The Senate Labor, Health and Human Services, and Education, and Related Agencies Appropriations Subcommittee today approved a fiscal year 2014 bill that provides $164.330 billion in discretionary budget authority to make important investments to reduce healthcare costs, bolster medical research, improve early childhood care and education, strengthen our mental health safety net, and help America's workers get vital job training services. The bill also provides $1.253 billion in cap adjustments for healthcare fraud and abuse control programs and for program integrity at the Social Security Administration, in accordance with the allocation for this bill. The fiscal year 2013 enacted level was $156.556 billion.
;"This bill makes crucial investments in early childhood care and education, targets fraud and abuse, trains and protects American workers, and fully funds the President's request for implementing the Affordable Care Act," said Senator Tom Harkin (D-IA), chairman of the subcommittee. "It includes priorities from both sides of the aisle, on topics ranging from Alzheimer's disease research and public health to science and math education and teacher quality. I look forward to the full Committee markup on Thursday, followed quickly by consideration of the bill on the Senate floor."
Among other highlights, the Labor-HHS-Education bill provides increases for Head Start and child care and new funding for Preschool Development Grants; more than doubles the funding to crack down on healthcare fraud; promotes the prevention of costly chronic diseases like diabetes; and improves school safety and access to mental health services in response to the recent mass shooting in Newtown, Connecticut.
A summary of the bill follows below. All comparisons are to the fiscal year 2013 enacted level. Some dollar figures are rounded.
Reducing Healthcare Costs
The nation's fiscal health is inextricably linked to our ability to curb the cost of healthcare. The Affordable Care Act (ACA) is vital to that effort. This bill also plays a critical role--by supporting the ACA's implementation, promoting efforts to prevent chronic diseases, and increasing funding for med¬ical research at the National Institutes of Health (NIH).
Implementing the ACA: The ACA has already re¬sulted in historic savings for the federal government and for American families. As just one example, the law has allowed more than 6.3 million Medicare beneficiaries to save more than $6.1 billion on prescription drugs. Fiscal year 2014 begins on the same day the ACA will open en¬rollment for new health coverage in the Health Insurance Market¬places, which will for the first time offer consumers a single place where they can compare the costs and benefits of different health insur¬ance plans and choose the one that fits their needs. This bill includes $5.2 billion for Program Manage¬ment at the Centers for Medicare and Medicaid Services (CMS), the lead agency with responsibility for overseeing the ACA. The fiscal year 2013 level was $3.9 billion.
Alzheimer's Disease: Without a medical breakthrough to prevent, slow, or stop this dis¬ease, the total payments for healthcare, long-term care, and hospice for people with Alzheimer's and other de¬mentias are projected to rise from $203 billion in 2013 to a staggering $1.2 trillion in 2050. This bill includes an $84 million increase for the National Institute on Aging, the NIH Institute with the primary responsibility for preventing, treating, and curing Alzheimer's disease. The bill also includes $20 million for a new Alzheimer's Disease Initiative that will strengthen dementia-capable long-term services and supports, assist caregivers of individ¬uals with Alzheimer's disease, and train healthcare providers on how to recognize the signs and symptoms of Alz-heimer's and manage the disease.
Bolstering Early Childhood Care and Education
High-quality early childhood care and education has been proven to have positive, lasting effects for children and families. It also supports the nation's long-term economic security by preparing our next generation of workers, entrepreneurs, and business leaders for future success. The bill provides a combined increase of $2.56 billion for Head Start, the Child Care and Development Block Grant (CCDBG), and Preschool Development Grants. Together, these programs address the entire age range of birth through 5.
Head Start: The bill includes $9.6 billion, a $1.6 billion increase, for Head Start. This in¬cludes $1.4 billion more to expand Early Head Start, in¬cluding the creation of new Early Head Start-Child Care Partner¬ships, to serve children and families from before birth through age 3.
Child Care: The bill includes $2.5 billion, a $176 million increase, for CCDBG. This includes a $110 million increase to improve the quality of the child care workforce and to strengthen health and safety standards.
