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An analysis of the state of the federal budget in the wake of the May 2023 agreement between lawmakers and President Biden, who struck a last-minute deal to raise the nation’s debt limit until 2025.

Predictions regarding how the health system would be impacted in the event of a U.S. default paint a grim picture for the country and for public health.

Hearing the Hill astho, association of state and territorial health officials, opioid crisis, covid-19 funds, public health, public health data and workforce, american rescue plan, promoting health, drug overdose death, coronavirus preparedness and response supplemental appropriations act 2020, de beaumont foundation, infectious diseases, substance use disorder, health equity, drug overdoses, january 2022, state local, opioid epidemic, opioid use disorder, workforce development, synthetic opioids, overdose deaths, prescription opioids, cares act, health departments, covid-19 pandemic Devon Page ASTHO | Takeaways from congressional meetings on leading public health topics. CSPAN is no Netflix. But that’s not to say this endless stream of content fails to entertain. In one short month, the new Congress has held several richly informative—and sometimes lively—hearings regarding the nation’s most pressing public health topics. The debates over COVID-19 funding, government oversight, and substance control—to name a few—illuminate the multiplicity of party agendas, how members of Congress are grappling with different issues, and opportunities for bipartisan collaboration. Since assuming the majority, House Republicans have been dutifully fulfilling their promise to scrutinize the origins of, funding for, and agency response to COVID-19. Three hearings were held in the first two weeks of February alone. The House Committee on Oversight and Accountability held a Feb. 2 hearing to discuss what Chair James Comer (R-KY) called “the greatest theft of taxpayer dollars in American history,” namely the fraud and improper payments that occurred within pandemic relief programs such as the Paycheck Protection Program, the Economic Injury Disaster Loan Program, and the Unemployment Insurance program. the fraud and improper payments that occurred within pandemic relief programs such as the Paycheck Protection Program, the Economic Injury Disaster Loan Program, and the Unemployment Insurance program. The hearing spotlighted the tradeoff between urgency and accountability: essentially, getting loans out the door quickly created vulnerabilities for fraud. To make matters worse, agencies were slow to implement modernization policies, such as data sharing between agencies, which only exacerbated the problem. While politicking reared its face in some cross-aisle imputations, committee members on the whole recognized that the issue warranted attention and demonstrated a willingness to work together to produce solutions to avoid similar instances of fraud in the future. Just down the hall, the House Committee on Energy and Commerce was holding a hearing titled, “Challenges and Opportunities to Investigating the Origins of Pandemics and Other Biological Events.” Here again, agreement penetrated party lines. Proactively addressing pandemics seemed a unanimous priority, albeit with some caveats: House Republicans focused chiefly on identifying the origin of the COVID-19 pandemic to help the U.S. better prepare for the next pandemic, where House Democrats tied this into preparedness and infrastructure. The blockbuster event of the COVID-19 hearings occurred a week later, featuring Lawrence Tabak of NIH, FDA Commissioner Robert Califf, and CDC Director Rochelle Walensky. Representatives, with a markedly more partisan fervor, explored a myriad of topics—from the impact of CDC guidance on declining public trust to NIH laggard interventional clinical trials for long COVID research—and expressed a mix of dissatisfaction and approval. Amid criticism from largely the conservative members, Walensky was steadfast in requesting broader public health data and workforce authority, as well as robust funding for public health core capacities. Rep. Diana DeGette (D-CO) echoed the director, calling for updated agency data infrastructure. The strong partisanship and serrated critiques of the agencies made clear the canyon-sized gap separating Democrats and Republicans on the federal COVID-19 response. In each of these hearings, at least one representative made mention of a different priority of this Congress: the fentanyl crisis. On Feb. 1, a House Energy and Commerce Health Subcommittee hearing was devoted entirely to the subject. And while Chair Brett Guthrie (R-KY) and Ranking Member Anna Eshoo (D-CA) appear postured to produce bipartisan legislation, differences in how the parties want to approach the issue are not insignificant. Republicans, on the one hand, favor classifying fentanyl as a Schedule 1 drug and cracking down on smuggling across the United States-Mexico border, while some Democrats strongly resist such measures. These points will likely be hashed out in future debates concerning H.R. 467, the Halt Fentanyl Act, and similar legislation. The committee also touched on the importance of investing in mental health. Rep. Tony Cárdenas (D-CA) emphasized the value of the 988 Hotline, and introduced H.R 498, the 988 Lifeline Cybersecurity Responsibility Act, to protect the hotline from cybersecurity incidents. Additionally, Rep. John Sarbanes (D-MD) requested that SAMHA’s Chief Medical Officer Neerja Gandotra, one of the hearing’s witnesses, explain why continued investment in mental health programs is paramount. Gandotra noted that the investments, specifically in youth, lead to decreased criminal justice involvement, fewer hospitalizations, and improved performance in school. There was also a Feb. 9 Senate hearing examining the state of the U.S. territories, which included testimony from the governors of the U.S. Virgin Islands, Guam, Puerto Rico, American Samoa, and Commonwealth of the Northern Mariana Islands. Both parties were resolute in supporting the governments. Several senators, including Ranking Member John Barrasso (R-WY) and Senator Mazie Hirono (D-HI), emphasized the importance of supporting Compacts of Free Association (COFA) citizens’ health and social safety nets. With just about 90% of this Congress’s session ahead of them, these issues, among others, will certainly be probed further as the object of congressional concern. Regarding public health, much remains to be said and—hopefully—done. Bipartisanship, no doubt to the surprise of many commentators, seems to be the reigning attitude: a sign of things to come or merely pretense? Only time will tell. website yes

