Heart on the Hill - August 2015

Heart on the Hill 

New Petition/Video Launched in School Meals Campaign

The association launched a new petition and video in our ongoing campaign to protect school meal standards. In June, we started a Change.org petition that currently has over 30,000 supporters. To keep the drumbeat going, with what was perhaps our most visible undertaking, AHA recently launched a video in partnership with Funny or Die, called “The Pizza Farm.” The video stars celebrity Nick Offerman and takes a satirical look at America’s food choices. The video went viral in July, with more than 1.5 million online views and 50 mentions in major media outlets.

Additionally, we have conducted several webinars on the subject, including one for school food service directors and coalition partners. We also worked with our CEO Nancy Brown to write a Huffington Post blog featuring a school district in Dallas that is having success with their farm-to-school program. We continue to participate in Team Up for School Nutrition Success’ technical assistance training, and our North Dakota affiliate hosted a state-wide school nutrition conference.

However, during the appropriations process this year, nutrition policies unfortunately received a blow and the very science supporting the policies was attacked. There are several provisions that we are actively opposing because they are detrimental to our nutrition priorities. The legislation and report include language that would:

  • Limit the scope of the Dietary Guidelines for Americans and its ability to effectively recommend nutrition policy based on science;
  • Postpone the enforcement of menu labeling by one-year;
  • Allow schools to take a waiver on the whole grains requirement and roll back the sodium standards in school meals;
  • Prohibit moving forward on Voluntary Sodium Guidelines until another scientific panel shows that there is no harmful health effects to lowering sodium; and
  • Delay the updated Nutrition Facts Label.

On the bright side, there were a few positive aspects of the bills. First, the Healthy Food Financing Initiative (HFFI), which supports projects that increase access to nutritious, affordable food in food deserts, received a million dollars in federal support. Also, despite heavy lobbying from the opposition to roll back all the standards in school meals, Congress decided to remain with status quo. This shows just how effective and important the association’s advocacy has been in protecting healthy school meals, and it is a big win for our efforts.

The school meals programs are set to expire on September 30. Fortunately, most of these programs are mandatory funding – meaning they will continue even if Congress fails to act on child nutrition reauthorization. Both chambers have been actively working to produce bipartisan bills, and the Senate is scheduled to consider their bill on September 17. However, we will likely see an extension through the end of the year as Congress works on a long-term bill.

Contact: Kristy Anderson

FAST Act and Cardiac Rehab Bill Introduced


AHA volunteer Nancy Lowman advocating for the FAST Act at an AHA Hill briefing in May.

Two new bills were introduced in Congress this summer that would provide stroke and heart patients with better access to care and treatment programs. The “Furthering Access to Stroke Telemedicine Act” or “FAST Act,” introduced in the Senate and House this summer, would improve Medicare beneficiaries access to telestroke evaluations. Another bill introduced in the House in July would help ensure that heart patients can utilize critical cardiac rehabilitation programs.


Introduced by Senator Mark Kirk (R-Ill.) and referred to the Committee on Finance, the FAST Act would require Medicare to reimburse for telestroke evaluations when the stroke patient presents at an urban or suburban hospital. Under current law, Medicare will only reimburse for telestroke evaluations – or any other covered telehealth service – when the patient is located at a rural originating site.

The House version of the bill was introduced by Representatives Morgan Griffith (R-Va.), Joyce Beatty (D-Ohio), Gregg Harper (R-Miss.), Mike Thompson (D-Calif.), James Sensenbrenner Jr. (R-Wis.) and David Scott (D-Ga.) in June and was referred to both the Committee on Energy and Commerce and the Committee on Ways and Means.

If you haven’t already done so, we encourage you to take action on our You’re the Cure alert and urge your congressional representatives to cosponsor the FAST Act!

In late July, another bill was introduced in the House by Reps. Lynn Jenkins (R-Kans.) and John Lewis (D-Ga.) that would help ensure access to critical cardiac rehabilitation programs, which are designed to improve a patient’s health and quality of life following a cardiac event. The bill would allow physician assistants, nurse practitioners and clinical nurse specialists to supervise cardiac and pulmonary rehabilitation programs on a day-to-day basis under Medicare. Current law only allows a physician to directly supervise and oversee these services, making it particularly difficult for programs to operate in areas where physicians are scarce. 

