Capitol Hill Briefing Focuses on Caregivers and Stroke
In recognition of American Stroke Month, the association teamed up with the National Stroke Association to host a congressional briefing on stroke on May 14. About sixty people, including congressional staffers, joined us for the event to learn more about the nation's number four killer and the caregivers who assist stroke survivors on the long road to recovery.
Briefing speakers included: Brendan E. Conroy, MD, FAAPM&R, medical director, Stroke Recovery Program, chief medical information officer, Medstar Rehabilitation Hospital; Gail Gibson Hunt, president and chief executive officer, National Alliance for Caregiving; and caregiver and You’re The Cure volunteer Robin Williams, who was accompanied by her husband Van Williams, a stroke survivor. Robin gave a face to the issue by sharing her story as her husband's caregiver, explaining the financial and emotional stress they're experiencing in the aftermath of Van's stroke. She emphasized the need for a tax credit for caregivers because they often struggle to work and take care of their loved ones at the same time. Robin added, "It is in our nation's best interests to provide better support for stroke survivors and their families."
Studies have shown that family caregivers provide approximately $6.1 billion each year in care to stroke survivors. Despite this significant contribution, family caregivers lack assistance that would allow them to provide their loved ones with the best care possible, post-stroke.
A group of the association’s stroke advocates also attended the briefing and afterwards stopped by the offices of their congressional members to drop off informational materials on stroke. The advocates also received a tour of the White House while in Washington.
FDA Proposes Regulations for E-Cigarettes, Other Tobacco Products
At the end of April, the Food and Drug Administration (FDA) issued a long awaited proposed rule that would extend its regulatory authority to include e-cigarettes, cigars, pipe tobacco, nicotine gels, hookah and certain dissolvables. Under the proposed rule, the FDA would require the manufacturers of e-cigarettes, cigars, pipe tobacco, nicotine gels, hookah, and certain dissolvables, to register these products with the agency, submit ingredient listings, obtain FDA approval to introduce a new or changed product, and include a health warning on product packages and advertisements. The rule would also prohibit the sale of these products to individuals under 18, sales in vending machines unless in adult-only facilities, the distribution of free samples and the use of reduced risk claims unless approved by FDA.
The association will submit its comment letter on the proposed rule, and will also launch a grassroots campaign to encourage individual advocates to submit their input. The current FDA deadline for the submission of comments on the rule is July 9.
In early March, the Food and Drug Administration (FDA) unveiled its draft plan to update the information displayed in the nutrition facts panel on food products.
Under the FDA proposal, food manufacturers would have to display calorie information more prominently, list the quantity of added sugars and include the potassium and Vitamin D content. The proposal would also lower the Daily Value (DV) for sodium from 2,400mg to 2,300mg per day.
In a related proposal, the FDA simultaneously announced it will change the serving size for several food categories to better reflect the amount of food consumers typically eat. For example, the serving size for bagels would change from half a bagel to one regular-size bagel. The FDA’s proposal would also require food manufacturers to provide nutrition information by serving, and for the entire container if the food product could be consumed during one eating occasion or multiple occasions.
In our upcoming comments to the FDA, the association will express overall support for the agency’s two proposals while recommending several changes, including further lowering the DV for sodium to 1,500mg per day and lowering the DV for saturated fat to less than six percent of calories.
Obama Administration Announces Better Coverage for Tobacco Cessation
On May 2, the Obama Administration announced clear, more specific minimum standards for the tobacco screening and cessation services that insurance companies must cover each year without cost-sharing under the Affordable Care Act.
Nearly one-third of the estimated 480,000 deaths each year that are caused by smoking-related illnesses are CVD-related, and improved coverage of tobacco screening and cessation services is critical to ensuring that the ACA fulfills its promise of helping tobacco users quit. Kicking the tobacco habit can lead to increased productivity by employees, less disability and chronic disease, and reduced medical expenditures.
Under the health law, most private insurance plans are required to cover preventive services that receive an “A” or “B” rating from the U.S. Preventive Services Task Force (USPSTF) at no additional cost to their enrollees. Despite evidence pointing to the value of tobacco cessation and the fact that the USPSTF’s “A” recommendation covers both pharmacotherapy and counseling for tobacco cessation, studies have found that health plan coverage of these services has been very uneven. Under the new guidance, health insurers are required to cover the following services, at a minimum, with no cost-sharing:
Screening for tobacco use
At least two tobacco cessation attempts per year for those who use tobacco products. This coverage must include:
Four tobacco cessation counseling sessions of at least 10 minutes each (including telephone counseling, group counseling and individual counseling) without prior authorization; and
All FDA-approved tobacco cessation medications (including both prescription and over-the-counter medications) for a 90-day treatment regimen when prescribed by a health care provider without prior authorization.