What’s Next? An Update From the Hill Devon Page The new year began with a storm. A rare snowy blaze was unleashed on D.C., causing confusion, bewilderment, and inactivity. Though the snowfall subsided, its remnants melted, and Sen. Tim Kaine (D-VA) is no longer stuck in Armageddon-level traffic, a disorienting flurry of political activity (and inactivity) continues to swarm the Hill and for that reason, with respect to crossing off some priorities on Democrats’ agenda, members of congress might as well still be stuck in traffic. Last week, the House passed a third continuing resolution to fund the government through March 11. In order to avoid a government shutdown, Senators must approve the resolution by Friday, Feb. 18. Despite the small window and ongoing disputes over vaccine mandates and harm reduction efforts, party leaders appear confident that they'll be able to avoid a shutdown. Furthermore, the past two weeks have marked significant progress in a months-long party standoff over funding the government for Fiscal Year 22. There is bipartisan agreement for top line numbers, and congressional staff are now actively engaged negotiating and writing legislation. Despite Senator Manchin’s (D-WV) insistence that the Build Back Better Act is dead, the social spending package lives in the minds of Democratic legislators. However, attention has shifted from passing the entire $2 trillion package to passing several popular provisions originally included in the legislation. With nothing set in stone, advocates are diving into the mud, pushing for their top priorities. Of all the great BBB provisions—and in the eyes of this correspondent, there are a lot—ASTHO is doubling down on two: the establishment of a mandatory public health infrastructure fund to provide sustained, flexible, and long-term funding for public health departments and a permanent fix for Medicaid funding for the U.S. Territories. Among a plethora of strategic advocacy efforts, ASTHO in a recent letter exhorted Senate Majority Leader Chuck Schumer (D-NY) to include the two policies in any revised social spending package. But, as of earlier this month Sen. Schumer’s title as Majority Leader might, well, be just that—a title. While Sen. Ben Ray Luján (D-NM) recovers from a stroke, Democrats are facing an effectively balanced Senate for the foreseeable future. So now passing party-line legislation has become not only a practical impossibility (because of filibuster rules); it’s also, without a majority, a theoretical impossibility. If the fragility of the Democratic majority has not yet been made indubitably clear, Sen. Luján’s absence certainly does. Hopefully—for reasons beyond just the political, however important the political are— Sen. Luján makes a speedy and full recovery. For the time being, it seems that BBB sits on the back burner—and not just because of Sen. Luján’s malady. There is, plainly, a lot to get done, and much of it has a deadline. Confirming a Supreme Court Justice, especially in the contemporary Senate, is neither easy nor quick. The cumbersome selection and confirmation process—filled with private meetings, stakeholder input, and high scrutiny—requires months. Justice Breyer’s retirement announcement adds another serving to an already full congressional plate. Although the future of federal policy and the Biden Administration’s agenda remains as unclear as ever before, optimism can—and I argue, should—be found. First, reports are surfacing that, without any complications, Sen. Ben Ray Luján could be back to the Senate in as little as a month. Additionally, it appears that bipartisan support is growing for several ASTHO priorities, notably for ensuring equitable Medicaid funding for the U.S. Territories. And after about a year, Senate Health, Education, Labor, and Pensions (HELP) Committee Chair Patty Murray (D-WA) and Ranking Member Richard Burr (R-NC) released a discussion draft of the long-awaited PREVENT Pandemics Act, marking a step forward for the advancement of bipartisan public health initiatives. (ASTHO has submitted comments on the discussion draft to the Chairwoman and Ranking Member.) Last but certainly not least, ASTHO’s annual hill day is around the corner. In the middle of an exciting and eventful Washington Week on Wednesday, Feb. 23, ASTHO members will hold meetings with their respective congressional delegations in support of ASTHO FY22 and FY23 appropriations requests among other legislative priorities. …and yes, you read that right: “FY23”… Traffic, as frustrating as it may feel, does not stop the world from moving. website yes

Access to quality and reliable transportation is an indispensable aspect of American life. But for too many, social and economic conditions stand in the way. How do residents of Elk County, Kansas—where the nearest hospital is about 70 miles away—obtain necessary care in the face of transportation issues? How do residents of any medical desert bedeviled by transportation issues obtain care? These questions, among others, are difficult to answer for both the individuals who confront them directly and the experts and policy makers who confront them only indirectly.

The ASTHO Federal Government Affairs team answers questions about the work Congress has done for public health so far in 2022.

Suicide is a leading cause of death in the United States and widely recognized as a crisis, specifically among our youth, a population in which incidences have been rapidly increasing. Fortunately, suicide prevention and mental health support are issues that benefit from bipartisan support.