Identical legislation was previously introduced in the Senate, and that bill now has 16 bipartisan co-sponsors. The association continues to work closely with its partners – including the American Association of Cardiovascular and Pulmonary Rehabilitation, the American College of Cardiology and WomenHeart: The National Coalition for Women with Heart Disease – to build support for the legislation in both the House and Senate and to secure its passage in both chambers during this Congress.      

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

Health Appropriations Bills Move then Stall

For the first time in six years, both the House and Senate Appropriations Committees approved its health spending bills. Each funding bill contains winners and losers for our top priorities. One winner, the National Institutes of Health (NIH), would receive significant increases in both bills.

The Senate Appropriations Committee’s bill would provide the NIH with a $2 billion increase over current funding and the House Appropriations bill would increase the NIH’s budget by $1.1 billion. Some other funding differences in the two bills include:

  • CDC’s heart disease and stroke prevention programs received a $40 million increase from the House, but no increase from the Senate;
  • HRSA’s Rural and Community Access to Emergency Devices Program was kept at current funding levels in the House bill, while the Senate legislation would terminate this initiative designed to save lives from cardiac arrest in rural areas;
  • The Agency for Healthcare Research and Quality (AHRQ) would cease to exist under the House legislation, and in the Senate version, funding for the agency was provided;
  • CDC’s tobacco control program was cut about 50 percent by the House Committee bill, but its funding was maintained by the Senate; and
  • Both the Senate and the House Appropriations bills zero out funding for CDC’s Partnerships to Improve Community Health.

Finally, under the win category, the association was successful in securing language in the report accompanying the Senate Appropriations Committee bill about the importance of NIH heart and stroke research, as well as CDC heart disease and stroke prevention, Million Hearts and WISEWOMAN. 

It’s important to note that both of these bills are now stalled in Congress. So, funding for all of the programs under this legislation, including the NIH, CDC’s heart disease and stroke prevention programs and the Health Resources and Services Administration’s Rural and Community Access to Emergency Devices Program are likely to be included in a continuing resolution at current funding levels until at least December of this year. 

For more details, see our side-by-side analysis of the House and Senate Appropriations Committees’ bills.

Contact: Claudia Louis

21st Century Cures Passes House

In early July, the U.S. House of Representatives passed the 21st Century Cures Act by a vote of 344-77. The House-backed bill included numerous provisions addressing a number of issues intended to speed the discovery and development of new cures. It also proposes to increase investments in medical research at the National Institutes of Health (NIH) and change some aspects of how the Food and Drug Administration (FDA) oversees the review and approval of new drugs, biologics and medical devices.

The legislation was ultimately supported by over 700 groups – including organizations that represent patients, researchers, universities, providers and drug and device manufacturers. The 21st Cures Act was the result of numerous hearings and roundtable meetings hosted by the House Energy and Commerce Committee, dating back to spring 2014. These events focused on a broad range of topics that included: how to modernize clinical trials, how to incorporate patient perspectives into medical research and regulatory processes, perspectives on personalized medicine and digital health care, and other topics.

The association and our You’re the Cure advocates worked hard to ensure the bill’s passage so that Congress can continue to advance biomedical research and find new ways to increase access to innovative and improved drug products for all patients. Specifically, we strongly supported a provision in the bill that would allocate an additional $8.75 billion in mandatory funding for the NIH over a five-year period to fund new research that would address major challenges in biomedical research and lead to new medical breakthroughs.

This new funding is particularly significant because the NIH budget has not kept pace with medical research inflation over the past decade, resulting in more than a 20 percent loss in the agency's purchasing power. Together with many different organizations and our advocates, we were successful in ensuring that this funding remained in the final bill.

Although no similar legislation has been introduced, our focus now turns to the Senate. As Congress continues its work to develop a medical innovation bill, we will push for mandatory funding for the NIH.

