterpart, sponsored by Congressmen Lynn Jenkins (R-KS) and John Lewis (D-GA) were key asks during our Lobby Day earlier this year.

These bills would expand access to cardiac rehabilitation programs by removing the physician supervision requirement to be 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 could directly supervise participating patients.

On Nov. 7-8, the association is bringing about a dozen health care professionals from cardiac rehab programs around the country to Washington, D.C. to advocate for support of these companion bills.

Contact: Katie Berge


AHA Participates in Fifth Annual Rally for Medical Research

Twelve association volunteers, including heart disease and stroke survivors and caregivers participated in the fifth anniversary of the "Rally for Medical Research Hill Day" on September 13. Our volunteers joined more than 350 people from 37 states and the District of Columbia to thank their congressional members for supporting the National Institutes of Health (NIH) and urged them to back a $2 billion increase for the agency.

The day before the rally, participants attended a Capitol Hill reception and heard from NIH Director Francis S. Collins, as well as Senators Roy Blunt (R-MO), Dick Durbin (D-IL), Chris Van Hollen (D-MD) and Jerry Moran (R-KS).

Contact: Claudia Louis

AHA Takes Part in Congressional Black Caucus Foundation's Annual Legislative Conference

The association again this year sponsored a booth in the exhibit hall at the Congressional Black Caucus Foundation’s Annual Legislative Conference in late September. In partnership with our Mid-Atlantic Affiliate and our National Multicultural Initiatives/Health Equity Team, we brought conference goers a wide spectrum of information on their heart health. We provided hands-on CPR training, blood pressure testing, information about sugar-sweetened beverages and snacks, as well as details about our federal policy initiatives.

In addition to our booth, the association was asked to provide a speaker for a panel organized by Rep. Bobby Rush’s (D-IL) office. The panel featured a number of African American women who shared their experiences with heart disease. African Americans are 26 percent more likely to die of cardiovascular disease than Caucasian women, according to 2013 data. Our volunteer, Meliah Jefferson, one of Go Red’s 2015-2016 Real Women, discussed her heart attack that occurred at age 33.

Both the exhibit and panel discussion provided a great opportunity for the association to connect with conference attendees from the African American community.

Contact: Alison Council


Oregon and Oklahoma City Pass Bike and Pedestrian Appropriations

The Oregon legislature approved a bill that will raise $5.3 billion for the state’s infrastructure. The funding will address these top priorities: reducing congestion, increasing alternative transportation options, investing in maintenance and preservation, improving safety of existing infrastructure and ensuring accountability in how taxpayers dollars are spent.

These funds will create safe street crossings, build sidewalks and help ensure kids have safe places to ride their bikes to school. A new excise tax on adult bicycles (that cost $200 or more) will produce an average of $1.2 million each year for additional bike and pedestrian infrastructure.

Under the bill, substantial new investments will be made in public transit to improve the connectivity and frequency of bus service in communities by instituting a statewide payroll tax of one tenth of one percent of wages. In 2018, this is expected to raise $103 million for public transit, with an emphasis on increasing reach, frequency and access for low-income transit riders, as well as bridging the gap between communities in rural areas.

In Oklahoma City, total funding for the city’s direct sidewalk projects will be $18.3 million. Improvements will also be made to existing and new trails with funding totaling $8.4 million. All 638,000 residents of Oklahoma City potentially benefit from the improvements to biking and walking trails, sidewalks, smart intersections, pedestrian access to bridges and updates to park and recreation facilities, which will result from the approval of these propositions and funding mechanisms.

Contact: Tim Vaske

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

Cardiac Systems of Care Policies Enacted in Missouri

Through the passage of a Missouri Senate bill, the association’s policy campaign established a mandatory statewide, centralized STEMI registry. More than 3,700 residents who suffer a STEMI each year will now be covered by stronger statewide STEMI systems of care through STEMI receiving designation.

Contact: Douglas Dunsavage

Healthier Food Options for Public Places Win in Prince George’s County, MD

Prince George’s County Council unanimously adopted a healthy vending policy, which was signed by the county executive in August. This policy will help ensure that the county’s more than 900,000 residents have access to healthier options while on public property. With Prince George’s County joining Montgomery County, Maryland-National Capital Park and Planning Commission, and Washington D.C., approximately 2.7 million residents are now covered by healthy vending laws in the greater Washington region.

Contact: Katie Bishop Kendrick

CCHD Screening Using Pulse Oximetry Wins in Florida and Wyoming

Florida and Wyoming recently joined the list of 45 other states and the District of Columbia, which screen all babies for critical congenital heart disease, using pulse oximetry.

Contact: Lucy Culp

Physical Activity Required in Mississippi Early Care and Education

Mississippi has a new regulation in place for both center-based and home-based early care and education providers that requires at least 60 minutes of moderate to vigorous physical activity per day for full day programs, and 30 minutes of moderate to vigorous physical activity for half-day programs.

Contact: Tim Vaske

California Passes School Marketing Policy

California passed a bill to prohibit the marketing of unhealthy foods and beverages (as defined by USDA under the Healthy, Hunger-Free Kids Act of 2010) on school campuses during the school day. This will impact over six million California students. California is one of the first states to take this action to protect children.

Contact: Tracy Weldon