Reducing COVID–19 Disparities by Investing in Public Health Act

I 116TH CONGRESS 2D SESSION H. R. 6638 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 APRIL 28, 2020 Mrs. HAYES 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 03:36 May 01, 2020 Jkt 099200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6652 E:\BILLS\H6638.IH H6638 kjohnson on DSK79L0C42PROD with BILLS 2 •HR 6638 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 03:36 May 01, 2020 Jkt 099200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H6638.IH H6638 kjohnson on DSK79L0C42PROD with BILLS 3 •HR 6638 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 immuno- 9 compromised—sometimes because of cancer or HIV/ 10 AIDS, people with diabetes, people with liver dis- 11 ease, people with severe obesity, and people with 12 chronic kidney disease undergoing dialysis. 13 (3) According to hospital data from the first 14 month of the COVID–19 epidemic in the United 15 States released by the CDC, roughly 1 in 3 people 16 who required hospitalizations from COVID–19 were 17 African American. While 33 percent of total hos- 18 pitalized patients are Black, African Americans con- 19 stitute just 13 percent of the entire American popu- 20 lation. Early data released by States and municipali- 21 ties show that African Americans suffer higher mor- 22 tality rates from COVID–19. Socioeconomic factors 23 further contribute to racial disparities seen in both 24 prevalence of chronic conditions and exposure to 25 VerDate Sep 11 2014 03:36 May 01, 2020 Jkt 099200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H6638.IH H6638 kjohnson on DSK79L0C42PROD with BILLS 4 •HR 6638 IH COVID–19. Individuals in low-income communities 1 and people of color are more likely to have many of 2 the chronic health conditions that have been identi- 3 fied as risk factors for complications from COVID– 4 19, yet suffer decreased access to care, compounded 5 by a decreased likelihood of undergoing appropriate 6 treatment. 7 (4) According to the American Diabetes Asso- 8 ciation, 12.1 percent of Hispanic Americans, 12.7 9 percent of African Americans, 8 percent of Asian 10 Americans, and 15.1 percent of American Indians/ 11 Alaska Natives have been diagnosed with diabetes, 12 compared to just 7.4 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 (5) 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 03:36 May 01, 2020 Jkt 099200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H6638.IH H6638 kjohnson on DSK79L0C42PROD with BILLS 5 •HR 6638 IH blood pressure, and have a higher rate of hyper- 1 tension and heart failure than their White counter- 2 parts. 3 (6) 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. The prevalence of 8 childhood asthma for African Americans is 12.7 per- 9 cent compared to 8 percent for White Americans, 10 while mortality rates in children and adults are 11 eightfold and threefold higher, respectively, for Afri- 12 can Americans compared to White Americans. 13 (7) President Trump has consistently proposed 14 budgets that would cut the Chronic Disease Preven- 15 tion and Health Promotion Fund. In fiscal year 16 2021, the President proposed to consolidate the 17 CDC’s primary chronic disease prevention activities, 18 including tobacco, diabetes, heart disease, and 19 stroke, and nutrition and physical activity, into a 20 single block grant to States, while proposing a 21 $427,000,000 cut to the account. In fiscal year 22 2020, the President proposed a $236,500,000 cut to 23 the account. In fiscal year 2019, the President pro- 24 posed a $138,300,000 cut to the account. In fiscal 25 VerDate Sep 11 2014 03:36 May 01, 2020 Jkt 099200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H6638.IH H6638 kjohnson on DSK79L0C42PROD with BILLS 6 •HR 6638 IH year 2018, the President proposed a $222,300,000 1 cut to the account. 2 (8) Cuts to this Fund and other public health 3 prevention efforts undermine efforts to create an af- 4 fordable and accessible health care system, and a 5 better quality of life for Americans of all ethnic, ra- 6 cial, and socioeconomic backgrounds. Cuts to this 7 Fund would also exacerbate existing disparities and 8 underlying health conditions that have created seem- 9 ingly vast disparities in hospitalization and mortality 10 rates due to COVID–19. 11 (9) Prevention efforts have proven to be effec- 12 tive. Funding increases for community-based public 13 health programs reduce preventable disease caused 14 by diabetes, cancer, and cardiovascular disease. Im- 15 proved access to intervention, treatment, and afford- 16 able care is also proven to mitigate the development 17 of associated chronic diseases and mortality rates. 