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Labor HHS Appropriations Bill on Senate Floor for First Time in a Decade

This week, the Senate will consider both the Defense and Labor-Health and Human Services (LHHS) Appropriations bills. Amendments will be offered on the floor of the Senate throughout this week, followed by a final vote.

The base bill passed out of the Appropriations Committee on June 28, 2018. Prior to the introduction of the bill, NRHA’s Government Affairs Team submitted written testimony asking for the needs of rural communities to be considered in the legislation. As requested, $318.8 million, $28 million above that provided in FY2018, was allocated for rural health programs. The Committee listened to the voice of rural Americans and responded with critical funding, explaining, “the obstacles faced by patients and providers in rural communities are unique and often significantly different than those in urban areas.”

Funding includes:
  • Rural Hospitals: $318,794,000, of which $49,609,000 will be available for carrying out the Medicare rural hospital, and of those funds $15,942,000 will be available for the Small Rural Hospital Improvement Grant Program.
  • Community Health Centers: As key providers in rural areas, funding included for these facilities includes the $200 million for behavioral health discussed above, but total $1.63 billion for all Community Health Center services.
  • State Offices of Rural Health: $10,000,000 was made available for the State Offices of Rural Health for FY2019, as NRHA requested.
  • Opioids: The original Senate LHHS Bill, prior to amendment, included $3.7 billion, an increase of $145 million, to fight the opioid crisis Funds will be targeted towards improving treatment and prevention efforts; finding alternative pain medications; workforce needs, especially in our rural communities; and behavioral health. Specific to rural were two provisions including:
    • $200 million for Community Health Centers to support and enhance behavioral health, mental health, or substance use disorder services.
    • $120 million focused on specifically on responding to the opioid epidemic in rural communities. This section directly cited a key fact included in NRHA’s written testimony: “According to the Centers for Disease Control and Prevention, drug-related deaths are 45 percent higher in rural communities, with rural states more likely to have higher rates of overdose deaths.”.
  • Telehealth Programs: The bill focuses resources toward efforts and programs to help rural communities, including $25.5 million, $2 million above FY2018, for Telehealth.  The Telehealth program expands the use of telecommunications technologies within rural areas that can link rural health providers and patients with specialists.
  • Workforce: The committee appropriated $40.25 million, $2 million above FY2018 for Area Health Education Centers (AHECs) which help to develop and maintain our “health care workforce, broaden the distribution of the health workforce, enhance health care quality, and improve health care delivery to rural and underserved areas and populations.” An additional  $15,000,000 will be available through September 30, 2021 to support the Rural Residency Development Program.

Some of our key rural health advocates have filed amendments to the LHHS package that would help improve the health and encourage growth in our rural communities. NRHA will monitor the progress of these amendments, and we will keep members updated here as to what is included in the final package:
  • Border Health: Senators Tom Udall (D-NM) and Martin Heinrich (D-NM) introduced an amendment directing HHS to reinstate cooperative agreements with the border states who are members of the U.S. Mexico Border Health Commission. In May, the HHS Secretary announced the cancelation of $1.1 million for the third year of a cooperative agreement with states to help them carry out public health activities in border regions, all of which are largely rural. This threatens important work being done in border states to ensure public health for Americans and places many employees jobs at risk of elimination.
  • Oral Health: While the National Rural Oral Health Initiative meets not far from the Capitol, Senator Doug Jones (D-AL) filed a no-cost amendment supporting infrastructure to include oral health as a part of primary care in existing rural health grants.

This is the first time in over a decade that the Senate has considered an LHHS Appropriations Bill and followed the historically established process for funding the government. In a statement regarding the process, Senate Appropriations Committee Chairman Richard Shelby (R-AL), said “Recent history suggests we face a tall task in passing these bills on the Senate floor.  The Senate has not passed a Labor-HHS appropriations bill in more than a decade… I strongly urge my colleagues to focus on accomplishing the big picture priorities...” While past processes have been undermined by partisan bickering and poison pill amendments (those that essentially kill legislation making it useless, illogical, or impossible to pass), this year’s work has shown a strong renewed bipartisan commitment focused on improving the lives of Americans.

At the end of his speech before the consideration of the LHHS Bill began, Senator Shelby explained the difference in the process this year, “What changed was the mindset of appropriators on both sides of the aisle who embraced a willingness to sacrifice partisan riders and priorities outside the committee’s jurisdiction for the good of the process.” We hope that this will continue to prove true, not just for the Senate Appropriations Committee, but for every member of the House and Senate.

As we move forward towards the Midterm Elections, legislation has stalled, but the people of rural America cannot keep waiting for Congress to provide them the key resources that will make a strong and healthy future a reality. Congress needs to act now to ensure the recovery and rebuilding of the many rural communities still struggling to rebound from the Great Recession.

Senator Shelby described this process as “what’s right by the American people.” Now, it’s time for Congress to continue doing what is right for rural Americans.

After the LHHS Bill passes the Senate, NRHA will post an updated blog detailing those provisions included in the final bill for rural communities. To watch the live discussion on the Senate Floor, please visit this link.

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