Heart on the Hill - February 2016

Heart on the Hill

Senate Child Nutrition Bill a Win for Kids’ Health

Child in the lunch line On January 20, the Senate Agriculture, Nutrition, & Forestry Committee unanimously passed the Improving Child Nutrition Integrity and Access Act. The bipartisan bill keeps school nutrition standards strong and was endorsed by the association.

Federal child nutrition programs were last reauthorized in 2010 under the law commonly known as the Healthy, Hunger-Free Kids Act, which expired last September. The Senate Committee’s legislation on child nutrition reauthorization took shape after a multi-year political battle, during which the association played a key role in crafting a compromise on school nutrition standards.

While the legislation isn’t perfect, it goes a long way to foster an agreement that all sides can embrace. More important, passing this bill will allow stakeholders and proponents to return their focus to promoting healthy school meals and providing technical assistance for programs that need it, rather than fighting political battles to protect children’s health.

Under the compromise, sodium levels for target 2 and target 3 for school lunch nutrition standards remain the same. Programs will get a two-year extension to implement the target 2 standards and the target 3 timeline stays the same. A report will be conducted once target 2 is met to identify the steps needed to reach the more challenging target 3.

Many schools have already met or will soon meet the target 2 sodium standards, and some schools have already begun implementing target 3. For those who have not, the extension will provide time for schools to access any technical assistance they need. In addition, while there are many products out there that meet the target 2 threshold, the extended deadline gives the food industry more time to create products that meet the standard.

Under the compromise, the standard for whole grains would be adjusted so that 80 percent of products would be required to be whole grain-enriched. This means that approximately one product a week could be exempt from being whole grain-enriched. Given that programs currently have to be at 100 percent whole grain-enriched to receive their extra 6 cent reimbursement certification, and 97 percent of schools are currently certified, most will likely continue to stay there. This proposed adjustment threshold gives school food service directors a little breathing room while keeping the majority of the whole grains standard in place. In addition, menu planning and procurement are done nearly a year in advance, and most school food service directors are not interested in going backwards. As a result, the food industry will need to keep innovating because it will be unclear which items, if any, schools might use as their weekly exemption.

Leading up to this process, there were some efforts to remove the extra half cup of fruits and vegetables requirement and to alter some of the competitive foods nutrition standards. Thankfully, there are no substantive changes to either of these policies, which is a huge victory.

The path forward for the bill currently remains unclear. Timing for the full Senate consideration is not yet known, and the House has not yet produced a bill. The White House has endorsed the Senate bill, so any legislation the House produces that deviates too far from the Senate bill would likely receive a veto threat and not be considered bipartisan.

To stay up-to-date on the latest on child nutrition reauthorization, visit www.heart.org/schoolmeals.

Contact: Kristy Anderson

FY 2016 Budget Boosts NIH Funding

President Obama at the end of 2015 signed into law a $1.1 trillion FY 2016 Omnibus Appropriations bill that funds the federal government through September 2016. In addition to the spending measure, the president signed a $622 billion tax package that will extend a number of business and individual tax breaks through 2016, including the so-called charitable IRA rollover.

The association was very pleased that Congress included in the bill a $2 billion increase in funding for the National Institutes of Health (NIH). After years of budget cuts and increases that didn’t keep pace with medical research inflation, the NIH this year received $32 billion, a 7 percent increase and the largest boost in regular funding since 2003. Within the NIH, the National Heart, Lung, and Blood Institute received a $118 million, or a 4 percent increase over its 2015 funding, and the National Institute of Neurological Disorders and Stroke received a $91 million, or a 6 percent increase.

On the tobacco front, Congress provided $210 million for the Centers for Disease Control and Prevention’s (CDC) tobacco prevention programs, a major improvement from the 50 percent cut proposed in a House bill last summer. This funding will allow CDC to continue the successful Tips From Former Smokers campaign and provide support for state tobacco prevention programs and quit lines. Additionally, the omnibus preserved the Food and Drug Administration’s (FDA) ability to protect the public’s health from all tobacco products by rejecting a policy rider that would have significantly limited FDA oversight of e-cigarettes, cigars and other tobacco products – a huge victory for tobacco control advocates.

Finally, despite the association’s aggressive advocacy efforts, lawmakers provided no funding for the Health Resources and Services Administration’s Rural and Community Access to Emergency Devices Program.

To read more about our most significant wins and losses, along with a more detailed explanation of provisions of interest to the association, click here.

Contact: Claudia Louis (NIH, CDC Heart Disease and Stroke) or Hannah Green (CDC Tobacco)

Congressional Women “Go Red” Again in 2016

Congressional Women Go RedMore than forty women in Congress participated in the fourth annual Congressional Women Go Red photo on February 3. The lawmakers who participated helped the American Heart Association and Go Red For Women promote National Wear Red Day (February 5) by promoting the photo via their own social media networks throughout the week.

