Issue Category: Infectious Disease

Trust for America’s Health Statement in Response to Congressional Passage of the Coronavirus Aid, Relief, and Economic Security Act (“CARES Act”)

March 27, 2020

“Congress took an important step today to begin giving public health the resources it needs now to respond to the COVID-19 pandemic. We are seeing in real-time the impact of the chipping away at public health budgets over the past 15 years. Health departments are facing unprecedented crises, and in many cases are doing so with a reduced workforce and 20th-century technologies.

The bill invests $4.3 billion in CDC, state and local public health to carry out critical response activities. It includes funding for state, local, tribal and territorial public health departments, global health security, and modernizing public health’s outdated data systems. We applaud Congress for allowing these funds to be spent over five years due to the increasing number and complexity of the nation’s public health challenges. The legislation includes funding for the Hospital Preparedness Program, a program that has seen its funding cut in half since 2003. It funds the development and purchase of vaccines and other critical needs.

Supplemental funding is critical during an emergency but cannot make up for long-standing, chronic underfunding of the public health system. We urgently need to rebuild and modernize the nation’s public health infrastructure and workforce. A significant, long-term commitment to public health infrastructure and programs is needed to prepare for the next pandemic and build a healthier, more resilient population. We need to strengthen the vaccine infrastructure, which will need to successfully and quickly distribute an eventual vaccine. We need to prevent and treat mental health issues and substance misuse, resolve health inequities and address the social determinants of health. The battle has begun.”

John Auerbach, President and CEO
Trust for America’s Health

10th Anniversary of the ACA: A Time to Reflect on its Impact and Refocus Efforts on the Act’s Purpose and Goals

COVID-19 has shown how important it is to fully fund the ACA created Prevention and Public Health Fund

March 23, 2020

This tenth anniversary of the enactment of the Affordable Care Act (ACA) is an appropriate time to measure its impact and recommit to its purpose.  Prior to the ACA, more than 44 million non-elderly adults were uninsured. By 2016, that rate of uninsured people reached a historic low as approximately 20 million Americans gained access to health insurance coverage under the ACA including 12 million adults who gained coverage due to Medicaid expansion.[1]

The ACA was transformative legislation in at least three ways. It offered Americans access to medical care when they were acutely ill and when they needed ongoing treatment for a chronic condition (78 percent of U.S. adults 55 and older have at least one chronic condition[2]). In addition, millions of Americans gained access to preventive care such as vaccinations and health screenings.   Thirdly, it helped advance health equity by narrowing – although not eliminating – the gaps in access to high-quality care experienced by people of color due to economic disadvantage and systemic discrimination.

Prior to the ACA, Black Americans were 70 percent more likely to be uninsured than Whites and the uninsured rate for Latinos was nearly three times the uninsured rate for Whites[3]. After the ACA became law, Latinos had the largest decrease in uninsurance rates, falling from 32.6 percent to 19.1 percent between 2010 and 2016. Uninsurance rates also fell by 8 percent for Asian Americans and Black Americans during the same period.[4]

Medicaid expansion states experienced significant coverage gains and reductions in uninsured rates among low-income individuals and within specific vulnerable populations.[5] A study by the National Bureau of Economic Research found that Medicaid expansion is associated with reduced mortality.[6]  According to the study, states that expanded Medicaid had an estimated 19,200 fewer adult deaths (ages 55 to 64) between 2014 and 2017 than did states that did not expand Medicaid.[7]

Furthermore, the ACA created the Prevention and Public Health Fund (PPHF) and allocated $2 billion annually as an “expanded and sustained national investment in prevention and public health programs”. Unfortunately, much of the PPHF funding has been reallocated to other programs outside prevention and public health. On this 10th anniversary of the passage of the ACA, Congress should redouble its efforts to ensure the Prevention Fund is fully funded and that those funds are directed as intended, to prevention and public health programs.

As the COVID-19 pandemic has put in the spotlight, individual health is often linked to community health. The Prevention and Public Health Fund’s intended purpose and emphasis: sustained investment in the nation’s public health infrastructure would, if fully realized, strengthen our national readiness for health emergencies. A level of readiness that the COVID-19 pandemic has shown to be seriously inadequate.

While this 10th anniversary of the Affordable Care Act is a time to recognize and applaud its significant impact, it is also a time to shine a spotlight on the fact that over 27 million Americans remain without access to healthcare due to being uninsured.  Ensuring that all Americans have access to healthcare is a priority of Trust for America’s Health and must be a national priority.

