Welcome Congress 2017 Delivery Briefing Please introduce yourself into chat box: Name, State & Organization/Coalition January 8, 2017
Briefing Outline Updates on ACA Repeal Outlook Key Messages Delivery Logistics DC In-district Q & A
UPDATES ON ACA REPEAL OUTLOOK
ACA Repeal Process Expected budget reconciliation mechanism: Allows for expedited consideration In Senate, not subject to filibuster, only need simple majority of 51 votes to pass (Republicans have 52 seats) To qualify for budget reconciliation, provision has to: Change spending (appropriations) Change revenues (taxes) Change federal debt limit
ACA Repeal Expectations: Before Holidays Observers had been looking to last year s attempt as template: H.R. 3762: Restoring Americans Healthcare Freedom Reconciliation Act Passed both Houses, but vetoed by Obama But Trump would sign it On 12/21, heard from partner lobbyists that a new bill was in the works from Republicans and would be out before Xmas, but this never materialized
ACA Repeal Expectations: In New Year No discussion from Congress of full repeal GOP leadership still moving to repeal and delay Senate Budget Committee introduced a budget resolution Wednesday containing reconciliation instructions to authorizing committees to achieve at least $1 billion each in deficit reduction over 10 years Deadline of 1/27 to report the legislation Reserves funds for repeal and replacement Floor consideration begins this week
No Repeal w/o Replace Growing chorus of no repeal w/o same-time replace : American Hospital Association & Federation of American Hospitals American s Health Insurance Plans (AHIP) American Academy of Actuaries American Medical Association American Public Health Association
Senators Objecting Republican Senators joining to express concern about repeal w/o replace: Rand Paul (KY) was first: Has committed to voting against budget resolution on debt reduction grounds (note this is not same as voting against repeal bill) He is planning to offer an alternative that would balance over five years Tom Cotton (AR), Bob Corker (TN), Susan Collins (ME) also objecting, but have not committed to voting against repeal bill GOP has 52 seats in Senate and needs 50 votes to pass budget measures, so two other Republicans would need to join Paul to block (really three, if consider Pence as tiebreaker)
House Freedom Caucus House GOP leadership needs support of Freedom Caucus to pass budget resolution Senator Paul talked with this conservative House caucus this week about his push to block the budget resolution, instead replacing it with a budget that balances Rep. Mark Meadows (R-NC), Freedom Caucus Chair, while calling for all of the ACA taxes to be repealed, also wants a replacement to come forward simultaneously Caucus will decide whether to oppose the budget at its meeting Monday night 1/9
Prevention & Public Health Fund (PPHF) Was created by ACA in 2010 (Sec. 4002) Limits cut in 2012 CURES Act just cut limits further Was a target for wholesale elimination in last year s reconciliation repeal bill Clearly subject to budget reconciliation Expect that repeal just a matter of timing (FY17 or FY18?) PPHF also used to backfill many other CDC programs Prevention Fund Budget Chart (from TFAH)
Update re: Budget Resolution Senator Blumenthal has filed an amendment to the budget that would create a Point of Order against any legislation that reduces funding for disease prevention efforts, increases the prevalence of disease rates amongst children, or reduces or eliminates the Prevention Fund. Cosponsors so far include: Udall, Coons, Markey, Van Hollen, Franken, Warren, Gillibrand, Murray, Feinstein, Klobuchar, and Brown. We urge you to 1) encourage these members to speak during the Monday colloquy, and 2) urge other Senators to join Senator Blumenthal as a cosponsor of the amendment.