Contact: Stephanie Mohl

HHS/USDA Release New Dietary Guidelines for Americans

In early January, the U.S. Departments of Health and Human Services (HHS) and Agriculture (USDA) released the 2015-2020 Dietary Guidelines for Americans. The guidelines, which are updated every five years, encourage Americans to follow a healthy eating plan that includes a wide variety of nutrient-dense foods such as vegetables, fruits, whole grains, low-fat and fat-free dairy, seafood, lean meats and poultry, nuts, and legumes, while limiting added sugars, saturated fat and sodium.

In addition to providing dietary advice, the guidelines play an important role in shaping federal nutrition policy. They inform federal feeding programs such as the School Meals program and the Special Supplemental Nutrition Program for Women, Infants, and Children. All nutrition education materials that are developed by the federal government for the public must also be consistent with the guidelines.

Upon the guidelines’ release, the association expressed its support for the nutrition standards. The association closely followed the development of the guidelines, shared our recommendations with the agencies and the advisory committee charged with reviewing the science; educated Members of Congress about the process used to develop the guidelines; and pushed back against efforts by special interests to politicize the guidelines’ recommendations.

Contact: Susan K. Bishop

Senate Committee Includes FAST Act in Chronic Care Options Paper

A doctor using telestroke technologyThe bipartisan leadership of the Senate Finance Committee, which has jurisdiction over Medicare, included the association’s Furthering Access to Stroke Telemedicine Act (FAST Act) among the two dozen policies in its “Chronic Care Working Group Options Paper.” The paper is the starting point for bipartisan legislation to improve health outcomes for Medicare beneficiaries with chronic illnesses.

The FAST Act (S. 1465/H.R. 2799) would provide Medicare coverage for telestroke consultations for stroke patients from urban or suburban hospitals. The legislation has a total of 50 co-sponsors in the House and Senate. To further increase support for the bill, the association will partner with the American Academy of Neurology for a Fly-In on March 1.

In our January comments to the Committee’s Chronic Care Working Group, the association applauded the inclusion of the telestroke provision in the options paper and urged the group to include the policy in its final proposal.

In addition to inclusion in the options paper, a FAST Act provision has also now been included in a number of broader bills to expand Medicare’s coverage of telehealth services, including the Medicare Telehealth Parity Act and the CONNECT for Health Act, which have both been endorsed by the association.

The association also strongly encouraged the Working Group to include a provision that would allow nurse practitioners, clinical nurse specialists and physician assistants to supervise cardiac rehabilitation programs under Medicare. Cardiac rehabilitation can be critical to helping patients recover following a cardiac event, like a heart attack.

Under current requirements, a physician must directly supervise such programs, which can lead to reduced access to these services in physician shortage areas and add unnecessary costs. The association argues that allowing other health professionals to supervise cardiac rehabilitation would ensure access to these programs, reduce health care costs and lead to a better quality of life for patients eligible for these services.

Contact: Kevin Kaiser (Cardiac Rehab) or Stephanie Mohl (FAST Act)

Legislation Introduced in Congress to Support Congenital Heart Disease Research

The American Heart Association endorsed the Congenital Heart Futures Reauthorization Act of 2015 (CHFRA), which supports a number of programs related to congenital heart disease (CHD). The bill was introduced by Sens. Richard Durbin (D-Ill.) and Bob Casey (D-Pa.) and Reps. Gus Bilirakis (R-Fla.) and Adam Schiff (D-Calif.).

CHFRA would help to increase research and awareness of congenital heart defects, which remain the most common birth defect in the U.S. and the leading killer of infants with birth defects.

In addition to creating a public awareness campaign around the issue, the bill would direct the Centers for Disease Control and Prevention to conduct a cohort study examining the epidemiology of CHD across the lifespan and require the National Institutes of Health to issue a report about their ongoing research efforts and future research plans related to CHD.

Contact: Hannah Green

Bipartisan ESSA Strengthens Physical Education Policy

On December 10, President Obama signed into law the Every Student Succeeds Act (ESSA), which reauthorizes the Elementary and Secondary Education Act and replaces the long overdue No Child Left Behind law. The bill passed Congress with overwhelming bipartisan support and is a big win for physical education.

The American Heart Association was a key advocate in ensuring that physical education policy remained strong in the bill. Association volunteer advocates from around the country also played a central role in securing a robust physical education policy, sending more than 27,000 messages to lawmakers urging their support.

