Wastewater Infrastructure: Overview, Funding, and Legislative Developments

Wastewater Infrastructure: Overview, Funding, and Legislative Developments. Congressional Research Service, Library of Congress. Jonathan L. Ramseur. May 22, 2018

The collection and treatment of wastewaterwastewater remains among the most important public health interventions in human history and has contributed to a significant decrease in waterborne diseases during the past century. Nevertheless, waste discharges from municipal sewage treatment plants into rivers and streams, lakes, and estuaries and coastal waters remain a significant source of water quality problems throughout the country.  The Clean Water Act (CWA) establishes performance levels to be attained by municipal sewage treatment plants in order to prevent the discharge of harmful wastes into surface waters. The act also provides financial assistance so that communities can construct treatment facilities and related equipment to comply with the law. Although approximately $104 billion in CWA assistance has been provided since 1972, funding needs for wastewater infrastructure remain high. The Environmental Protection Agency (EPA) estimates that the nation’s wastewater treatment facilities will need $271 billion over the next 20 years to meet the CWA’s water quality objectives.

[PDF format, 19 pages].

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Prescription Drug Monitoring Programs

Prescription Drug Monitoring Programs.  Congressional Research Service, Library of Congress. Lisa N. Sacco, Johnathan H. Duff, Amanda K. Sarata. May 24, 2018

 In the midst of national concern over the opioid epidemic, federal and state officials are paying greater attention to the manner in which opioids are prescribed. Nearly all prescription drugs involved in overdoses are originally prescribed by a physician (rather than, for example, being stolen from pharmacies). Thus, attention has been directed toward better understanding how opioids are being prescribed and preventing the diversion of prescription drugs after the prescriptions are dispensed. Prescription drug monitoring programs (PDMPs) maintain statewide electronic databases of prescriptions dispensed for controlled substances (i.e., prescription drugs with a potential for abuse that are subject to stricter government regulation). Information collected by PDMPs may be used to educate and inform prescribers, pharmacists, and the public; identify or prevent drug abuse and diversion; facilitate the identification of prescription drug-addicted individuals and enable intervention and treatment; outline drug use and abuse trends to inform public health initiatives; or educate individuals about prescription drug use, abuse, diversion, and PDMPs themselves. 

 [PDF format, 34 pages].

Frequently Asked Questions About Prescription Drug Pricing and Policy

Frequently Asked Questions About Prescription Drug Pricing and Policy. Congressional Research Service, Library of Congress. Suzanne M. Kirchhoff, Judith A. Johnson,  Susan Thaul. April 24, 2018

 Prescription drugs play an important role in the U.S. health care system. Innovative, breakthrough drugs are providing cures for diseases such as hepatitis C and helping individuals with chronic conditions lead fuller lives. Studies show that prescription drug therapy can produce health care savings by reducing the number of hospitalizations and other costly medical procedures. Congress and presidential administrations have attempted to ensure that Americans have access to pharmaceuticals by enacting the Medicare Part D prescription drug benefit as part of the Medicare Modernization and Prescription Drug Act of 2003 (MMA; P.L. 108-173) and expanding drug coverage under the 2010 Patient Protection and Affordable Care Act (ACA; P.L. 111-148, as amended). Congress also has enacted laws to encourage manufacturing of lower-cost generic drugs, as well as cutting-edge biologics and biosimilars.

 [PDF format, 38 pages].

The Healthy America Program: Building on the Best of Medicare and the Affordable Care Act

The Healthy America Program: Building on the Best of Medicare and the Affordable Care Act. Urban Institute. Linda J. Blumberg, John Holahan, Stephen Zuckerman. May 14, 2018

 Since efforts to “repeal and replace” the Affordable Care Act (ACA) have failed, and bipartisan attempts to improve the law have stalled, some policymakers are now looking beyond incremental fixes. In this paper, Urban Institute researchers present a set of policy ideas that would provide universal access to comprehensive coverage but would also allow people to keep their employer-sponsored coverage, would offer a range of insurer options and ensure broad pooling of health care risk, would not have an employer mandate, would provide income-related federal assistance, and would create a more flexible individual incentive to remain insured than that under the ACA. [Note: contains copyrighted material].

 [PDF format, 24 pages].

Federal Requirements on Private Health Insurance Plans

Federal Requirements on Private Health Insurance Plans. Congressional Research Service, Library of Congress. Annie L. Mach, Bernadette Fernandez. May 1, 2018

 A majority of Americans have health insurance from the private health insurance (PHI) market. Health plans sold in the PHI market must comply with requirements at both the state and federal levels; such requirements often are referred to as market reforms.  The first part of this report provides background information about health plans sold in the PHI market and briefly describes state and federal regulation of private plans. The second part summarizes selected federal requirements and indicates each requirement’s applicability to one or more of the following types of private health plans: individual, small group, large group, and self-insured. The selected market reforms are grouped under the following categories: obtaining coverage, keeping coverage, developing health insurance premiums, covered services, cost-sharing limits, consumer assistance and other patient protections, and plan requirements related to health care providers. Many of the federal requirements described in this report were established under the Patient Protection and Affordable Care Act (ACA; P.L. 111-148, as amended); however, some were established under federal laws enacted prior to the ACA.

 [PDF format, 26 pages].

The National Health Service Corps

The National Health Service Corps.  Congressional Research Service, Library of Congress. Elayne J. Heisler. March 9, 2018

 The National Health Service Corps (NHSC) provides scholarships and loan repayments to health care providers in exchange for a period of service in a health professional shortage area (HPSA). The program places clinicians at facilities—generally not-for-profit or government-operated— that might otherwise have difficulties recruiting and retaining providers.  The NHSC is administered by the Health Resources and Services Administration (HRSA), within the Department of Health and Human Services (HHS). Congress created the NHSC in the Emergency Health Personnel Act of 1970 (P.L. 91-623), and its programs have been reauthorized and amended several times since then.

 [PDF format, 19 pages].

A Ripe Moment for Reducing Vaccine-Preventable Disease

A Ripe Moment for Reducing Vaccine-Preventable Disease. Center for Strategic & International Studies. Nellie Bristol. March 13, 2018

 Immunizations are one of the most effective and cost-effective health promotion tools, improving child well-being and lowering the risk of epidemic-prone diseases. Yet despite focused efforts to increase global vaccine delivery, more than one in ten children received no vaccines in 2016, while an additional one in seven missed receiving all recommended doses and thus remains vulnerable to potentially deadly diseases.

 Over the next several years, three global health activities growing out of programs championed by the U.S. government will come together in a way that could catalyze immunization system improvements in the most disease-prone countries. These include immunization and disease surveillance goals outlined in the Global Health Security Agenda (GHSA) and two activities related to global polio eradication: the need for worldwide delivery of the inactivated polio vaccine; and the repurposing of the polio infrastructure for immunization and other health activities, a process known as polio transition. All three activities create concerted attention to immunization systems that could result in sustained increases in global vaccination rates and amplify U.S. investments in vaccine promotion mechanisms, such as Gavi, the Vaccine Alliance. [Note: contains copyrighted material].

 [PDF format, 8 pages].