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NCHS Policy Watch is designed to provide regular updates on congressional and administrative policies that impact NCHS and summarize implications for the broader health community, including researchers, policy analysts, practitioners, industry representatives, patient advocates, and decision makers in the public and private sectors that use NCHS data. Future of NCHS Funding Unclear; But Proposed Increases Won’t Materialize The House and Senate this week will pass a short-term, two-week spending extension to allow more time to reach a compromise on funding for the remainder of the fiscal year. The two-week extension, which runs through March 18, cuts $4 billion from current spending by eliminating earmarks and eight programs the president has targeted for termination—none of which are from the Department of Health and Human Services (HHS). The government has been operating under under a continuing resolution (CR) that holds funding flat at fiscal 2010 levels, which was passed before Christmas to keep the government running after Congress failed to finalize spending bills before the fiscal year ended on September 30, 2010. The House last month passed spending legislation that would cut $60 billion from the current fiscal 2010 spending levels for the remaining seven months of the fiscal year. The Centers for Disease Control and Prevention (CDC) is cut by more than $1 billion under the House’s legislation; funding for the National Center for Health Statistics (NCHS) is held flat at current levels of $138 million. While the president, House, and Senate had all provided a $23 million increase to NCHS in previous fiscal 2011 spending proposals, the best case for NCHS is maintaining its current funding. NCHS and other non-defense domestic programs will not receive funding increases this year. The president issued a Statement of Administration Policy that he would veto a spending bill that cut as deeply as the House’s proposal, and Congress seems to be at an impasse with no clear path to a long-term solution. House Republicans insist on deep cuts, and Senate Democrats insist the House cuts go too far. Many experts suggest that a government shutdown is imminent. The last government shutdown occurred in 1995, a time similar to this year when Republicans had just retaken the House of Representatives. Federal agencies like NCHS would have to designate “critical” personnel to keep working during a shutdown, but routine work would likely be affected, further complicating agencies’ administrative work approach under the current continuing resolution.
On Monday, February 14, the president released his budget request for fiscal 2012. As in last year’s budget request, the president once again recommends $161.8 million for NCHS—a $23 million increase. Funds would be used to support the National Heath Interview Survey (NHIS), the National Health and Nutrition Examination Survey, and National Health Care Survey, and to purchase a full 12 months of vital statistics collected by the states and territories. The budget request also includes funding to support the implementation of electronic birth records in the states. In addition to the $161.8 million for NCHS, the president requests $35 million for “health statistics” from the new Prevention and Public Health Fund established by the Affordable Care Act—a mandatory stream of funding that is automatically made available each year to support public health programs and activities. Specifically, the president proposes a portion of the Prevention and Public Health Fund be used to support the Behavioral Risk Factor Surveillance System and NCHS’s National Health Interview Survey to monitor health reform implementation. Despite the significance of the president’s requested increase for NCHS, the current stalemate on fiscal 2011 spending does not bode well for the fiscal 2012 appropriations process. Securing funding for NCHS—or any other domestic priorities—will be a particular challenge in this environment. For more information about the president’s budget request for CDC and NCHS, visit:
On January 28, the NCHS Board of Scientific Counselors met to review ongoing programs and discuss the impact of Affordable Care Act (ACA) provisions on the 2011 NHIS. Dr. Edward Sondik, director of NCHS, reviewed program changes and the budgetary impact of both the ACA and the current congressional debate on the fiscal year 2011 budget. As directed by ACA, the 2011 NHIS will be expanded to include questions on the access, affordability, and utilization of care, specifically, private health insurance, financial barriers to care and medication use, immunizations, well-child visits, and health information technology use. These data collection efforts will help evaluate the impact of certain ACA provisions, including the expansion of private health insurance to dependents up to age 25, and the availability of health care providers given increased demand. Dr. Sondik also reviewed the Health Indicators Warehouse (www.healthindicators.gov), a new data resource that provides public access to “standardized health outcome and health determinant indicators along with associated evidence-based interventions, which can be easily displayed, and will benefit a broad variety of users.” Cross-agency partners such as the Centers for Medicare and Medicaid Services, the Health Resources and Services Administration, and several offices within HHS (including the Office of the Assistant Secretary for Planning and Evaluation and the Office for Minority Health) have joined NCHS and CDC in funding and supporting the data hub for the HHS Community Health Data Initiative, which is the flagship for the HHS Open Government Initiative to release data. Public use and comment are welcome, particularly regarding state-specific data inclusion, non-federal data inclusion, and treatment of modeled estimates. Please visit www.healthindicators.gov for more information. During the vital statistics update, Robert N. Anderson, Ph.D., chief of the Mortality Statistics Branch, Division of Vital Statistics (DVS), discussed the transition to ICD-11 and inherent challenges to full implementation. The most significant differences between ICD-10 and ICD-11 are production style (collaborative authoring instead of annual revision conferences), category information (addition of structure descriptions and textual definitions), linkages to terminologies and ontologies (such as gene ontology) and deliverables (addition of digital products). A beta draft will be ready for field trials no earlier than May 2014, with full implementation to occur no earlier than 2016. Last, Julia Kowaleski, statistician with DVS, discussed revisions to the Model State Vital Statistics Act and regulations, which promote uniformity among states in the definitions, registration practices, and disclosure and issuance procedures of vital statistics. A Model Law Revision Work Group was established with representatives from CDC and states to improve data security, develop the electronic infrastructure, improve confidentiality and disclosure, establish new records of live birth, and enhance continuity of operations planning. The revised Model Law should be finalized by June 2011.
The KIDS COUNT Data Center is a one stop shop for key data on children and families in areas of education, health, family structure, and economic well-being for a wide range of geographies across the United States. The Annie E. Casey Foundation’s online KIDS COUNT Data Center now has much of its invaluable data on child and family well-being available broken out by congressional district. Advocates, researchers and policymakers can now create profiles for congressional districts in their state, and compare each congressional district to others by ranking, mapping or graphing indicators like Child Poverty.
Watch this short video to see how you can access data for your congressional district now. KIDS COUNT, a project of the Annie E Casey Foundation, is a national and state-by-state effort to track the status of children and families in the United States. The KIDS COUNT Data Center provides easy online access to hundreds of indicators on children and families for the nation, states, cities, counties, school districts, and now congressional districts.
On February 17, NCHS released the 2011 edition of Health, United States, which is an annual publication on ”national trends in health statistics on such topics as birth and death rates, infant mortality, life expectancy, morbidity and health status, risk factors, use of ambulatory and inpatient care, health personnel and facilities, financing of health care, health insurance and managed care, and other health topics.” Six new trend tables are included, such as selected health conditions among children, respondent-reported heart disease, cancer and stroke, and prescription drug use. The report is available at http://www.cdc.gov/nchs/hus.htm.
NCHS has announced an opportunity to comment on revisions to the National Ambulatory Medicare Care Survey, which will include a provider-based mail survey to “assess physician workflow before and after electronic medical record implementation,” a proposed asthma supplement for primary care physicians, among others. Comments are due by March 14, 2011, to omb@cdc.gov and should be addressed to the CDC desk officer. For more information, please refer to the Federal Register notice.
Congressional Briefing: 12:00 p.m. - 1:30 p.m. 3:00 p.m. - 4:00 p.m. Sponsored by: The Annie E. Casey Foundation, Congressman Danny Davis, and Congresswoman Carolyn Maloney RSVP: Mary Jo Hoeksema at 202-341-7283 or paaapc@crosslink.net __________________________________________________________ |
