Despite increasing health threats, the White House is calling for slashing hundreds of millions of dollars from the country’s lead public health agencies.
In February, President Donald Trump released his federal budget proposal for fiscal year 2021, calling for a cut of more than $693 million at the Centers for Disease Control and Prevention, as well as a $742 million cut to programs at the Health Resources and Services Administration. Overall, the president’s budget proposes a 9% funding cut at the U.S. Department of Health and Human Services, a 26% cut at the U.S. Environmental Protection Agency, massive cuts in Medicare and Medicaid spending, and funding decreases for safety net programs such as food and housing assistance.
“This budget, put simply, is a disinvestment in the health of Americans,” said APHA Executive Director Georges Benjamin, MD, in a news release. “We have an incredibly dedicated public health workforce that is ready to act. But we need federal investments to make that happen. An adequate and rational investment in the health of Americans is missing from this budget.”
Within the CDC budget proposal, the White House is calling for a more than $426 million cut to chronic disease prevention and health promotion, a $152 million cut at the National Institute for Occupational Safety and Health, and a more than $85 million cut to emerging and zoonotic infectious diseases work. It proposes more than $48 million in cuts to CDC’s National Center on Birth Defects and Developmental Disabilities, and would cut over $38 million for global health activities, reduce funding for public health preparedness and response by more than $25 million, and shear nearly $32 million from environmental health work, including a proposal to eliminate CDC’s crucial Climate and Health Program. The Agency for Toxic Substances and Disease Registry faces a more than $14 million cut.
On the flip side, the president’s budget requests an additional $231 million for HHS’ Ending the HIV Epidemic Initiative, $50 million more for global health security, $40 million more for flu planning and response, and more than $13 million in additional funds for vector- and tick-borne disease. It also proposes an additional $48 million for infectious disease and opioid addiction, $50 million more for CDC’s Infectious Diseases Rapid Response Reserve Fund, and an extra $10 million for public health lab capacity. The budget proposal also calls for an increase of $12 million to support CDC’s work to expand Maternal Mortality Review Committees to every state and Washington, D.C.
While White House budget proposals are typically considered dead on arrival — meaning the final budget that makes it out of congressional negotiations and is signed into law will likely look nothing like Trump’s proposal — health advocates warn that it still serves as a starting point for negotiations.
“When it comes to the budget, you have to keep calm, but advocate on. We can’t rest on our laurels.”
— Emily Holubowich
“Even if the entire budget isn’t approved as submitted, having certain budget cuts proposed by the administration means they’re more likely to be taken seriously by Congress,” said APHA member John Auerbach, MBA, president and CEO of Trust for America’s Health. “It certainly wouldn’t be surprising if some of these cuts were approved.”
Auerbach said the president’s proposed 9% cut to CDC’s budget would be “devastating” for the nation’s public health system, as about two-thirds of CDC’s budget goes out to state, local and tribal health agencies. Of particular concern, Auerbach said, are proposals to cut public health preparedness funding — funds that have already been on the decline for many years.
For instance, the budget proposal partially would restore funds for the Infectious Diseases Rapid Response Reserve Fund, which was established to support public health in quickly responding to threats without waiting for Congress to approve emergency funds. However, the proposed restoration would still leave the fund with much less money than it had before HHS tapped it for its COVID-19 response.
“Unless we put more money into that reserve, we’ll find ourselves less prepared for the next emergency,” Auerbach told The Nation’s Health. “If we’ve learned anything from coronavirus and other infectious disease emergencies, it’s that you have to respond quickly and we have to have resources pre-approved.”
Another point of concern is the White House proposal to block grant CDC funds for preventing chronic diseases, which are key drivers of health spending and remain leading causes of death and disability in the U.S. The shift would eliminate specific, line-item funding for chronic disease issues such as obesity and tobacco use and instead gives states a block of money they can spend as they choose. Administration officials argue that the change gives states more flexibility, but in reality, block granting is “really just a mask for budget cuts,” said APHA member Emily Holubowich, MPP, vice president for federal advocacy at the American Heart Association.
“With consolidation, there’s always cutting,” she told The Nation’s Health.
Trump’s budget also takes aim at tobacco control, proposing to move the Center for Tobacco Products out of the U.S. Food and Drug Administration and create a new HHS agency instead. In essence, the proposal would undermine the regulatory authority FDA gained over tobacco via the landmark Family Smoking Prevention and Tobacco Control Act of 2009. Holubowich said the proposal could threaten years of work on tobacco regulation and potentially open the door to increased pressures from the tobacco and vaping industry.
“It opens up the risk that the person appointed to direct (the new center) will be from the very industry we’re trying to regulate,” she said. “Now is no time to rearrange the deck chairs, especially when we’re facing an epidemic of youth e-cigarette use.”
Other decreases in the White House budget proposal include a nearly $3 billion cut to the National Institutes of Health, more than $100 million in cuts at the Substance Abuse and Mental Health Services Administration, and zeroing out funding for the Agency for Healthcare Research and Quality. It also calls for cutting the Supplemental Nutrition Assistance Program by more than $180 billion over 10 years, and slashing public housing funding by $3.2 billion in 2021.
On health care access and coverage, Trump’s budget calls for $1 trillion less funding for Medicaid and the Affordable Care Act over the next decade. According to the Center on Budget and Policy Priorities, by 2030, such cuts would be akin to eliminating the ACA’s Medicaid expansion and coverage subsidies altogether. Such a loss, the center estimated, would cause 20 million Americans to lose health coverage. Trump’s budget also reduces Medicare spending by $500 billion over 10 years, mostly in the form of decreasing payments to health providers.
Angela Ostrom, JD, executive director of the Coalition for Health Funding, of which APHA is a member, noted that CDC is already “woefully” underfunded and still operating below the high-mark funding levels of 2010. If Trump’s budget cuts came to fruition, she said, it would put an incredible strain on the nation’s public health infrastructure. She, like fellow advocates, called on supporters to educate lawmakers on the critical role of public health.
“The president’s budget may be dead on arrival, but it’s still so important for advocates of public health and health care to remain vigilant,” Holubowich said. “When it comes to the budget, you have to keep calm, but advocate on. We can’t rest on our laurels.”
For a copy of the president’s new budget proposal, visit www.whitehouse.gov.
- Copyright The Nation’s Health, American Public Health Association
