Heart on the Hill- August 2013

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The American Heart Association will once again join 180 research and patient organizations from 40 states on Sept.17-18 for the “Rally for Medical Research Hill Day.” The two-day event, spearheaded by the American Association of Cancer Research (AACR), will help raise awareness about the need to invest in the National Institutes of Health for the health and economic securityof our nation.

As one of the leading organizations involved in this effort,the association will bring nearly 40 volunteers to Washington, D.C. for the two days. The volunteers will join advocates from the other organizations to meet with their congressional representatives.

In addition to the association, other participating organizations include the American Diabetes Association,the Federation of American Societies for Experimental Biology, and the National Stroke Association. The American Cancer Society has a previously planned lobby day the week before and will not attend, but offered their support.

Last April the association played a leadership role in AACR’s first Rally for Medical Research.

: Claudia Louis, claudia.louis@heart.org

You’re the Cure Launches Photo Petition to Protect the NIH
In order to make sure that everyone’s voice is heard, not just those You’re the Cure advocates who will be in Washington, D.C. for the “Rally for Medical Research Hill Day” on Sept. 18, You’re the Cure has launched a “Hearts for Research” photo petition campaign.

We are asking You’re the Cure advocates from around the country to send in photos showing their support for medical research. Each name and picture submitted in support for prioritizing our nation’s investment in medical research will be delivered to Congress during the rally Hill Day.

To submit a photo for the “Hearts for Research” petition campaign visit You’re the Cure.

Contact: Clarissa Garcia, Clarissa.garcia@heart.org

Senate Committee Approves Labor/HHS Funding
On July 11 the Senate Appropriations Committee approved the 2014 appropriations bill for the departments of Labor, HHS, and Education. The Senate legislation boosted funding levels for federal research, treatment and prevention programs including the National Institutes of Health, the Health Resources and Services Administration’s Rural and Community Access to Emergency Devices (AED) Program, the Centers for Disease Control and Prevention’s Division for Heart Disease and Stroke Prevention, the Million Hearts initiative, and WISEWOMAN.

The bill was based on the assumption that the sequester will be avoided in 2014, which few congressional experts expect to happen. For example, the legislation included a $1.8 billion increase for the NIH. However, if the sequester remains in place, the NIH increase will be $307 million. In addition, the Senate legislation would continue to fund CDC’s Million Hearts at $5 million. The Senate panel also included $5 million for HRSA’s AED program, an initiative we advocate for which was started with the help of the association. This appropriation is particularly notable because the Obama administration has proposed no money for continuing the program. The comparable House Appropriations Subcommittee on Labor-HHS-Education did not act on its version of the legislation before Congress left for recess Aug. 2. If the House Subcommittee takes up the legislation, it will be based on an allocation $43 billion lower than the Senate bill.

With the new federal fiscal year starting on October 1, members of Congress have been discussing the content of a Continuing Resolution to keep the government open past that date. 

Contact: Claudia Louis, claudia.louis@heart.org

AHA Leadership Meet with NIH Directors
AHA officers and senior staff traveled to Washington, D.C. on July 29 for their annual meetings with various directors from the National Institutes of Health.

NIH directors who participated included Gary Gibbons, M.D., the new director of the National Heart, Lung, and Blood Institute; Walter Koroshetz, M.D., deputy director of the National Institute of Neurological Disorders and Stroke, and Richard Hodes, director of the National Institute on Aging. Attending from the association were Bernard Dennis, chairman of the board, Donna Arnett, Ph.D., immediate past president, Elliott Antman, M.D., president-elect, Hank Wasiak, chairman of the ASA advisory committee, Joseph Broderick, M.D., chairman of the AHA Stroke Council, Nancy Brown, chief executive officer, and Rose Marie Robertson, M.D., chief science officer.. The purpose of the yearly meetings is to establish and expand lines of communication, discuss mutual areas for potential collaboration and influence funding priorities.

Contact: Claudia Louis, claudia.louis@heart.org

Association Weighs In on Stroke Measures
Despite concerns raised by the association and other stakeholder groups, the Centers for Medicare and Medicaid Services (CMS) announced on August 2 that it will move forward with two stroke-related outcome measures as part of the Medicare hospital payment final rule.

However, in the final rule, CMS pledged to work with the association and other organizations to improve the measures – “We appreciate and have heard the concerns of the stakeholders on this issue. We are committed to working with the stakeholder communities and to continuously refine our measures, which for the stroke outcome measures includes risk adjusted patient severity.”

When CMS formally proposed including the acute ischemic stroke 30-day mortality and 30-day hospital readmission measures in the Medicare Hospital Inpatient Quality Reporting (IQR) Program back in April, the association mounted a coordinated effort to get stakeholder groups and members of Congress to express concern to CMS about the measures.

