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November 3, 2014

From the Executive Director's Office

By now I am sure many of you have seen the exciting news regarding NAO being one of the ​four national awardees of a grant to work in partnership with the Centers for Disease Control and Prevention on an HPV Immunization initiative; this is another great opportunity for NAO and our AHEC Network to showcase our value in creatively adapting national initiatives to address local and regional healthcare issues!

The other awardees for this initiative are the American Cancer Society, the Academic Pediatric Association and the American Academy of Pediatrics. The goal of the overall project is to improve HPV immunization rates of 11- and 12-year-old males and females throughout the country by improving clinician training and understanding of the vaccine. The ultimate outcomes are a decrease in parents who report their child's provider did not recommend the HPV vaccine, and most importantly, an increase in HPV immunization rates-

There will be many opportunities for AHEC participation in this project as we develop our NAO National Training Center. Please see below for details on how to learn more about our project.

From NAO National Training Center

HPV Project Kick-off Webinar
What's this about a new national project? Yes! You've heard the news! Now get an overview of the project and the different ways that AHECs can become involved. There are three opportunities for you to log in and/or phone in to learn more:

Content will be the same at each session. Pick the day and time that works best in your schedule. It's only 30 minutes! Already providing HPV education to health profession students, preceptors and/or health professionals? Drop us a note about what you're doing at

NAO 2104 Fall Conference

Please be sure to register as soon as you can for our NAO 2014 fall conference. The agenda is coming together quite nicely; we have a great ​meeting planned. Please go to for information on how to register for both the conference and hotel. See you in a month!​

A comprehensive summary of policy issues related to healthcare and workforce programs in light of the election tomorrow

2014 Congressional Midterm Elections Overview

On November 4, 2014, Americans will vote in the 2014 midterm elections for the make-up of the 114th Congress. All 435 members of the House of Representatives are running as well as 36 Senators (Class II Senators and vacancies). Republicans are expected to keep their majority in the House and are strong contenders to gain control of the Senate. If the Republicans gain control of both chambers, they will have an easier time passing Republican-leaning legislation through Congress. Policy issues that hang in the balance include the future of health reform and the size and priorities of federal spending.

Current 113th Congress Senate House
Democrats 53 199
Republicans 45 234
Other 2 Independents 2 Vacancies
Washington Post and University of Virginia Predicted Outcome of the 2014 Elections*
Senate House
Democrats 46 193
Republicans 52 242
Other 2 Independents

*Predictions in this memo are based on analyses from the Washington Post and the University of Virginia Center for Politics

The U.S. Senate in the 114th Congress

The real drama of the 2014 midterm elections is control of the Senate. Currently in the 113th Congress, Democrats control the Senate and Republicans control the House. Strong partisan differences led to an historic gridlock. In November, the numbers favor the Republicans: 36 Senate seats are up for reelection and 21 are seats held by Democrats. 13 of the 36 races are competitive, and of those, 10 are held by Democrats. One party would need a super majority of 60 seats to block a filibuster, however, the Republicans are not expected to achieve this and the Democrats will likely have a blocking minority. Barring any game-changing events, Republican control of the Senate is potentially short-lived. In 2016, 24 of the 34 Senate seats up for reelection will be held by Republicans.

The Future of Health Reform

The Republican Party threatens significant changes to the Affordable Care Act (ACA) – a signature policy achievement of the Obama Administration – if they take the Senate. Senate Republican Leader Mitch McConnell and his colleagues are campaigning on repealing ACA. However, the October Kaiser Health Tracking Poll found that most Americans support improving upon ACA rather than repealing it completely. Furthermore, it would be difficult to alter provisions that have extended coverage to nearly 10 million Americans, and ended overtly discriminatory practices against persons with pre-existing conditions. Republican leadership cite interest in removing ACA tax burdens like the medical device tax and health insurance premium tax, addressing the rising premiums and cancelled plans for people who already had insurance before ACA and liked it, and reducing the federal control over health insurance.

Unlike the 2010 midterm elections when Republicans swept the House in a backlash against ACA, ACA is not the key issue for voters this year. Kaiser found that voters are more concerned with the economy and jobs than health care. Public opinion of ACA has decreased slightly, however, most voters have already formed their perspective and are less likely to be swayed. The 2015 insurance plan premium increases will be known before the elections and could negatively affect Democrat candidates.

Federal Discretionary Health Spending

Discretionary health spending supports much of the public health infrastructure as well as the nation's medical research portfolio. The Republican Party has been the driving force for the recent efforts to cut discretionary spending including a $1.394 billion cut for the National Institutes of Health (NIH) and a $99 million cut for the Centers for Disease Control and Prevention (CDC) since fiscal year 2010 (FY10). If they gain control of the Senate, Republicans will attempt additional cuts in the annual appropriations bills. Factors that could stem the tide of further Republican-led austerity include the President's power to veto legislation and the expected blocking minority of the Senate Democrats. In addition, the negative fallout for the Republican's role in the government shutdown in 2013 over health reform spending is still fresh in the minds of GOP decision makers. Finally, the Republicans will be mindful of the Presidential election in 2016 and the need to demonstrate leadership ability.

L-HHS Appropriations Subcommittees

The facts of life as a legislator – retirements, scandals, deaths, and competitive races – have opened up powerful committee positions in the 114th Congress. Of interest to the health community, the Chairs of both the House and Senate Labor, Health and Human Services, Education and Related Agencies (L-HHS) Appropriations Subcommittees are leaving at the end of the 113th Congress. Senate L-HHS Chair Tom Harkin (D-IA) is retiring as a long-serving and dominant advocate for public health and medical research spending. House Chair Jack Kingston (R-GA-1) chose to run for the Senate and could not simultaneously run for his House seat. Below are tables of the House and Senate L-HHS Appropriations Committee members running for office and the status of their campaigns.

