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• U.S. Department of State

Summary

When catastrophes overwhelm state and local response capabilities, 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 (PHS) Act by which he can provide assistance in response to public health and medical emergencies. He has limited means, however, 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 in which there are overwhelming public health and medical needs. In addition, some concerns have been expressed about federal leadership and delegations of responsibility for the public health and medical response to incidents, as carried out according to the National Response Plan (NRP). Neither the Stafford Act nor the PHS Act provides a dedicated mechanism to reimburse victims or their providers for the uninsured costs of individual health care that may be needed as a consequence of a disaster. Furthermore, there is not agreement that this should be a federal responsibility. However, following Hurricane Katrina, Congress provided $2.1 billion for short-term assistance to host states, through the Medicaid program, to cover the uninsured healthcare needs of eligible Katrina evacuees. Some in Congress have proposed establishing a mechanism to cover certain uninsured healthcare costs of responders and others exposed at the World Trade Center site in New York City following the 2001 terrorist attack, some of whom are experiencing related health problems five years after exposure. There are concerns about how a public health and medical response would be managed during a flu pandemic. There is precedent, under the Stafford Act, for the President to declare an infectious disease threat an emergency (which provides a lower level of assistance), but no similar precedent for a major disaster declaration (which provides a higher level of assistance). In any case, many of the needs likely to result from a flu pandemic could not be met with the types of assistance provided pursuant to the Stafford Act, even if a major disaster declaration applied. 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 and potential gaps in 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.

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