Contact: Kevin Kaiser

Care Planning Act Introduced, CMS Proposal for Advanced Care

In June, the association was pleased to support the Care Planning Act of 2015, introduced by Senators Mark Warner (D-Va.) and Johnny Isakson (R-Ga.). The legislation would create a Medicare benefit for patient-centered care planning for Americans with serious illnesses. This benefit would allow Medicare to reimburse a team of health professionals who provide a voluntary, structured discussion about the patient’s goals, illness and treatment options.

The new legislation would also supply resources for public and professional education materials about care planning, test new models for more intensive services for those with advanced illness, and support the development of quality metrics that will measure how well documented care plans and patients’ stated goals match their treatments and outcomes. Because many Americans with heart disease and stroke now live longer and face prolonged, unpredictable treatment scenarios, we strongly believe that advance-care planning will play an important role in aligning quality care with the goals of patients and their families. 

Similarly, the Centers for Medicare and Medicaid Services (CMS) also recently proposed to begin reimbursing doctors who provide advance-care planning services with their patients.  Currently, Medicare does not pay doctors for such separate meetings. But under the proposed policy change, physicians would get paid for conversations with patients about the directives they want followed in the event of a life-threatening illness or health emergency.

The association plans to submit comments to CMS in support of this new policy and will urge them to include payment for advance-care planning services in its final rule that updates reimbursement rules for physicians. Together, these efforts will ensure that healthcare professionals, patients and their families can have open and proactive dialogues about advanced illness care, and provide the practical and emotional support patients need. Additionally, the proposals align with our belief that all Americans deserve proper care no matter where they are on the health spectrum.

In May, American Heart Association volunteer, Dr. Mary Beth Morrissey participated in a Capitol Hill briefing on this topic. The briefing, co-hosted by the Coalition to Transform Advanced Care and the Alliance of Community Health Plans, educated congressional staff about different models of care that help meet the medical and psychosocial needs of older individuals with advanced illnesses from the point of diagnosis through the end of life.

At the briefing, Dr. Morrissey, a gerontological health and social work research and health care attorney affiliated with the Fordham University Global Healthcare Innovation Management Center, shared her personal story about her own experience caring for her mother and brother as they lived with serious illnesses. She spoke about the challenges and opportunities that exist for supporting patients and caregivers as they navigate the healthcare system, while facing significant financial and emotional burdens. Dr. Morrissey also pointed to the need for a comprehensive federal policy that addresses all aspects of advanced illness care.

Contact: Kevin Kaiser

Senate passes Older Americans Act

The U.S. Senate unanimously passed legislation in July, supported by the association, which would reauthorize programs under the Older Americans Act. This act authorizes funding for a number of programs that aid individuals aged 60 and older with cardiovascular diseases to lead healthy, independent lives. This includes programs that fund disease prevention and health promotion activities, nutrition services, family caregiver support programs and other supportive services. Progress in addressing cardiovascular diseases for America’s aging population depends, in part, on the services afforded through this legislation. 

The bill now awaits action in the House of Representatives. The association looks forward to continuing its work to advance this bill so these vital programs can be renewed without any further delay.

Contact: Kevin Kaiser

AHA Calls on CMS for PAD Medicare Coverage

In late July, a Centers for Medicare and Medicaid Services (CMS) advisory committee held a public meeting to discuss treatment interventions for peripheral artery disease (PAD). At the meeting, the Medicare Evidence Development and Coverage Advisory Committee (MEDCAC) examined the impact that medical therapy, exercise therapy and revascularization have on patient health outcomes.

Joshua Beckman, MD, MS, Chair of the AHA Council on Peripheral Vascular Disease represented the association at the meeting. In his presentation, Dr. Beckman described how PAD is underdiagnosed and undertreated, which leads to increased mortality. He also urged CMS to provide Medicare coverage for PAD screening tests, as well as supervised exercise rehabilitation.

Dr. Beckman’s presentation was part of a series of coordinated presentations made by the AHA, the American College of Cardiology, the American College of Radiology, the Society for Cardiovascular Angiography and Interventions, the Society of Interventional Radiology, the Society for Vascular Medicine and VIVA Physicians. These groups are working together to ensure that patients with PAD are properly identified and have access to appropriate treatments. 

More information about the meeting is available on the CMS website.

