APHA annual congressional record: How members of Congress supported public health

1. Health reform repeal (House roll call vote 58)

H.R. 596: To Repeal the Patient Protection and Affordable Care Act. Passage of the bill, Feb. 3, 2015. The bill would repeal the ACA 180 days after the bill’s enactment and would call on the House committees with jurisdiction to develop an alternative plan. Passed 239-186: R 239-3, D 0-183.

APHA opposed passage of the bill. Under the ACA, millions of previously uninsured Americans now have affordable and comprehensive health insurance coverage through the health insurance marketplaces, as well as through the expansion of the Medicaid program, significantly reducing the uninsured rate. By December 2015, about 11.3 million people had enrolled in coverage through the health insurance marketplaces. Since its enactment, the law has provided 71 million Americans with access to preventive health care services, such as vaccines, disease screenings, well-child visits and tobacco cessation counseling without co-pays or deductibles. Thirty-seven million seniors have also accessed preventive services without cost through the Medicare program. More than 3 million young adults up to age 26 are able to stay on their parents’ health insurance plans and nearly 129 million people with pre-existing conditions are protected from insurance coverage denials. In addition, the ACA provides critical mandatory funding through the Prevention and Public Health Fund for community-based prevention and wellness activities, including efforts to control the obesity epidemic, reduce tobacco use and modernize vaccination systems.

2. Children’s Health Insurance Program reauthorization (House roll call vote 144)

H.R. 2: Medicare Access and CHIP Reauthorization Act of 2015. Passage of the bill, March 26, 2015. The bill would reauthorize funding for CHIP, community health centers, teaching health centers, the National Health Service Corps and Maternal, Infant and Early Childhood Home Visiting Program for two years. The bill would also repeal the sustainable growth rate formula for calculating updates to Medicare payment rates to physicians. Passed 392-37: R 212-33, D 180-4.

APHA supported passage of the bill. CHIP has been an essential source of health coverage for families, ensuring access to high-quality, affordable and age-appropriate health care for children in working families who do not qualify for Medicaid and cannot afford to purchase private health insurance. The program has played a critical role in reducing the number of uninsured children by more than 50 percent while improving health outcomes and access to care for children and pregnant women across the nation. The bill provided two years of additional mandatory funding for community health centers, which provide quality services and play a critical role in the health care system by serving as a vital source of care for newly insured patients, and remain an important source of care for those who cannot gain access to coverage. The bill also reauthorizes the National Health Service Corps and Teaching Health Center Graduate Medical Education Program, which help support recruitment and training and improve the distribution of the health professional workforce in underserved communities.

3. Fiscal year 2016 budget conference report (House roll call vote 183)

S. Con. Res 11: Fiscal Year 2016 Budget Conference Report. Passage of the conference report, April 30, 2015. The conference report would implement steep cuts to nondefense discretionary spending, well beyond the caps set in the Budget Control Act of 2011. The measure would also defund the Affordable Care Act and severely cut funding for Medicaid and other programs that benefit low-income Americans. Passed 226-197: R 226-14, D 0-183.

APHA opposed the conference report. The proposal would cut nondefense discretionary spending over 10 years by nearly $500 billion below the already-austere spending caps. Cuts of such magnitude would likely devastate the nation’s public health and safety net system and would have a disproportionate impact on the nation’s most vulnerable people. It would cut $500 billion over 10 years from the Medicaid program that would likely force states to scale back benefits to those enrolled in the program. The proposal would repeal the benefits of the Affordable Care Act, causing tens of millions of Americans to become uninsured, and eliminate the Prevention and Public Health Fund. In addition, the conference report would cut $300 billion from agriculture programs over 10 years, likely threatening the Supplemental Nutrition Assistance Program, which provides food benefits to low-income Americans.

4. Abortion restrictions (House roll call vote 223)

H.R. 36: Pain-Capable Unborn Child Protection Act. Passage of the bill, May 13, 2015. The bill would place a nationwide ban on abortions at 20 weeks, with limited exceptions. The bill would also criminalize health care providers for providing abortions, imprisoning providers for up to five years. Passed 242-184: R 238-4, D 4-180.

