A MARTÍNEZ, HOST:
The $1.5 trillion spending bill that President Biden signed late last Friday contained a lot more than the funds to keep the government running. Many health initiatives were tucked into the legislation, as well - everything from the closing of a tobacco regulation loophole to changes in food assistance programs. Now, one thing, though, that was noticeably missing - COVID funding. NPR's Allison Aubrey is here. Allison, let's start with the tobacco regulation loophole. The FDA has been stepping up regulation of e-cigarettes, which are popular with teens. What changed?
ALLISON AUBREY, BYLINE: Good morning, A. One of the ways the makers of flavored e-cigarettes have tried to avoid FDA's tobacco regulation is by switching to synthetic nicotine, which is made in a lab, not from tobacco. For example, one of the brands most popular with teens, Puff Bar, comes in delicious-sounding flavors such as cool mint or banana ice. It uses synthetic nicotine. Matthew Myers of the Campaign for Tobacco-Free Kids told me this makes it tougher to rein in teen vaping. But with the signing of this bill, this loophole will be closed.
MATTHEW MYERS: The key here is that as FDA cracked down on flavors like cookie crunch, these companies simply switched the kind of nicotine they were using in order to sell products that wouldn't otherwise be allowed. That's why closing this loophole is so critical.
AUBREY: Though vaping decreased some early in the pandemic, the most recent data shows millions of teens are still vaping regularly. So Myers says this is good news, a step in the right direction.
MARTÍNEZ: All right. So let's move on to another item. Something else in this huge spending package is the continuation of telehealth benefits. How significant is this?
AUBREY: Well, there's a temporary extension of the flexibility that's been allowed amid the pandemic in the Medicare program for folks 65 and up. So providers who see Medicare patients can continue to bill for telehealth visits. And the bill also extends some flexibility for mental health visits via telehealth, too. Now, the temporary extension lasts about five months or so. But, you know, people are getting accustomed to the convenience of telehealth. So a lot of providers, a lot of patients would like to see permanent changes.
MARTÍNEZ: The spending bill also makes some changes to food assistance programs that have helped millions of Americans during the pandemic. What are those details?
AUBREY: When the pandemic started and schools shut down, school nutrition directors had to really scramble to feed kids in a whole new way. So they were given waivers from the rules, which allowed for a lot more flexibility on what they could serve and how to serve it. This led to creative, new ways to get food to those who need it. I spoke to Donna Martin. She heads the school nutrition program in Burke County, Ga. She told me she's been able to send home big boxes of fresh food to families, enough for several days.
DONNA MARTIN: Oh, my gosh. It was a game-changer. We were able to give food that was amazing. We're able to give, like, whole heads of broccoli and whole heads of cauliflower and unusual fruits and vegetables because it was economy of scale. So we could give much, much better food.
AUBREY: And she says this is the type of food families really want and need, but this waiver program is set to expire in June.
MARTÍNEZ: I'd like to ask kids about the broccoli, though, by the way. OK, so what does this mean...
AUBREY: (Laughter).
MARTÍNEZ: ...When it comes to school nutrition programs? Will they have to go back to the old way of doing things?
AUBREY: Maybe. I mean, there was a big push to extend these waivers that have given schools more flexibility, more money. But in the end, the waiver did not make it into the spending bill. Some lawmakers resisted, saying things can go back to normal with the pandemic easing.
MARTIN: This is going to be a disaster for my program. We're going to have to really cut back on the quality of the meals, and I don't want to do that.
AUBREY: She says there is already a high level of food insecurity in her county in rural Georgia.
MARTÍNEZ: So does that mean fewer kids might be fed?
AUBREY: This really is the concern. Many schools say they'll have to scale back if the flexibility waivers expire. I spoke to Lisa Davis of Share Our Strength's No Kid Hungry campaign. She says programs like this have such a solid return on investment. You keep kids well-fed. There are all kinds of positive benefits to health and well-being.
LISA DAVIS: The latest USDA numbers showed that because of all of the steps the government took - from making sure schools could continue to get meals to kids in new and different ways, the child tax credit enhancement, so many different policies - food insecurity, on whole, did not rise significantly.
AUBREY: The concern is that this progress could be lost. The group says they will look for other ways to keep the waivers in place.
MARTÍNEZ: All right, so let's end on the item that was not there, was not included in the spending bill, and that's COVID funding. So why was COVID funding taken out of this bill when when, really, so much else was included?
AUBREY: You know, I think a lot of people were asking that question when the bill was signed on Friday as we passed the second anniversary of the World Health Organization declaring the pandemic. But, you know, there were lawmakers who said they wanted a full accounting of the trillions of dollars already spent before more COVID relief has passed. Senator Mitt Romney and a bunch of Republican colleagues wrote a letter pressing for an accounting. I think, you know, lots of taxpayers agree this is a valid question. But the flip side to this is that scientists and public health experts say it is imperative we plan for another potential variant, another outbreak. That means continuing to invest in surveillance, continuing to buy medicines and vaccines. And as Zeke Emanuel, a health policy expert at the University of Pennsylvania, points out, the U.S. has made a pledge to help vaccinate the globe, which will require funding.
ZEKE EMANUEL: And we have to remember that delta and omicron, that we've just suffered from - they came from overseas. And we have an urgent need from our own self-interested standpoint to continue our work to fight COVID overseas.
AUBREY: So there is a recognition that many want an accounting of prior COVID spending, but lots of doctors, public health experts say there are so many initiatives that require ongoing funding to make sure the U.S. is prepared for whatever may come next.
MARTÍNEZ: All right. That's NPR's Allison Aubrey. Thanks a lot.
AUBREY: Thank you, A.
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