 

[1] Garfield R, Orgera K, Damico A. The uninsured and the ACA: a primer—key facts about health insurance and the uninsured amidst changes to the Affordable Care Act [Internet]. San Francisco (CA): Henry J. Kaiser Family Foundation; 2019 Jan 25.  https://www.kff.org/uninsured/report/the-uninsured-and-the-aca-a-primer-key-facts-about-health-insurance-and-the-uninsured-amidst-changes-to-the-affordable-care-act/ Google Scholar

[2] CDC, National Center for Health Statistics. Percentage of U.S. Adults over 55 with Chronic Conditions. https://www.cdc.gov/nchs/health_policy/adult_chronic_conditions.htm

[3] Buchmueller TC, Levinson ZM, Levy HG, Wolfe BL. Effect of the Affordable Care Act on racial and ethnic disparities in health insurance coverage. Am J Public Health. 2016;106(8):1416–21

[4] Garfield R, Orgera K, Damico A. The uninsured and the ACA: a primer—key facts about health insurance and the uninsured amidst changes to the Affordable Care Act [Internet]. San Francisco (CA): Henry J. Kaiser Family Foundation; 2019 Jan 25.  https://www.kff.org/uninsured/report/the-uninsured-and-the-aca-a-primer-key-facts-about-health-insurance-and-the-uninsured-amidst-changes-to-the-affordable-care-act/

[5] Madeline Guth, et al. The Effects of Medicaid Expansion Under the ACA: Updated Findings from a Literature Review. March 17, 2020.

[6] Sarah Miller et al., “Medicaid and Mortality: New Evidence from Linked Survey and Administrative Data,” National Bureau of Economic Research working paper, August 2019, https://www.nber.org/papers/w26081.

[7] Ibid

Cross-Sector Group of Eighty-eight Organizations Calls on Congress to Address Americans’ Mental Health and Substance Misuse Treatment Needs as Part of COVID-19 Response

Nation must prepare for immediate and long-term impacts of COVID-19 on the nation’s mental health

(Washington, DC – March 20, 2020) — A cross-sector group of 88 organizations from the mental health and substance misuse, public health and patient-advocacy sectors are jointly calling on the Trump Administration and Congress to address the immediate and long term mental health and substance misuse treatment needs of all Americans as part of their COVID-19 response. Such consideration is especially important as the anxiety and social isolation related to the COVID-19 pandemic are likely to increase the need for mental health and substance misuse care, according to the group’s leaders.

In a letter sent to Vice President Pence and House and Senate leadership today, the group recognizes the importance of social distancing but also cites the need to proactively address the short and long-term impacts of social isolation on Americans’ mental health. Of particular concern are those people who are currently being treated for a mental health or substance misuse issue, treatment that may be interrupted by illness, stay-at-home orders, business shut-downs or the loss of income or health insurance.

Access to mental health and substance misuse treatment is an ongoing concern, likely to be exacerbated by the COVID-19 crisis. Currently, 112 million Americans live in a mental health professional shortage area. Furthermore, loneliness and social isolation are already a daily reality for many Americans and is estimated to shorten a person’s life by 15 years – the equivalent impact of having obesity or smoking 15 cigarettes a day. This problem will only increase as further social distancing requirements are put in place.

The cross-sector group is calling for immediate action to address Americans’ mental health and substance misuse needs during the COVID-19 response. And, for the longer term, strengthening the nation’s mental health and substance misuse treatment system so it meets the needs of all Americans, regardless of their socioeconomic status, their employment status or where they live.

The group is following for the following action steps: The Administration and/or Congress should:

Immediately implement measures to ensure access and continuation of mental health and substance use services to all individuals during the COVID-19 response and during future public health emergencies including:

  • HHS should issue guidance clarifying that mental health and substance use clinicians and professionals are included in priority testing for COVID-19as well as targets of emergency medical supplies including masks, respirators, ventilators, and other needed resources for health care professionals during this crisis.
  • CMS should issue guidance for various care contingencies should substance use treatment providers become sick or unable to work and affect required quotas for reimbursement.
  • SAMHSA should issue guidance to support remote recovery support groups.
  • Congress should pass S. 2244/H.R. 4131, the Improving Access to Remote Behavioral Health Treatment Act, to clarify the eligibility of community mental health and addiction treatment centers to prescribe controlled substances for opioid use disorder via telemedicine. HHS recently waived the Ryan Haight restrictions for this pandemic, but this ends once the national emergency ends which could create treatment gaps.
  • HHS should launch a special enrollment period for commercial health insurance in the healthcare.gov marketplace during this crisis and future public health crises.
  •  Congress should ensure that all government health plans provide extended supplies and/or mail order refills of prescriptions.
  •  Congress should allow for all current discretionary and block grant funds for mental health and substance use programs, including prevention, intervention, treatment, and recovery support, across all relevant agencies across the federal government that cannot be spent this fiscal year due to the pandemic to be automatically extended into Fiscal Year 2021.

