NATIONAL
Fiscal Year 2003 Appropriations Stall (H.R. 5320/S.2766)
Fiscal Year (FY) 2003 started on October 1, 2002; however, Congress has not yet passed the FY 2003 appropriations bill for the U.S. Department of Health and Human Services (HHS) or any federal government agency except Defense. Given the experience of previous years, the bill may not pass until December. Until then, Congress must pass continuing resolutions that allow the government to operate at the same budget levels as FY 2002. This poses significant challenges for agencies expecting significant increases, like the National Institutes of Health, which is expecting an increase of $4 billion.
The Senate's version of the HHS appropriations bill has been approved by the Senate's appropriations committee and is ready to be voted on by the entire Senate. However, the House version of the appropriations bill has not been approved by its appropriations committee. Moreover, the two bills contain major differences, which will have to be reconciled in a joint conference committee of the House and Senate before it goes to President Bush for signature. Both the House and Senate appropriations bills, as well as the Senate Appropriations Committee report, are available online at http://thomas.loc.gov/home/approp/app03.html.
Congress passes Reathorization of Community Health Centers (S. 1533)
On October 17, 2002, Congress passed the Health Care Safety Net Amendments Act of 2002. This legislation is a key part of the Administration's plan to address the challenge of the uninsured. The final bill reauthorizes the consolidated health centers program as well as the National Health Service Corps Program. The final bill also includes "Access Grants" for community health centers that serve a significant limited-English proficient population; however, no specific dollar amount was authorized to be appropriated for these grants.
Congress Leaves Major Health Legislation Unfinished
A number of factors are combining to push health and social service legislation off of the legislative agenda for this year: Congress has only passed two of the thirteen required appropriations bills so far, debates on presidential priorities (e.g., Iraq) have taken priority, and many Members of Congress are anxious to get home and campaign for re-election. Congress is currently in recess until one week after the elections at which time they will conclude the appropriations bills. However, it is unclear if any other legislation , including the bills listed below will be considered or how long Congress will be in session. More information about these bills can be found at: http://thomas.loc.gov.
Reauthorization of Temporary Assistance for Needy Families (H.R. 4737)
The House passed its bill reauthorizing the Temporary Assistance for Needy Families (TANF) program for another 5 years in May. In June, the Senate Finance Committee approved a version of the House bill that was much more favorable for legal immigrants (see APIAHF August Policy Update). However, the full Senate has not considered the bill. Alternatively, there are discussions in the Senate Finance Committee to continue the TANF program for three more years with tougher work requirements and more funding for child care. However, this would mean that the current exclusions of legal immigrants would also continue. Depending on the composition of the next Congress, it may be more difficult to press for the changes made by the Senate Finance Committee. The TANF reauthorization bill is called "The Work, Opportunity and Responsibility for Kids (WORK) Act of 2002." The Senate Committee report is available at http://finance.senate.gov/sitepages/legislation.htm.
Patient Navigator, Outreach and Chronic Disease Prevention Act (H.R. 5187)
Introduced in July, this bill would authorize the Health Resources and Services Administration (HRSA) and the National Cancer Institute (NCI) to make grants for "patient navigator programs" and other model programs for populations experiencing health disparities. The bill has been sent to the Health Subcommittee of the House Committee on Energy and Commerce for consideration.
Patient's Bill of Rights (H.R. 2563/S.283)
The Bipartisan Patient Protection Act passed both houses last year, but a conference committee was never convened this year to reconcile the major differences between the House and Senate versions.
Immigrant Child Health Improvement Act (ICHIA) (H.R. 1143/S. 582)
This bill would provide federal funds to states that choose to allow legal immigrant children and pregnant women to participate in the Medicaid and the State Children's Health Insurance Program (SCHIP) regardless of date of entry. The bill has not been passed by either House or Senate committees; however, the bill was included in the Senate's TANF reauthorization bill, mentioned above.
New HHS Rule Provides SCHIP Eligibility for Unborn Children
On Wednesday, October 2, 2002, the Bush Administration announced new regulations that allow states to cover health care for fetuses under the State Children's Health Insurance Program (SCHIP). This is a departure from previous SCHIP policy that provided health coverage to children and in some cases parents of eligible children, but not "unborn children". Currently, states cover pregnant women through the Medicaid program. The new regulations also allow states to cover pregnant immigrants who are currently ineligible under SCHIP or Medicaid (e.g., because of the five year bar on receipt of benefits after entry, or undocumented status). The Administration claims that this will provide states with additional options for providing care to pregnant women. Critics however argue that the new rule sets a dangerous precedent and is being used to establish legal status for fetuses in order to further a political agenda regarding abortion. Furthermore, they argue that it fails to provide meaningful comprehensive coverage for pregnant women (as services that are intended to benefit the women, such as anesthesia or post-partum care, will not be covered), and that the new rule creates so many implementation barriers that it will not actually provide any real expansion of care.
For more information see the October 2, 2002 Federal Register (67 Fed. Reg. 61955-74) www.access.gpo.gov
Institute of Medicine Publishes Guidance on National Health Disparities Report
The Agency for Healthcare Research and Quality (AHRQ) will be producing an annual report called the National Healthcare Disparities Report (NHDR). In preparation for this report, the Institute of Medicine (IOM) convened a special committee to provide guidance to AHRQ. This guidance is now available to read and purchase at www.nap.edu/catalog/10512.html. It addresses such issues as measuring disparities in access to and the quality of health care, measuring socioeconomic status, developing adequate data sources, and determining AHRQ's need for adequate financial and other resources to produce the NHDR. (Download APIAHF's testimony - *.pdf).