While the association generally supports outcome measures, we believe these particular ones are flawed because they do not adjust for stroke severity, the most important variable for determining stroke patient outcomes. In our June comment letter to CMS, we argued that these measures as written could negatively impact the care provided to the most severe stroke patients, unfairly penalize hospitals caring for these patients, and worsen health disparities.

At least a dozen other organizations joined us in our effort to oppose these stroke measures, including the major hospital associations, the American Academy of Neurology and other professional societies, patient and consumer groups. In addition, 23 House members led by Congressional Heart and Stroke Coalition co-chairs Chris Smith (R-N.J.) and Lois Capps (D-Calif.), and stroke survivors Sen. Tim Johnson (D-S.C.) and Sen. Mark Kirk (R-Ill.) sent letters to CMS.

We are committed to working expeditiously with the agency and other stakeholders to fix the outcome measures before they are added to the IQR in 2016.

: Stephanie Mohl, stephanie.mohl@heart.org

ACA Implementation Update
With the new health insurance marketplaces scheduled to open on October 1, HHS is working hard to educate the public about the new insurance options that may be available to them after that date via the Affordable Care Act. In addition, since our last issue…

• The Centers for Medicare and Medicaid Services released a final rule on Medicaid expanded eligibility, coverage of essential health benefits, and other issues related to Medicaid. The final rule includes a number of provisions supported by the association, including clarifying that Medicaid expansion alternative benefit plans must cover all preventive services given an ‘A’ or ‘B’ by the U.S. Preventive Services Task Force without cost-sharing. The final rule also expands the types of providers that are eligible to be reimbursed by Medicaid for preventive services.

• The Obama administration announced it will delay the enforcement of the minimum coverage requirement (i.e. the employer mandate) for large employers with 50 or more full-time employees until 2015. The impact of this extension is likely to minimal because approximately 95 percent of companies with 50 or more workers already offer coverage to their workers. It’s important to note that this development does not delay or otherwise affect the opening of the small business marketplaces (SHOP exchanges) in every state on October 1.

• The final rule on employment-based wellness programs was released by the administration. The rule strikes a balance between supporting workplace health promotion and prevention as a means to reduce the burden of chronic illness and improve health and ensuring that employees are protected from unfair practices that could make it more difficult for them to access needed care and preventive services.

Stay tuned for more information about new association resources to help staff and volunteers in their efforts to educate the public about the new insurance marketplaces and coverage options available to uninsured Americans.

Contact: Stephanie Mohl, stephanie.mohl@heart.org

American Stroke Association Hosts Congressional Briefing
In honor of American Stroke Month, the association hosted a briefing in late May for Congressional staff to inform them about the BRAIN Initiative and its implications for stroke, and to release new stroke data. More than 50 people attended the event.

Two leading scientists from the National Institutes of Health (NIH) helped explain the ambitious new BRAIN Initiative. Dr. Kathy Hudson, deputy director for Science, Outreach, and Policy, gave the audience an overview of this project to “map” the human brain. Dr. Story Landis, director of the National Institute of Neurological Disorders and Stroke, shared examples of how a greater understanding of the brain can lead to advancements in the treatment of stroke patients and individuals with other major neurological conditions.

The association also released a new study on Forecasting the Future of Stroke in the United States. Dr. Bruce Ovbiagele, the lead author of the paper and the chairman of the Department of Neurology at the Medical University of South Carolina, spoke about how stroke is projected to increase 20 percent by 2030 and stroke costs are projected to more than double –especially for Hispanics and African-Americans. As Dr. Ovbiagele pointed out, this looming stroke “tsunami” means policymakers at all levels should take steps to avert the crisis through more research and strategies that will lead to better prevention, treatment, and recovery from stroke.

The final speaker, Maryland stroke survivor and advocate José Maldonado, shared his story and helped to put a human face on the new stroke data presented and the need for the BRAIN Initiative.

Contact: Stephanie Mohl, stephanie.mohl@heart.org

AHA Praises Supreme Court Decision on Gene Patents
On June 13 the U.S. Supreme Court issued a historic decision in the gene patenting case, Association for Molecular Pathology v. Myriad Genetics. The court ruled that Myriad’s patents on two breast cancer genes were invalid because the genes were found in nature and not produced in a laboratory.

The court’s decision provided an opportunity for the association to renew its push to get the Obama administration to release anticipated guidance on laboratory developed tests as more tests will likely come to market due to this ruling.