Specifically, the law designates physical education as a part of the well-rounded curriculum, making it eligible for Title I funding – the largest pot of federal funding for schools. This designation also makes physical education eligible for professional development funding under Title II of the law, as well as an eligible use under Title IV for summer, before and after school programming.

In addition, Title IV contains a new block grant program divided into three buckets of funding, and physical education is eligible to dip into two of the three, where there are designated set-asides, and there is a strong case that physical education is eligible for the third bucket. The program is structured in a way that improves how physical education grants are currently distributed. Under the new program, more schools – especially low-income schools – will likely be eligible to receive grants. Because this new law consolidates funding for physical education, it is likely the current Carol M. White Physical Education Program will end as a result.

It is important to note that none of these provisions guarantee that physical education programs are suddenly flush with cash; the work is just beginning and will require aggressive state and local advocacy, capitalizing on regulatory and guidance opportunities, and pushing for Title IV to receive full funding. However, these are funding opportunities that were previously unavailable for physical education and this is an exciting new landscape for federal physical education policy that can help get more quality physical education in our schools.

Contact: Kristy Anderson

New Study Finds Insurance Gains for Those with CVD or Its Risk Factors

A study released on January 19 by the association found that more than 6 million adults at risk for cardiovascular disease (CVD) and 1.3 million adults who have suffered from heart disease, hypertension or stroke gained health insurance between 2013 and 2014, the first year coverage was available under the Affordable Care Act (ACA).

In a press release about the study’s findings, the association's CEO Nancy rown said, “In just its first year of enrollment, the Affordable Care Act made it possible for millions of Americans fighting cardiovascular diseases to focus on improving their health, instead of worrying about whether they can obtain or afford the quality care they deserve.”

In other ACA news, the third annual open enrollment period for coverage through the Health Insurance Marketplaces ended on January 31. The Department of Health and Human Services (HHS) announced that 12.7 million Americans enrolled in or renewed coverage through the Marketplaces during the open enrollment period.

We continue to work to ensure that the law is helping to meet the needs of patients with heart disease or stroke. For example, over the last several months the association:

  • Submitted comments to HHS on the proposed rule on Benefit and Payment Parameters for 2017
  • Issued comments to the Centers for Medicare and Medicaid Services on the draft 2017 Letter to Issuers in the Federally Facilitated Marketplaces
  • Was actively involved in the National Association of Insurance Commissioners’ (NAIC) work to update its Network Adequacy Model Act. Through our Consumer Representative to the NAIC, we partnered with Community Catalyst, Consumers Union, Families USA and the National Partnership for Women & Families on a December 14 webinar to educate advocates about the NAIC’s updated model act and the opportunities it presents at the state level to improve access to care. View a recording of the webinar and find more tools and resources for advocates about network adequacy here.

Contact: Stephanie Mohl

Cardiac Rehabilitation Update

A patient and nurse participate in cardiac rehab In addition to trying to get a provision on cardiac rehabilitation (CR) included in a final proposal to be released by the Senate Finance Committee’s Chronic Care Working Paper (see FAST Act story above), the association is actively working to increase support for stand-alone legislation (S. 488/H.R. 3355) that would allow physician assistants, clinical nurse specialists and nurse practitioners to directly supervise CR programs.

More than 20 House lawmakers and nearly a quarter of the Senate have added their support to our CR bills. In addition, late last year Million Hearts – a national initiative led by the Centers for Disease Control and Prevention and the Centers for Medicare & Medicaid Services – convened a group of individuals and organizations, including the American Heart Association, to kick off a year of collective action to improve the uptake of CR. The aim of this all-comers group is to lay out specific steps to improve referral, participation and the sustainability of CR programs, and to collectively help more people take advantage of this great resource for cardiovascular health.

Contact: Kevin Kaiser

Transportation Bill Includes Heart-Healthy, Kid-Friendly Provisions

After several false starts and short-term extensions on a transportation reauthorization, President Obama signed the Fixing America’s Surface Transportation Act (FAST Act) on December 4. Policies that help keep students and communities active by providing access to sidewalks and bike paths, such as Safe Routes to School, were ultimately preserved and funding even got a slight increase. The programs now reside under the Surface Transportation Program Setaside, which is also known as the Transportation Alternatives Program.

Importantly, the bill guarantees seamless continuity for state and local partners for the next five years as they continue to plan projects and apply for and administer these funds.

The association considers preserving these popular provisions and receiving the bump in funding as a significant policy victory, given that at the beginning of this year, some lawmakers were determined to completely eliminate all such programs.

Recently, the association’s federal policy staff and Voices for Healthy Kids teamed up with the Safe Routes to School National Partnership and the National Complete Streets Coalition to host a webinar for stakeholders on the legislation and its potential impact moving forward.

