Epidemiologist Hilda Aleman prepares a dose of a COVID-19 vaccine in San Juan, Puerto Rico, in December 2020. With the end of federal pandemic funding, states expect to lose 1,000 epidemiology staff, making it harder to handle other outbreaks
Photo by Ricardo Arduengo, courtesy AFP/Getty Images
Public health faces a tough funding climate in Congress this year, especially under a presidential administration with a history of supporting large funding cuts for key health agencies.
During President Donald Trump’s first term, the U.S. Department of Health and Human Services and its agencies frequently landed on the chopping block. In 2017, his White House budget proposed cutting funds for the Centers for Disease Control and Prevention by 17%, or $1.2 billion. In 2019, his federal budget called for a 12% cut to overall HHS funding, including a $750 million cut to CDC.
In 2020, just days after global health officials raised the alarm about COVID-19, Trump’s budget proposed cutting CDC funds by 16%.
“Looking back at the first Trump administration, there is certainly fear that we’ll see the same appetite for cutting public health funds again,” Don Hoppert, director of government relations at APHA, told The Nation’s Health. “It’s going to be more important than ever for decision-makers to hear from voters.”
Presidential funding proposals have to go through congressional negotiations and are typically just starting points for federal budget talks. Numerous changes are usually made and final funding measures often look little like what was proposed. None of Trump’s previously proposed CDC budgets became reality, for example.
But advocates such as Hoppert said the new Congress, with members of Trump’s Republican party in the majority in both the House and Senate, could be more sympathetic if the White House pushes large cuts again.
Recent budget proposals in the U.S. House may also portend challenging times for public health. Last summer, the Republican-led House Appropriations Committee adopted a fiscal year 2025 labor-HHS-education appropriations bill aimed at reducing CDC funding by 22%. The bill would have focused CDC on communicable diseases rather than social engineering,” the committee said in a news release.
On the Senate side, however, lawmakers have proposed a fiscal year 2025 budget that would keep CDC funding stable.
Because Congress did not meet its deadline to pass a fiscal year 2025 budget last year, the nation is being funded by a continuing resolution that expires in March. That means CDC funding levels for both fiscal year 2025 and 2026 budgets are still up for congressional debate.
“While proponents of CDC funding might have a little less leverage in negotiations, they still have a lot of leverage,” said Eric Gascho, executive director of the Coalition for Health Funding, of which APHA is a member. “There is still a lot to be determined.”
CDC is currently operating at the fiscal year funding level of about $9.2 billion, which is 3% less than the prior budget year, when accounting for inflation, according to the Trust for America’s Health. For the final fiscal year 2025 budget, public health advocates such as TFAH and APHA — and hundreds of others who are members of the CDC Coalition — are urging Congress to raise CDC funding to $11.5 billion.
J. Nadine Gracia, MD, MSCE, CEO and president of TFAH, said protecting public health funding is especially important as emergency monies allotted to combat the COVID-19 pandemic dry up.
Gracia noted that the infusion of emergency funds that went to CDC and then out to state and local health departments during the early years of the pandemic supported critical infrastructure upgrades, such as expanded wastewater surveillance, improved disease forecasting, and increased numbers of public health workers.
Adequate CDC funding moving forward is key to maintaining those investments, she said.
For example, states anticipate losing more than 1,000 epidemiology staff with the end of COVID-19 funding, according to an October report from the Council of State and Territorial Epidemiologists. The loss would leave the U.S. “unprepared to respond to looming threats, including H5N1,” the report said.
“The public health system is at an inflection point,” Gracia said. “We’re at risk of returning to a bust phase.”
Most of CDC’s funding — upward of 80% — is distributed to state and local public health agencies. So any cut to CDC’s budget will have an immediate trickle-down impact on the country’s thousands of health departments, said Adriane Casalotti, MPH, MSW, chief of government and public affairs at the National Association of County and City Health Officials.
Casalotti said local health departments are “in a really tight spot.”
“Resources during the emergency phase of COVID-19 are either gone or expiring very soon, and Congress has not yet shown an appetite to really address that fiscal cliff,” she told The Nation’s Health.
In addition to the difficulty of securing more funding, it could also get harder to hold on to it.
Casalotti noted that in recent years, Congress passed bills to rescind hundreds of millions in COVID-19 emergency funds that would have otherwise gone to support local public health. For instance, federal funds for hiring more disease intervention specialists and providing uninsured adults with COVID-19 vaccines were both rolled back.
“I think part of this is a misunderstanding that even though the emergency phase is over, the work does not disappear,” Casalotti said.
Public health advocates told The Nation’s Health that they are also concerned about impoundment, which is when federal officials block authorized funds from being spent. The legality of such action is highly questionable, according to experts, as the U.S. Constitution specifically gives Congress the so-called power of the purse.
But both President Trump and his nominee to lead the White House Office of Management and Budget, Russell Vought, have publicly supported presidential impoundment powers.
“It’s something we’re concerned about and that we’re keeping a close eye on,” Gascho at the Coalition for Health Funding told The Nation’s Health.
Brian Castrucci, DrPH, president and CEO of the de Beaumont Foundation, a public health philanthropy, noted that funding challenges will also collide with major workforce shifts. The foundation’s Public Health Workforce Interests and Needs Survey, or PH WINS, previously found that governmental public health was on track to lose up to 100,000 staff by this year.
Castrucci said 2025 will be a revealing test of Congress’ support for public health.
“If we see policies that truly align with improving health for all Americans, I’m all in,” Castrucci told The Nation’s Health. “But so far, it’s all about cutting and downsizing and divesting in public health. That’s dangerous.”
For more on public health funding and tips for advocacy, visit www.apha.org/policies-and-advocacy.
- Copyright The Nation’s Health, American Public Health Association