18 (10) Increasing the Chronic Disease Prevention 19 and Health Promotion Fund funding to 20 $2,400,000,000 annually will allow the Fund to in- 21 vest in more innovative, evidence-based public health 22 programs, maintain and expand investments in pro- 23 grams with demonstrated success, and help reduce 24 racial health disparities and rates of chronic disease 25 VerDate Sep 11 2014 03:36 May 01, 2020 Jkt 099200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H6638.IH H6638 kjohnson on DSK79L0C42PROD with BILLS 7 •HR 6638 IH that can put persons of color at greater risk of hos- 1 pitalization or death from COVID–19. 2 (11) Further, the Office of Minority Health in 3 the Office of the Secretary of Health and Human 4 Services (established by section 1707 of the Public 5 Health Service Act (42 U.S.C. 300u–6)) was de- 6 signed for the purpose of ‘‘improving minority health 7 and the quality of health care minorities receive, and 8 eliminating racial and ethnic disparities’’. The Office 9 of Minority Health and Health Equity at the CDC 10 serves to decrease health disparities, address social 11 determinants of health, and promote access to high- 12 quality preventative health care. The Office of Mi- 13 nority Health and Health Equity at the Food and 14 Drug Administration promotes and protects the 15 health of diverse populations through research and 16 communication of science that addresses health dis- 17 parities. The National Institute on Minority Health 18 and Health Disparities leads scientific research that 19 advances understanding of minority health and 20 health disparities. 21 (12) Increasing funding for these and other 22 critical health programs will enable the United 23 States and State departments of public health to 24 VerDate Sep 11 2014 03:36 May 01, 2020 Jkt 099200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H6638.IH H6638 kjohnson on DSK79L0C42PROD with BILLS 8 •HR 6638 IH better combat disparities that have emerged during 1 the COVID–19 crisis and beyond. 2 SEC. 3. REDUCING COVID–19 DISPARITIES BY INVESTING IN 3 PUBLIC HEALTH. 4 (a) CHRONIC DISEASE PREVENTION AND HEALTH 5 PROMOTION.—There is authorized to be appropriated, and 6 there is hereby appropriated, out of any money in the 7 Treasury not otherwise appropriated, for ‘‘Centers for 8 Disease Control and Prevention—Chronic Disease Preven- 9 tion and Health Promotion’’, for fiscal year 2020 and each 10 subsequent fiscal year, $2,400,000,000. 11 (b) NATIONAL INSTITUTE ON MINORITY HEALTH 12 AND HEALTH DISPARITIES.—There is authorized to be 13 appropriated, and there is hereby appropriated, out of any 14 money in the Treasury not otherwise appropriated, to the 15 National Institute on Minority Health and Health Dis- 16 parities, for fiscal year 2020 and each subsequent fiscal 17 year, $672,000,000. 18 (c) OFFICE OF MINORITY HEALTH.—There is au- 19 thorized to be appropriated, and there is hereby appro- 20 priated, out of any money in the Treasury not otherwise 21 appropriated, to the Office of Minority Health in the Of- 22 fice of the Secretary of Health and Human Services (es- 23 tablished by section 1707 of the Public Health Service Act 24 (42 U.S.C. 300u–6)), for fiscal year 2021 and each subse- 25 VerDate Sep 11 2014 03:36 May 01, 2020 Jkt 099200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\H6638.IH H6638 kjohnson on DSK79L0C42PROD with BILLS 9 •HR 6638 IH quent fiscal year, the amount that is twice the amount 1 of funds made available to such Office of Minority Health 2 for fiscal year 2020. 3 (d) OTHER OFFICES OF MINORITY HEALTH WITHIN 4 THE DEPARTMENT OF HEALTH AND HUMAN SERV- 5 ICES.—There is authorized to be appropriated, and there 6 is hereby appropriated, out of any money in the Treasury 7 not otherwise appropriated, to the Office of Minority 8 Health of the Agency for Healthcare Research and Qual- 9 ity, the Office of Minority Health of the Centers for Dis- 10 ease Control and Prevention, the Office of Minority 11 Health of the Centers for Medicare & Medicaid Services, 12 the Office of Minority Health of the Food and Drug Ad- 13 ministration, the Office of Minority Health of the Health 14 Resources and Services Administration, and the Office of 15 Minority Health of Substance Abuse and Mental Health 16 Services Administration (as established pursuant to sec- 17 tion 1707A of the Public Health Service Act (42 U.S.C. 18 300u–6a)), for fiscal year 2021 and each subsequent fiscal 19 year, the amount that is twice the amount of funds made 20 available to the respective Office of Minority Health for 21 fiscal year 2020. 22 Æ VerDate Sep 11 2014 03:36 May 01, 2020 Jkt 099200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6301 E:\BILLS\H6638.IH H6638 kjohnson on DSK79L0C42PROD with BILLS