APHA opposed passage of the bill. By banning pre-viability abortion, the bill would violate constitutional standards and directly challenge Roe v. Wade. States are not allowed to ban abortion prior to fetal viability, and post-viability bans must include adequate protections for both a woman’s life and health, which H.R. 36 does not. To qualify for an exception, the bill would require a rape survivor to report the crime or seek medical care or counseling at least 48 hours prior to getting an abortion. The reporting requirement would create additional and unnecessary burden for women and may act as a barrier to accessing the needed care. The ban would also interfere with and obstruct the patient-provider relationship by criminalizing the delivery of an abortion.

5. Repeal prevention funding (House roll call vote 376)

H.R. 1190: Protecting Seniors’ Access to Medicare Act of 2015. Passage of the bill, June 23, 2015. The bill would divert $8.85 billion from the Prevention and Public Health Fund over fiscal year 2017-2026 to offset the cost of repealing the Independent Payment Advisory Board, an advisory board established under the Affordable Care Act that is charged with developing proposals to reduce Medicare spending growth. Passed 244-154: R 233-0, D 11-154.

APHA opposed the bill. The fund provides critical public health funding in every state, and has contributed a total of $5.25 billion since 2010 to support a variety of community prevention and clinical prevention programs, bolster the public health infrastructure and workforce, expand access to immunizations and expand public health research and tracking efforts. Eliminating or cutting the fund would devastate the programs and be a setback for public health systems in every state. Cuts to the fund would also leave a massive hole in the budget of the Centers for Disease Control and Prevention, which received more than $886 million from the fund in 2015.

6. Defund Planned Parenthood (House roll call vote 505)

H.R. 3134: Defund Planned Parenthood Act of 2015. Passage of the bill, Sept. 18, 2015. The bill would block federal funding for one year for Planned Parenthood Federation of America, or any of its affiliates or clinics, unless the group certifies that the affiliates and clinics will not perform abortions or provide funds to other providers during that time period. The bill would provide additional funding for community health centers during the one-year period. Passed 241-187: R 239-3; D 2-184.

APHA opposed the bill. Planned Parenthood health centers provide 2.7 million women, men and young people with health care every year, offering important health services, including cervical cancer screenings, breast exams, contraceptive services and tests and treatment for sexually transmitted infections. The services contribute to the nation’s efforts to improve access to health care and have been critical in preventing unintended pregnancies, decreasing infant mortality and improving women’s health. It is an unfounded assumption that even with additional funding community health centers could absorb the full loss of care that would result from a ban on Planned Parenthood funding.

7. Budget reconciliation bill (House roll call vote 568)

H.R. 3762: Restoring Americans’ Healthcare Freedom Reconciliation Act of 2015. Passage of the bill, Oct. 23, 2015. The bill would defund Planned Parenthood for one year, fully eliminate the Prevention and Public Health Fund and repeal other ACA provisions, including the individual and employer mandates and requirement for large employers to automatically enroll new full-time employees in a health care plan. Passed 240-189: R 239-7, D 1-182.

APHA opposed the reconciliation package. The budget reconciliation recommendations would cut all funding for community-based prevention and wellness activities provided through the Prevention and Public Health Fund. The bill would also defund Planned Parenthood for one year, redirecting $235 million — the projected savings from defunding Planned Parenthood — to community health centers. The bill would end health insurance coverage for millions of Americans by repealing the ACA’s individual and employer mandates. Repealing the individual mandate would result in 14 million fewer people insured in 2025 compared to today, and it is expected that premiums would increase by 20 percent for individuals. Repealing the employer mandate would also likely increase the number of uninsured Americans and add an estimated $149 billion to the deficit over 10 years. Finally, the proposal would also repeal the ACA’s requirement for large employers to automatically enroll new full-time employees in a health care plan, a provision that has not yet gone into effect.

8. Raise spending caps (House roll call vote 579)

H.R. 1314: Bipartisan Budget Act of 2015. Passage of the bill Oct. 28, 2015. The bill would raise the discretionary spending budget caps for fiscal year 2016 by $50 billion and for fiscal year 2017 by $30 billion, eliminating 90 percent of the sequestration budget cuts for nondefense discretionary programs in fiscal year 2016 and about 60 percent in 2017. The increased funding would be split equally between defense and nondefense discretionary spending. The proposal would also suspend the debt limit until March 15, 2017; reduce a pending premium increase for many Medicare Part B beneficiaries; and extend the solvency of the Social Security Disability Insurance Trust Fund. Passed 266-167: R 79-167, D 187-0.

