First, preparedness and response are different. When there is a catastrophe in the United States, state and local governments take the lead in response activities. When the resources of states and localities are overwhelmed, the President can provide certain additional assets and personnel to aid stricken communities, and can provide funding to individuals and to government and not-for-profit entities to assist them in response and recovery. This assistance is provided under the authority of the Robert T. Stafford Disaster Relief and Emergency Assistance Act (the Stafford Act), upon a presidential declaration of an emergency (a lower level of assistance) or a major disaster (a higher level of assistance). Second, the Secretary of Health and Human Services (HHS) has authority under the Public Health Service Act (PHS Act) to draw upon a special fund to support departmental activities in response to unanticipated public health emergencies, but there is at present no money in the fund. This report focuses on incident response activities (versus preparedness activities) and examines (1) the statutory authorities and coordinating mechanisms of the President (acting through the Secretary of Homeland Security) and the Secretary of HHS in providing routine assistance, and in providing 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 to fund the costs of a response to public health and medical emergencies. This report will be updated as needed. A listing of these and other federal public health emergency authorities is provided in the Appendix . Would the Stafford Act Apply in a Flu Pandemic? Legislation introduced in the 110 th Congress ( H.R. 6569 / S. 3312 ) proposed to authorize the HHS Secretary, when he or she has made a Section 319 public health emergency determination, to use the PHEF to provide temporary emergency health care coverage for uninsured individuals affected by the emergency. There is no federal assistance program designed purposefully to cover the uninsured or uncompensated costs of individual health care that may be needed as a consequence of a disaster. Given that some U.S. uninsured health care needs go unmet under normal circumstances, there is not consensus that the costs of health care for these disaster victims should be a federal responsibility. Congress has provided intermittent appropriations to support the costs of medical treatment for some of these individuals, through treatment programs established after the terrorist attack. Following Hurricane Katrina, Congress defined in statute the roles of the two Secretaries with respect to the public health and medical response to catastrophes. Assistance to states: Pursuant to Section 311 of the Public Health Service Act, the Secretary of HHS has broad authority to assist state and local governments in their disease control efforts, upon their request, as follows: "The Secretary may, at the request of the appropriate State or local authority, extend temporary (not in excess of six months) assistance to States or localities in meeting health emergencies of such a nature as to warrant Federal assistance.
When there is a catastrophe in the United States, state and local governments lead response activities, invoking state and local legal authorities to support them. 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 of HHS 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 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 National Response Framework (NRF), published by the Department of Homeland Security.
There is no federal assistance program designed purposefully to cover the uninsured or uncompensated costs of individual health care that may be needed as a consequence of a disaster. While there is not consensus that this should be a federal responsibility, Congress has provided such assistance to victims of some specific disasters in the past. For example, following Hurricane Katrina, Congress provided short-term assistance to host states, through the Medicaid program, to cover a portion of the uninsured health care costs of eligible evacuees. Congress has provided funding—and some have proposed establishing statutory authority—to cover certain uninsured health care costs for responders and others who are having health problems related to exposures at the World Trade Center site in New York City after the 2001 terrorist attack. Also, legislation introduced in the 110th Congress proposed to grant the Secretary of HHS the authority to use a special fund to provide temporary emergency health care coverage for uninsured individuals affected by future public health emergencies.
This report examines, with respect to public health and medical incidents, (1) the authorities and coordinating mechanisms of the President and the Secretary of HHS in providing routine assistance, and assistance pursuant to the Stafford Act and/or the Public Health Service Act; (2) mechanisms to assure a coordinated federal response to these incidents, and overlaps or gaps in agency responsibilities; and (3) existing mechanisms, potential gaps, and proposals to fund the costs of a response to public health and medical incidents. A listing of federal public health emergency authorities is provided in the Appendix. This report will be updated as needed.