Many Senate Democrat appropriators are running for office and face competitive campaigns:

Senate L-HHS Appropriations Subcommittee
Tom Harkin (D-IA), Chair, L-HHS Retiring
Mary Landrieu (D-LA), Member, L-HHS Competitive race, lead opponent is Rep. Bill Cassidy (R-LA-6). Win: toss-up
Mark Pryor (D-AR), Member, L-HHS Competitive race, lead opponent is Rep. Tom Cotton (R-AR-4). Win: likely R
Jeanne Shaheen (D-NH), Member, L-HHS Competitive race, lead opponent is former MA Sen. Scott Brown. Win: likely D
Jeff Merkley (D-OR), Member, L-HHS Relatively safe race
Dick Durbin (D-IL), Member, L-HHS; Chair, DOD Safe race
Jack Reed (D-RI), Member, L-HHS Safe race
Thad Cochran (R-MS), Member, L-HHS Safe race
Lamar Alexander (R-TN), Member, L-HHS Safe race
Lindsey Graham (R-SC), Member, L-HHS Safe race
Mike Johanns (R-NE), Member, L-HHS Safe race

With the exception of Rep. Kingston, most House appropriators are expected to return in the 114th Congress:

House L-HHS Appropriations Subcommittee
Jack Kingston (R-GA-1) Ran for the Senate and lost, did not run for the House
Steve Womack (R-AR-3) Safe race
Chuck Fleischmann (R-TN-3) Safe race
David Joyce (R-OH-14) Safe race
Andy Harris, MD (R-MD-1) Safe race
Martha Roby (R-AL-2) Safe race
Chris Stewart (R-UT-2) Safe race
Rosa DeLauro (D-CT-3) Safe race
Nita Lowey (D-NY-17) Safe race
Lucille Roybal-Allard (D-CA-40) Safe race
Barbara Lee (D-CA-13) Safe race
Mike Honda (D-CA-17) Competitive race, lead opponent is Democrat Ro Khanna. Win: likely Honda

Strategy for the 114th Congress

It will be important to continue to educate new members as well as incumbents on the importance of NIH, CDC, and the other Public Health Service agencies. While every Member of Congress can impact legislation and policy, committee members have a powerful influence on their subjects of jurisdiction. Committee and subcommittee membership will be determined after the election and throughout the month of January. Organizations should become acquainted with the relevant committees and subcommittees early in the 114th Congress.

"Tuesdays with Trachtenberg"

Our next call will be Tuesday November 4th and will now go to every other week. The call after 11/4 will be on 11/18 and then again on 12/9 as we will be in Washington, DC for the NAO fall conference on 12/2.

**Next Call: Tuesday 11/4/14: 12:30-1:30 EST: Please dial in at 1-605-475-3220. Please make note of the new dial-in number, Passcode: 245171#. Please join us to see where the dialogue will go!

Have a great week!

Technology Interventions for Traumatic Brain Injury

Date/Time: Nov. 13, 2014; 1-2:30 p.m. (EST)

The integration of innovative technologytools to support the assessment and treatment of traumatic brain injury (TBI) isan area of increasing interest and importance to providers in the military healthcare system. Technology tools may provide increased compliancy with treatment and engagement with care, increased validity of patient reports and efficiency in the delivery of care by maximizing engagement between sessions to make meaningful lasting changes in the lives of patients.

At the conclusion of this webinar, participants will be able to:

  • Identify innovative technology tools and their impact on clinical practice with patients who have sustained a TBI
  • Describe technology tools which can help minimize or eliminate the short- and long-term adverse effects of military-related TBI
  • Examine research, legal, ethical and other considerations when employing technology in TBI care

David C. Cooper, Psy.D.
Psychologist, Mobile Health Program
National Center for Telehealth and Technology
Joint Base Lewis-McChord
Tacoma, Wash.

MAJ Pamela DiPatrizio, AN, MSN, CEN, CPEN
Chief, Office of Education Outreach
Defense and Veterans Brain Injury Center
Silver Spring, Md.

Continuing Education
Continuing education credit is available from Duke Medicine. You must register on or before Nov. 13, 2014, at 3 p.m. (EST) to qualify for the receipt of continuing education credit.

To qualify for receipt of continuing education credit for applicable webinars, eligible participants must create a profile in the Duke Medicine Learning Management System and register for the event on, or before, the event registration deadline. Complete responses to all pre-registration questions are required to be eligible to receive credit for attending this event. For guidance on creating a user account and event registration in the Duke Medicine Learning Management System site, please visit

Please note:  DCoE's awarding of continuing education credit is limited in scope to health care providers who actively provide psychological health and traumatic brain injury care to U.S. active-duty service members, reservists, National Guardsmen, military veterans and/or their families.

For details, please visit: since September 2014 for Psychology: This activity complies with all of the continuing education criteria identified through the American Psychological Association (APA) Continuing Education Requirements.

Sign up for the webinar at
Upon completion of registration, a confirmation email will be sent providing webinar event details.

If your network security settings do not allow access to the Duke Medicine website, use another network or device to access the registration page. Once registered, you may use Adobe Connect or Defense Connect Online to attend the webinar.