APHA supported passage of the bill. APHA and other advocates of nondefense discretionary programs advocated strongly for lifting the existing budget caps for nondefense discretionary programs. The bipartisan budget deal provides Congress with additional resources to ensure that much-needed additional funding for public health and other nondefense discretionary programs, which continue to be woefully underfunded, would be available in 2016 and 2017.

Congress voted on numerous measures that were of importance to public health, some of which are featured in this record.

Photo by Dlitch, courtesy iStockphoto

9. Block EPA carbon pollution restrictions for existing power plants (House roll call vote 650)

S.J. Res. 24: A Joint Resolution Providing for Congressional Disapproval of a Rule Submitted by the U.S. Environmental Protection Agency. Also known as the Clean Power Plan, the rule relates to Carbon Pollution Emission Guidelines for Existing Stationary Sources: Electric Utility Generating Units. Passage of the resolution, Dec. 1, 2015. The resolution would employ the Congressional Review Act to disapprove of EPA’s Aug. 3 final rule to reduce carbon emissions from existing fossil fuel-fired power plants. If enacted, the resolution would block EPA from implementing the rule or implementing any substantially similar rule unless specifically authorized to do so by Congress. Passed 242-180: R 238-2, D 4-178.

APHA opposed the resolution, which would indefinitely block EPA from moving forward with carbon pollution limits for existing power plants. EPA estimates that by 2030, the Clean Power Plan would prevent 3,600 premature deaths, 90,000 asthma attacks in children and up to 1,700 heart attacks. Power plants are the largest source of carbon dioxide emissions in the U.S., comprising about one-third of all domestic carbon pollution emissions. Limiting emissions from these sources is essential in mitigating climate change and protecting the public’s health from other dangerous air pollution. Climate change threatens human health and well-being in many ways, including effects from increased extreme heat and weather events, wildfires, decreased air quality, threats to mental health and illnesses transmitted by food, water and disease-carriers such as mosquitoes and ticks.

1. Children’s Health Insurance Program reauthorization (Senate roll call vote 144)

H.R. 2: Medicare Access and CHIP Reauthorization Act of 2015. Passage of the bill, April 14, 2015. The bill would reauthorize funding for CHIP, community health centers, teaching health centers, the National Health Service Corps and Maternal, Infant and Early Childhood Home Visiting Program for two years. The bill would also repeal the sustainable growth rate formula for calculating updates to Medicare payment rates to physicians. Passed 92-8: R 46-8, D 44-0, I 2-0.

APHA supported passage of the bill. CHIP has been an essential source of health coverage for families, ensuring access to high-quality, affordable and age-appropriate health care for children in working families who do not qualify for Medicaid and cannot afford to purchase private health insurance. The program has played a critical role in reducing the number of uninsured children by more than 50 percent while improving health outcomes and access to care for children and pregnant women across the nation. The bill provided two years of additional mandatory funding for community health centers, which provide quality services and play a critical role in the health care system by serving as a vital source of care for newly insured patients, and remain an important source of care for those who cannot gain access to coverage. The bill also reauthorizes the National Health Service Corps and Teaching Health Center Graduate Medical Education Program, which help support recruitment and training and improve the distribution of the health professional workforce in underserved communities.

2. Fiscal year 2016 budget conference report (Senate roll call vote 171)

S. Con. Res 11: Fiscal Year 2016 Budget Conference Report. Passage of the conference report May 5, 2015. The conference report would implement steep cuts to nondefense discretionary spending, well beyond the caps set in the Budget Control Act of 2011. The measure would also defund the Affordable Care Act and severely cut funding for Medicaid and other programs that benefit low-income Americans. Passed 51-48: R 51-2, D 0-44, I 0-2.

APHA opposed the conference report. The proposal would cut nondefense discretionary spending over 10 years by nearly $500 billion below the already-austere spending caps. Cuts of such magnitude would likely devastate the nation’s public health and safety net system and would have a disproportionate impact on the nation’s most vulnerable people. It would cut $500 billion over 10 years from the Medicaid program that would likely force states to scale back benefits to those enrolled in the program. The proposal would repeal the benefits of the Affordable Care Act, causing tens of millions of Americans to become uninsured, and eliminate the Prevention and Public Health Fund. In addition, the conference report would cut $300 billion from agriculture programs over 10 years, likely threatening the Supplemental Nutrition Assistance Program, which provides food benefits to low-income Americans.