These requirements are based on the Public Health Service’s Clinical Practice Guideline for Treating Tobacco Use and Dependence, which the association supports.
The association and its partners advocated for greater clarity in the coverage of these life-saving services, and view this as a significant victory in the fight against tobacco.
After a slow start, President Barack Obama announced April 17 that enrollment through the federal and state Health Insurance Marketplaces reached 8 million Americans, a million more than the goal for the first open enrollment period. Millions more Americans also gained health care coverage through Medicaid and because they were young adults under 26 who could remain on their parents’ plan. In addition, more Americans signed up for employer-sponsored coverage. Although more analysis is needed to determine how many people obtained new coverage (as opposed to switching from one plan to another), here’s what we know so far:
34 percent of those who signed up through the federal Marketplace are under 35 years old.
More than 4.8 million more people enrolled in coverage through Medicaid and the Children’s Health Insurance Program compared to before the Marketplaces opened.
Three million young adults under age 26 obtained coverage through their parents’ plan.
A RAND survey reported a net gain of 9.3 million American adults with health insurance coverage from September 2013 to mid-March 2014. This decreases the uninsured population from 20.5 percent to 15.8 percent. RAND also estimates 7.2 million Americans who were previously uninsured gained coverage through an employer.
HHS released final enrollment reports on May 1 for the first open enrollment period, which includes state-by-state data and data on coverage by race and ethnicity for the first time.
Additionally, the association submitted comments on these proposed rules on the following dates:
Association Testifies at FDA Hearing on Research Diversity
Our Chief Science Officer Dr. Rose Marie Robertson testified at a public hearing convened by the U.S. Food and Drug Administration (FDA) on April 1. The hearing was called by the agency to help inform their work on an action plan to improve the representation of women, minorities, and the elderly in industry-sponsored clinical trials.
The action plan is the direct result of lobbying by the association and other groups on the FDA Safety and Innovation Act of 2012. Under this law, Congress required the FDA to issue a report last summer to examine the extent to which data about how new drugs and medical devices work in women, minorities, and the elderly were collected, analyzed, and made publicly available by the agency. The report found that while progress had been made in the last two decades since FDA first required analysis of data on sex differences in the evaluation of new drugs, gaps still remain. To address these gaps, Congress requested that the FDA draft and finalize an action plan by the summer of 2014.
The association believes that only by insisting on the availability of subgroup-specific analyses and improving the public availability of the results of this data, can health care providers and their patients make the most informed decisions about which medical treatment will work best for them.
Despite months of negotiations on the framework for a permanent fix to the faulty formula used by Medicare to pay physicians for the services they deliver, Congress could not come to agreement on how to best pay for the Sustainable Growth Rate (SGR) legislation.
To avoid a 24 percent cut in pay for physicians treating Medicare patients, Congress passed a law with a 12-month patch, which was signed into law by President Obama on April 1. Over the past few months, the association advocated for a reformed system that paid physicians based on the quality of care, not on the quantity of care delivered. We urged Congress to develop a framework that was based on tested and proven models, supportive of the best clinical evidence, and truly patient-centered.
While the association was disappointed that a permanent SGR fix was not passed, we were pleased a number of important provisions we advocated for on Medicare Therapy Caps and Medicare Advantage Special Needs Plans were included in the 12-month patch. The legislation extended the Medicare Therapy Caps exceptions process for an additional year (currently the Medicare program has annual caps on the amount of expenses a patient can accrue for outpatient therapy services in a given year). We will not rest until these caps are permanently repealed, but are pleased that stroke survivors on Medicare will continue to have uninterrupted access to rehabilitation through this extension. The bill also extended the Medicare Advantage Special Needs Plans (SNPs) for one year, through 2016. These plans take a more focused approach by enhancing care coordination and providing patients with specialized, highly-personalized care that includes customized benefits. The association has advocated for the reauthorization of SNPs because we know that patients with heart failure benefit from these services.
We want to thank our You’re the Cure advocates who were very active in the months leading up to the passage of the law – more than 8,500 messages were sent to lawmakers. Volunteers also made phone calls to key offices, urging the members to remove the therapy caps.
