Reducing COVID–19 Disparities by Investing in Public Health Act

I 117TH CONGRESS 1ST SESSION H. R. 3904 To increase the annual funding for the Chronic Disease Prevention and Health Promotion Fund, the National Institute on Minority Health and Health Disparities, and the Offices of Minority Health within the Office of the Secretary of Health and Human Services, the Agency for Healthcare Research and Quality, the Centers for Disease Control and Prevention, the Centers for Medicare & Medicaid Services, the Food and Drug Administration, the Health Resources and Services Administra- tion, and the Substance Abuse and Mental Health Services Administra- tion to enable the United States and State departments of public health to better combat disparities that have emerged during the COVID– 19 crisis and beyond, and for other purposes. IN THE HOUSE OF REPRESENTATIVES JUNE 15, 2021 Mrs. HAYES (for herself and Mr. THOMPSON of Mississippi) introduced the following bill; which was referred to the Committee on Energy and Commerce A BILL To increase the annual funding for the Chronic Disease Prevention and Health Promotion Fund, the National Institute on Minority Health and Health Disparities, and the Offices of Minority Health within the Office of the Secretary of Health and Human Services, the Agency for Healthcare Research and Quality, the Centers for Disease Control and Prevention, the Centers for Medi- care & Medicaid Services, the Food and Drug Adminis- tration, the Health Resources and Services Administra- tion, and the Substance Abuse and Mental Health Serv- VerDate Sep 11 2014 00:49 Jul 02, 2021 Jkt 019200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6652 E:\BILLS\H3904.IH H3904 kjohnson on DSK79L0C42PROD with BILLS 2 •HR 3904 IH ices Administration to enable the United States and State departments of public health to better combat dis- parities that have emerged during the COVID–19 crisis and beyond, and for other purposes. Be it enacted by the Senate and House of Representa- 1 tives of the United States of America in Congress assembled, 2 SECTION 1. SHORT TITLE. 3 This Act may be cited as the ‘‘Reducing COVID–19 4 Disparities by Investing in Public Health Act’’. 5 SEC. 2. FINDINGS. 6 The Congress finds the following: 7 (1) Funding under this Act is essential to core 8 efforts at the Department of Health and Human 9 Services and in local and State health departments 10 to prevent and control the spread of chronic disease 11 and conditions. The National Center for Chronic 12 Disease Prevention and Health Promotion works to 13 raise awareness of health disparities faced by minor- 14 ity populations of the United States such as Amer- 15 ican Indians, Alaska Natives, Asian Americans, Afri- 16 can Americans, Latino Americans, and Native Ha- 17 waiians or other Pacific Islanders. One of the pri- 18 mary functions of the Center is to reduce risk fac- 19 tors for groups affected by health disparities. 20 (2) Six in ten Americans live with at least one 21 chronic disease, like heart disease and stroke, can- 22 VerDate Sep 11 2014 00:49 Jul 02, 2021 Jkt 019200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H3904.IH H3904 kjohnson on DSK79L0C42PROD with BILLS 3 •HR 3904 IH cer, or diabetes. These and other chronic diseases 1 are the leading causes of death and disability in 2 America. Specifically, chronic diseases are respon- 3 sible for 7 in 10 deaths each year. According to the 4 Centers for Disease Control and Prevention 5 (‘‘CDC’’), individuals who are at high risk for severe 6 illness from COVID–19 are people with chronic lung 7 disease or moderate to severe asthma, people with 8 serious heart conditions, people who are 9 immunocompromised—sometimes because of cancer 10 or HIV/AIDS, people with diabetes, people with liver 11 disease, people with severe obesity, and people with 12 chronic kidney disease undergoing dialysis. 13 (3) According to the CDC, adults suffering 14 from cancer, chronic kidney disease, chronic lung 15 diseases, including chronic obstructive pulmonary 16 disease (COPD), asthma, interstitial lung disease, 17 cystic fibrosis, and pulmonary hypertension, demen- 18 tia or other neurological conditions, diabetes, Down 19 syndrome, heart conditions, including heart failure, 20 coronary artery disease, cardiomyopathies or hyper- 21 tension, HIV infection, liver disease, sickle cell dis- 22 ease, stroke, or cerebrovascular disease are more 23 likely to get severely ill from COVID–19 and face in- 24 VerDate Sep 11 2014 00:49 Jul 02, 2021 Jkt 019200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H3904.IH H3904 kjohnson on DSK79L0C42PROD with BILLS 4 •HR 3904 IH creased rates of hospitalization, intensive care, as- 1 sisted ventilation, or even death. 