As Advocates for EMS begins to think about the planning process for 2009, the current political climate deserves consideration.  Specifically, there are 3 factors worth your attention:

 

1.    There is every reason to believe Congress will fail to enact fiscal year 2009 appropriations bills by October 1st, leaving agencies to operate under a continuing resolution;

2.    The Presidential transition will create significant voids in key leadership and decision making positions; and

3.    The fiscal year 2010 budget and appropriations process will be delayed while the new Administration gets settled and new priorities are identified. 

The fiscal year 2009 appropriations cycle has proven difficult at best.  There were two major stumbling blocks to completing action on time:  overall spending limits and controversial legislative riders related to off-shore drilling. 

Similar to fiscal year 2008, the Democratic Congress has been unable to successfully negotiate with the Bush Administration on overall spending limits.  Where Democrats in Congress support a total discretionary federal budget of $1.0 trillion, the President was unwilling to go beyond a total of $987.6 billion and has indicated his intent to veto any spending bill that exceeds this amount.  In response to the threat of a Presidential veto, Congress seems determined to wait out this Administration in hopes of getting a more favorable reception from a new President. 

In addition to the general impasse on overall spending, immediately prior to the August break, Congressional action on the appropriations bills came to a screeching halt in the House when Republicans attempted to offer an amendment related to off shore drilling to the Labor, Health and Human Services appropriations bills. Congress went home for the August break without completing action on any of the fiscal year 2009 appropriations bills.   

Congress reconvened the week of September 8th and they had two weeks to complete action on all 12 bills –a virtually impossible task. Therefore, Congress passed a

FY 2009 Continuing Resolution

Recently, President Bush signed a “continuing resolution” or “CR.” However, the bill included full FY 2009 appropriations for military construction and the departments of Defense, Veterans Affairs and Homeland Security. A CR is a stop-gap funding measure that provides agencies authority to operate for a specified period of time, or until regular appropriations bills are enacted, whichever is sooner.  This means that agencies are limited to the amount of funding they received this fiscal year (2008). Under a CR, agencies are prohibited from starting new programs, projects and activities; if an effort was not funded in the current year, it will not be funded under a continuing resolution.  The rest of the government, including programs and agencies under the department of Health and Human Services and the Department of Transportation will be funded at FY 2008 levels through March 6, 2009.  Under a CR, funds are tightly controlled by the Office of Management and Budget (OMB); OMB will issue a directive dictating how much money each agency (and program) has for the duration of the CR.  Specific guidance by OMB will be issued after the CR is enacted into law.  The CR will last until March 6, 2009. 

Department of Homeland Security FY 09 Funding Levels

The House and Senate Homeland Security Appropriations reports contained report language regarding emergency medical services and first responder readiness.  The report language states:

House of Representatives FY 09 DHS Appropriations EMS Related Report Language

Emergency Medical Services

FEMA is directed, in conjunction with the Office of Health Affairs, to report to the Committee regarding the current state of disaster preparedness capabilities of emergency medical services providers and the capabilities required to meet future preparedness goals.  This report is due no later than six months after the enactment of this Act and shall include an analysis of the gap between current and target capabilities.  FEMA is directed to include in its grants guidance, language requiring State and local governments to include EMS providers in their Statewide Homeland Security Plans as well as their UASI plans.  If a State provides no funding to EMS providers, the State should justify lack of funding through demonstrating related targeted capabilities have been met or identify other pressing priorities. 
 
First Responder Readiness

The Committee is concerned about the nation’s ability to respond to all disasters in U.S. territories, especially disasters that offer no warning.  FEMA is directed to analyze the response capabilities of the U.S. territories, including the level of readiness of first responders and the availability of adequate training programs.  FEMA shall report to the Committee on the results of this analysis within six months after the enactment of this Act.  The Committee also directs FEMA to examine the utility of additional sites for all-hazard first responder training and report to the Committee on its findings no later than February 16, 2009. 

Senate FY 09 DHS Appropriations EMS Report Language

“The Committee is concerned that EMS is not considered an equal partner among the first responder community and encourages FEMA to require State and local governments to include EMS representatives in planning efforts.”

FY 09 DHS Appropriations Conference Report Language

The House and Senate reconciled the differences between the two versions of the FY 09 Department of Homeland Security Appropriations bills.  The final FY 09 DHS Appropriations Report contained some
additional report language regarding first responder readiness.  That report language states:

Measuring Preparedness

The bill provides $5,000,000 to accelerate efforts at FEMA to develop tools to measure the achievement and effectiveness of certain grant programs, including how grants increase the capability of States and local communities to respond to all-hazard.  GAO is directed to evaluate these grants measurement tools and determine whether the tools are reasonable and effective in measuring how grants increase the preparedness level and capabilities of each grant recipient and reduce risk.  FEMA is directed to create a task force and consult with State and local governments, as specified in the Senate report with regard to this effot.

First Responder Readiness

FEMA is directed to submit a report, as specified in the House report, regarding the availability of training and an analysis of response capabilities of the U.S. territories.  FEMA is directed to examine major training programs to determine the utility of additional sites of all-hazard first responder training to the Committees on its findings.

