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Public Health Funding on Hold and in the Crossfire

Posted By Emily J. Holubowich , Friday, August 5, 2016
Updated: Thursday, August 4, 2016

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

The dog days of summer have arrived and lawmakers have left town for the campaign trail, leaving behind a weighty to-do list for the few short weeks between Labor Day and the end of the fiscal year, September 30. Before the summer recess, both the House and Senate Appropriations Committees approved spending legislation for the Department of Health and Human Services and within it, the Centers for Disease Control and Prevention (CDC). At the same time, funding for the Zika virus has hit a political roadblock.

To review, the president sought $7.014 billion for CDC in FY 2017, a 2 percent decrease from current levels that included $5.967 billion in base discretionary funding or “budget authority,” and roughly $1 billion in mandatory funds from the Affordable Care Act’s Prevention and Public Health Fund (PPHF). The House Appropriations Committee provides CDC $7.783 billion in budget authority and PPHF, and the Senate provides CDC $7.060 billion in budget authority and PPHF.

The National Center for Emerging and Zoonotic Infectious Diseases (NCEZID) received a $97.6 million increase in the House and a $1 million decrease in the Senate. The wide discrepancy in funding levels between the chambers is based on their different approaches to funding the Zika response; the House preferring to provide at least some funding through the regular appropriations process, and the Senate preferring to provide supplemental funding (more on that below!). Within NCEZID, both the House and Senate continue funding for the Combating Antibiotic-Resistant Bacteria or “CARB” initiative at $160 million and $163 million, respectively. As with the recent award of $64 million to build CARB capacity in the states, we would expect much of the CARB funding, and NCEZID funding overall, to support 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 propose for the sixth consecutive year.

A summary table of funding levels for CDC and all program lines proposed by the administration, the House Appropriations Committee, and the Senate Appropriations Committee is available here:  https://www.cste2.org/docs/2017_House_and_Senate_Mark_Detail_Table.pdf.


Meanwhile, the debate about the Zika virus response is hot. There was hope cooler heads would prevail during the lawmakers’ summer break, but it’s only getting hotter as we get closer to the election and more domestic cases emerge. To review, the President requested $1.9 billion in supplemental, emergency funding in February. The House and Senate both passed legislation to fund the response—$1.1 billion with no strings attached in the Senate, and about half of that funding in the House with offsets and conditions unappealing to Democrats. Lawmakers convened a conference to negotiate a final package and were making progress; that is until House Democrats staged a sit-in to force a vote on gun violence legislation (which has yet to happen). In what some have called a retaliatory move, the House Republicans walked away from the Zika negotiations and passed a partisan $1.1 billion package in the late evening of the Democrats’ protest. The Senate has since tried twice to move the House package but has failed as Democrats object to politically toxic provisions that would negatively impact women’s access to family planning and roll back environmental regulations of pesticides. Senate Majority Leader Mitch McConnell is expected to call up the House bill for another vote the week of Labor Day when lawmakers return. Though some members of Congress—including Senate Minority Leader Harry Reid and Florida Senators Bill Nelson and Marco Rubio—are urging colleagues to return from recess to act now.

While Congress dawdled, the administration was forced to redirect toward the Zika efforts nearly $600 million previously allocated to fight Ebola—under the assumption that this funding will eventually be made whole by Congress—as well as $44 million from public health emergency preparedness grants intended for use by the states (indeed, the House in its appropriations bill does provide $45 million to make “PHEP” whole in FY 2017). Unfortunately, the administration now reports half of that funding has already been used. Secretary of Health and Human Services Sylvia Burwell yesterday sent this letter to Congress, summarizing the response and expenditures to date, and providing examples of activities that “demonstrate the urgent need” for additional funding soon.


So what now? Political and fiscal dynamics make it unlikely that either chamber’s public health spending bill will see floor time. With just four working weeks remaining before the September 30 fiscal year’s end—and the recess for the November elections—the best-case scenario is a short-term continuing resolution to keep the government running. Worst-case scenario: a six-month continuing resolution that kicks the can until March. And in the end, all Congress may be able to accomplish is a year-long continuing resolution at current levels if passing final spending legislation proves too hard in the lame-duck scramble. It wouldn’t be the first time; Congress has passed year-long continuing resolutions in the last two presidential election cycles.


As for Zika, it’s anyone’s guess how they will proceed or when the stalemate will break. If confirmed cases continue to multiply and/or extend beyond Miami, lawmakers may feel a renewed sense of urgency to put politics aside and act. In the meantime, expect to see lots of finger pointing on the airwaves and the Op Ed pages (e.g., this, by House Speaker Paul Ryan in USA Today).

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