President Barack Obama’s proposed budget for fiscal year 2015 makes a number of investments in public health, but also cuts millions of dollars from critical health agencies.
The president’s $77 billion budget proposal for discretionary programs in the U.S. Department of Health and Human Services is $1.3 billion less than the enacted budget for fiscal year 2014. The proposal, released March 4, invests in community health centers and global health security, but also includes cuts to programs that build the workforce pipeline — particularly in rural and disadvantaged areas.
“While there are a few bright spots, overall funding for core public health programs is inadequate and shortsighted,” said APHA Executive Director Georges Benjamin, MD. “In the face of fiscal pressures, we look forward to working with the administration and Congress to reverse austerity measures that prevent adequate investment in programs that promote and protect public health.”
Under Obama’s proposal, the Centers for Disease Control and Prevention would see cuts to its program-level funding of about $243 million, or 3.5 percent, from fiscal year 2014. The agency’s budget would shrink from $6.85 billion to $6.61 billion. As part of that funding, CDC would receive $810 million from the Prevention and Public Health Fund, the landmark fund created by the Affordable Care Act to support prevention programs nationwide.
CDC programs facing cuts under the proposed budget include its immunization program, which will lose $36 million — in part because the administration expects that more immunizations will be covered by insurance in fiscal year 2015 — and public health preparedness and response programs, which will lose $54 million. The budget also proposes the elimination of the Preventive Health and Health Services Block Grant and a decrease of $52 million from several occupational safety and health programs.
In a March letter to members of the U.S. House and Senate appropriations committees, APHA noted that Obama’s proposed budget would cut CDC’s budget authority to fiscal year 2003 levels.
CDC Director Tom Frieden speaks at a March meeting with the CDC Coalition at APHA headquarters in Washington, D.C.
Photo by Natalie McGill, The Nation’s Health
“While we appreciate some of the targeted increases in the president’s budget, other important CDC programs would face level funding or significant reductions,” said the letter, which was signed by members of the CDC Coalition. “We believe that Congress should prioritize funding for all of the activities and programs supported by CDC that are essential to protect the health of the American people.”
The letter asks Congress to provide $7.8 billion to CDC in its final appropriations legislation.
“While we acknowledge the ongoing fiscal pressures on federal discretionary funding, we are deeply concerned that the administration is proposing deep cuts to CDC’s budget authority, particularly on the heels of the fiscal year 2014 omnibus spending bill that restored some of the prior reductions to CDC’s budget,” Benjamin said. “Ongoing cuts to public health programs continue to leave all of us at risk.”
Despite the cuts, the proposed budget also makes room for some growth at CDC. It would spend $45 million on a new global health security program aimed at prevention and detection of global health threats, as well as $30 million on programs to detect and protect against the spread of antibiotic-resistant pathogens.
“Fundamentally, it’s about saving lives, time and money by unlocking the microbial genome to more quickly identify outbreaks, stop them and figure out how to prevent them,” said CDC Director Tom Frieden, MD, MPH, during a March meeting with the CDC Coalition.
The Infectious Diseases Society of America called the effort to address the resistance problem “an important step forward,” and urged Congress to fully fund the effort.
The Health Resources and Services Administration will see even deeper cuts in its discretionary budget under the president’s proposal, dropping from about $6 billion to $5.3 billion. That represents a cut of 19 percent in nominal dollars since fiscal year 2010, and 25 percent when adjusted for inflation.
The agency would strengthen the health workforce by increasing the reach of the National Health Service Corps, whose members do primary care work in underserved communities. Funding levels proposed in the budget would support 15,000 providers from 2015-2020 and serve more than 16 million patients.
HRSA’s Community Health Center Fund would also receive $960 million under the proposal.
“I think it’s one of the largest increases we’ve ever had in our program,” said Jim Macrae, MPP, MA, associate administrator for primary health care, speaking at a Friends of HRSA briefing at APHA headquarters in Washington, D.C., March 13. “With those resources and the impact of the Affordable Care Act, we project that health centers will serve a little more than 30 million people across the country and 1,300 health centers at over 9,500 sites.”
At the same time, the budget could cut HRSA’s rural health programs by $18 million, putting at risk some of the gains that could be made in health in rural areas, advocates warned.
HHS noted in its budget brief that, in addition to continuing to serve newly insured patients in 2015, health centers will also remain a vital source of primary care for patients who cannot gain access to coverage, as well as insured patients seeking care for services not covered by insurance.
Both the Health Service Corps Fund and the Community Health Center Fund are set to expire at the end of fiscal year 2015, and advocates caution that in the absence of continued mandatory funding, Congress must make sure that they are able to continue their work.
APHA and other members of Friends of HRSA asked Congress in a March letter to restore funding for the agency to $7.48 billion.
“The programs administered by HRSA serve the health needs of people who are medically underserved, low-income and geographically isolated in every state and U.S. territory,” the letter noted.
The budget proposal would have effects on other HHS agencies and programs as well. Another population that will struggle if the current proposal passes is people with HIV/AIDS said Joel Gallant, MD, MPH, FIDSA, chair of the HIV Medicine Association. The President’s Emergency Plan for AIDS Relief would receive no increase under the budget and has seen cuts totaling $500 million since 2011. If the proposal becomes reality, advocates caution that the administration’s stated goal of an AIDS-free generation is at risk.
PEPFAR implementation is overseen by a range of U.S. agencies, including the Department of State and U.S. Agency for International Development. But many HHS agencies administer its prevention, treatment and care programs.
“Over the past few years, the administration has “seriously invested in antiretroviral therapies” through PEPFAR, said Matthew Kavanagh, EdM, senior policy analyst with the Health Gap Global Access Project during a conference call discussing the budget.
In 2013, 1.6 million people were added to PEPFAR’s treatment rolls, for a total of 6.7 million. But if the current flat funding continues, PEPFAR will add just 300,000 people in the next year, he said.
The Indian Health Service, however, would see a bump in program-level funding of about $228 million, bringing its budget to about $6 billion. Of that, most would come from increases in clinical services, at $169 million. About $85 million would go toward health facilities construction, according to HHS, the same as in 2014. IHS provides health services to members of more than 560 federally recognized tribes in more than 630 hospitals, clinics and health stations on or near Indian reservations.
The Food and Drug Administration’s proposed budget of $4.7 billion is an 8 percent increase over fiscal year 2014. Food safety efforts would receive a $263 million bump to help implement the 2011 Food Safety Modernization Act and other efforts. The proposal also includes $25 million to strengthen oversight of compounding pharmacies following the 2012 fungal meningitis outbreak that killed 64 people.
Beyond HHS, the Environmental Protection Agency would receive about $310 million less than it did in 2014, but the budget invests heavily in addressing global climate change. In his remarks on the proposal, Obama noted that it includes more than $1 billion in new funding for technologies to help communities prepare for climate change and to set up incentives to build “smarter, more resilient infrastructure.”
The funds, about $41 million over 2014, would support the implementation of the President’s Climate Action Plan released last year and would allow the agency to hire 24 new staff to work on climate issues, EPA said in a news release. It would also provide funding to states to help them implement the Clean Air Act.
For more information on HHS’ proposed 2015 budget, visit www.hhs.gov/budget.
- Copyright The Nation’s Health, American Public Health Association