Contact: Susan K. Bishop

Tobacco riders opposed by AHA

The ability of the Food and Drug Administration (FDA) to protect all Americans from unregulated and untested e-cigarettes, cigars and other tobacco products that are currently on the market was significantly limited by the House Appropriations Committee agriculture spending bill approved last month. 

By changing the so-called “grandfather date” for these products, the bill language exempts them from FDA’s premarket approval process. As part of this important product review requirement, manufacturers are required to provide information to the FDA about what the tobacco product contains, how it is made, what its health risks are, and how it will likely be used and by whom.

The association joined with our tobacco partners to strongly oppose the inclusion of this language in the House legislation. We sent a letter signed by more than 40 health groups to Congress asking them to remove this language from the bill. In addition, our volunteers contacted key members of the House Appropriations Committee.

At the committee’s mark-up of the legislation, an amendment offered by Rep. Nita Lowey
(D-N.Y.) to strike the language unfortunately did not pass, but there was bipartisan support for her amendment. Additionally, we were pleased that the language was not included in the agriculture spending bill that the Senate Appropriations Committee approved in July.  
Because the appropriations bills are on hold, it’s unclear whether this language will be included in a continuing resolution or omnibus appropriations bill later this year. When the bills do move, we will maintain our work to protect FDA’s authority to regulate all tobacco products and to protect the public from the dangers associated with tobacco use. 

Contact: Hannah Green


Supreme Court Upholds the ACA

The biggest news on the Affordable Care Act (ACA) this quarter was the U.S. Supreme Court’s 6-3 decision to once again uphold the law at the end of June. In its ruling, the Court maintained the Internal Revenue Service (IRS) regulation that allows low- and moderate-income Americans to access health insurance premium tax credits even if they live in a state where the federal government operates the Health Insurance Marketplace.

The association joined with the American Cancer Society, the American Diabetes Association and the National Multiple Sclerosis Society in filing an amicus brief in support of the availability of these tax credits in all states, and we released a joint statement applauding the Court’s decision.

An important aspect of the decision was that Chief Justice John Roberts and the majority did not rely on the Chevron rule, which requires courts to defer to reasonable interpretation of ambiguous statutes by federal agencies when upholding the IRS’s rules. Instead, the Court stated that this was one of those “extraordinary cases” of “deep economic and political significance” and “center to this statutory scheme” that it was up to the Court to determine what the statute meant. This means that future administrations will not be able to reverse the regulation, but instead, only Congress can act to limit the availability of tax credits in the future. Chief Justice Roberts’ decision sent a strong message to the lower courts about how they should view future cases related to the ACA: “Congress passed the Affordable Care Act to improve health insurance markets, not to destroy them. If at all possible, we must interpret the Act in a way that is consistent with the former, and avoids the latter.” Hopefully, this admonishment will discourage future litigation against the ACA.

The association also continues to work to help spread the word about coverage options for the uninsured, and to work on improving the law for patients with heart disease and stroke. Here are some highlights of our latest efforts: 

  • We submitted comments to the Centers for Medicare and Medicaid services in July on proposed regulations updating rules which protect consumers enrolled in Medicaid or Children’s Health Insurance Program managed care plans; and
  • In June, the Department of Health and Human Services launched its “Healthy Self” campaign that encourages consumers to take steps to improve their health by taking advantage of preventive services available with no cost-sharing and making healthy lifestyle choices. As part of the campaign, individuals are urged to take and share a #HealthySelfie when they take a healthy action.

Contact: Stephanie Mohl

Senate Passes ESEA

The Senate passed their Elementary and Secondary Education Act Reauthorization (ESEA) with a bipartisan vote of 81-17. This bill is a huge win for physical education and for the overall advocacy efforts of the American Heart Association. The Senate bill would strengthen physical education (PE) by making it an allowable use in a new consolidated grant program, restoring the PEP program, which was originally cut from the legislation, and make PE a core subject.

However, there are still some uphill battles as neither appropriations bills fund PEP and the Senate provisions must make it through what is anticipated to be a difficult conference, given the vast differences between the two bills. In particular, the House completely eliminates funding for physical education. We are working to restore this funding and keep federal physical education policy stronger and robust.