Pass, implement, and/or appropriate funding to strengthen crisis services and surveillance including:

  •  S. 2661/H.R. 4194, the National Suicide Hotline Designation Act, which would formally designate a three-digit number for the Lifeline.
  • H.R. 4564, The Suicide Prevention Lifeline Improvement Act, which would implement a set of quality metrics to ensure resources are effective and evidence-based.
  • H.R. 4585, the Campaign to Prevent Suicide Act, which establishes an educational campaign to advertise the National Suicide Prevention Lifeline and suicide prevention resources.
  • H.R. 1329, Medicaid Reentry Act, which would allow Medicaid-eligible incarcerated individuals to restart their benefits 30 days pre-release.
  • Increase funding for the Disaster Distress Helpline.
  • Increase funding to serve people who are homeless and to divert people who are at immediate risk of becoming homeless during this crisis.

Pass and implement reforms to ensure long-term availability of care, especially for populations at higher risk of self-harm or substance misuse, including:

  • S. 824/H.R. 1767, the Excellence in Mental Health and Addiction Treatment Expansion Act, which would expand the Certified Community Behavioral Health Clinic Program.
  • S. 1122/H.R. 1109, the Mental Health Services for Students Act which expands SAMHSA’s Project AWARE State Educational Agency Grant Program to support the provision of mental health services.
  • S. 2492/H.R. 2599, the Suicide Training and Awareness Nationally Delivered for Universal Prevention (STANDUP) Act, which would create and implement suicide prevention training policies in states, tribes, and school districts.
  • Enforce mental health parity and pass S. 1737/H.R. 3165, the Mental Health Parity Compliance Act and S. 1576/H.R. 2874, the Behavioral Health Transparency Act.
  • Expand HRSA’s NHSC Substance Use Disorder Workforce Loan Repayment Program H.R. 2431, the Mental Health Professionals Workforce Shortage Loan Repayment Act, which would establish a loan repayment program for mental health professionals working in shortage areas.
  • S. 2772/H.R. 884, the Medicare Mental Health Access Act, which would allow expanding the definition of “physician” under Medicare, allowing psychologists to practice to the full extent of their state licensure without physician oversight of Medicare facilities.

HHS should consider the mental health and substance use effects of future pandemics and national emergencies including:

  • Establishing an interagency taskforce or advisory committee on disaster mental health and substance use to ensure future responses take proper measures to coordinate care, allocate resources, and take appropriate measures to ensure recovery.
  • Convening a working group to review current research and funding on disaster mental health through NIH, AHRQ, CDC, SAMHSA, HRSA, FDA, and the Department of Justice, and other relevant agencies and identify gaps in knowledge, areas of recent progress, and necessary priorities.

Signing on to the letter were:

2020 Mom, AAMFT Research & Education Foundation, Active Minds, Addiction Connections Resource, Advocates for Opioid Recovery, African American Health Alliance, American Academy of Addiction Psychiatry, American Art Therapy Association, American Association for Marriage and Family Therapy, American Association for Psychoanalysis in Clinical Social Work, American Association of Suicidology, American Counseling Association, American Dance Therapy Association American Foundation for Suicide Prevention American Group Psychotherapy Association, American Mental Health Counselors Association, American Psychological Association, American Public Health Association, Anxiety and Depression Association of America, California Pan-Ethnic Health Network Center for Law and Social Policy (CLASP)Centerstone, Children and Adults with Attention-Deficit/Hyperactivity Disorder, Clean Slate Medical Group -Addiction Treatment, Clinical Social Work Association, Coalition to End Social

Isolation & Loneliness, College of Psychiatric and Neurologic Pharmacists (CPNP )Colorado Children’s Campaign Columbia Psychiatry, Community Anti-Drug Coalitions of America (CADCA, )Community Care Alliance Davis Direction Foundation, Depression and Bipolar Support Alliance, Easterseals, Eating Disorders Coalition, Families USA, Flawless Foundation, Foundation for Recovery, Global Alliance for Behavioral Health and Social Justice, Greater Philadelphia Business Coalition on Health, Health Resources in Action, Hogg Foundation for Mental Health, InnovaTel, Telepsychiatry International, OCD Foundation,

