Federal Priorities for the 117th Congress: Lung Health

CDC has faced severe and significant underfunding that have had a dramatic impact on its ability to respond to health threats. The public health and research programs carried out by CDC will help to prevent lung disease, improve health and, by extension, save the lives of millions of Americans. In FY21, the American Lung Association and the public health community asked for $11 billion in base funding. Congress must make robust investments in our nation’s public health system and supporting programs.

Each of the individual institutes within NIH, including the National Heart, Lung and Blood Institute, the National Institute of Allergy and Infectious Diseases, National Cancer Institute,  the National Institute on Minority Health and Health Disparities and the National Institute for Environmental Health Sciences, would benefit greatly from and should receive increased funding. With increased support, these agencies will be able to continue their investments in research in pursuit of treatments and cures for lung disease. Congress must make sustained investments in each individual institute so that the promise of biomedical research can be achieved.

All patients, including those who are underinsured or uninsured, should have access to both viral and antibody testing. Congress must clarify existing law regarding insurance coverage and provide the necessary public health funding to allow for all Americans to have access to COVID-19 testing at no cost, regardless of the reason the test is required.

Patients with suspected or confirmed cases of COVID-19 need coverage for emergency care, hospitalizations, specialists, medications, and other necessary treatments and without cost-sharing. Congress must enact legislation that guarantees coverage of treatment for COVID-19 for all those impacted.

COVID-19 vaccines should be available for all, including those who are underinsured or uninsured (including individuals who are undocumented), at no-cost. Congress has already taken steps to ensure that some individuals will have access to COVID-19 vaccines at no-cost, including those in Affordable Care Act (ACA)-compliant health plans and those enrolled in Medicare. Gaps remain, though, for those enrolled in non-ACA-compliant plans, those who are uninsured, and those enrolled in Medicaid in states that decline to cover COVID-19 vaccines. Congress must enact additional legislation to ensure that everyone will have access to vaccines for the novel coronavirus. As a part of this, Congress must provide sufficient funding to enable the nation’s public health infrastructure to distribute such vaccines.

• In order to position our nation to be better able to respond to public health crises of this magnitude, Congress and the Administration must: 
  • Provide robust funding for CDC as well as for state, local, territorial and tribal health departments.
  • Reinstate the US Pandemic Response Team.
  • Restore, expand and maintain the Strategic National Stockpile and protocol for effective distribution of personal protective equipment (PPE), ventilators and treatments.
  • Maintain a strong public health infrastructure, including workforce, surveillance and contact tracing. 
  • Maintain a strong hospital and healthcare infrastructure, including funding to ensure adequate staffing levels, appropriate patient care and adequate PPE.
  • Provide funding for the World Health Organization in order to ensure global preparedness.

• The NACP tracks asthma prevalence, promotes asthma control and prevention, and builds capacity in state programs. This program has been highly effective, however, currently, only 25 states, territories and municipalities receive funding – leaving a nationwide public health void that can lead to unnecessary asthma-related attacks and healthcare costs. Congress must expand funding of the NACP to at least $34 million for FY2022 and work to increase funding for the program to $65 million to fund all 50 states plus territories. 
• In order to adequately treat and manage asthma in this country, as well as determine those areas and populations with the greatest burden of disease, there must be comprehensive and consistent surveillance data for all 50 states and territories. Congress must provide increased funding for the NACP to provide better surveillance, management and treatment of asthma.

Despite being the 4^th leading cause of death in the U.S., there is no stand-alone program at CDC dedicated to COPD. In FY21, the House created a new line for chronic disease education and awareness within CDC’s National Center for Chronic Disease Prevention and Health Promotion and appropriated $3 million in funding. This additional line would allow CDC to respond to chronic diseases – including COPD – that do not have stand-alone programs. Congress must enact and fund this program so CDC can address COPD and implement the National COPD Action Plan. 

Many patients with COPD and other conditions depend on supplemental oxygen. As a result of the existing reimbursement and competitive bidding framework, oxygen and the training and service associated with its provision can often be difficult to acquire, particularly in the case of liquid oxygen. Congress and the Centers for Medicare and Medicare Services (CMS) must enact policies to ensure uninterrupted access to appropriate oxygen modalities for COPD patients. 

At the request of congressional leaders, the National Institutes of Health (NIH) and CDC recently developed a National COPD Action Plan. This plan outlines measures to address COPD in this country, including ways to empower patients and raise awareness, increase surveillance, and improve the standard of care. While great strides have been made, it is time for federal agencies, working together with relevant external partners, to fully implement the National COPD Action Plan. 

NIH and DOD play a critical role in advancing research to better understand and treat lung cancer. NIH research on lung cancer and the peer-reviewed lung cancer research program at DOD facilitate both ongoing and emerging activities that advance scientific understanding of lung cancer. Congress must continue to invest in the vital research taking place at both NIH and DOD.

Improving survival rates for lung cancer will require a comprehensive approach that includes risk reduction strategies, improving utilization of screening for those at high risk, eliminating disparities in lung cancer treatments, and many other strategies. Congress must increase funding for CDC’s Cancer Control Program to develop and implement public health strategies to address lung cancer. 

TB outbreaks continue to occur across the country in schools, workplaces and prisons, costing the U.S. over $460 million annually. In order to continue our progress towards the elimination of TB in this country, Congress must provide $225 million in FY2022 for CDC’s state and local TB programs. 

Similar to COPD, many patients with PF require supplemental oxygen. For all patients experiencing chronic lung disease, Congress and CMS must enact policies to ensure uninterrupted access to appropriate oxygen modalities.

The cause of pulmonary fibrosis is not well understood, and there is no cure. Consequently, significantly more research is necessary to ensure that patients with PF can live longer and have a better quality of life. Congress must continue to invest in the critically important research taking place at NIH.