December 2004
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Lame Duck Congress Wraps Up FY 2005 Spending Bills As is usually the case with such enormous measures that are crafted in a short period of time, only a handful of professional Congressional staff actually knew the details of the bill. As the media have widely reported, the insertion of one ill-conceived provision governing Hill access to tax returns was discovered and resulted in a delay in sending the bill to the White House for the President’s signature. Everyone else will be spending the next few weeks unraveling the bill’s other mysteries. In order to “find” extra funds to avoid some undesirable cuts, Congress imposed a 0.8 percent across-the-board cut in all programs. This means that programs funded at last year’s levels actually will have nearly one percent less available. Last year Congress employed the same strategy, using a .59 percent across-the-board cut. As inflation, particularly in health care costs, eats away at available dollars, the result of cumulative small cuts in available funds may make it increasingly difficult for many health and public health programs to sustain current services. For public health, there were no big surprises, either pleasant or unpleasant. The best news for governmental public health came when two threatened cuts did not materialize. NACCHO lobbied hard against both potential cuts. First, the House and Senate conferees did not agree to a cut in bioterrorism preparedness funding proposed by the Administration. They sustained funding for state and local capacity-building (less the across-the-board cut) at $934 million, of which about $871 million is for grants and cooperative agreements to state and local health departments. The conferees also stipulated that Health Alert Network funding must be sustained at least at the FY 2004 level. The conferees adopted by reference language in the Senate Appropriations Committee report, similar to that last year, which states: “The Committee continues to recognize that bioterrorism events will occur at the local level and will require local capacity, preparedness and initial response. It is the Committee’s intent that significant funding for State and local public health infrastructure be used to improve local public health capacity and meet the needs determined by local health departments. The Committee’s intent remains firm. Because it is essential to the Nation’s public health readiness that bioterrorism funding be made available at the local level, the Committee urges the CDC and the Department to ensure that monies appropriated for State and local capacity building be spent to improve local public health readiness in a manner with which local public health officials concur. It is expected that local health departments are and will continue to be full partners in developing State plans.” NACCHO will be vigorously advocating that the new cooperative agreement guidance for next year’s bioterrorism funding reflect this Congressional intent and provide a method for monitoring and ensuring that it is met. Second, the conferees restored a cut of 17 percent in the Preventive Health and Health Services block grant program proposed by the House. That program also will continue at the FY 2004 funding level of about $131 million. Overall, funding for the Centers for Disease Control and Prevention (CDC) will increase by about 4.7 percent, while funding for the Health Resources and Services Administration (HRSA) will increase by about 3.5 percent. One major change from “business as usual” by which Congress kept within its self-imposed budget limits for the entire bill was to restrict the increase in funding for the National Institutes of Health (NIH). Biomedical research has received double-digit increases for many years, which resulted in a doubling of its budget over a five-year period that has ended. This year Congress granted it an unprecedented small increase of about three percent. In addition, Congress added $100 million in funding for activities related to improving influenza vaccine production and, if the HHS Secretary deems necessary, for purchase of influenza vaccine. Details concerning funding levels in agencies of the Department of Health and Human Services can be found at http://thomas.loc.gov/home/omni2005/h4818divf.pdf. Congress this year changed the way that the CDC budget is displayed and consolidated programs within broader categories. This means that it is necessary to read the “fine print” of the conference report to determine specific line item funding and that comparisons with last year’s funding are not provided. Anyone reading the fine print associated with the appropriations bill will discover another factor that affects the amount of appropriated funds within each category that is actually available for CDC or HRSA to use or to grant under the usual rules for each program. That factor is the “earmark”, a designation of a specific amount of funding for a specific project. Earmarks are usually added only at the conference report stage – they are not included in the earlier House or Senate Committee reports. Entities that receive earmarks due to a special request made by a Senator or Representative are happy, as is the Member of Congress who succeeded in bringing the funding directly to his or her district or state. Others are less pleased by the time-honored practice of “pork-barrel” spending. The final bill directs CDC to make grants of specific amounts ranging from $25,000 to $2 million to 207 colleges and universities, hospitals, health centers, and community agencies. The HRSA portion of the bill contains similar earmarks for more than 900 such special projects. Next month we’ll take a look at the new Congress and the prospects for public health in 2005. |