The American Heart Association joins the entire medical community in urging Congress to continue bipartisan efforts to pass a permanent fix to the SGR during the next year. We stand ready to be a resource to congressional staff and hope to provide technical assistance on issues as they arise.
In February, the association joined 13 other scientific, business and higher education organizations in support of a video: Close the Innovation Deficit. This creative four-minute video urges Congress to end this deficit with strong federal investments in research and higher education. The innovation deficit is the gap between actual and needed federal investments in research and higher education at a time when other nations such as China, India and Singapore are dramatically boosting research funding to develop the next great technological and medical breakthroughs.
We also co-signed a statement for the Senate Appropriations Committee’s April 29 hearing on “Driving Innovation through Federal Investments.” The statement defined the innovation deficit and discussed its serious impact on our nation. The directors of the National Institutes of Health, White House Office of Science and Technology Policy, National Science Foundation; and Department of Defense Advanced Research Projects Agency; and the Secretary of Department of Energy also testified at the hearing.
In early March, President Barack Obama submitted his proposed FY 2015 budget to Congress. It provided $30.2 billion for the National Institutes of Health, only about $200 million over the previous year’s budget. In a statement following the release of the budget proposal, American Heart Association President Dr. Mariell Jessup described the NIH funding level as “utterly inadequate.” The association joins the rest of the medical research community in advocating for an appropriation of $32 billion for the NIH.
The President’s budget also included:
$130.188 million for CDC’s Division for Heart Disease and Stroke Prevention, the same as FY 2014, which includes $73 million increase for CDC’s DHDSP. We are advocating for $130.188 million for the DHDSP.
$4 million for Million Hearts®, a public-private partnership to prevent 1 million heart attacks and strokes by 2017. We are requesting $5 million.
$21.170 million for WISEWOMAN to help uninsured, underinsured low-income women avoid heart disease and stroke. We continue to advocate for $37 million for this program.
In addition, the President proposed the elimination of all funding for HRSA’s Rural and Community Access to Emergency Devices (AED) Program. We are advocating for $8.9 million to support this program.
Following the budget release, we asked our You’re the Cure network to contact their members of Congress and urge them to include $32 billion for the NIH. We also visited or contacted each member of the House and Senate Labor-HHS-Education Appropriations Subcommittees, and asked them to include our funding recommendations in the FY 2015 appropriations bill. The FY 2015 appropriation process is unlikely to be finalized until after the November election.
The American Heart Association supports the American Cures Act, introduced on March 12 by Sen. Richard Durbin (D-IL), co-chair of the Congressional Heart and Stroke Coalition and Senate Majority Whip. The legislation would create a mandatory funding mechanism to help support the National Institutes of Health, the Centers for Disease Control and Prevention, the Department of Veterans Affairs Medical and Prosthetic Research Program, and the Department of Defense Health Program. Representative Anna Eshoo introduced a comparable bill in the House.
Gabriella Miller Kids First Research Act Becomes Law
On April 3, the Gabriela Miller Kids First Research Act was signed into law. This law would terminate taxpayer subsidies for presidential conventions, authorizing $126 million over 10 years for National Institutes of Health (NIH)-supported research on pediatric cancer and other childhood disorders. This law is an authorization and funds would have to be appropriated in subsequent legislation.
Prior to passage of the bill, Senator Harry Reid (D-NV), Senate Majority Leader and a member of the Congressional Heart and Stroke Coalition, made an impassioned floor speechon behalf of the NIH.
2014 Tax Reform Act Poses Challenges for Nonprofits
On February 26, House Ways and Means Committee Chairman Dave Camp’s (R-MI) released a draft of the “ Tax Reform Act of 2014.”
The 1,000 page bill revises numerous sections of the Internal Revenue Code, related to charitable giving and tax-exempt organizations. Most political prognosticators believe the proposal has little chance of being enacted into law in the near term, but it may provide a framework for future tax legislative efforts on tax reform.
In a detailed summary, the Independent Sector highlights provisions in the proposed legislation that may impact the American Heart Association and other members of the charitable and philanthropic sector, including:
Restructuring the individual code to discourage 95 percent of taxpayers from claiming itemized deductions, including the charitable deduction
Allowing individuals to deduct only the amount of their charitable contributions exceeding two percent of their adjusted gross income;
Creating an extension through April 15 for making deductible charitable donations on the prior year’s tax filing;
Expanding unrelated business income tax to include revenues such as corporate sponsorships, while restricting nonprofits’ ability to offset taxable revenues with losses;
Establishing a five-year distribution requirement for donor-advised funds; and
Instituting a 25-percent excise tax on annual compensation exceeding $1 million for an organization’s five highest-paid employees.