Additional EMS-Related Language

FEMA is directed in conjunction with the Office of Health Affairs to report to the Committees regarding the current state of disaster preparedness capabilities of emergency medical services, as discussed in the House report.  FEMA is encouraged to require State and local governments to include Chief Information Officers in planning efforts, as discussed in the Senate report.  Further, FEMA, is encouraged to consider the need for mass evacuation planning and pre-positioning of equipment for areas potentially impacted by mass evacuations in allocating first responder funds.

Additional EMS Legislation Advocates for EMS Followed in the 110th Congress

The 110th Congress left with more of a whimper than a bang when it came to passing legislation prior to departing to campaign for re-election. Minus the Wall Street bailout and the CR, other bills that Advocates were following simply did not make it through the process.  Those bills include the Improving Emergency Medical Care and Response Act, the reauthorization of the Emergency Medical Services for Children program, the Veterans to Paramedics Transition Act and the Stroke Treatment and Ongoing Prevention (STOP) Stroke Act.  These bills will have to be reintroduced in the New Year when the 111th Congress convenes.

Finally, Advocates has partnered with the IAFF, IAFC, the NVFC and the National Association of Government Employees in addressing an issue that is of importance to all first responders.  Emergency responders are protected by a number of laws and standards of care regarding occupational exposure to communicable diseases. One of those provisions was included in the emergency response provisions of the original Ryan White CARE Act that passed by Congress in 1990 (P.L. 101-381).  Part E, Subpart II, Notification of Possible Exposure to Infectious Diseases (Section 2681-2690) required emergency response employers (i.e. fire departments, police departments, emergency medical services providers) to have a “Designated Officer” (Infection or Exposure Control) to field calls from employees regarding exposures to communicable diseases and obtain the disease status of the source patients in those exposures from the medical facility providing treatment to that patient.
 
This provision was included in subsequent reauthorizations of the Ryan White CARE Act until the last reauthorization that passed in 2006 (P.L. 109-415).  As a result of that language disappearing, concerns are developing throughout the country that emergency responders will no longer be able to find out whether or not they have been exposed to an infectious disease in a timely manner and be tested and treated outside of the emergency department at a lower cost.  In addition, there are concerns developing among hospitals and health systems that the release the results of a source-patient test would be a violation of the Health Insurance Portability and Accountability Act (HIPAA). 

Advocates and representatives from fire organizations have been meeting with offices on Capitol Hill asking them to consider reinstating this language.  Staff have been very receptive to reinstating the language, however, due not many pieces of legislation moving due to election year politics this issue will have to be addressed when the 111th Congress convenes next year. 

Presidential Transition

For most agencies, the Presidential transition is a procedural exercise where career bureaucrats simply keep the trains running until new political appointees are in place.  In fact, most agencies have already started the process, particularly those with “operational” responsibilities such as at the departments of Defense, Homeland Security and Justice.  Transition books are being prepared and programs and activities that must operate under any scenario are being identified.  In general, until new policies are established by the incoming Administration, all programs will operate in a status quo mode. 

Officially, the new Administration will begin organizing immediately after the election.  Unofficially, both campaigns are preparing now, with each group having established transition teams.

In addition to putting political appointees in place, the first order of business for the new Administration will be the submission of the President’s FY 2010 budget, due to Congress on Monday, February 2nd. 

FY 2010 President’s Budget

By law, the President must submit his budget to Congress the first Monday in February of each year.  During Presidential transition years, the budget that is submitted is typically a “place holder”, sent to Congress in compliance with the Congressional Budget Act but not reflecting the incoming Administration’s policies and priorities.  This year, it is expected the new President will continue this tradition, directing OMB to submit what is referred to as a “current services budget” –in essence a budget that reflects current programs and policies simply adjusted for inflation and other mandatory increases.   Congress will receive this budget but will defer any serious work until the new Administration submits a formal budget amendment – it is this amendment that will reflect the new Administration’s policies and programs.  Although we will likely hear of new initiatives during the campaign, final numbers will not be known until the formal budget amendment is submitted –sometime in April, 2009.   Once submitted, the Congressional budget and appropriations process will begin in earnest, with the goal of sending the President all appropriations bills by October 1st. 

Until the President’s budget is submitted in April, and until we know how Congress reacts to that budget, it is unlikely we will see any major or immediate shifts in spending.   If Obama wins, Congress is likely to endorse major spending shifts early on –perhaps even using the FY 2009 cycle to move the Obama agenda forward.  Conversely, if McCain wins, we would expect Congress to be less willing to hand the President any immediate victories, again, prolonging debate on any major Presidential initiatives.  

If you have an item that you would like Advocates for EMS to consider for its agenda in 2009 please contact Lisa Meyer at Cornerstone Government Affairs at This e-mail address is being protected from spam bots, you need JavaScript enabled to view it   The Advocates for EMS Board will begin to develop a list of priorities in the months of November and December.