This Week in Congress

Appropriations

This week Senate Appropriations Committee Democrats released FY’23 drafts of the twelve appropriations bills and reports. The House made their funding recommendations last month.  Final conference negotiations between the House and Senate are not expected until December.

The Senate Labor, Health and Human Services and Education subcommittee recommended $179,310,000 for the sexually transmitted disease program at CDC, an increase of $15,000,000 over the FY’22 funding level, the largest one-year funding increase in the history of the program.

In addition, the bill includes the following funding and language provisions:

• Encourages the CDC to provide a minimum of $20,000,000 to continue funding STI clinics from monies contained in the Ending the HIV Epidemic Initiative, to curb the spread of HIV and increase capacity at STI clinics.
• Provides $130,000,000 for Teen Pregnancy Prevention, an increase of $29,000,000 over the previous year’s funding level to expand evidence-based prevention approaches to prevent teen pregnancy and STIs among adolescents and young adults.
• Provides $9,000,000,000 for the Public Health and Social Services Emergency Fund to “support the COVID-19 pandemic response or respond to any disease with potential for causing a pandemic.” A portion of these funds “could” be used for monkeypox, but no specific funding level or language for monkeypox was included anywhere in the Senate bill or report.
• Provides $10,000,000 to establish an HHS reproductive health ombudsman to help connect individuals with STD and Title X clinics; oversee reports of failure by insurers to adequately cover birth control costs; abortion funds; and provide information on safety related to self-managed abortions.
• Moves the PCHD grant year award forward by one month, each year, for the next three years, to provide for a more efficient grant application and management process.
• Encourages the CDC to hold harmless PCHD grant funding to ensure that no grantee would receive less funding than the previous year.
• Encourages CDC to work with other agencies to address the high rates of STIs.
• Encourages the National Institute of Allergy and infectious Diseases at the National Institutes of Health to accelerate work to find new diagnostic tools, vaccines, and treatment options for gonorrhea and syphilis.
• Encourages the National Institute of Child Health and Human Development to coordinate efforts with the National Institute of Allergy and Infectious Diseases for new testing, diagnosis, and treatment efforts for congenital syphilis.

The Senate LHHS bill summary can be found here

The Senate LHHS draft report can be found here

Reconciliation

The Senate is expected to take up a reconciliation package that includes climate and tax provisions next week. The agreement came together after Senator Manchin announced he had struck a deal with Senate Majority Leader Schumer on a package that would include the climate and tax provisions that two weeks ago Manchin said he would not support. In a joint press release, Manchin and Schumer stated that the bill would lower deficits by $300 billion over a decade; provide $369.8 billion for clean energy and climate change programs; and extend expanded subsidies to purchase health insurance on the 2010 health care law’s exchanges for three years.

Chips-plus

This week, the House and Senate passed the US Innovation and Competition Act. Majority Leader Schumer praised the bill as one of this Congress’ most consequential bipartisan achievements.” The bill provides funding to support U.S. semiconductor manufacturing, research and development, and supply chain security. The bill now heads to the White House for the President’s signature.

Veterans Health and Benefits

Last evening the Senate failed to get cloture on S. 3373. The vote was 55-42, short of the 60 votes needed to end the debate on the legislation. Republicans mounted an 11th-hour challenge to the legislation over the fact it would reclassify nearly $400 billion in current-law VA spending from discretionary to mandatory accounts.  “It’s about a budget gimmick that’s designed to allow hundreds of billions of dollars in additional unrelated spending, having nothing to do with veterans,” said Senator Toomey. The House passed the bill two weeks ago on a 342-88 vote. The legislation would provide easier access to health and disability benefits to more than 3.5 million veterans who were exposed to toxic substances while on overseas deployments.

Other Legislation and Happenings Around the Nation

Monkeypox

Statistics:  Worldwide cases – 21,148 in 78 countries.  The US has the highest count of any country with 4,907 cases (New York and California are leading the states in confirmed cases).

Vaccines:  This week, the Department of Health and Human Services is making available 786,000 vaccine doses available to states and jurisdictions. Department of Health and Human Services Secretary Xavier Becerra said in a statement that HHS will also announce allocations and a distribution plan. The FDA has cleared an additional facility in Denmark to finish manufacturing monkeypox vaccines, allowing more doses to be distributed and administered across the U.S.