3. Health reform repeal (Senate roll call vote 253)

H.R. 22: Fixing America’s Surface Transportation Act. Amendment No. 2328 to fully repeal the Affordable Care Act and the Health Care and Education Reconciliation Act of 2010. Motion to invoke cloture, which limits debate, July 26, 2015. A majority of three-fifths is required to proceed. Failure to invoke cloture effectively kills the amendment. Failed 49-43: R: 49-0, D 0-42, I 0-1.

APHA opposes any effort to repeal the ACA. Under the ACA, millions of previously uninsured Americans now have affordable and comprehensive health insurance coverage through the health insurance marketplaces, as well as through the expansion of the Medicaid program, significantly reducing the uninsured rate. By December 2015, about 11.3 million people had enrolled in coverage through the health insurance marketplaces. Since its enactment, the law has provided 71 million Americans with access to preventive health care services, such as vaccines, disease screenings, well-child visits and tobacco cessation counseling without co-pays or deductibles. Thirty-seven million seniors have also accessed preventive services without cost through the Medicare program. More than 3 million young adults up to age 26 are able to stay on their parents’ health insurance plans and nearly 129 million people with pre-existing conditions are protected from insurance coverage denials. In addition, the ACA provides critical mandatory funding through the Prevention and Public Health Fund for community-based prevention and wellness activities, including efforts to control the obesity epidemic, reduce tobacco use and modernize vaccination systems.

4. Defund Planned Parenthood (Senate roll call vote 262)

S. 1881: A Bill to Prohibit Federal Funding of Planned Parenthood Federation of America. Motion to invoke cloture on the motion to proceed to the bill, Aug. 3, 2015. A majority of three-fifths is required to proceed. The bill would block federal funding for Planned Parenthood Federation of America, or any of its affiliates, subsidiaries, successors or clinics. Failed 53-46: R 51-2, D 2-42, I 0-2.

APHA opposed any effort to prevent Planned Parenthood health centers from participating in federal health programs. Planned Parenthood health centers provide 2.7 million women, men and young people with health care every year, offering important health services, including cervical cancer screenings, breast exams, contraceptive services and tests and treatment for sexually transmitted infections. The services contribute to the nation’s efforts to improve access to health care and have been critical in preventing unintended pregnancies, decreasing infant mortality and improving women’s health. Blocking funding would cut off access to critical preventive care.

5. Abortion restrictions (Senate roll call vote 268)

H.R. 36: Pain-Capable Unborn Child Protection Act. Motion to invoke cloture on the motion to proceed to the bill, Sept. 22, 2015. A majority of three-fifths is required to proceed. The bill would place a nationwide ban on abortions at 20 weeks, with limited exceptions. The bill would also criminalize health care providers for providing abortions, imprisoning providers for up to five years. Failed 54-42: R 51-2, D 3-38, I 0-2.

APHA opposed passage of the bill. By banning pre-viability abortion, the bill would violate constitutional standards and directly challenge Roe v. Wade. States are not allowed to ban abortion prior to fetal viability, and post-viability bans must include adequate protections for both a woman’s life and health, which H.R. 36 does not. To qualify for an exception, the bill would require a rape survivor to report the crime or seek medical care or counseling at least 48 hours prior to getting an abortion. The reporting requirement would create additional and unnecessary burden for women and may act as a barrier to accessing the needed care. The ban would also interfere with and obstruct the patient-provider relationship by criminalizing the delivery of an abortion.

6. Raise spending caps (Senate roll call vote 294)

H.R. 1314: the Bipartisan Budget Act of 2015. Passage of the bill, Oct. 30, 2015. The bill would raise the discretionary spending budget caps for fiscal year 2016 by $50 billion and for fiscal year 2017 by $30 billion, eliminating 90 percent of the sequestration budget cuts for nondefense discretionary programs in fiscal year 2016 and about 60 percent in 2017. The increased funding would be split equally between defense and nondefense discretionary spending. The proposal would also suspend the debt limit until March 15, 2017; reduce a pending premium increase for many Medicare Part B beneficiaries; and extend the solvency of the Social Security Disability Insurance Trust Fund. Passed 64-35: R 18-35, D 44-0, I 2-0.