2 (4) According to hospital data from the first 3 month of the COVID–19 epidemic in the United 4 States released by the CDC, roughly 1 in 3 people 5 who required hospitalizations from COVID–19 were 6 African American. While 33 percent of total hos- 7 pitalized patients are Black, African Americans con- 8 stitute just 13 percent of the entire American popu- 9 lation. Early data released by States and municipali- 10 ties show that African Americans suffered higher 11 mortality rates from COVID–19. 12 (5) Racial and ethnic disparities in COVID–19 13 hospitalization were driven by both a higher risk of 14 exposure to the disease, often from essential front- 15 line work performed at disproportionate rates by 16 Black and Latino workers, and social determinants 17 of health. Social inequities and environmental injus- 18 tices, such as differing access to healthy food, clean 19 air, safe drinking water, safe neighborhoods, edu- 20 cation, job security, and reliable transportation, af- 21 fect health risks and outcomes, reinforcing dispari- 22 ties in health and access to care. 23 (6) Socioeconomic factors further contribute to 24 racial disparities seen in both prevalence of chronic 25 VerDate Sep 11 2014 00:49 Jul 02, 2021 Jkt 019200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H3904.IH H3904 kjohnson on DSK79L0C42PROD with BILLS 5 •HR 3904 IH conditions and exposure to COVID–19. Individuals 1 in low-income communities and people of color are 2 more likely to have many of the chronic health con- 3 ditions that have been identified as risk factors for 4 complications from COVID–19, yet suffer decreased 5 access to care, compounded by a decreased likelihood 6 of undergoing appropriate treatment. 7 (7) According to the American Diabetes Asso- 8 ciation, 12.5 percent of Hispanic Americans, 11.7 9 percent of African Americans, 9.2 percent of Asian 10 Americans, and 14.7 percent of American Indians/ 11 Alaska Natives have been diagnosed with diabetes, 12 compared to just 7.5 percent of White Americans. 13 The CDC calculated that compared to non-Hispanic 14 Whites, Hispanics are 40 percent more likely to die 15 from diabetes, African Americans are twice as likely 16 to die from diabetes, and American Indians/Alaska 17 Natives are almost twice as likely to die from the 18 disease. 19 (8) According to the National Institutes of 20 Health, African Americans are more than 30 percent 21 more likely to die from heart disease, are twice as 22 likely to have a stroke—which tends to be more se- 23 vere with a higher morbidity and results in higher 24 mortality, are 40 percent more likely to have high 25 VerDate Sep 11 2014 00:49 Jul 02, 2021 Jkt 019200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H3904.IH H3904 kjohnson on DSK79L0C42PROD with BILLS 6 •HR 3904 IH blood pressure, and have a higher rate of hyper- 1 tension and heart failure than their White counter- 2 parts. 3 (9) Minority groups suffer from asthma at a 4 disproportionate rate, have the highest number of 5 emergency room visits and hospital stays due to 6 asthma, and have higher mortality rates from asth- 7 ma than their White counterparts. African Ameri- 8 cans, American Indians, and Alaska Natives are 42 9 percent more likely than their White counterparts to 10 have asthma. The prevalence of childhood asthma 11 for African Americans is 11.7 percent higher than 12 for White Americans, while mortality rates in chil- 13 dren and adults are eightfold and threefold higher, 14 respectively, for African Americans compared to 15 White Americans. 16 (10) Vaccinations are key to disease prevention 17 and overall health outcomes, especially in the case of 18 COVID–19. However, a longstanding history and 19 legacy of systemic racism, discrimination, and mis- 20 treatment has contributed to a larger distrust of the 21 health care system and medical establishment within 22 communities of color, which can further engender 23 disparities and perpetuate rates of chronic disease. 24 According to data from the CDC, despite higher 25 VerDate Sep 11 2014 00:49 Jul 02, 2021 Jkt 019200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H3904.IH H3904 kjohnson on DSK79L0C42PROD with BILLS 7 •HR 3904 IH COVID–19 mortality, hospitalization, and infection 1 rates amongst African Americans, the rate of 2 COVID–19 vaccination amongst Black Americans 3 still lags behind those of White individuals in almost 4 every State. This necessitates increased funding for 5 education, increased access to care, and targeted ef- 6 forts to reach communities of color and address ra- 7 cial inequities. 8 (11) Cuts to, or even level funding for, the 9 Chronic Disease Prevention and Health Promotion 10 Fund and other public health prevention efforts un- 11 dermine efforts to create an affordable and acces- 12 sible health care system, and a better quality of life 13 for Americans of all ethnic, racial, and socio- 14 economic backgrounds. Cuts to this Fund would also 15 exacerbate existing disparities and underlying health 16 conditions that have created seemingly vast dispari- 17 ties in hospitalization and mortality rates due to 18 COVID–19. 