We believe strongly that genetics plays an important role in the future of cardiovascular disease prevention, treatment and research. Genetics also affects how people respond to treatment, including specific medications. The AHA hopes the court’s ruling will help unleash innovative research in cardiovascular genetics and its safe and efficient translation to patient care.

: Marko Mijic, marko.mijic@heart.org

AHA Endorses Medication Adherence Legislation
The American Heart Association has strongly endorsed the Medication Therapy Management (MTM) Empowerment Act of 2013. This bipartisan and budget neutral legislation provides a unique opportunity to increase medication adherence among Medicare beneficiaries, while decreasing overall healthcare costs. Medicare patients often have chronic conditions, such as high blood pressure, and fail to take their prescribed medications, resulting in further complications and added costs.

Medication Therapy Management (MTM) programs can improve medication adherence, reduce the risk of adverse events and help control healthcare costs. To enroll in the current Medicare Part D MTM programs, an individual must have multiple chronic conditions, take multiple drugs and incur more than $3,000 in annual Part D drug costs. However, the new legislation allows beneficiaries with a single costly chronic condition—like high blood pressure—to be eligible for MTM services. This is an important change because just one chronic condition can have a major health impact.

The AHA has been actively urging members of Congress to cosponsor the legislation in order to improve the quality of healthcare and reduce healthcare costs.

: Marko Mijic, marko.mijic@heart.org

FIT Kids Act Re-Introduced
The association was pleased that the Fitness Integrated in Teaching (FIT) Kids Act was reintroduced on May 23 with the bipartisan support of Senator Tom Harkin and Representatives Ron Kind and Aaron Schock.

The legislation was updated to reflect changes in the policy and political landscape since it was first introduced in 2007, but maintains the ultimate goal of increasing the number of quality physical education programs in schools. The bill also provides critical information that parents and local leaders need to improve physical education and activity within their schools and communities, and necessary support for professional development. FIT Kids language was included in the Senate Elementary and Secondary Education Act (ESEA) that passed out of committee. It was given dedicated funding under a larger consolidated grant program, which was a major victory for FIT Kids. Despite the best efforts of the bill’s House co-sponsors, FIT Kids was not included in the ESEA reauthorization bill that ultimately passed.

The association will continue to strongly advocate for FIT Kids. So far support for FIT Kids is gaining momentum; 70 organizations support the legislation and the cosponsor list is growing. In addition, we will be having a fly-in in the fall, targeting key congressional members. Be sure to continue to watch your e-mail for action alerts asking Congress to support FIT Kids.

Contact: Kristy Anderson, kristy.anderson@.heart.org 

Still No Farm Bill
In a rerun of last year there is currently no agreement between the House and the Senate on a farm bill. The current legislation expires on September 30.

The association supports the Senate bipartisan bill which passed earlier this year. The legislation will strengthen efforts to increase healthy food consumption.

The House made two attempts to pass a comprehensive farm bill. The first version, which failed, would have been devastating to nutrition programs. The next version of the bill addressed agricultural programs but deliberately left out nutrition and hunger programs – which comprised two-thirds of the authorization. Senate leaders have informed the states that they refuse to negotiate a compromise without strong nutrition programs.

While many of the nutrition programs will continue past the Sept. 30 deadline, the longer the farm bill goes without a reauthorization, the more difficult it will be to find support for these programs. Congressional staff will attempt to come up with a version that both houses can pass during the August recess.

Contact: Kristy Anderson, kristy.anderson@heart.org


“Signs of Progress” in Childhood Obesity
On July 9, more than 250 people came to Washington D.C. to celebrate “Signs of Progress” in combating childhood obesity rates. The event was hosted by Voices for Healthy Kids, a joint national advocacy initiative of the Robert Wood Johnson Foundation (RWJF) and the American Heart Association. The new partnership seeks to help reverse the nation’s childhood obesity epidemic by 2015.

Moderated by Nancy Brown and Risa Lavizzo-Mourey, President and CEO of the Robert Wood Johnson Foundation, the event featured ten leaders from communities across the country with declining childhood obesity rates. An additional 800 individuals participated in the event via webcast.

During the event, panelists from four states and five cities or counties discussed the successful strategies they have used to reduce high rates of childhood obesity in their areas. While the specifics varied for each location, the declines ranged from a 1.1 percent drop among students in grades 5, 7, and 9 in California, to a 13 percent decrease among K-5 students in Mississippi.