In addition, a bill we have long advocated for, the Promoting Physical Activity for Americans Act, was recently introduced. This bipartisan, bicameral legislative would call on the Department of Health and Human Services (HHS) to issue physical activity recommendations based on the latest scientific and medical evidence every ten years, with a five-year interim update.

This bill came close to passing in the last Congress and we look forward to pushing this important bill across the finish line.

Contact: Kristy Anderson

Transportation Programs Extended Again

Right before the Senate and House left for the August recess, both chambers approved a bill that would temporarily extend transportation programs for another three months through October 29. This extension gives the House more time to work on long-term legislation.

The Senate also approved a six-year bill prior to the break in a bipartisan vote 65-34. The Senate bill maintains the Transportation Alternatives Program, through which programs for Safe Routes to School and biking and walking initiatives are authorized. The Senate bill also contains a Complete Streets provision. Overall, we were pleased with the Senate bill as it maintains the status quo for programs that support walking and biking, and, in some cases, strengthens them.

Contact: Kristy Anderson

New Expert Panel Advises AHA on Payment/Delivery System Reform

Toward the end of June, the American Heart Association convened an in-person meeting of its Expert Panel on Payment and Delivery System Reform. The group came together to inform the association’s involvement in policy initiatives focused on payment and delivery system issues.

The panel is comprised of national experts on healthcare finance and organization and how they relate to cardiovascular and stroke care. Representatives from the Centers for Medicare and Medicaid Services (CMS) along with congressional staff presented to the group on CMS’ Health Care Payment and Action Learning Network and pilot project to use the association’s atherosclerotic cardiovascular disease risk calculator, as well as on the Senate Committee on Finance’s chronic care legislation.

In the immediate future, the group will assist staff in developing comments on the discussed initiatives. It also intends to develop a series of papers, starting with one that outlines the need for the association’s engagement in payment and delivery system policy issues, and ultimately outlining best practices for implementing new care models in cardiovascular and stroke care.

 Contact: Madeleine Konig


Tobacco Tax Increases in Nevada and Kansas

In early June, Nevada Governor Brian Sandoval signed Senate Bill 483 that increases Nevada’s tax on cigarettes from $0.80 to $1.80 per pack. This $1 increase will have a significant impact on smoking rates – including keeping an estimated 10,000 youth from becoming smokers and helping more than 15,000 current smokers quit – while also generating approximately $96 million per year in state revenue.

In Kansas, AHA staff, volunteers and partners worked together to significantly increase the state cigarette tax, and in the end, it went up from $0.79 to $1.29 per pack. Key partners in this campaign included the Kansas Health Foundation, American Cancer Society Cancer Action Network, Kansas Academy of Family Physicians, Campaign for Tobacco Free Kids, American Lung Association, Kansas Hospital Association, The University of Kansas Cancer Center and Kansas Health Consumer Coalition.

Additionally, AHA’s Board of Directors in Kansas City and Wichita adopted the tobacco tax campaign as part of their Community Plan 2.0.

Contact: Chris Sherwin

Massachusetts DOT Funds New Complete Streets Program

After a few years of hard work, the Massachusetts Department of Transportation will be making use of $12.5 million of transportation-dedicated funds to implement a new Complete Streets program. This will support cities and towns in the design and construction of roadways that accommodate all users and modes of transportation. The Complete Streets program will supply funding for both design and construction, which will allow the state to support communities that may be challenged to provide these funds. It will also help create a pipeline of Complete Streets projects that will further the goal of more and better mobility options across the Commonwealth.