KEY MESSAGES
Protect ACA Breastfeeding Supports Funding for CDC Breastfeeding Initiatives, especially Maternity Care Practice Improvement Health Plan Coverage of Breastfeeding Counseling, Education, Equipment & Supplies "Break Time for Nursing Mothers" (Workplace Support) Provision
Updated Cost Analysis Just published in journal Maternal & Child Health Combined both maternal & pediatric health outcomes and associated costs Based on 2012 breastfeeding rates, if 90% of infants were breastfed according to medical recommendations, would prevent annually: 3,340 deaths $3 billion in medical costs $14.2 billion in costs of premature death
Maternity Care Practices Hospital routines can help or hinder new mothers and babies while they are learning to breastfeed. Systematic practice improvement enables patients to make and carry out informed decisions, highlighting medical professionals role in providing patient-centered, evidence-based care. BFHI describes Ten Steps to Successful Breastfeeding shown to increase breastfeeding rates. Unfortunately, only about 20% of births occur at Baby-Friendly designated facilities. CDC collects data every 2 yrs on maternity care practices & policies related to infant feeding via national mpinc survey. Show them mpinc State Report
CDC Breastfeeding Funds Joint letter to Congressional Appropriations Cte leaders w/ briefing document: 7 March 2011 Co-signed by 38 national organizations and 98 regional/state/local organizations Asked for $15 million from PPHF Allocated from PPHF since FY12 FY12 = $7M FY13 = $2.5M FY14, FY15, FY16 = $8M FY17 President s Budget, House & Senate Cte Bills = $8M Show them state fact sheet with info on how spent in their state: state health departments, hospitals
Workplace Support More than half of mothers of infants are in the workforce When separated for more than a few hours, mother must express breast milk to maintain supply and avoid discomfort, leaking, inflammation and infection Returning to work typically a significant barrier to breastfeeding; often unable to take breaks, find a private/sanitary location, store milk; face fears over job insecurity Workplace accommodations = win-win for employers and employees; almost 3:1 return on investment for employers via lower health care costs, absenteeism, and turnover, and improved morale, job satisfaction, and productivity
Nursing Breaks Law Section 4207 of ACA requires employers to provide reasonable break time & private, non-bathroom place for nonexempt workers to express breast milk included with unanimous bipartisan support during 2009 Senate HELP Committee markup does NOT cover ~12 million salaried exec/admin/prof l employees, including teachers In response to 2011 DOL Request for Information on the law, industry associations [including National & State Restaurant Assn and National Assn of Manufacturers] expressed recognition of importance of providing break time and space Emphasized need for flexibility and open communication between employers/employees, as well as guidance that fits needs of varying types of workforces. This feedback has been carefully considered, resulting in development of resources to support employers, most notably HHS Office on Women s Health Supporting Nursing Moms at Work: Employer Solutions, a comprehensive online resource that demonstrates cost-effective tips and simple solutions for all industries
Breastfeeding Counseling & Supplies Most women are generally aware that breastfeeding is the best source of nutrition for most infants, but they often lack specific information and are uncertain of what to expect. Even though breastfeeding is often described as natural, it is also an art with specific skills and techniques that may need to be taught. Moreover, women who encounter problems early on are less likely to continue to breastfeed without assistance. Most problems, if identified and treated early, need not pose a threat to successful continuation, yet women report receiving conflicting problemsolving advice from clinicians. Meanwhile, in the absence of paid family leave, many mothers will return to work or school and need an electric breast pump to pump quickly and efficiently during breaks to keep up supply.
Breastfeeding Support in Preventive Services ACA amended Sec. 2713 of Public Health Service Act Breastfeeding doubly covered via US Preventive Services Task Force (USPSTF) and Women s Preventive Services (WPS) USPSTF only covers counseling, not supplies, but does define as all three types: Professional Support, Peer Support, Formal Education WPS recommends comprehensive lactation support services, including counseling, education, and breastfeeding equipment and supplies, during antenatal, perinatal, and postpartum periods
DELIVERY LOGISTICS
DC Delivery Logistics Find us in the Capitol Visitor s Center room SVC-214 Be prepared to go through security screening Bring your ID! No foods or liquids Nothing sharp Wear walking shoes and dress for the weather! Consider bringing a bag for carrying welcome kits Contact Sarah Walz at (202) 367-1132 x26 if you have any questions
Social Media Amplify your impact by posting and tweeting on social media! Use the hashtags #BFinginACA and #ProtectOurCare Take and share lots of photos! Tag Members of Congress and follow up with them after your delivery we ll provide a sample tweet
Welcome Kit Contents Welcome note w/ asks from online petition Fact sheets and story booklet about the three key breastfeeding-related components of ACA Customized fact sheet with state breastfeeding metrics, info about federally funded projects and breastfeeding coalition CDC BF Report Card, SGCTA Exec. Summary, State mpinc report Unique dollar-themed notepad to remind Senators and Reps to keep breastfeeding families at the top of their "to do" list
In-district Delivery Logistics Download kit contents to print from www.usbreastfeeding.org/welcome-115-packet Recording & slides will be posted within same link Can either do a drop-off or make an appointment If having a meeting with an Appropriations Committee leader, please be in touch with Megan Renner at mrenner@usbreastfeeding.org
Questions & Follow-up If they have any questions you can't answer, don't hesitate to take a business card and let them know that you'll find out and get back to them by e-mail. You can also refer them to the USBC staff as a future resource (business card in folder) and to their state breastfeeding coalition (web address included on their state fact sheet). If they are your Representative or Senator, we definitely recommend an individual follow-up e-mail regardless!
Thank you!