Moving forward, Voices for Healthy Kids will work to ensure that children have access to healthy foods and beverages, as well as safe opportunities for physical activity. The new national advocacy initiative will accomplish this by partnering with other expert organizations to pursue policy-change strategies in six key areas:

1.) Foods in Schools – The Pew Charitable Trusts
2.) Healthy Drinks – The Yale Rudd Center for Food Policy & Obesity
3.) Marketing Matters – Berkeley Media Studies Group
4.) Food Access – The Food Trust
5.) Active Places – Safe Routes to School National Partnership
6.) Active Kids Out of School – YMCA of the USA

To learn more about Voices for Healthy Kids:
Follow us on Twitter @Voices4HK or visit www.VoicesforHealthyKids.org

To view the Signs of Progress webcast, go to: http://www.youtube.com/user/americanheartassoc/videos

Contact: Suzette Harris, suzette.harris@heart.org

Momentum Continues to Build Nationwide for CPR Training in Schools
Momentum continues to grow for the AHA's nationwide effort to encourage policymakers to enact legislation/regulation requiring that all students be trained in psychomotor skill-based, CPR prior to high school graduation. In mid-2013 we saw success in Georgia, Rhode Island, Texas and Washington. These states join the eight others which have enacted strong laws making CPR a graduation requirement.

Contact: Jeff Ranous, jeffrey.ranous@heart.org

More States Pass Pulse Oximetry Laws
Ten more states have enacted policies requiring that all newborns be screened for critical congenital heart disease (CCHD) using pulse oximetry. The states are Alabama, Alaska, Arkansas, Delaware, Louisiana, Minnesota, Nevada, New York, North Carolina and Oregon. Several other states, including Ohio and Missouri, are developing rules to carry out previously enacted legislation to implement CCHD pulse oximetry screening. Pulse ox tests offer a quick, painless way to screen newborns, for critical congenital heart defects. Early identification enables health providers to treat the defect quickly. More than 85 percent of children who undergo surgery for the defects reach adulthood.

Contact: Jeff Ranous, jeffrey.ranous@heart.org

States Strengthen Stroke/STEMI Systems of Care
Efforts to address critical stroke and STEMI system of care polices have advanced in four states. North Carolina Governor Pat McCrory signed a bill that will improve the state’s stroke systems of care by formally recognizing primary stroke centers. In Colorado, Governor John Hickenlooper signed legislation which requires the department of public health to recognize accredited stroke and STEMI hospitals. The Nevada bill, signed by Governor Brian Sandoval will create a state level recognition process for hospitals that have achieved certification to most effectively treat STEMI patients. Finally in Oregon, a new bill signed by Governor John Kitzhaber establishes a stroke care committee and statewide stroke registry to collect and track stroke data and improve health outcomes for stroke patients.

Contact: Jeff Ranous, jeffrey.ranous@heart.org


Massachusetts Increases Tobacco Tax by $1 per Pack
The Massachusetts legislature overrode Governor Deval Patrick’s veto in July to enact a new state cigarette tax, handing AHA advocates a dramatic victory. The $1.00 per pack tax brings the total cigarette tax to $3.51 per pack in Massachusetts. This increase will help prevent more than 27,000 Massachusetts children from becoming smokers, while pushing almost 25,000 current adult smokers to quit. This new tax could help prevent more than 15,000 smoking related pre-mature deaths in Massachusetts and save taxpayers over $994 million in future health care costs.

This campaign is supported with funds from the association, the American Cancer Society- Cancer Action Network, the Tobacco Free Massachusetts coalition, and the Center for Tobacco Free Kids – all members of the new tobacco policy initiative.

Contact: Chris Sherwin, chris.sherwin@heart.org

Two States Increase Funding for Tobacco Prevention and Cessation Program
Legislators in Oregon and Iowa passed funding increases for their state’s tobacco prevention and cessation programs. In Oregon, the legislature increased funding by $2 million per year. These funds will come from Oregon’s Master Tobacco Settlement and marks the first time they will be used for state tobacco prevention. Additionally in Iowa, lawmakers signed off on a funding increase of $1.5 million per year. While both these increases are modest, they are a positive development after many states cut funding for tobacco prevention during the economic downturn. The association is working to build on this momentum and is currently advocating for funding increases in others states.

Contact: Chris Sherwin, chris.sherwin@heart.org

Oregon and Alaska invest in Obesity Prevention Programs
Alaska Governor Sean Parnell recently included an increase of $1 million for the Obesity Prevention and Control Program in the state budget. The funds will be used to support school wellness policies, curriculum training for PE teachers, the Alaska Farm to School program, a pilot using electronic SNAP benefits at farmers markets, and training on childhood obesity and school nutrition for rural educators.
In Oregon, Governor John Kitzhaber recently signed legislation which includes an allocation of $4 million for physical education grants. The funds will be available to all schools from grades K-8 through a competitive grant process to help train and fund PE teachers, and ensure more children have access to high quality physical activity throughout the school day.

Contact: Ashley Bell, ashley.bell@heart.org

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