HHS Releases Five Year Strategic Plan
The Department of Health and Human Services (HHS) released its draft strategic plan for FY 2003-2008 in July. The plan establishes eight strategic goals that reflect department-wide priorities that cut across individual HHS agencies and programs. The plan does not document every implementation strategy for HHS agencies. Furthermore, the goals and objectives do not specify specific target populations. For example, Goal 3 is to close the gaps in health care, but no particular populations are identified. It is also not clear how the strategic plan relates to the Health People 2010 objectives to reduce medical disparities. HHS solicited comments through September 9, 2002. (Download APIAHF's comments - *.pdf).
CALIFORNIA
Davis Vetoes Key Legislation Affecting LEP Persons, but Signs Others
As the legislative session came to a close, a number of bills that would affect the health and safety of AAPIs were passed by the legislature and were sent to Governor Gray Davis for his approval or veto.
VETOED: Assembly Bill 2739 (Chan) – Cultural and Linguistic Requirements
This bill would have established minimum, uniform requirements for all HMOs participating in the Medi-Cal and Healthy Families programs to provide culturally and linguistically appropriate care to all beneficiaries. APIAHF, along with six collaborating partners, sponsored the bill, navigating it through both houses of the California legislature in spite of opposition from the HMO association. In his veto message, the Governor, after recognizing the diversity of Californians, stated that he would rather that the cultural and linguistic service requirements remain in the contracts the state negotiates with the HMOs (instead of making them law, which the bill would have done).
VETOED: Senate Bill 987 (Escutia) – Implementation of the Dymally-Alatorre Act
This bill would have helped to ensure that state and local agencies are accessible to limited English proficient (LEP) persons, which is already required under the Dymally-Alatorre Act. It would have required state agencies to conduct assessments of bilingual staffing, develop an implementation plan and would provide the State Personnel Board with expanded authority and duties to ensure implementation. While this bill was vetoed, Governor Davis did sign into law another bill (AB 3000), which included some of the provisions of SB 987, including the assessment requirement.
SIGNED: Assembly Bill 2837 (Koretz) – Occupational Safety and Health
This bill contained provisions requiring the California Division of Occupational Safety and Health "make all efforts to ensure that limited-English-proficient persons can communicate effectively with the division." The division would further be required to prepare a progress report by July 30, 2004, on the provision of information and services to non-English-speaking persons.
SIGNED: Assembly Bill 116 (Nakano) - APIA Commission
This bill creates the Commission on Asian and Pacific Islander American Affairs to advise the Governor, Legislature, state agencies, and departments on issues relating to the social and economic development, and the rights and interests of Asian Pacific Islander American (APIA) communities. The Commission would act as a liaison with APIA communities, hold meetings on issues affecting the APIA community, and submit an annual report with recommendations by December 1 of each year to the Governor and the Legislature that details the commission's activities and sets forth its action plan for the following year.
New HMO Report Card Contains Information on Linguistic Services
On October 1, the California Office of the Patient Advocate (OPA) launched its second annual report card on health maintenance organizations (HMOs) and medical groups for consumers. APIAHF, along with other advocates, successfully worked with OPA to include information about what HMO services are available for limited English proficient members. The report card includes information on whether each HMO: provides customer service in non-English languages, arranges for telephone and in-person interpreters during doctors' visits, and translates written materials into non-English languages. The information is further differentiated by whether these services are available for enrollees with Medi-Cal, Healthy Families, Medicare or private/employer coverage.
The Report Card is available on the Internet at www.opa.ca.gov and print copies are currently being distributed at over 300 pharmacies, 500 public libraries, and through consumer assistance organizations. Both print and web versions are available in Spanish and Chinese.
California Budget Signed; Includes Reductions in Health and Human Service Programs
After the longest delay in California history, Governor Davis signed the 2002-03 budget on September 5, sixty-three days into the new fiscal year. The final budget includes a number of program reductions, deferrals and loans to address the $23.6 billion deficit. The two largest gap-closing measures are $7.5 billion in program reductions, and an infusion of $4.5 billion drawn down from future tobacco settlement funds. The Governor used his line item veto authority to further reduce spending approved by the Legislature by $235 million. Three-quarters of the Governor's vetoes were in Health and Human Services programs. These include:
- Healthy Families Expansion: Deleting $143 million ($52 million state funds) to expand the Healthy Families Program to cover parents of eligible children
- County Administration: Reducing funding for Medi-Cal county administration by $58 million.
- Express Lane Eligibility: Eliminating $12 million to streamline enrollment of children into Medi-Cal by coordinating with enrollment in the state's school lunch and food stamp programs.
- Two Month Transitional Coverage: Deleting $22 million to fund a two-month "bridge" in coverage for children transitioning from Medi-Cal to Healthy Families.
- EPSDT: Deleting $5 million by shifting a 10% share of cost for growth in the Early and Periodic Screening, Diagnosis, and Treatment program to counties.
- Trauma Care: Deleting $5 million in funding for trauma care providers.
For more information, contact the APIAHF Policy Division staff:
Gem Daus, Legislative and Government Affairs Coordinator, GDaus@apiahf.org
