Legislative Update November 2011
Latest Action: On September 21st, the Senate Appropriations Committee reported out the FY 2012 Labor HHS appropriations bill. Overall, the FY 2012 Labor-HHS-Education bill totals $158 billion and is $308 million below the FY 2011 comparable funding level. (Senate bill S. 1599, Senate Report 11-148). Therefore, any funding increases have to be offset by cutting elsewhere in the bill. The bottom line for the 317 program is a $50 million increase or about 10% over the prior year funding level. On the table below, PPH Fund is the Prevention and Public Health Fund which is a mandatory appropriation in the Affordable Care Act that is allocated in the annual appropriations bill. In FY 2011, the PPHF made available an additional $750 million for Public Health Service Act programs to augment normal discretionary spending, and $100 million was directed to the 317 program. In FY 2012, the PPHF increases to $1 billion, and the Senate allocated an additional $50 million to the 317 program. The Senate is not expected to take the Labor HHS appropriations bill to the Floor anytime soon, and may in fact skip floor action and go directly to conference negotiations with their House counterparts.
Lead Senate champions for the program were Senators Reed and Durbin who are on the Subcommittee, and, of course, Chairman Harkin who is the sponsor of the legislation. Senators who signed the Dear Colleague letter to Chairman Harkin and Ranking Member Shelby include: Reed, Durbin, Whitehouse, Udall (Tom), Blumenthal, Stabenow, Lautenberg, Sanders, Wyden, Leahy, Gillibrand, Levin and Kerry.
Fiscal Year 2012 began on October 1, 2011, and none of the 12 annual appropriations bills have been enacted. The government is currently operating on a short term continuing resolution that expires on November 18. While several appropriations bills are likely to be completed by the November 18th date, that will not include the Labor HHS appropriations bill that includes the CDC funding. So another continuing resolution will likely be enacted to continue the government through December 23, 2011, with a goal of completing all remaining appropriations bills by that deadline.
In the House, Labor HHS Subcommittee Chairman Rehberg has introduced a bill, (HR 3070), but cancelled a planned subcommittee markup when it appeared that he didn’t have sufficient votes to move the bill to the Full Committee. While some details of the House bill are available, many of the finer details, including the funding level for the 317 program, are not yet public. A Committee report was drafted, but since a full Committee markup did not occur to approve the report, it was not made public and has no official standing. Of particular note, the House bill eliminated all funding for the Prevention and Public Health Fund, and this will likely be a contentious conference issue with the Senate.
| Program | FY 2011 Appropriation | FY12 President's Budget Request |
FY12 317 Coalition Request |
FY 2010 Senate |
| 317 Immunization | $425,571 | $433,503 | $618,000 | $425,571 |
| PPH Fund | 100,000 | 61,599 | -- | 150,000 |
| Program Operations | $63,005 | $66,889 | $67,000 | 63,005 |
| Total | $588,576 | $561,991 | $685,000 | $638,576 |
Below is the text of the Senate report (S. Rept 112-148) language that accompanies the bill, and it largely reflects the language recommended by the 317 Coalition, including an update of the annual report to Congress from CDC on the 317 program needs, and a discussion of how the 317 program many evolve and transition in the coming years with the prospect of expanded health care coverage.
Section 317 Immunization Program — The Committee recognizes that high rates of childhood immunization coverage are important for reducing child mortality and saving costs over a lifetime. For every $1 spent on the childhood series of vaccines, $16.50 is saved. Therefore, the Committee has included $150,000,000 from the PPH Fund to expand the section 317 immunization program. The additional funding will allow more recommended immunizations to be available through the existing network of private and public immunization providers, and support and expand the network as needed.
Immunization Infrastructure — The Committee recognizes that the Nation’s immunization infrastructure is essential for ensuring the continued high rates of childhood immunization coverage and supports efforts to modernize this infrastructure in making recommended immunizations more widely available. The Committee supports CDC’s decision to support these efforts out of the PPH Fund rather than at the expense of funding used for vaccine purchase. The Committee urges the Secretary to continue this policy.
As investments are made to modernize the immunization infrastructure, and as the Nation’s health care delivery system continues to evolve through enhanced health insurance coverage, the Committee recommends that CDC develop strategies to (1) modernize immunization information systems; (2) prepare public health departments for changes in the health care delivery system, including new billing procedures related to privately insured patients; and (3) strengthen the evidence base to inform immunization policy and program monitoring including vaccine-preventable disease surveillance, vaccine coverage assessment, and laboratory training. The strategy should also address how CDC will maintain and expand partnerships with the healthcare sector to provide routine and emergency immunization services.
The Committee recognizes that past cost savings from the section 317 program that supported an at-risk adult hepatitis B vaccine initiative have been expended. The Committee commends CDC for its efforts to provide hepatitis vaccinations through the section 317 program.
Immunization Report — The Committee finds the annual report on the estimated funding needs of the section 317 immunization program to be vital information and requests that it be submitted not later than February 1 of each year to reflect the following fiscal year cost estimates. The report should include an estimate of optimum State and local operations funding, as well as CDC operations funding needed relative to current levels to conduct and support childhood, adolescent, and adult programs. In addition, the report should include a discussion of specific strategies to improve the overall immunization infrastructure and to reduce barriers and increase adult immunization rates in the United States and how section 317 immunization program funds are currently used to reach immunization goals. The report should further include a discussion of the evolving role of the 317 program as expanded coverage for vaccination becomes available from private and public sources over the next several years.