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Public Health Fares Better than Usual in President’s Budget

Posted By Emily J. Holubowich , Friday, February 13, 2015
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Emily Holubowich, Senior Vice President at CRD Associates is CSTE’s Washington representative and leads our advocacy efforts in the nation’s capital.

On February 2, President Obama delivered his $4-trillion fiscal year (FY) 2016 budget request to Congress. The president proposes a balanced approach for replacing sequestration (something CSTE has supported through the advocacy efforts of the Coalition for Health Funding and its anti-austerity campaign, NDD United). This sequestration relief would free up an additional $70 billion to support funding increases across the government, including the Centers for Disease Control and Prevention (CDC)—the first increase the administration has proposed in several years.

The administration seeks $7 billion for CDC in FY 2016, a 2 percent increase that includes $6.096 billion in base discretionary funding or “budget authority,” and $914 million in mandatory funds from the Affordable Care Act’s Prevention and Public Health Fund (PPHF). Together, this funding translates into increases for Emerging and Zoonotic Infectious Diseases (73 percent increase) and Public Health Workforce (29 percent increase) through which applied epidemiology fellows are funded.

One of the administration’s top funding priorities—public health or otherwise—would rely heavily on state and local epidemiology capacity. Combating Antibiotic-Resistant Bacteria or CARB is a new, $1.2-billion initiative that spans several different federal departments (Health and Human Services and Agriculture among them) and several different health agencies, including CDC.

Within the $264-million CARB request for CDC, approximately $100 million would be dedicated to Epidemiology and Laboratory Capacity (ELC) grants to support core infectious disease surveillance capacity at state and local health departments. If appropriated, this would bring total funding for ELC to $210 million—more than double the FY 2015 level of $102.5 million.

Provided below is more detail on the proposed funding levels for some of CSTE’s key advocacy priorities. Much of the new funding requested by the president focuses on building capacity to fight infectious diseases at home and abroad. However, if appropriated these funds would ultimately serve a dual purpose. We know from past experience that funding provided to support communicable disease monitoring and response ultimately bolsters the overall epidemiology infrastructure needed to fight non-communicable diseases, as well.

  • Epidemiology and Laboratory Capacity Grants. Within the total, a $210 million funding request for ELC, the program would once again be provided $40 million from the PPHF, consistent with the last four fiscal years.
  • Advanced Molecular Detection (AMD). The president’s budget once again requests $30 million for the AMD initiative, consistent with the current funding level. This funding would be used to continue to improve CDC’s capability and to initiate state projects to improve the application of genome sequencing to public health issues of concern.
  • Food Safety. The president’s budget request seeks nearly $50.1 million for foodborne disease surveillance, an increase of $2.1 million over the current level. Approximately one half of this increase would go to state and local health departments to enhance surveillance, outbreak detection and response, and food safety prevention efforts.
  • Global Health Security. The president’s budget request seeks $448 million for global health, an increase of $31.6 million above FY 2015. Of this, the president seeks to dedicate nearly $77 million—a $21.6 million increase—to expand the global health security agenda and accelerate progress in preventing the spread of global health threats. Applied epidemiologists at the state and local level will continue to be a critical component of any response strategy.
  • National Healthcare Safety Network (NHSN). The president requests more than $32 million for the NHSN, an increase of $14 million over the current level. The new funding would support NHSN reporting in more than 17,000 health care facilities to help eliminate healthcare-associated infections and guide prevention activities.
  • Epidemiology Fellows. The Public Health Workforce program—through which the CSTE/CDC Applied Epidemiology Fellowship receives funding—would see an increase of $15.2 million under the president’s request, bringing total funding to $67.4 million. Of this, the administration would use $36.2 million from the PPHF to support professional development. It’s worth noting that two years ago Congress eliminated $15 million in PPHF dollars for Public Health Workforce in the wake of sequestration of the PPHF—so this could be a heavy lift.

    With this increase, the CDC could support up to 667 fellows, or approximately 80 additional fellows, which would ultimately increase the number of fellows assigned to state and local health departments. The budget request does not specify how much funding would be dedicated to the Applied Epidemiology Fellowship Program per se, but a rising tide would certainly lift all boats. The administration in the budget request does single out “high-priority” professional development activities, including the Epidemic Intelligence Service (EIS), the Public Health Associate Program (PHAP), public health informatics, and population health training of areas of potential funding.

Even with the increase for CDC writ large, many public health programs are not immune to cuts in the president’s budget. Section 317 Immunization Program (-$50 million or -8 percent), Environmental Public Health Tracking Network (-$12 million or -32 percent), and several chronic disease programs see proposed cuts. Of particular note, the president’s budget once again proposes to eliminate funding for the Preventive Health and Health Services Block Grant (-$160 million). So far, each year Congress has rejected such cuts to the “Prevent Block.”

With the release of the president’s budget, the appropriations process begins in earnest. The budget request serves as roadmap for funding, but the “power of the purse” ultimately lies with Congress—and it will be at lawmakers’ discretion to determine what to fund and at what level. And if Congress adopts the president’s plan for stopping sequestration or comes up with their own fix, funding levels will be held at their austere levels, making many of the president’s proposed increases impossible…at least without deep cuts to other public health programs. CSTE will once again partner with the Association of Public Health Laboratories and other colleagues in the public health community to advocate for our key priorities—strong support for disease monitoring and for training the next generation of epidemiologists. We will be sure to keep you apprised of our efforts.

For more information about funding levels for your specific priorities, please click here for a copy of CDC’s explanation of the budget request. You may also be interested in CDC’s operating plan for the current fiscal year available here, which outlines where CDC is spending funding now.

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