Working closely with the Independent Sector and other nonprofit organizations, the association will attempt to understand the background and motivations that led to the development of these proposals and assess their impact. The ultimate goal of this effort will be a united response that helps enhance, rather than diminish, the resources of the nonprofit sector.
A bipartisan group of Congressional women joined American Heart Association CEO Nancy Brown to “go red” in honor of American Heart Month and National Wear Red Day in early February.
Forty women Members of Congress, including the House’s highest ranking Republican and Democratic women, Congresswomen Cathy McMorris Rodgers (R-WA), the Republican Conference Chairman, and Nancy Pelosi (D-CA), the Democratic Leader, assembled for the second annual Congressional Women Go Red photo to help raise awareness about heart disease, the leading killer of women. The photo and video were widely shared by Congressional women via their Facebook, Twitter, and other social media accounts.
In addition, Go Red for Women and WomenHeart: The National Coalition for Women with Heart Disease also partnered with the Department of Health and Human Services (HHS) on the fourth annual State of Women's Heart Health webinar. Nancy Brown was joined on the webinar by some of the nation's leading health experts to discuss the latest in cardiovascular research and prevention, including: Health and Human Services Secretary Kathleen Sebelius and National Heart, Lung and Blood Institute Director Dr. Gary Gibbons.
Federal legislation that would help ensure infants throughout the country are screened for treatable conditions continues to move forward in Congress. The Newborn Screening Saves Lives Reauthorization Act of 2013 was passed unanimously by the Senate in January, and a key House of Representatives committee unanimously approved similar legislation in early April. The bill now moves to the full House for consideration.
The association will continue to advocate for passage of the bill and hopes that it will move quickly through Congress and be signed by the president.
At the end of September, the current law that reauthorizes federal transportation funding, known as Moving Ahead for Progress in the 21st Century Act,” or MAP-21, will expire. Passed in June 2012, the law represented a step backwards for public health. It consolidated a number of walking and biking programs – including the Safe Routes to School – into a newly created Transportation Alternatives Program (TAP).
The consolidation significantly reduced annual funding for these programs – a cut of approximately one-third, or $1.2 billion, to just over $800 million, and forces trail, walking, and biking projects to compete with other eligible uses for these fewer federal dollars.
The prognosis for reauthorization looks bleak. The Highway Trust Fund becomes broke mid-summer, and Congress currently does not have a way to pay to keep the current bill solvent until it expires, much less pay for a full reauthorization. This means all work on bridges, road, highways – and the jobs that go with them – will stop. In addition, TAP will not see an increase in funding and will be in jeopardy of losing funding.
Nevertheless, the association is advocating to protect existing active transportation policies, including: maintaining current funding levels for TAP to ensure states and communities can provide safe and accessible active transportation options for all their citizens; giving more local control for TAP funding – currently states control half of TAP funding and can transfer these funds out to use for any transportation project that does not support walking, biking or recreation infrastructure; and changing policy so matching dollars can be provided at an aggregate level, not for individual projects, a measure that would help low-income communities benefit from active transportation projects
In December 2010, the Healthy, Hunger-Free Kids Act was signed into law. For the first time in decades, the U.S. Department of Agriculture (USDA) was required to institute new national nutrition standards for school meals, as well as establish nutrition standards for other foods sold in schools during the school day.
Studies have shown that a healthy school environment helps improve children’s physical well-being, enhances learning, minimizes behavior problems, and increases attendance. Research indicates that children who participate in the National School Lunch Program eat greater amounts of healthy foods, get more essential vitamins and minerals, drink fewer sugar-sweetened beverages, and have an overall better-quality diet.
Nearly 90 percent of schools in the National School Lunch Program (NSLP) are meeting the new nutritional standards, up from 14 percent in 2009-2010. As a result, fruit and vegetable consumption at lunch has increased, which means that an overwhelming majority of children are receiving heart-healthy lunches while at school. The law has had several other positive effects on school nutrition and health, including: strengthening local wellness policies; implementing Smart Snacks – or competitive foods standards; increasing reimbursement rates for schools that meet the updated nutrition standards for lunch; and funding for farm-to-school programs.
