The U.S. House Energy and Commerce Health Subcommittee on June 27 passed the Pandemic and All Hazards Preparedness Reauthorization Act of 2018 (PAHPRA), sending it to the full committee along with four other public health bills under consideration.
“The mark up of these five important bills will strengthen our public health workforce and protect our country from potential biological threats,” said Health Subcommittee Chairman Michael Burgess (R-TX).
“Some of these bills will equip our health care system with the tools to maintain a robust, well-educated workforce, while the Pandemic and All Hazards Preparedness Act reauthorization bill will provide a framework for our emergency preparedness infrastructure to plan for threats such as disease outbreaks.”
Rep. Burgess, a licensed medical doctor, said the draft legislation to reauthorize the Pandemic and All Hazards Preparedness Act (PAHPA), which evolved from the bioterrorism threats after 9/11, also would reauthorize provisions related to more recent public health threats to Americans, such as the Zika virus and H3N2 influenza virus outbreak.
“Our partners at the federal, state and local levels must have the necessary tools and resources to quickly and effectively respond when disaster strikes,” Rep. Burgess said.
U.S. Rep. Greg Walden (R-OR), chairman of the full House Energy and Commerce Committee, made it clear to his colleagues that reauthorizing PAHPA before its Sept. 30 expiration date is a top priority.
“It is important that we get this right and that we reauthorize this program in a timely manner,” Rep. Walden said, noting that between the subcommittee’s markup and the forthcoming one to be held by the full committee, it’s important that lawmakers continue to work in a bipartisan manner to ensure everyone’s policy priorities are incorporated “on this very, very important reauthorization.”
“Those of us who’ve been in the … briefings understand that we need to get this done and not mess around with it,” Rep. Walden added.
U.S. Rep. Anna Eshoo (D-CA), coauthor with U.S. Rep. Susan Brooks (R-IN) of the draft PAHPA reauthorization bill, assured the committee chairman that she’d continue to work closely with him and other members to finalize reauthorization before the deadline.
“But we all need to understand that this is still a work in progress,” Rep. Eshoo said. “There are many member priorities and stakeholder proposals still to be incorporated.”
One amendment that made it into the PAHPA reauthorization draft was a manager’s amendment offered by Rep. Brooks regarding public health emergencies and cybersecurity.
“We face threats around the globe,” Rep. Brooks reminded her fellow lawmakers.
The congresswoman held up the most recent Ebola outbreak declared on May 8 by the Democratic Republic of Congo, the country’s ninth Ebola outbreak in 40 years, she said. And while previous outbreaks there have occurred in remote, isolated areas, Rep. Brooks said that this new one surfaced in a busy port city having more than 1 million inhabitants.
Then on May 20, she said, India’s government confirmed an outbreak of the deadly Nipah virus. “By the end of May, 19 cases had been reported; 17 were fatal,” said Rep. Brooks.
When such outbreaks occur, the overall draft reauthorization bill would create a Public Health Emergency Response Fund for the HHS Secretary to use as a bridge for immediate funds, the lawmaker said, until funding becomes available that could be supplemented with an emergency appropriations bill.
“PAHPA reauthorization is a unique opportunity to examine our response to threats, and ensure that as we look towards the future, we have the procedures, resources and support in place to protect ourselves,” Rep. Brooks said.
Toward such goals, her manager’s amendment for Section 319 of the Public Health Service Act (PHSA) would allow the HHS Secretary to spend monies from the proposed emergency fund “if the Secretary determines there is the significant potential for a public health emergency.”
The secretary would be allowed “to rapidly respond to the immediate needs resulting from such public health emergency or potential public health emergency,” according to the draft text of the amendment.
The secretary could use funds for making grants, providing awards, facilitating coordination between federal, state, local, tribal, and territorial entities with public and private health care entities, and by accelerating advanced research and development of security countermeasures or qualified pandemic or epidemic products, and by bolstering biosurveillance capabilities and lab capacities, among other actions listed in the amendment.
Regarding cybersecurity, Rep. Brooks’ amendment proposes that the HHS Secretary include a strategy focused on cybersecurity threats for establishing an effective and prepared public health and health care system in the next version of the National Health Security Strategy.
The amendment was accepted and the draft PAHPA reauthorization bill was approved and sent to the full House Energy and Commerce Committee.