APHA supported passage of the bill. APHA and other advocates of nondefense discretionary programs advocated strongly for lifting the existing budget caps for nondefense discretionary programs. The bipartisan budget deal provides Congress with additional resources to ensure that much-needed additional funding for public health and other nondefense discretionary programs, which continue to be woefully underfunded, would be available in 2016 and 2017.

7. Block EPA power plant pollution restrictions (Senate roll call vote 306)

S.J. Res. 24: A Joint Resolution Providing for Congressional Disapproval of a Rule Submitted by the U.S. Environmental Protection Agency. Also known as the Clean Power Plan, the rule relates to Carbon Pollution Emission Guidelines for Existing Stationary Sources: Electric Utility Generating Units. Passage of the resolution, Nov. 17, 2015. The resolution would employ the Congressional Review Act to disapprove of EPA’s Aug. 3 final rule to reduce carbon emissions from fossil fuel-fired power plants. If enacted, the resolution would block EPA from implementing the rule or implementing any substantially similar rule unless specifically authorized to do so by Congress. Passed 52-46: R 49-3, D 3-41, I 0-2.

APHA opposed the resolution, which would indefinitely block EPA from moving forward with carbon pollution limits for existing power plants. EPA estimates that by 2030, the Clean Power Plan would prevent 3,600 premature deaths, 90,000 asthma attacks in children and up to 1,700 heart attacks. Power plants are the largest source of carbon dioxide emissions in the U.S., comprising about one-third of all domestic carbon pollution emissions. Limiting emissions from these sources is essential in mitigating climate change and protecting the public’s health from other dangerous air pollution. Climate change threatens human health and well-being in many ways, including effects from increased extreme heat and weather events, wildfires, decreased air quality, threats to mental health and illnesses transmitted by food, water and disease-carriers such as mosquitoes and ticks.

8. Expand background checks for gun purchases (Senate roll call vote 321)

H.R. 3762: Restoring Americans’ Healthcare Freedom Reconciliation Act of 2015. Amendment No. 2908 to expand background checks for firearms purchases. Motion to waive the budget point of order, Dec. 3, 2015. The amendment would expand the existing federal criminal background checks system for most private firearms purchases, including those sold by unlicensed private sellers at gun shows and on the Internet. A majority of three-fifths is required to waive the budget point of order against the amendment. Failure to waive the budget point of order effectively kills the amendment. Failed 48-50: R 4-49, D 42-1, I 2-0.

APHA supports expanding background checks for gun purchases. The amendment would expand the requirement for criminal background checks to private gun sales, including those at gun shows and on the Internet. Current law, which only requires background checks for guns purchased from federally licensed dealers, is inadequate and contains a significant gap that provides access to weapons for felons, domestic abusers, people who have serious mental illness and others prohibited from owning firearms. Gun-related suicides and gun-related murders associated with domestic violence are significantly lower in states that already require background checks for all gun purchases.

9. Budget reconciliation bill (Senate roll call vote 329)

H.R. 3762: Restoring Americans’ Healthcare Freedom Reconciliation Act of 2015. Passage of the bill, Dec. 3, 2015. The bill would defund Planned Parenthood for one year, fully eliminate the Prevention and Public Health Fund and repeal or amend other ACA provisions, including removing the penalties used to enforce individual and employer mandates, phasing out Medicaid expansion and eliminating subsidies to help individuals buy coverage through health exchanges. Passed 52-47: R 52-2, D 0-44, I 0-1.

APHA opposed the reconciliation package. The budget reconciliation recommendations would cut all funding for community-based prevention and wellness activities provided through the Prevention and Public Health Fund. The bill would also defund Planned Parenthood for one year, redirecting $235 million — the projected savings from defunding Planned Parenthood — to community health centers. It is an unfounded assumption that even with additional funding community health centers could absorb the full loss of care that would result from a ban on Planned Parenthood funding. Additionally, the bill would neuter the ACA’s individual and employer mandates by removing the enforcement mechanism of penalties. Medicaid expansion would be eliminated by 2018, rolling back health coverage for millions of low-income individuals who gained coverage in the 30 expansion states and prevent future Medicaid expansion for the remaining states. Finally, the proposal would eliminate subsidies for the majority of people enrolled in marketplace coverage. The vast majority of people who enrolled during the 2015 open enrollment period qualified for financial support.

Download a PDF of this complete issue to read the votes.