Proposed U.S. Budget Would Take Billions From Public Health

Charlotte Tucker

Disclosures

Nations Health. 2012;42(3) 

Abstract and Introduction

Introduction

The Prevention and Public Health Fund is one of the big losers to come out of President Barack Obama's proposed budget for the 2013 fiscal year, public health officials said, setting the tone for what may be a tight year for public health funding.

Obama released his proposed budget Feb. 13 to mixed reactions from health groups. Obama's budget is a jumping off point for the budgeting process. Congress will look at the proposals contained therein and will make changes to the budget in the coming weeks and months.

Obama's proposed budget would allocate about $76.7 billion to the Department of Health and Human Services, a 4 percent decrease from his 2012 fiscal year request.

A key tenet of his overall 2013 fiscal year budget is jobs, Obama said.

"At a time when our economy is growing and creating jobs at a faster clip, we've got to do everything in our power to keep this recovery on track," he said during a speech at a Virginia community college.

In the health field, that means the budget would support the placement of more than 7,100 primary care providers in underserved areas, said HHS Deputy Secretary Bill Corr.

It also means expanding the country's network of community health centers, Corr said during a press event unveiling the budget.

"Together with 2012 resources, our budget will create more than 240 new access points for patient care," Corr said. "And overall, our investment in health centers will provide access to quality care for 21 million people, 300,000 more people than last year, in addition to creating new jobs across the country."

But looking carefully at the numbers, some public health advocacy groups said they have real concerns with the proposed budget.

Under Obama's proposal, the Centers for Disease Control and Prevention would take a $660 million cut to its budget authority. Some of that loss would be made up by taking money from the Prevention and Public Health Fund and fund transfers from HHS, so in the end the cut to CDC would be about $220 million.

Robert Pestronk, executive director of the National Association of County and City Health Officials, called the cuts "troubling."

"Overall, there continues to be a decline in the budget available to CDC, which reduces resources for local and state health departments at a time when reductions are already happening at the state and local levels," he told The Nation's Health.

As far as the Prevention and Public Health Fund, the landmark fund created under the Affordable Care Act, the cuts would be dramatic. Originally, contributions to the fund were supposed to begin at $1.25 billion per year in 2013 and then climb to $2 billion per year through the 2022 fiscal year, for a total of $18.75 billion. Obama's budget cuts the amount that would be contributed to the fund by a total of $4.5 billion.

Those cuts are "really not a good idea from the standpoint of people who worry about new and emerging diseases," said James Hughes, MD, a professor of medicine and public health at Emory University and the immediate past president of the Infectious Diseases Society of America.

He said the emergence of diseases such as West Nile virus and monkeypox illustrate the need for entities that can respond.

"It baffles me that despite the repeated demonstrations of the need to be able to detect and respond to these things, we are actually reducing the local public health workforce and diminishing state budget support for disease control," he told The Nation's Health.

John Rother, president and CEO of the National Coalition on Health Care, called the cuts to the fund "short-sighted."

"Savings recouped by cuts to the fund are dwarfed by the potential future savings it could produce," Rother said in a statement.

Pestronk said he is also worried that the Prevention and Public Health Fund is being used to fill CDC line items in the budget that would otherwise be cut. The fund was created to expand and sustain the nation's capacity to fight disease, not to be used as a source of funding for other programs when that funding is not available, he said.

Obama's proposed cuts to the Prevention and Public Health Fund are further complicated by Congress's decision to cut $6.25 billion from the fund when it passed H.R. 3630, the Temporary Payroll Tax Cut Continuation Act of 2011, on Feb. 17. The act, which Obama signed on Feb. 22, could impact the cuts proposed for the fund as the budget process continues.

The proposal would also cut funding for the Substance Abuse and Mental Health Services Administration by nearly $200 million. The budget proposes to freeze mental health block grants in the 2013 fiscal year. It would also cut a children's mental health services program by about $29 million.

On the environmental front, Obama proposed an $8.3 billion budget for the Environmental Protection Agency, about $105 million less than was enacted in the 2012 fiscal year.

"This budget is focused on fulfilling EPA's core mission to protect health and the environment for millions of American families," said EPA Administrator Lisa Jackson in a statement. "It demonstrates fiscal responsibility, while still supporting clean air, healthy waters and innovative safeguards that are essential to an America built to last."

The Health Resources and Services Administration would see a bump of $228 million in the proposed budget over the previous year, bringing it to a total of $8.4 billion. Programs that would see increases include the AIDS Drug Assistance Program and a health care workforce assessment program.

HIV/AIDS advocates said they were disturbed by proposed cuts to the President's Emergency Plan for AIDS Relief of more than $500 million dollars. But they also praised potential increases in funds to help pay for HIV drug treatment and prevention.

On the positive side, the budget invests heavily in transportation and safety. It requests $981 billion for the National Highway Traffic Safety Administration, $181 billion more than was enacted in the 2012 budget. It also provides nearly $30 billion over the next six years for surface transportation safety programs and includes $330 million over six years for the administration's campaign against distracted driving.

APHA Executive Director Georges Benjamin, MD, FACP, FACEP (E) said Obama's budget proposal "shortchanges key federal programs that protect public health and prevent our nation's leading causes of premature death and disability." But he said APHA is looking forward to working with the Obama administration and Congress to craft a budget that will "ensure adequate funding for important prevention and health promotion programs that help make and keep America healthy."

Pestronk said that now is not the time for public health professionals to be discouraged.

"It's time to redouble efforts, to speak out on behalf of CDC's budget and the Prevention and Public Health Fund and to be in regular contact with elected officials at all levels of government," he said.

For more on the president's proposed budget, visit www.whitehouse.gov/omb/budget. For the HHS proposal, visit www.hhs.gov/budget. For more news from The Nation's Health, visit www.thenationshealth.org.

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