19 (12) Prevention efforts have proven to be effec- 20 tive. Funding increases for community-based public 21 health programs reduce preventable disease caused 22 by diabetes, cancer, and cardiovascular disease. Im- 23 proved access to intervention, treatment, and afford- 24 VerDate Sep 11 2014 00:49 Jul 02, 2021 Jkt 019200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H3904.IH H3904 kjohnson on DSK79L0C42PROD with BILLS 8 •HR 3904 IH able care is also proven to mitigate the development 1 of associated chronic diseases and mortality rates. 2 (13) Increasing the Chronic Disease Prevention 3 and Health Promotion Fund funding to 4 $2,400,000,000 annually will allow the Fund to in- 5 vest in more innovative, evidence-based public health 6 programs, maintain and expand investments in pro- 7 grams with demonstrated success, and help reduce 8 racial health disparities and rates of chronic disease 9 that can put persons of color at greater risk of hos- 10 pitalization or death from COVID–19. 11 (14) Further, the Office of Minority Health in 12 the Office of the Secretary of Health and Human 13 Services (established by section 1707 of the Public 14 Health Service Act (42 U.S.C. 300u–6)) was de- 15 signed for the purpose of ‘‘improving minority health 16 and the quality of health care minorities receive, and 17 eliminating racial and ethnic disparities’’. The Office 18 of Minority Health and Health Equity at the CDC 19 serves to decrease health disparities, address social 20 determinants of health, and promote access to high- 21 quality preventative health care. The Office of Mi- 22 nority Health and Health Equity at the Food and 23 Drug Administration promotes and protects the 24 health of diverse populations through research and 25 VerDate Sep 11 2014 00:49 Jul 02, 2021 Jkt 019200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\H3904.IH H3904 kjohnson on DSK79L0C42PROD with BILLS 9 •HR 3904 IH communication of science that addresses health dis- 1 parities. The National Institute on Minority Health 2 and Health Disparities leads scientific research that 3 advances understanding of minority health and 4 health disparities. 5 (15) Increasing funding for these and other 6 critical health programs will enable the United 7 States and State departments of public health to 8 better combat disparities that have emerged during 9 the COVID–19 crisis and beyond. 10 SEC. 3. REDUCING COVID–19 DISPARITIES BY INVESTING IN 11 PUBLIC HEALTH. 12 (a) CHRONIC DISEASE PREVENTION AND HEALTH 13 PROMOTION.—There is authorized to be appropriated, and 14 there is hereby appropriated, out of any money in the 15 Treasury not otherwise appropriated, for ‘‘Centers for 16 Disease Control and Prevention—Chronic Disease Preven- 17 tion and Health Promotion’’, for fiscal year 2021 and each 18 subsequent fiscal year, $2,400,000,000. 19 (b) NATIONAL INSTITUTE ON MINORITY HEALTH 20 AND HEALTH DISPARITIES.—There is authorized to be 21 appropriated, and there is hereby appropriated, out of any 22 money in the Treasury not otherwise appropriated, to the 23 National Institute on Minority Health and Health Dis- 24 VerDate Sep 11 2014 00:49 Jul 02, 2021 Jkt 019200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\H3904.IH H3904 kjohnson on DSK79L0C42PROD with BILLS 10 •HR 3904 IH parities, for fiscal year 2021 and each subsequent fiscal 1 year, $782,000,000. 2 (c) OFFICE OF MINORITY HEALTH.—There is au- 3 thorized to be appropriated, and there is hereby appro- 4 priated, out of any money in the Treasury not otherwise 5 appropriated, to the Office of Minority Health in the Of- 6 fice of the Secretary of Health and Human Services (es- 7 tablished by section 1707 of the Public Health Service Act 8 (42 U.S.C. 300u–6)), for fiscal year 2021 and each subse- 9 quent fiscal year, the amount that is twice the amount 10 of funds made available to such Office of Minority Health 11 for fiscal year 2021. 12 (d) OTHER OFFICES OF MINORITY HEALTH WITHIN 13 THE DEPARTMENT OF HEALTH AND HUMAN SERV- 14 ICES.—There is authorized to be appropriated, and there 15 is hereby appropriated, out of any money in the Treasury 16 not otherwise appropriated, to the Office of Minority 17 Health of the Agency for Healthcare Research and Qual- 18 ity, the Office of Minority Health of the Centers for Dis- 19 ease Control and Prevention, the Office of Minority 20 Health of the Centers for Medicare & Medicaid Services, 21 the Office of Minority Health of the Food and Drug Ad- 22 ministration, the Office of Minority Health of the Health 23 Resources and Services Administration, and the Office of 24 Minority Health of Substance Abuse and Mental Health 25 VerDate Sep 11 2014 00:49 Jul 02, 2021 Jkt 019200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\H3904.IH H3904 kjohnson on DSK79L0C42PROD with BILLS 11 •HR 3904 IH Services Administration (as established pursuant to sec- 1 tion 1707A of the Public Health Service Act (42 U.S.C. 2 300u–6a)), for fiscal year 2021 and each subseque [Text truncated for display. 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