Public Health Emergency:  The Biden administration is expected to declare monkeypox a public health emergency in the coming days. The declaration would follow a similar decision made last weekend by the World Health Organization. By designating the outbreak an emergency, HHS could access money and appoint new personnel. But the decision is not yet final, and a spokesperson for HHS said the agency “is continuing to explore options.”

San Francisco:  This week, San Francisco and the state of New York, the two states hardest hit by monkeypox, declared public health emergencies amid the growing outbreak, the latest in escalating measures in response to the rapidly spreading virus. The action comes after the World Health Organization declared a global emergency.  San Francisco Mayor Breed announced the local public health emergency, noting that cases of monkeypox had nearly doubled in a week. She said the move would mobilize resources, accelerate emergency planning, and allow for future spending to be reimbursed by the state and federal governments.

New York:  After the state of New York recorded more than 1,200 cases, State Health Commissioner Bassett on July 28, 2022, declared an imminent threat to public health, retroactive to June 1. “This declaration means that local health departments engaged in response and prevention activities will be able to access additional State reimbursement, after other Federal and State funding sources are maximized, to protect all New Yorkers and ultimately limit the spread of monkeypox in our communities.”

Is Monkeypox an STD?: For most of the six decades that monkeypox has been known to affect people, it was not known as a disease that spreads through sex. Now that has changed. The current outbreak indicates that the disease has spread mainly by men who have sex with men. While there is broad agreement among health officials that monkeypox is being transmitted during sexual encounters, some experts debate whether it should be called an STD. They worry that the term unfairly stigmatizes and that it could undermine efforts to identify infections and tame the outbreak. Jason Farley, an epidemiologist at the Johns Hopkins School of Nursing. That’s what happened in the early days of the AIDS epidemic which contributed to the spread of HIV to other groups. Farley said. “We learn nothing from our history. This is the fine line between having a public health approach that focuses on the epidemiology of now, compared to the likelihood of the continued emergence of new cases in” the general community, he said. “Monkeypox is not a sexually transmitted infection,” he said. “It is an infection that can be transmitted with sexual contact.”

David Harvey, Executive Director of the National Coalition of STD Directors noted that much of the work on monkeypox has been done by professionals who operate sexual health clinics or specialize in STDs. Harvey stated: “The U.S. government’s response needs to be led by people with that expertise. The STD field has a wealth of knowledge and expertise in these areas developed over decades fighting various outbreaks and diseases affecting the very communities … we’re seeing monkeypox taking a toll on today.”

HHS Secretary Becerra:  This week, HHS Secretary Becerra suggested that states and localities bear some of the responsibility for what critics have called a flawed response. “We don’t control public health in the 50 states, in the territories and in the tribal jurisdictions,” said Secretary Becerra, in response to question about whether the virus could be eliminated. “We rely on our partnership to work with them. They need to work with us.” Still speaking of the states, he added, “They are ultimately the ones to determine how health care is administered in their jurisdictions.” The secretary may have been trying to deflect criticism from advocates for people with H.I.V. and AIDS, who face disproportionate risk of contracting monkeypox and have been vocal about their unhappiness with the response.

David Harvey, Executive Director of the National Coalition of STD Directors stated that “Becerra’s comments showed a lack of understanding for the full breadth of this crisis. Clinics around the country are pleading with federal health officials for the information, supplies and staffing they need to successfully bring an end to this outbreak.”

Letters:  On July 25, 109 Members of Congress, spearheaded by Reps. Nadler and Cicilline, sent a letter to President Biden, HHS Secretary Becerra, and CDC Director Walensky requesting that $100 million be provided to implement federal monkeypox response efforts, with at least $30 million of those funds allocated to the CDC for resources, infrastructure, and prevention efforts for STD programs.  The letter is available here.

Abortion

Wyoming and North Dakota:  Abortion bans set to take effect this week in Wyoming and North Dakota have been temporarily blocked by judges in those states amid lawsuits arguing that the bans violate their state constitutions. A judge in Wyoming sided with a firebombed women’s health clinic and others who argued the ban would harm health care workers and their patients, while a North Dakota judge sided with the state’s only abortion clinic, Red River Women’s Clinic in Fargo.

West Virginia:  WVA’s Republican-dominated House of Delegates passed an abortion ban this week that makes providing the procedure a felony punishable by up to 10 years in prison. The bill now heads to the Senate for consideration.  The bill includes exceptions for victims of rape and incest, as well as for medical emergencies.