Contact: Kristy Anderson


Boston and Cleveland Raise Minimum Sales Age for Tobacco to 21

In mid-December, Boston health officials voted to raise the minimum sales age for purchasing tobacco and nicotine products to 21, joining more than 86 other cities and towns in Massachusetts. The policy, which includes e-cigarettes, went into effect on February 15.

The Cleveland City Council also passed a policy in December raising the tobacco sales age to 21. In addition to Cleveland, four other cities in Ohio – Bexley, Grandview, New Albany and Upper Arlington – have raised the minimum sales age to 21.

Contact: Chris Sherwin

Utah Passes Policy on Stroke Facility Designation

Utah has become the twelfth state along with Washington, D.C. to formally recognize all three tiers of stroke facilities and require local and regional Emergency Medical Services authorities to develop and implement protocols for the transport of acute stroke patients. As a result of this success, the state’s nearly three million residents, including about 4,600 individuals who suffer a stroke each year, will now be covered by a stronger statewide stroke system of care.

Contact: Douglas Dunsavage

Georgia Finalizes Rule Requiring Pulse Oximetry Screening for Newborns

In November 2015, the Georgia Department of Public Health published its Newborn Screening Manual, marking the final step in the process of ensuring all babies in Georgia are screened for critical congenital heart defects (CCHD) using pulse oximetry. The association worked closely with its partners – American Academy of Pediatrics, Association for Women’s Health, Obstetric and Neonatal Nurses, Emory University Hospital, March of Dimes and Wellstar – to secure this regulatory win.

Contact: Lucy Culp

Texas Funds Obesity Prevention in Low-Income Communities, Passes Smoke-Free Ordinances

EdinburgAdvocates in Austin, Texas worked with the city council to dedicate $400,000 to obesity prevention programs, including a Healthy Corner Store program aimed at increasing access to healthier foods in low- to moderate-income communities.

In addition, five Texas cities – Sherman, Waco, DeSoto, Port Lavaca and Edinburg (supporters pictured) – recently passed local smoke-free ordinances, which will help to decrease the number of heart attacks, strokes, asthma attacks and hospitalizations in these cities.

Contact: Kim Milbrath (Prevention) or Chris Sherwin (Tobacco)

Multiple States See Safer Routes and Biking, Walking Infrastructure Funding

Three months after codifying the Safe Routes to School program, Colorado advocates engaged the Colorado Transportation Commission to dedicate $2.5 million annually for projects that increase kids’ access to walking and biking to school. In addition, the city of Denver committed $7.1 million to bicycle and pedestrian infrastructure projects in its 2016 budget. This funding will be devoted to opening new dedicated bike lanes, as well as adding sidewalks, lighting and crosswalks to ensure pedestrian-friendly pathways across the city.

In Connecticut, advocates secured state authorization for issuing bonds to fund the construction of bikeways and walkways. At the September State Bond Commission hearing, advocates were able to successfully direct $9.8 million towards biking and walking programs in the state.

Contacts: Tim Vaske

Maryland and North Carolina Commit to Healthier Food and Beverage Procurement Standards

Advocates in Mecklenburg County, North Carolina – which encompasses the Charlotte metro region – worked to revise an outdated healthy food vending policy from 2011 to meet the American Heart Association guidelines for healthy vending. The revision will give more than 5,000 county employees access to healthier choices.

Meanwhile, the city of Baltimore finalized a five-year contract that ensures the availability of healthier vending options for more than 18,000 city employees and 600,000 city residents.

Contacts: Katie Bishop

Georgia and Alabama Take Steps to Improve School Nutrition

To improve the nutritional quality of competitive foods in schools, advocates in Georgia worked with the Department of Education to finalize a Statewide School Nutrition Program in July 2015 and spent the following few months finalizing the necessary implementation components. Georgia schools now have adequate staff support and training to apply the healthier competitive food standards for 1.7 million students enrolled in Georgia public schools.

Similarly, the Alabama State Board of Education last summer adopted an amended resolution endorsing changes to the state’s implementation of the U.S. Department of Agriculture’s Smart Snacks in School and Fundraising Activities Policy. The policy took effect at the beginning of the 2015-2016 school year. Members of the association’s Alabama Advocacy Committee and Birmingham Board became deeply involved in the campaign in early 2015 and were instrumental in this policy win, working for several months after the adoption of the standards to ensure successful implementation across all Alabama public schools.

Contacts: Stephanie Tama-Sweet

Media Advocacy Contacts

Retha Sherrod
Director, Media Advocacy
(202) 785-7929

Samantha Carter
Associate Communications Manager, Media Advocacy
(202) 785-7935

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