Contact: Tim Vaske

Safer Routes in Washington

Washington State Gov. Jay Inslee signed 2ESHB 1299 into law in June, approving $15.3 million for bicycle and pedestrian safety projects and $6.75 million for Safe Routes to School in the state’s 2015-2017 biennial transportation budget.  After much hard work from advocates and Government Relations Director Lindsay Hovind, Gov. Inslee held a public signing ceremony in July for a tremendous multimodal transportation budget backed by groups including the association, Childhood Obesity Prevention Coalition (COPC) and Washington Bikes.
Last year, COPC, the association and Washington Bikes, set out to enable more kids to bike and walk to school, particularly in those communities where safe streets and places to exercise are needed most. When they first launched the Safe Routes Healthy Kids campaign, only one in four eligible Safe Routes to School grant applications were funded in the state. Doubling that investment, the new 16-year transportation revenue package includes an impressive:

  • $56 million in new state revenue for SRTS
  • $75 million in new state revenue for Pedestrian and Bicycle grant projects
  • $89 million in new state revenue for the state project list (primarily Ped/Bike projects)
  • $106 million in new state revenue for Complete Streets Grant Program

Contact: Tim Vaske

Utah and Oregon Take Steps to Improve School Nutrition

The Utah State School Board of Education recently approved Administrative Rule R277-719, which formally establishes standards for competitive foods and requires working within government departments to enact new implementation policies. Similarly, Oregon, a long-time leader on school nutrition, took another step forward when Governor Kate Brown signed HB 2404 – a strong competitive foods bill. That bill aligns with the updated federal guidelines, protects policy that extends the competitive foods guidelines to the extended school day, and does not allow fundraisers that don’t meet the smart snacks standards.

Contact: Stephanie Tama-Sweet

Berkeley Imposes Penny-Per-Ounce Tax on SSBs

In November of 2014, Berkeley, California became the first city in the U.S. to impose a penny-per-ounce tax on soda and other sugar-sweetened beverages. The tax took effect on March 1, 2015 and generated $116,000 in its first month. A portion of the taxes ($250,000) have already been earmarked for the Berkeley school district’s nutrition education program, delivering a big win in the fight against the obesity and diabetes epidemics. With contributions and advocacy support from the AHA, Berkeley is expected to be a trendsetter for the nation.

Contact: Katie Bishop

Two More States Require Pulse Oximetry Screening for Newborns

Colorado and Hawaii are the latest states to require newborn screening for critical congenital heart defects using pulse oximetry. The Colorado bill was signed into law in late May, and the Hawaii bill in early July. More than 40 states now require this simple, life-saving test for newborns.

Contact: Lucy Culp

States Move Toward Comprehensive Systems of Care

Minnesota, Louisiana, Oklahoma and Rhode Island have established the recognition of all three tiers of nationally certified stroke care facilities. In these states, EMS authorities are now required to develop and implement formal transport protocol plans for stroke patients. The policy enacted in Louisiana also establishes the recognition of nationally accredited facilities for STEMI facilities and requires EMS authorities to develop and implement transport protocols for STEMI patients. As a result, patients in these states will have more access to quality, comprehensive care and will be much more likely to be transported to the most appropriate stroke or heart attack facilities.

Nevada and Hawaii recently passed laws establishing a statewide stroke registry – another step in building comprehensive systems of care for patients in these states. Additionally, both Minnesota and Texas secured funding for statewide stroke registries, while Texas was also able to secure funding for a statewide STEMI registry.

Contact: Douglas Dunsavage

CPR in Schools at the State and Community Level

Thanks to the work of dedicated AHA volunteers and board members, the San Francisco Unified School District (SFUSD), which serves 56,000 students, will now require all high school students to learn Hands-Only CPR and receive AED training in a course needed for graduation.

Passed unanimously by the school board in late May, the requirement will begin with the 2015-2016 school year. As a result, 4,700 students in San Francisco’s public schools will now be trained in CPR annually. This is an exciting moment for the San Francisco-San Mateo Board of Directors, which chose CPR as a graduation requirement as one of its Community Plan 2.0 Health Goals in Fall 2014. (Read more: San Francisco’s Addition of CPR to its High School Curriculum; San Francisco school district to require CPR training to graduate)

At the state level, Indiana, Oregon and Connecticut recently passed legislation requiring CPR training for high school graduation. A total of 24 states now have CPR in Schools requirements in place.
Additionally, AHA advocates and partners in North Dakota secured an important funding victory: $450,000 for supporting CPR in Schools. Every public and private school in North Dakota is now eligible to receive $15 per student trained in a middle school or high school grade level of the school’s choosing.

Contact: Douglas Dunsavage


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(202) 785-7935

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