RL33579 - The Public Health and Medical Response to Disasters: Federal Authority and Funding
1-Aug-2008; Sarah A. Lister; 40 p.
Update: Previous releases:
September 19, 2007
October 10, 2006
Abstract: When there is a catastrophe in the United States, state and local governments lead response activities, invoking state and local legal authorities to support these activities. When state and local response capabilities are overwhelmed, the President, acting through the Secretary of Homeland Security, can provide assistance to stricken communities, individuals, governments, and not-for-profit groups to assist in response and recovery. Aid is provided under the authority of the Robert T. Stafford Disaster Relief and Emergency Assistance Act (the Stafford Act) upon a presidential declaration. The Secretary of Health and Human Services (HHS) also has both standing and emergency authorities in the Public Health Service Act, by which he or she can provide assistance in response to public health and medical emergencies. At this time, however, the Secretary has limited means to finance activities that are ineligible, for whatever reason, for Stafford Act assistance.
The flawed response to Hurricane Katrina, and preparedness efforts for an influenza (“flu”) pandemic, have each raised concerns about existing federal response mechanisms for incidents that result in overwhelming public health and medical needs. These concerns include the delegation of responsibilities among different federal departments, and whether critical conflicts or gaps exist in these relationships. In particular, there are some concerns about federal leadership and delegations of responsibility as laid out in the recently published National Response Framework (NRF).
There is no federal assistance program designed purposely to cover the uninsured or uncompensated costs of individual health care that may be needed as a consequence of a disaster, nor is there consensus that this should be a federal responsibility. Following Hurricane Katrina, Congress provided short-term assistance to host states, through the Medicaid program, to cover the uninsured health care needs of eligible Katrina evacuees. Some have proposed establishing a mechanism to cover certain uninsured health care costs of responders and others who are having health problems related to exposures at the World Trade Center site in New York City following the 2001 terrorist attack. Legislation introduced in the 110th Congress (H.R. 6569/S. 3312) would authorize the Secretary of HHS to use a special fund to provide temporary emergency health care coverage for uninsured individuals affected by public health emergencies.
This report examines (1) the authorities and coordinating mechanisms of the President and the Secretary of HHS in providing routine assistance, and assistance pursuant to emergency or major disaster declarations and/or public health emergency determinations; (2) mechanisms to assure a coordinated federal response to public health and medical emergencies, and overlaps or gaps in agency responsibilities; and (3) existing mechanisms, potential gaps, and proposals for financing the costs of a response to public health and medical emergencies. A listing of federal public health emergency authorities is provided in the Appendix. This report will be updated as needed.