Preschool Development Grants: The bill includes $750 million for a new program to support States' efforts to ex¬pand or create high-quality preschool systems for 4-year-olds from low- and moderate-income families.
Improving Fiscal Accountability
Congress has an obligation to promote the fiscal account¬ability and effective use of taxpayer dollars. This bill provides fund¬ing for several efforts to combat fraud, waste, and abuse within federal programs.
Healthcare Program Integrity: Fraud committed against federal healthcare programs diverts critical resources from services that are intended for some of the nation's most vulnerable populations. The bill includes $640 million for healthcare fraud and abuse control activities at CMS, more than double the fiscal year 2013 level of $309 million. Every $1 spent on these activities returns approximately $7.90 to the Treasury.
Social Security Program Integrity: The bill includes $1.2 billion, a $441 million increase, for Social Security pro¬gram integrity activities, including continuing disability reviews (CDRs) and Supplemental Security Income redeterminations. CDRs and redeterminations save $9 and $5, respectively, for each $1 spent by reducing waste, fraud, abuse, and improper payments in the Social Security, Medi¬care, and Medicaid programs.
Unemployment Insurance (UI) Program Integrity: The bill includes $80 million, an increase of approxi¬mately $20 million, to conduct reemployment and eligibility as¬sessments (REAs) and UI improper payment reviews. This level is projected to save State UI trust funds an estimated $315 million through REAs by helping claimants exit the UI program faster and avoid exhaust¬ing their benefits.
Protecting Students and Taxpayers: The bill includes a new provision prohibiting colleges and universities from spending federal educational funding on marketing, recruitment, and adver-tising. This reform will ensure that federal resources are targeted at educating students as opposed to online advertisements and ag¬gressive recruiting activities, so that both students and taxpayers receive a good return on their investment.
Spending on Conferences: The bill helps prevent exces¬sive spending on conferences and other administrative expenses by requiring departments, agencies, boards, and commissions funded in this bill to report to Inspectors General or senior ethics officials on the costs and contracting procedures involved in any conference that costs more than $100,000.
Promoting Policy Reform
The bill launches or continues several initiatives that will lever¬age policy reform and transform key federal services.
Race to the Top--College Affordability and Completion: The bill includes $400 million to support a new Race to the Top program focused on college affordability and completion. Funding will incentivize states to reduce costs for students and families and improve academic outcomes.
Public Access to Federally Funded Research: Four years ago, Congress required NIH to improve the public's ability to access tax¬payer-funded research by means of an online NIH repository. This effort has been highly successful. The bill includes a new provision that extends the requirement to other agencies funded in the bill.
Investing in Innovation: The bill provides $170 million for the Investing in Innovation education program, which allows grantees to develop and test promising new ideas and replicate programs that are successful.
Accelerating Cures: The bill includes $50 million, five times the fiscal year 2013 level, for the Cures Acceleration Net¬work, an NIH initiative intended to help speed the translation and application of discoveries that have shown signs of success at the laboratory level but have not advanced far enough to attract sig¬nificant investments from the private sector.
Nearly three-quarters of all healthcare costs are attributable to chronic diseases, the majority of which are preventable. This bill promotes prevention efforts by supporting implementation of the ACA, which will enable millions of newly insured Americans to re¬ceive preventive screenings; providing discretionary funding for programs such as childhood immunizations and cancer screenings; and allocating the Prevention and Public Health (PPH) Fund, which will total $1 billion in fiscal year 2014. Key prevention programs listed below are either funded in this bill or through transfers from the PPH Fund.
Community Transformation Grants: The bill includes $290 million, an increase of $144 million, for evidence-based pub¬lic health interventions to reduce obesity and smoking and make preventive services more accessible.
Childhood Immunizations: The bill includes $579 million for immunization programs. Immunization saves $10.20 in direct medical costs for every $1 invested.
Smoking Prevention: The bill includes $203 million for the Office of Smoking and Health at CDC. This funding, an in¬crease of $35 million, will continue the successful media campaign, "Tips From a Former Smoker," and expand state smoking quit-lines.
