Budget calls for end to sequestration, boosts for public health programs: Increases for CDC
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* Kim Krisberg

Advocates are cautiously welcoming President Barack Obama’s fiscal year 2016 budget proposal, which includes new funding to address critical public health threats. But advocates warn that before the proposal has a chance at becoming a reality, Congress must first act to end sequestration and its cuts to public health capacity.

On Feb. 2, Obama released his federal budget proposal, which includes a $141 million increase for the Centers for Disease Control and Prevention and a $112.9 million increase for the Health Resources and Services Administration.

After years of cuts and minimal funding bumps, Obama’s CDC budget would bring the agency to a new high. However, advocates noted that even if enacted, the increase is still lower than 2010 funding levels when adjusted for inflation. Overall, the budget proposes an increase of $4.8 billion in discretionary funding for the U.S. Department of Health and Human Services.

The president’s budget proposal also includes new measures to combat key public health threats, such as doubling federal spending to fight antibiotic resistance. In addition, Obama proposed a $99 million increase to help federal health agencies combat explosive growth in prescription painkiller abuse and overdoses, including funds to enhance state-based prescription drug monitoring systems.

“This proposal doesn’t optimally fund our nation’s primary public health agencies, but its call for critical investments puts us in a better position to respond to everyday threats and unexpected emergencies,” said APHA Executive Director Georges Benjamin, MD.

Obama’s budget proposal is predicated on the assumption that Congress will act to reform current federal budget caps — known as sequestration — and includes a plan to offset proposed funding increases with additional revenues and program cuts. Currently, the 2011 Budget Control Act calls for an automatic sequester of federal budget caps. If Congress acts to stop the scheduled sequestration, it could free up about $37 billion for nondefense discretionary programs — which include issues such as health and education programs — said Emily Holubowich, MPP, executive director of the Coalition for Health Funding and an APHA member, who noted that federal lawmakers negotiated deals to stop sequestration in fiscal years 2014 and 2015. However, if Congress does nothing to stop sequestration in the coming fiscal year, Holubowich said some federal funding levels could plummet to their lowest levels in decades. In fact, discretionary spending could drop 17 percent below 2010 levels.

“There’s a lot of great pieces in the president’s budget and it shows what’s possible if more money is available,” she told *The Nation’s Health*. “Still, we’re not where we should have been without austerity (measures) and we continue to do more with less in public health.”

Within CDC, the president’s budget proposes a number of increases, including an increase for climate change activities and an additional $15 million to enhance public health workforce capacity. The budget also recommends a $128.1 million increase for the Vaccines for Children Program, which provides free immunizations to kids who might otherwise go unvaccinated.

At HRSA, one of the high points includes funding for a new program to recruit and train physicians in rural settings. HRSA’s Health Center Program would also expand services to about 1.1 million more Americans. But the budget would also end the Area Health Education Centers Program, which recruits and trains a diverse health workforce for underserved communities.

Advocates pointed out that many of the increases are paired with proposed cuts to other programs. For instance, while CDC’s climate and health program is increased by $10 million, the National Environmental Public Health Tracking Program is slated for an $11 million cut. And while the mandatory Vaccines for Children Program would see an increase, CDC’s Section 317 immunization program, which allows states to vaccinate underinsured children and adults, is slated for a $50 million cut.

In justifying the immunization program cut at a time when public health workers are confronting a new measles outbreak, White House Press Secretary Josh Earnest said mandatory vaccine coverage under the Affordable Care Act would offset the shortfall.

But Laura Hanen, MPP, chief of government and public affairs at the National Association of County and City Health Officials, said it might be too early to make such an assumption. Considering that about half of states have not expanded Medicaid and a Supreme Court case threatening Affordable Care Act tax subsidies looms, Hanen said the ability of the act to sustain and increase vaccination rates remains to be seen.

“Whether it’s immunization funding, preparedness funding or infectious disease funding, it’s very important that we have sustained resources going to state and local health departments,” she told *The Nation’s Health*. “We can’t just surge funding from crisis to crisis.”

Obama’s budget also eliminates funding for the Preventive Services Block Grant, which Hanen said is the “only flexible pot of money” that state and local health departments can use to address unmet needs and backfill funding shortfalls. The budget also eliminates the Racial and Ethnic Approaches to Community Health program, which addresses costly chronic disease among vulnerable populations. On the positive side, the budget proposed a $29 million increase for public health preparedness.

“We’re very pleased with the preparedness funding — it’s a significant bump up,” APHA member Jeff Levi, PhD, executive director of the Trust for America’s Health, told *The Nation’s Health*. “We’re glad to see it’s there and it’s not just the kind of spike we see after an emergency.”

Other bright spots in Obama’s budget include a proposal to extend funding through 2019 for the Children’s Health Insurance Program, funding for which is set to expire later this year. The president’s budget would pay for CHIP — which covers 8 million children — by increasing federal tobacco taxes, raising more than $95 billion in new revenue during the next decade. The budget also proposes a $486 million increase for the Indian Health Service, with funds targeting health care services, construction projects and tribal partnerships.

To improve food safety, the president’s budget proposes consolidating the U.S. Department of Agriculture’s Food Safety and Inspection Service with related components of the Food and Drug Administration to create a single new HHS food safety agency. FDA’s Center for Food Safety and Applied Nutrition would also receive an $84 million increase to address foodborne illness.

The U.S. Environmental Protection Agency would receive a $450 million boost over fiscal year 2015 levels. Included in EPA’s budget is $4 billion for its Clean Power State Incentive Fund, which will support states that go beyond minimum requirements for carbon pollution reductions.

Public health advocates are taking note of proposed increases that would impact the social determinants of health. For example, the president’s budget would authorize a $4 billion increase for the U.S. Department of Housing and Urban Development, addressing funding for programs such as housing for seniors and people with disabilities. It would also invest $82 billion over 10 years in early childhood education to ensure low-income families have access to quality child care, and expand tax credits to help boost income for low-wage workers. The budget also recommends funds to help states develop paid leave programs and an additional $500 million to expand access to quality preschool.

“Socio-economic conditions and opportunities absolutely impact people’s health,” said Hanen. “Making sure people are stably housed and have access to good education, particularly early childhood education, is critically important to establishing good health from the beginning.”

Ideally, a finalized fiscal year 2016 budget approved by Congress would be ready for the president’s signature by fall 2015.

For more information, visit [www.whitehouse.gov/omb](http://www.whitehouse.gov/omb) and [www.hhs.gov/budget](http://www.hhs.gov/budget).

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