The USDA is providing robust assistance to help schools overcome any challenges they face in implementing the new standards – most of which will be resolved as school food service and students adjust to the changes, according to the Government Accounting Office (GAO). In fact, recent interviews by the GAO showed that students like to eat healthy food and think the new school meals are healthier, while parents are happier that their children are receiving more nutritious meals.
Despite the overwhelming evidence that the new school meal standards are working and are popular, there are some in Congress who want to turn back the clock on our children’s health. Of particular concern is the agriculture appropriations process for this year. Some of the changes being discussed are waivers to delaying the breakfast and Smart Snack standards – allowing junk food to remain in schools, postponing or eliminating sodium reductions, and decreasing fruit and vegetable offerings – all essential to children’s diets. It is critical that the school meal standards remain focused on children and that schools are not forced to stop mid-stream or receive mixed messages on the standards. The association is working tirelessly to stop provisions from being included in this year’s agriculture appropriations bill that would undermine the new law and our children’s health. We will continue this advocacy to protect the standards as child nutrition faces reauthorization in 2015.
In March, the Environmental Protection Agency (EPA) announced that it will finalize a rule that the American Heart Association, along with a coalition of air quality advocates, played an active role in shaping. The final rule is designed to reduce air pollution from passenger cars and trucks.
Starting in 2017, this rule known as the Tier 3 program, will set new vehicle emissions standards and lower the sulfur content of gasoline for passenger cars and trucks. The rule will also reduce tailpipe and evaporative emissions, and establish gasoline sulfur standards that will make emission control systems more effective for both existing and new vehicles. Together, these standards will help cut ozone and particulate matter pollution, which are linked to a number of health issues – including heart disease. By 2030, EPA estimates that the new rule will annually prevent nearly 800 non-fatal heart attacks, and there will be 210 fewer cardiovascular related hospital admissions each year.
In April, the American Heart Association sponsored a tele-townhall featuring guest speakers Gina McCarthy, Administrator of the EPA; Dr. Howard Koh, Assistant Secretary for Health at the U.S. Department of Health and Human Services; and other public health leaders for a discussion on the impact of air pollution on chronic diseases, including heart disease. The speakers highlighted the inflammatory effects air pollution has on the heart, causing chronic cardiovascular problems. Short-term exposure can increase the risk of heart attack, stroke, arrhythmias and heart failure in susceptible people, and the risk of death is greater from long-term exposure. The health leaders pointed out that additional work is needed to clean up major air pollution sources despite improvements through the Clean Air Act. They also stressed that reducing air pollution to help prevent chronic diseases will grow more challenging and have a bigger impact unless aggressive, collaborative action is taken.
Iowa, Maryland and Vermont recently made great strides in working to prevent and manage chronic diseases. These states took the necessary steps to ensure that critical preventive benefits, essential for patients with cardiovascular disease, will be available to all Medicaid enrollees. In Arkansas, a Private Option Funding Bill was signed into law, ensuring that nearly 100,000 Arkansas residents will continue to have access to health care and many more are eligible.
The governors in Arizona, Massachusetts and New Mexico recently signed legislation that will ensure all newborns are screened for Critical Congenital Heart Defects (CCHD) using pulse oximetry. American Heart Association staff and volunteers partnered closely with parent advocates and key organizational partners in these states to ensure that all newborns will receive this potentially life-saving screening moving forward.
Advocates Stand Against Unhealthy Food Advertising in Schools
Nearly 60,000 people sent a clear message to the U.S. Department of Agriculture (USDA) last month – companies shouldn’t advertise unhealthy products such as candy, chips or sugary soda to kids on school campuses.
Advocates of You’re the Cure and PreventObesity.net joined forces to make the campaign a success, voicing their support for the stronger local wellness policy standards announced in March that would empower schools to ban the marketing of unhealthy food and drinks and prioritize physical activity.
The American Heart Association President Nancy Brown, Alliance for a Healthier Generation Chief Executive Officer Dr. Howell Wechsler, Director of the Berkeley Media Studies Group Lori Dorfman, and actress Jennie Garth added their voices and organizational support to the campaign, along with 19 partners in the movement to end childhood obesity.
PreventObesity.net is a project of Voices for Healthy Kids, a program of the Robert Wood Johnson Foundation and American Heart Association.
– These stories are intended to inform and encourage the many public and private efforts underway to improve health care delivery in the United States, particularly in the context of the accountable care movement.