Diabetes Prevention: The bill includes $10 million for the Diabetes Prevention Program, a set of lifestyle interventions that has been proven to reduce the risk of developing diabetes by 58 percent in individuals at high risk.
Elder Falls: In 2010, 2.3 million older adults were treated in emergency departments after a fall, with more than 662,000 of these patients hospitalized. Many falls are prevent¬able with lifestyle interventions and appropriate physical supports. In a new initiative, the bill includes $10 million to research and implement evidence-based approaches to preventing elderly falls.
Strengthening Our Mental Health System and Reducing Violence--Now Is the Time
The mass shootings last year at an Aurora, Colorado, movie the¬ater and at Sandy Hook Elementary School in Newtown, Con¬necticut, raised public awareness about the problems of violence and mental illness in our communities as perhaps never before.
There are approximately 30,000 firearm-related homicides and suicides in the United States each year, and almost one-quarter of 14- to 17-year-olds have witnessed a shooting in their lifetime. Re¬search shows that exposure to community violence can impact chil¬dren's mental health and development and can substantially in¬crease the likelihood that these children will later commit violent acts themselves. Unfortunately, less than half of children and adults with diagnosable mental health problems receive the treat¬ment they need. Addressing these challenges will require complex, comprehensive solutions that are beyond the scope of any single school, commu¬nity, state, or set of laws. But funding provided in this bill to pre¬vent violence, increase access to mental health treatment, and im¬prove school safety can play an important role.
Mental Health Services: The bill includes $119 million in new funding to increase access to mental health services. This includes a total of $95 million for the administration's Now is the Time initiative: $15 million for Mental Health First Aid programs that teach individuals to identify and respond to the signs of mental illness; $40 million for Project AWARE State grants, which will focus on making schools safer and connecting young people with mental health services; and $40 million in new funding to address shortages in the behavioral health workforce. In addition, the bill includes a new 5 percent set-aside within the Community Mental Health Services Block Grant that will allocate $24 million to evidence-based programs addressing the needs of individuals with the early signs of serious mental illness.
Safe and Healthy Schools: Safe, positive school environments can help reduce unhealthy student behavior, increase academic achievement, and counter the effects that vio¬lence can have on students. The bill includes $195 million specifically to improve learning conditions in the Nation's schools. Highlights include: $50 million for a new School Climate Transformation Grants program; $25 million to help school districts develop, implement, and improve their emergency management plans; $25 million for Project Prevent, which will help schools in troubled communities break the cycle of violence; and up to $8 million for Project SERV, which offers education-related services following a violent or traumatic event.
Tracking Violent Deaths: The National Violent Death Reporting System (NVDRS) is an 18-State surveillance system that pulls together information on vio¬lent deaths with the aim of developing effective interventions and preventive measures. The bill includes $18.5 million, an increase of $15 million, to expand NVDRS to additional States and communities.
Public Health Research: Behind motor vehicle injuries, firearm injuries are the second leading cause of injury and mortality in the United States. The bill includes $10 million to build the public health research base on how to reduce the threat of fire¬arm-related violence.
Helping America's Workers
Job Training: The bill includes $2.7 billion, an increase of $86 million, for Workforce Invest¬ment Act Grants to States to provide job training skills and assist¬ance to low-skilled adults, dislocated workers, and low-income youth with barriers to employment.
Paid Leave for Workers: The bill includes $5 million to support a new State Paid Leave Fund. The fund will provide planning and implementation grants to states that wish to estab¬lish paid leave programs and provide benefits to workers who need to take time off for reasons covered under the Family and Medical Leave Act.
Veterans Employment and Training: The bill includes $301 million, an increase of $37 million, to expand employment services to transitioning servicemembers, vet¬erans with disabilities, and their spouses and caregivers.
Protecting Whistleblowers: The bill in¬cludes $567 million for the Occupational Health and Safety Administration and targets a $6 million increase for its enforcement of whistleblower laws. These laws provide im¬portant protections for workers who raise issues in their workplace about practices that could impact fellow employees or the public.