Subcommittee Chairman Burgess also suggested tagging on a bill he introduced last February to the PAHPA reauthorization proposal known as the MISSION ZERO Act, or the Military Injury Surgical Systems Integrated Operationally Nationwide to Achieve ZERO Preventable Deaths Act, H.R. 880, as well as language to improve the technological infrastructure of the BioWatch program.
“MISSION ZERO already passed the House earlier this year with strong bipartisan support, and I expect we can reach a bipartisan consensus on both initiatives prior to the legislation’s markup at the full committee,” Rep. Burgess said about his bill.
H.R. 880 would amend the PHSA to require HHS to fund and train military trauma care providers and trauma teams to provide trauma care and related acute care at certain trauma centers that receive HHS grants, among other provisions.
Passionate pleas
Rep. Eshoo brought up a controversial issue that ended up dominating a large chunk of the roughly three-hour subcommittee hearing: immigration reform.
“PAHPA is especially timely because it authorizes ASPR,” said Eshoo, referring to the U.S. Department of Health and Human Services’ (HHS) Office of the Assistant Secretary for Preparedness and Response (ASPR).
On June 22, HHS announced the creation of an unaccompanied children reunification task force, Eshoo said, the intent being “to respond to the crisis that the Trump administration is creating at the southern border; that it’s going to be won by ASPR.”
The congresswoman told her colleagues, “I think this committee really needs to be prepared and to do oversight relative to how ASPR — because it is within our jurisdiction — how the needs of the families and the children are being met.”
Toward such prep, U.S. Rep. Frank Pallone (D-NJ) offered an amendment to the PAHPA reauthorization bill that called for three things: the HHS Secretary should consult with public health officials to determine whether the separation of children from their parent or guardian as a result of a “zero tolerance” policy is a public health emergency; (2) the House Energy and Commerce Committee should hold at least one hearing to examine the current status and welfare of these children and the long-term implications of such policy on their health; and (3) ASPR, the HHS Secretary and the Director of the Office of Refugee Resettlement should be called as witnesses for such a hearing.
However, the subcommittee’s majority successfully held off the minority in an 18-11 roll call vote against the amendment’s inclusion.
“The statue of liberty is weeping today at how we’re treating children,” said U.S. Rep. Janice Schakowsky (D-IL).
However, a related amendment did make it into the reauthorization draft, one offered by U.S. Rep. Marsha Blackburn (R-TN).
Agreed to unanimously in a 29-0 roll call vote, the amendment would require ASPR to make weekly reports to the Energy and Commerce Committee on the status and welfare of children separated from their parent or guardian who are awaiting reunification, as well as the number of children in facilities funded by HHS.
Additionally, the amendment would require that ASPR submit to the committee a formal strategy on reunifying these children, as well as a strategy to address deficiencies identified by the committee as early as 2014 regarding HHS’s oversight of, and care for, unaccompanied children in their custody.
Also being sent to the committee are:
1. The Title VIII Nursing Workforce Reauthorization Act of 2017, HR. 959, introduced by U.S. Rep. David Joyce (R-OH), which would amend Title VIII of the PHSA to reauthorize nursing workforce development programs that support the recruitment, retention and advanced education of skilled nursing professionals.
2. The Palliative Care and Hospice Education and Training Act, H.R. 1676, introduced by U.S. Reps. Elliott Engel (D-NY), Tom Reed (R-NY), and Buddy Carter (R-GA), which would direct HHS to award grants to improve the training of health professionals in palliative care; increase education and awareness about the benefits and services of palliative care; and enhance research on palliative care.
3. The Educating Medical Professionals and Optimizing Workforce Efficiency Readiness (EMPOWER) Act of 2017, H.R. 3728, introduced by U.S. Reps. Larry Bucshon (R-ID), Burgess, and Schakowsky, to amend Title VII of the PHSA to reauthorize the health professions workforce programs that support loan repayment and provider training in primary care, dentistry, rural or underserved areas, and in community-based settings. The bill also would restructure the geriatric health professional grant program.
4. The Children’s Hospital GME Support Reauthorization Act of 2018, H.R. 5385, introduced by Rep. Burgess and U.S. Rep. Gene Green (D-TX), committee ranking member, to reauthorize payments to children’s hospitals that operate graduate medical education (GME) programs for five years.