President Barack Obama’s proposed fiscal year 2014 budget for public health falls short in many areas — including reductions to prevention grants — but advances others.
Overall, the president’s 2014 budget request for the Department of Health and Human Services is $80.1 billion, $3.9 billion above the 2012 enacted level. Of that, the request would allocate $6.6 billion to the Centers for Disease Control and Prevention, a decrease of $270 million from the 2012 fiscal year.
The budget calls for the lowest levels of CDC discretionary funding — funding that is used for non-mandatory purposes — since 2003. And while the funding levels are not exactly a surprise, they will call for public health to notch its belt just a little bit tighter.
“We have challenges,” said CDC Director Thomas Frieden, MD, MPH, at an April 15 CDC Coalition meeting at APHA headquarters. “When public health suffers, it’s not about an agency in Atlanta. It’s about people who need prevention on the front lines not getting care.”
CDC Director Thomas Frieden speaks at an April CDC Coalition meeting.
Photo by Charlotte Tucker
The budget picture is particularly muddled this year because budget levels for the 2013 fiscal year were finalized just days before the 2014 proposal was released.
Particularly troubling for many in public health is that in recent years, the amounts allocated to the Prevention and Public Health Fund have been cut significantly. The Prevention and Public Health Fund is the landmark fund created by the health reform law to fund prevention programs. It was to have received $1.25 billion in 2013 and $1.5 billion in 2014, but in February 2012 the fund was cut to $1 billion for each year.
Then in March and April of this year, the fund was cut by a further $51 million by sequestration, while $454 million was diverted to help with enrollment in the new health insurance marketplace, which ramp up as part of the Affordable Care Act in 2014. All told, the prevention fund was cut by 38 percent in the 2013 fiscal year.
Obama’s April 10 budget request keeps $1 billion for the fund in 2014, but it is not clear if that will be further reduced.
“In terms of prevention, (the budget) is austere,” said Larry Cohen, MSW, an APHA member and the founder and executive director of the Prevention Institute.
He said taking money from the Prevention and Public Health Fund is not the way to achieve better health.
“When health reform was first announced, I thought the president’s emphasis on prevention was really a sign of a new way of thinking and working,” he told The Nation’s Health. “Now we’re using it as a piggybank…Year after year what was always known as a modest investment in prevention has been whittled away.”
The 2014 budget would also eliminate the Preventive Health and Health Services Block Grant, which helps local public health departments.
APHA Executive Director Georges Benjamin, MD, said that while tough financial times mean it is necessary to take a balanced approach to deficit reduction, it should not be achieved “at the expense of our nation’s health and well-being.”
He noted that the proposed budget includes a cut of more than $430 million to CDC’s budget authority, a 7.7 percent reduction over the 2012 fiscal year. It also reduces the Health Resources and Services Administration’s budget by $190 million compared to 2012.
“Cuts outlined in today’s budget will hamper the capacity of state and local public health departments, already beset by drastic spending cuts, to do their work including detecting and responding to disease threats, confronting violence, curbing obesity rates and ensuring clean air and water,” Benjamin said.
Among the proposed allocations for HRSA in fiscal year 2014 are $3.8 billion for health center programs, including funding for 40 new access points, and $2.4 billion for HIV/AIDS programs, including the AIDS Drug Assistance Program.
HRSA staff already have been working to address budget challenges at the agency, such as the 5 percent across-the-board sequester cuts that took effect in March, according to Administrator Mary Wakefield, PhD, RN.
“I certainly haven’t ever had a year quite like this one,” Wakefield told an April meeting of the Friends of HRSA Coalition at APHA headquarters in Washington, D.C.
The Environmental Protection Agency, which has many programs focused on public health, would see a cut of about $300 million in 2014, giving it an $8.15 billion budget. Highlights of EPA’s budget plan include $177 million for work to cut greenhouse gas emissions and $175 million to meet court-ordered deadlines to develop, implement and review ambient air quality standards and guidance and air toxics regulations.
EPA would save $54 million by eliminating several programs that have completed their goals or can be implemented through other federal or state efforts, the agency said.
Both EPA and CDC noted that they have taken strides to reduce their own footprints in order to save money. Both agencies have given up hundreds of thousands of square feet of office space and are working to increase efficiency in other areas.
Despite the cuts, the 2014 proposed budget has some bright notes for public health.
An increase in cigarette taxes would bring the federal tobacco tax to about $2 per pack, and the funds derived from the increase would be used to expand early childhood education programs, Frieden said. The increase would have the added benefit of saving $63 billion in health care costs, according to the American Cancer Society’s Cancer Action Network.
HRSA Administrator Mary Wakefield speaks to a meeting of the Friends of HRSA Coalition in Washington, D.C., in April. HRSA is one of many health agencies addressing funding cuts.
Photo by Michele Late
“The proposal comes at a time when there is much conversation about how to reduce health care costs,” said John Seffrin, PhD, MS, CEO of the action network and an APHA member. “For every pack of cigarettes sold in the United States, our country spends an additional $10.47 on health care costs. Increasing the tobacco tax would dramatically reduce those costs and save lives at the same time.”
The Food and Drug Administration would also see a bump if the proposed budget is approved. Obama has requested $4.7 billion, an increase of 21 percent of $821 million, over 2012. New fees would provide part of the funding to support the Food Safety Modernization Act and strengthen FDA’s ability to oversee imported food.
“Our budget increases are targeted to strategic areas that will benefit patients and consumers and overall strengthen our economy,” said FDA Commissioner Margaret Hamburg, MD.
In keeping with Obama’s statements in January about increasing research on gun violence, the proposed budget includes $30 million for new investments in gun violence research and an expansion of the National Violent Death Reporting System, or NVDRS.
“The NVDRS allows states to look in depth at how violent deaths occur,” said APHA member Amber Williams, executive director of the Safe States Alliance.
Williams told The Nation’s Health that she applauds the proposed budget and that it will allow greater surveillance for injury and violence prevention. She said, however, that the zeroing out of the Preventive Health and Health Services Block Grant, which represented 9.4 percent of total funding reported by state health department injury and violence prevention programs in 2011, is “a big disappointment.”
The budget also includes a 2.9 percent increase to the Indian Health Service, which would receive $4.4 billion. The funding includes increases of $35 million to help purchase health care from the private sector, $77.3 million to support staffing, operating costs and new and replacement facilities and $5.8 million to support tribes managing their own health programs.
If the proposed budget is enacted, funding for the Indian Health Service will have increased 32 percent since the 2008 fiscal year.
The budget also calls for a $1.5 billion increase in funding for drug treatment and prevention over the 2012 fiscal year, for a total of $10.7 billion.
For more information on the president’s proposed 2014 fiscal year budget, visit www.whitehouse.gov/omb.
- Copyright The Nation’s Health, American Public Health Association