Preventing Misclassifications: The bill includes an increase of $14 million to address the misclassification of workers as independent contractors. Misclassifications deny workers their rights to unemployment benefits, overtime pay, and other benefits, and also reduce revenue to the UI, So¬cial Security, and Medicare trust funds, as well as to the Treasury.
OTHER HIGHLIGHTS OF THE BILL
Special Education: The bill provides $11.7 billion, an increase of $125 million, under section 611 of Part B Grants to States for educating students with disabilities. The bill also includes $463 million, an increase of $21 million, to support statewide systems of coordi¬nated and early intervention services for children with disabilities 2 years old and younger, as well as their families; and nearly $70 million, an increase of $20 million, to support research on how people with disabilities learn and how best to meet their edu¬cational needs.
NIH: The bill provides $30.955 billion, an increase of $307 million, to fund biomedical research at the 27 Institutes and Centers that comprise NIH. This level will allow NIH to allocate $40 million for the new Brain Research through Application of Innovative Neurotechnologies (BRAIN) Initiative.
Pell Grants: The bill maintains the discretionary portion of the maximum Pell grant award level at $4,860 for the 2014--2015 school year. Combined with mandatory funding, the total maximum award will rise by $140 to $5,785.
Community Health Centers (CHCs): The bill includes nearly $1.6 billion for CHCs. Combined with mandatory funding pro¬vided in the ACA, the fiscal year 2014 program level for CHCs is almost $3.8 billion, an increase of $700 million.
Title I (Education for the Disadvantaged): The bill in¬cludes $14.6 billion, an increase of $125 million, for Title I grants to school districts for improving education for low-income students. These funds support 90 percent of the nation's 14,000 school dis¬tricts.
Children's Hospitals Graduate Medical Education: The bill includes $267 million for this program, the same level as in fiscal year 2013.
Low Income Home Energy Assistance Program (LIHEAP): The bill includes nearly $3.5 billion for LIHEAP, the same level as in fiscal year 2013.
Community Services Block Grant: The bill in¬cludes $676 million for this program, the same level as in fiscal year 2013.
AIDS Drug Assistance Program (ADAP): The bill includes $943 million for ADAP, an increase of $47 million.
Promise Neighborhoods: The Promise Neighborhoods program supports cradle-to-career services designed to improve educational outcomes for students in distressed neighborhoods. The bill includes $100 million, an increase of $40 million, for this program.
Social Security Administration (SSA): The bill includes nearly $12 billion, an increase of $534 million, for SSA's administrative expenses. This includes a $441 million increase for program integrity activities and a $93 million increase in core ad¬ministrative expenses for SSA to keep pace with an aging popu¬lation and record-high workloads.
TRIO: The bill includes nearly $850 million, an increase of $11.7 million, to help low-income and first generation college students plan, prepare for, and succeed in college through the TRIO programs.
Senate Bill as Compared to the House Bill
Because the House of Representatives has yet to mark up its Labor-HHS bill, it is impossible to provide a direct comparison. However, the House allocation for Labor-HHS is $121.8 billion, or 25.9 percent lower than the Senate level. Applying an across-the-board cut of 25.9 percent to the Senate mark, the House bill would produce the following results:
18.6 million fewer meals would be served to needy seniors than under the Senate bill.
6 million fewer students would be served through Title I than under the Senate bill. Title I Grants to Local Educational Agencies is the cornerstone federal program for helping all students, especially those from disadvantaged backgrounds, meet high academic standards.
NIH funding would be slashed by roughly $8 billion below the Senate level. To put that figure in perspective, $8 billion is more than the entire amount that NIH spends on research on cancer and cardiovascular diseases combined.
275,000 fewer children and their families would receive early childhood services through Head Start, including 125,000 fewer infants and toddlers in Early Head Start.
If the House chose to cut any of these programs by less than 25.9 percent, other programs in the bill would have to be reduced by a greater percentage.