August 2004

House Committee Completes Health Funding Measure
The House Appropriations Committee completed its work on FY 2005 funding for the Department of Health and Human Services in early July. A summary of the Committee's actions on programs of most concern to local health departments appears below. It is important to understand what this means and what it does not mean. It is important also to remember that public health is but one part of a huge bill that funds all federal programs in health, education and labor. The bill is second in size only to the defense appropriations bill.

The House Appropriations Committee was faced with a task of allocating funding among many programs under a tight overall budget cap for health. In order to accommodate increases in some places, cuts were made in others. The next step in the House of Representatives (theoretically) is House floor action. No such action is yet scheduled and whether it will occur in September remains unknown. However, the funding measure has grown increasingly complicated due to various (and predictable) policy controversies over such issues as abortion, stem cell research, and federal overtime regulations.

Meanwhile, the Senate has not yet scheduled any action on health ppropriations. Final funding levels for FY 2005 cannot be known until the Senate has acted and the House and Senate have conferred and agreed on final numbers. It is highly likely that such final agreement will not occur at least until a lame duck session after the November elections. Characteristically, the Senate provides higher funding levels for many health programs than the House. The House often uses a strategy of under-funding some programs in its version of the bill in order to meet its budget caps, knowing all the while that the Senate will insist on restoring the cuts it makes. For this reason, the House Appropriations Committee funding levels do not necessarily predict final outcomes for specific programs, although it is unlikely that any of the House-proposed funding levels would be cut further. However, it is clear that the pattern of annual substantial increases that many federal public health programs have received in the past is at an end. The programs taking the biggest hits include the Community Access Program (CAP), which would be eliminated, and the Preventive Health and Health Services block grant, for which the Committee proposed a 17.5% decrease.

The House Appropriations Committee explicitly rejected the Administration's proposal to cut bioterrorism preparedness funding for states and localities by $105 million. The Committee also restored a small portion of the cuts that HHS made in its recent redirection of funds. It left in place the Cities Readiness Initiative, but restored funding that HHS had redirected to the US Postal Service and the federal BioSense program. In light of this action, it is highly unlikely that the Senate will accept the proposed cut, which suggests that the bioterrorism funding will at least be level next year. NACCHO continues to advocate for increases to accommodate local needs.