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A Mixed Bag for Public Health: Appropriators Favor Infectious Disease in Spending Legislation

Posted By Emily Holubowich, Friday, July 17, 2015
Updated: Friday, July 17, 2015

Emily Holubowich, Senior Vice President at CRD Associates, is CSTE’s Washington representative and leads our advocacy efforts in the nation’s capital.

Emily Holubowich provides an update on congressional activities at the recent CSTE Annual ConferenceThe week of June 22, both the House and Senate Appropriations Committees approved along party lines their respective spending bills for the Departments of Labor, Health and Human Services, Education and Related Agencies (Labor-HHS). Starting from nearly $4 billion lower than the current, already austere funding level, the bills force draconian cuts in many programs to support increases in others. Each chamber took a slightly different approach to making these necessary tradeoffs—the House preferring big cuts to fewer programs (e.g., the Agency for Healthcare Research and Quality and Title X Family Planning, which were eliminated) and the Senate preferring to spread the pain more evenly. But in both chambers, it’s a mixed bag for public health and epidemiology.

To review, the president sought $7 billion for the Centers for Disease Control and Prevention (CDC) in FY 2016, a 2 percent increase that included $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 translated 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.

The House Appropriations Committee grants the president’s request for CDC budget authority and PPHF, but the Senate provides CDC only $5.747 billion in budget authority (a $220 million cut compared to FY 2015) and $893 million in PPHF dollars.

The National Center for Emerging and Zoonotic Infectious Diseases (NCEZID) received a $107.6 million increase in the House and a $35.6 million increase in the Senate, both still less that the president’s significant, $294 million request. Within NCEZID, the new Combating Antibiotic-Resistant Bacteria or “CARB” initiative would receive $120 million from the House and only $30 million from the Senate, in each case much less than the president’s requested $264 million. We would expect much of the NCEZID funding, including CARB, to support core infectious disease surveillance capacity at state and local health departments through Epidemiology and Laboratory Capacity (ELC) grants, in addition to $40 million from the mandatory PPHF that the House and Senate both provide for the fifth consecutive year. Among our other NCEZID appropriations priorities, food safety, advanced molecular detection, and National Healthcare Safety Network are essentially flat funded—plus or minus nominal amounts—in the House and Senate.

The Public Health Workforce program, through which the CDC/CSTE Applied Epidemiology Fellowship receives funding, would also see flat funding of $52.2 million in both chambers and no supplemental PPHF funding. The appropriations bills do not specify how much funding would be dedicated to the Applied Epidemiology Fellowship program per se, but with flat funding of the program we might expect flat funding for our fellows. The president had requested a $15.2 million increase in budget authority, as well as $36.2 million in PPHF. Two years ago, Congress eliminated $15 million in PPHF dollars for Public Health Workforce in the wake of sequestration.

Funding increases in some areas such as CARB necessitated cuts to other public health programs. For example:

  • NCZEID’s “emerging infectious disease” program was cut by $11 million in the House;
  • The National Center for Chronic Disease Prevention and Promotion was cut by $100 million in the House and $146 million in the Senate;
  • CDC’s safe water program was zeroed out in the Senate and the environmental and health outcome tracking network was cut significantly in both chambers;
  • The childhood lead poisoning prevention program’s budget authority was zeroed out in both chambers (though both House and Senate do continue PPHF funding).

Given the political and fiscal environment, forward progress on Labor-HHS and other spending bills is expected to halt. The House leadership seems to have postponed floor action on appropriations bills after pro-Confederate flag amendment on the Interior and Environment spending bill caused a melee on the House floor last week. In the Senate, Democrats have vowed to filibuster all spending bills that come to the floor on the grounds that they lock in austere spending levels under sequestration. A continuing resolution to keep the government running on autopilot seems imminent come September 30. The question is whether or not it will be only for a limited period of time while Congress finalizes spending legislation before the end of the calendar year; or whether it will be for the full year if Congress determines there’s no path to a compromise on final appropriations language. And of course, the big question in Washington is will there or won’t there be a government shutdown come October 1. It’s too soon to tell, but the fact that budget experts are suggesting it—and lawmakers are already pointing fingers across the aisle to place blame—leads one to believe that a shutdown is more than a distinct possibility.

For more information about funding levels for your specific priorities, please click here for a copy of CDC’s detailed budget table.

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