Congress Passes Supplemental Pandemic Influenza Funding
May and June were busy months on Capitol Hill. Lawmakers settled on final spending caps for FY07, passed a large FY06 supplemental spending bill that included more funds for pandemic influenza preparedness, and began work on FY07 public health funding measures. In the midst of all this, NACCHO sponsored a standing-room-only Capitol Hill briefing on local pandemic influenza preparedness.
NACCHO Briefing Highlights Local Flu Planning
A meeting room in the Rayburn House Office Building became cramped as Hill staffers crowded in to hear about cutting-edge practices in local pandemic influenza planning. NACCHO conducted a briefing for Congressional staff on May 22, 2006, which featured the work of two of the Advanced Practice Centers for Public Health Preparedness (APC’s). Dr. Marty Fenstersheib, Health Officer for the Santa Clara County (CA) Health Department, and Dorothy Teeter, head of Public Health-Seattle and King County (WA) discussed the endless complexities of local pandemic influenza preparedness and fielded numerous questions on all aspects. Rep. Dave Reichert (R-WA) and Rep. Zoe Lofgren (D-CA) sponsored the briefing.
Fenstersheib explained how the response to an influenza pandemic will be completely local in nature, because substantial aid from either the state or federal government is unlikely. He described five key areas of focus in his county’s plan: hospital planning; planning for alternative care settings; the use of social distancing, isolation and quarantine to contain the spread of disease; public education; and community engagement in preparedness. Teeter honed in on working with private businesses and discussed a local business council that has become actively engaged in influenza preparedness. She talked about how health departments and businesses can help each other prepare. Businesses are seeking help with the public health aspects of their plans for continuity of operations and early notice of actions that will affect their workforce, such as school closures and changes in public transportation.
Congress Votes Extra Funding for Pan Flu Preparedness
Congress passed a $94.5 billion emergency supplemental spending bill in mid-June. The bulk of the funds are for military operations, foreign aid, and hurricane relief. Also included was an additional $2.3 billion for pandemic influenza preparedness, of which $250 million was designated for state and local capacity-building. This sum was a compromise between the Senate, which had proposed $300 million, and the House, which had proposed nothing for state and local preparedness. These funds are an addition to the $350 million for state and local preparedness that were appropriated late last year (of which $100 million has so far been released by HHS). The conference report accompanying the bill included language suggested by NACCHO asking HHS to ensure that federal pandemic influenza planning and funding be consistent with operational realities at the local level. The remainder of the pandemic flu funding is for international surveillance, antiviral purchases, and other federal expenditures.
Budget Caps Set for FY07 – or What They Told You in Civics Class Is Not True
If you have been following earlier communications from NACCHO, you may remember that Senators Harkin (D-IA) and Specter (R-PA) were successful in adding $7 billion to the Senate Budget Resolution to make room for restoring cuts in health, education and labor programs. The Budget Resolution sets an overall spending cap for domestic discretionary spending – the higher the cap, the more money the appropriators have available to work with. House Republican moderates and Senate Democrats ultimately were successful in adding $4 billion to the House Budget Resolution.
In June, the situation took an interesting twist. Rather than try to have a separate House-Senate negotiation on the budget resolutions, House and Senate rolled the budget cap right into the emergency supplemental spending measure (discussed above). The $7 billion and the $4 billion extra disappeared so that the overall budget cap would be the same as that proposed by the Administration. However, the House ultimately shifted $4 billion over to health and education and the Senate ultimately shifted $5 billion for health and education when they made the actual allocations to appropriations subcommittees. The source of the funds was defense, and it is a reasonable guess that both House and Senate recognized they’d be doing another emergency supplemental for defense sooner or later and could restore the defense funding then. This set of maneuvers is a sterling illustration of how everything we learned in high school civics about how Congress operates isn’t true.
House Takes First Step Towards FY07 Public Health Funding…. and Into a Minimum Wage Mire
The House Appropriations Committee took the extra $4 billion and ran with it, passing its bill funding the Departments of Health and Human Services, Education and Labor on June 13. A table showing funding for all line items can be found at http://appropriations.house.gov/_files/LH_Detail_FCWEB.pdf. The bottom line: it isn’t as bad as it might have been, but it sure isn’t great. Most programs were level-funded (same as FY06), subjected to small cuts, or given small increases. Overall, CDC took a cut of about 3%, compared to the 4% cut the Administration requested. Public health preparedness funding for state and local health departments was the same as the current fiscal year (a big cut over last year). The Preventive Health and Health Services Block grant also remained level after last year’s cut. HRSA’s funding would increase by more than 7%, most of which is attributable to a generous increase for community health centers and restoration of earmarks for specific health facilities and programs in individual Congressional districts that were zeroed out in FY06. HRSA funding for public health, preventive medicine, and dental public health education programs was eliminated.
The House leadership hoped to pass the Labor-HHS-Education funding bill immediately, but a collection of political tensions arose and it will not go to the House floor before mid-July. Chief among those tensions is a partisan dispute over increasing the minimum wage, to which the bill’s future is currently tied, and it remains possible that the House ultimately will defer action until after the November elections. It is important to remember that the House Appropriations Committee action is not the final word, just the first word.
On the Senate side, Appropriations Committee action on public health spending is planned for mid-July. The Senate is unlikely to act on a final bill before the election. Echoes of the quacking from previous lame duck sessions can be heard faintly already. Don’t expect to know the funding future of public health programs for FY07 before Thanksgiving.
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