Mental Health America, NAADAC, the Association for Addiction Professionals, National Association of County Behavioral Health and Developmental Disability Directors, National Association for Rural Mental Health (NARMH), National Alliance on Mental Illness, National Association for Children of Addiction (NACoA, )National Association of Community Health Workers, National Association of Counties, National Association of Social Workers, National Association of Social Workers -Texas Chapter, National Association of Social Workers at the University of Southern California, National Association of State Mental Health Program Directors, National Council for Behavioral Health, National Eating Disorders Association, National Federation of Families for Children’s Mental Health, National Organization on Fetal Alcohol Syndrome, National Register of Health Service Psychologists, Network of Jewish Human Service Agencies, Neurofeedback Advocacy Project, New Jersey Association of Mental Health and Addiction Agencies, Inc., O’Neill Institute for National and Global Health Law, Postpartum Support International, Prevention Institute, Public Health Foundation, Residential Eating Disorders Consortium, Robert Graham Center, San Francisco AIDS Foundation, San Juan County Behavioral Health Department, Sandy Hook Promise SMART Recovery, Staten Island Partnership for Community Wellness, Suicide Awareness Voices of Education, Texans Care for Children, The Confederation of Independent Psychoanalytic Societies (CIPS), The Gerontological Society of America, The Institute for Innovation & Implementation at UMBSSW, The Jed Foundation, The National Alliance to Advance Adolescent Health, The Trevor Project, The Voices Project, Trust for America’s Health, United States of Care, University of Southern California, Well Being Trust.

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Trust for America’s Health is a nonprofit, nonpartisan organization that promotes optimal health for every person and community and makes the prevention of illness and injury a national priority. Twitter: @HealthyAmerica1

55 Organizations Call for Passage and Fast Implementation of Paid Sick Leave for all Workers as a Critical Part of COVID-19 Response

(Washington, DC) – A cross-sector group of 55 public health, health, labor, business and social policy organizations are jointly calling on the Trump Administration and Congress to pass and quickly implement a federal paid sick leave law that provides 14 days of such leave to all workers, available immediately upon declaration of a public health emergency. Fourteen days aligns with the currently recommended quarantine period for COVID-19. Furthermore, and beyond the COVID-19 response, the coalition recommends that the new law require all employers, regardless of their size, to allow workers to earn up to seven days of paid sick leave for use when they or a family member is ill or for preventative care.

The group is also proposing tax relief or interest free loans to be made available for small businesses that provide sick leave benefits during a public health emergency and that employees be allowed to take leave if schools or places of employment close due to a public health emergency. Furthermore, employees should be allowed to use leave to care for family members and should be protected from job loss or any other forms of reprisal if they comply with public health or medical advice to stay home.

Multiple health studies have found that the absence of paid sick leave has been linked to or has exacerbated infectious disease outbreaks in the past. In dealing with the current novel coronavirus, the experience of other countries indicates that aggressive social distancing measures can help slow the spread of the virus. Yet for the 34 million individuals who do not have access to paid sick leave, staying at home may not be a realistic option. Many individuals without paid sick time earn low wages, and a disproportionate percentage work in the service industry. Just 30 percent of low-wage workers in the private sector have access to paid sick leave, compared to 93 percent of higher-wage workers.

“Everyone has a role to play in managing the COVID-19 outbreak. Immediate passage and fast implementation of a national paid sick leave law will allow all workers to follow the directions of their communities’ public health officials. It is critical to mitigation efforts that people be able to stay home from work if they are sick or if they may have been exposed to the virus without facing the impossible choice of their health or their financial stability,” said John Auerbach, President and CEO of Trust for America’s Health.

A letter outlining the recommended policy actions was delivered today to Vice President Mike Pence, Senate Majority Leader Mitch McConnell, (R-KY), Senate Minority Leader Charles Schumer, (D-NY), House Speaker Nancy Pelosi, (D-CA), and House Republican Leader Kevin McCarthy (R-CA).

Organizations signing-on to the letter were:

