There was a flurry of activity on Capitol Hill last week – and this week – with big implications for public health funding. The House Appropriations Committee approved along party lines its fiscal 2018 spending bill for the Departments of Labor, Health and Human Services, Education and Related Agencies (Labor-HHS). Starting from $5 billion lower than the current, already austere funding level, the bill forces more cuts in many health programs to support increases in others. As in years past, the bill is a mixed bag for applied epidemiology.
To be sure, the bill is a marked improvement from the president’s fiscal 2018 budget request for the Centers for Disease Control and Prevention (CDC), which proposed an 18 percent cut to the agency’s total budget, deeper cuts to many of the agency’s programs, and the outright elimination of others. The House’s proposal largely rejects many of the President’s priorities, and provides the agency roughly $7 billion – nearly 2.5 percent below current levels.
Within CDC’s budget, the Public Health Workforce activities, through which the CDC/CSTE Applied Epidemiology Fellowship receives funding, are cut by roughly $5 million, with total proposed funding of $45 million. The appropriations bills do not specify how much funding would be dedicated to the Applied Epidemiology Fellowship program per se, but with a cut in funding for the program we might expect a cut in available funding for our fellows. The president had requested a $7 million cut in the program.
The National Center for Emerging and Zoonotic Infectious Diseases (NCEZID) receives $599.5 million, $33.4 million less than current funding, but $122.5 million more than the president’s request. Within NCEZID, the emerging infectious diseases programs absorbs most of the proposed cut. Most other programs receive flat funding – antibiotic resistance ($163 million), advanced molecular detection ($30 million), food safety ($54 million), vector-borne diseases ($26.4 million) – which means we might expect Epidemiology and Laboratory Capacity (ELC) grants to be flat funded since much of ELC funding is driven by NCEZID’s overall budget.
Interestingly, the House’s spending bill would appropriate funding from the Affordable Care Act’s (ACA) Prevention and Public Health Fund, including flat funding of $40 million for ELC and $12 million for hospital acquired infections at the same time the House voted to repeal the Prevention Fund beginning in fiscal 2019 as part of its ACA repeal effort, the American Health Care Act (AHCA). As we’ve noted before, elimination of the Prevention Fund would deal a devastating blow to CDC and public health more broadly, resulting in a 12 percent cut to CDC’s overall budget, a 20 percent cut to ELC, a 33 percent cut to immunizations, and complete elimination of all funding for core public health capacity supported by the Preventive Health and Health Services Block Grant.
On Tuesday, the Senate narrowly agreed to begin debate on ACA repeal or rather, the various repeal options released to date, and potentially others yet to be released. Of the bills made publicly available, all include repeal of the Prevention Fund.
First up was a vote on the Better Care Reconciliation Act (BCRA) – the repeal and replace legislation that would repeal the Prevention Fund beginning fiscal 2019. The BCRA was rejected by a vote of 43-57. On Wednesday, Senators rejected 45-55 the Obamacare Repeal Reconciliation Act (ORRA), the “repeal” only bill that was vetoed by President Barak Obama in early 2016. If enacted, ORRA would've repealed the Prevention Fund immediately more or less, and rescinded unobligated funds.
As a last ditch effort to pass some sort of ACA repeal, Senate Majority Leader Mitch McConnell is reportedly considering a “skinny repeal” bill that may be more likely to gain 50 votes needed for passage, since it would simply eliminate the penalty for the ACA's individual mandate – possibly along with its employer mandate and some taxes on the health care industry. There are also credible reports this “skinny repeal” will include a provision to repeal the Prevention and Public Health Fund to ensure the bill complies with reconciliation instructions. If introduced, this legislation would likely be the last and final bill to be considered, possibly around 5:00 am Friday morning (check out this helpful article and up-to-date flowchart on the procedural timetable here).
With Congress set to leave Washington for the August recess, there won’t be any further activity on fiscal 2018 spending legislation until after Labor Day when they return to the Capitol. At that time, we should have a better sense of where the Prevention Fund stands and when the Senate will consider its own public health spending bill. In any event, a continuing resolution to keep the government running on autopilot after September 30 will be needed.
In the meantime, August is an ideal time to connect with lawmakers while they’re back home in district/state to educate them on the value of public health broadly and applied epidemiology particularly. We recommend downloading this guide prepared by the Association of State and Territorial Health Officials (ASTHO), which explains why it’s important for public health professionals to interact with policymakers and how to do so. With all the threats facing public health, your voices are needed now more than ever.