American Lung Association
American Medical Student Association
American Public Health Association
American School Health Association
American Sexual Health Association
American Society of Tropical Medicine and Hygiene
Antibiotic Resistance Action Center, George Washington University
Asian & Pacific Islander American Health Forum
Association for Prevention Teaching and Research
Association for Professionals in Infection Control and Epidemiology
Association of Maternal & Child Health Programs
Association of Public Health Laboratories
Association of Schools and Programs of Public Health
Center for Global Health Science and Security Georgetown University
Center for Public Policy Priorities
Center for Science in the Public Interest
Children’s Environmental Health Network
Clean Habitat Inc
Colorado Association of Local Public Health Officials
Council of State and Territorial Epidemiologists
de Beaumont Foundation
Florida Institute for Health Innovation
Georgetown University Center for Global Health Science and Security
Green & Healthy Homes Initiative
Health Resources in Action
HIV Medicine Association
Immunize Nevada
Infectious Diseases Society of America
Liver Health Initiative
March of Dimes
National Association of County and City Health Officials
National Association of School Nurses
National Coalition of STD Directors
National Council of Jewish Women
National Fragile X Foundation
National Health Care for the Homeless Council
National Network of Public Health Institutes
National Organization for Women
NERDS RULE INC
NW Unangax Culture
NYU School of Global Public Health
PATH
Peggy Lillis Foundation
People’s Action
Prevention Institute
Public Health Institute
Public Health Solutions
Rollins School of Public Health
Safe States Alliance
Shriver Center on Poverty Law
Society for Public Health Education
Sumner M Redstone Global Center for Prevention and Wellness
Trust for America’s Health
Washington State Department of Health
Washington State Public Health Association
Women’s Law Project

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Trust for America’s Health is a nonprofit, nonpartisan organization that promotes optimal health for every person and community and makes the prevention of illness and injury a national priority.  Twitter: @healthyamerica1

TFAH’s Dr. J. Nadine Gracia’s Testimony before House Committee on Homeland Security, Subcommittee on Emergency Preparedness, Response, and Recovery. COVID-19 Response

Dr. J. Nadine Gracia, Executive Vice President and Chief Operations Officer of Trust for America’s Health (TFAH), provided testimony during the Community Perspective on Coronavirus Preparedness and Response before the Subcommittee on Emergency Preparedness, Response, and Recovery of the House Committee on Homeland Security. Dr. Gracia’s testimony highlights TFAH’s policy recommendations to strengthen our nation’s preparedness for public health emergencies and improve the national response to the novel coronavirus.

TFAH Applauds Passage of Supplemental Funding for COVID-19 Response: Now Funding Must Move Quickly to States and Other Entities

(Washington, DC – March 5, 2020) – Trust for America’s Health, a nonprofit, nonpartisan public health policy organization, applauds Congress’ fast action in approving the Coronavirus Preparedness and Response Supplemental Appropriations Act (H.R 6074). We now call on the tasked federal agencies to move quickly to send the appropriated monies to the agencies and localities working at the frontlines of the COVID-19 crisis.

Emergency funding is critical now for the following:

  • Domestic public health. The supplemental provides essential support to states and local public health departments. This will provide support for their work which includes identifying and investigating cases, isolating and quarantining individuals, screening travelers at airports, ensuring the laboratory capacity to test patients for the virus, coordinating with the health sector to guarantee needed services are available, assessing the needs of those who are most vulnerable because of social, economic or environmental conditions and communicating with the public and healthcare facilities. The breadth of the response is quickly exhausting the funding provided in annual appropriations bills.
  • Healthcare response.  The supplemental provides support to hospitals, health centers and other clinical facilities across the nation have begun to identify, isolate and care for patients with COVID-19.  Among the work of the health care system is training healthcare workers on the identification of COVID-19 cases and on appropriate infection control practices and treatment.  The supplemental includes funding for training, provision of healthcare at community health centers, who serve the most vulnerable Americans, and ensuring the health care sector has appropriate personal protective equipment, necessary clinical supplies and equipment, and surge capacity.
  • Medical countermeasures research and development. The supplemental ensures the U.S. prioritizes development and procurement of COVID-19 diagnostics, vaccines, and treatments. The federal government must be a reliable partner in development of products to combat the virus.
  • Global health security. The supplemental supports global efforts through the World Health Organization, USAID and other agencies to boost the capacity of lower-income countries to detect and control infectious disease outbreaks.  This will protect Americans as well as other countries by decreasing the likelihood of transmission as a result of travel and commerce.
  • Investing in standing reserve funds. The supplemental fully replaces funds spent from the Infectious Disease Rapid Response Reserve Fund and adds money in this fund, so new funding can be immediately accessed if needed to fight COVID-19 and as an investment in protecting Americans from future outbreaks.
  • Replacing funds lost due to transfers. The supplemental includes a requirement to pay back the $136 million transferred between HHS program for the initial COVID-19 response.

The full extent of the outbreak in terms of public health, healthcare and personal costs remains to be seen, but this investment is needed now.  Taking immediate steps to mitigate the effects of the outbreak will save lives and prevent harm.

Trust for America’s Health is a nonprofit, nonpartisan public health policy, research and advocacy organization that promotes optimal health for every person and community and makes the prevention of illness and injury a national priority.