June 2005

Congress agreed on a budget at the end of April that rejected the $35 billion in Medicaid cuts proposed by the Administration, but still requires $10 billion in federal Medicaid cuts in the next five years. The budget assumes all of the cuts in discretionary funding proposed by the White House. However, it is now up to the Appropriations Committees in the House and Senate to determine individual line-item funding for all discretionary (non-entitlement) programs. The appropriators must stay within the overall budget caps on which Congress agreed.

On the House side, the FY 2006 budgeted level for the bill that funds the Departments of Labor, Health and Human Services, and Education is a slight 0.1% lower than FY 2005. What this means is that, as predicted, funding for public health and health programs will be tighter than in any recent years, because the cap will require any program increases to require a commensurate decrease in other programs. Appropriators, who collectively are reluctant to slice funding for most programs, will be in the unenviable position of "robbing Peter to pay Paul" if they wish to grant increases proposed by the Administration. Budgetary gimmickry and the adoption of small across-the-board cuts have prevented serious consequences to public health programs in the past, but this year appropriators do not know how they will find money to keep all programs whole if any are to increase, even to account for inflation.

The House health appropriations subcommittee is slated to act on its bill on June 6 and action by the full House is planned this summer. The Senate, now embroiled in bitter, well-publicized debates about federal judicial appointments, usually acts after the House. This year, however, the Senate timing remains most uncertain. If the Senate ties itself in knots over other issues, the likelihood increases that health appropriations will be rolled into an omnibus measure for government-wide spending in the fall. It is too soon to offer any realistic prediction about the ultimate result for the Preventive Health and Health Services block grant that the Administration wishes to eliminate, nor for any other particular public health line item.

At the same time, both House and Senate are required to make changes in entitlement programs that will result in meeting the budget caps established for those. Neither House nor Senate has yet put forth any substantive proposals, but the GOP leadership on both sides has pledged to change both Medicaid and Medicare to achieve the required reductions before the year is out. It is likely that many of the Medicaid changes would address eligibility and expenditures for skilled nursing facility care.

The public health issue with highest visibility at this moment is pandemic influenza preparedness. Numerous House and Senate Committees with some claim to jurisdiction over the issue have held hearings at which HHS witnesses have outlined the Administration's long-term plans to improve vaccine availability and move forward on pandemic planning. Senator Richard Burr (R-NC) has been given the job of producing legislation that will address a variety of issues related to public health preparedness, particularly incentives and funding for pharmaceutical companies to develop countermeasures to biological terrorism. Influenza vaccine provisions are being folded into a variety of such proposals, and Burr expects to spend several months studying the issues and developing legislation. The prospects for legislation, which NACCHO is monitoring carefully to assure that vaccine distribution issues are addressed constructively, depend on the Senate's ability to move past the filibuster issue and on the House's willingness to act concomitantly.

NACCHO Briefs Capitol Hill on Local Bioterrorism Preparedness

On May 20, 2005, 60 policymakers gathered at the Rayburn House Office Building on Capitol Hill in Washington, D.C., to attend a NACCHO Advanced Practice Centers policy briefing. The Advanced Practice Centers are eight local health departments who receive CDC funds administered by NACCHO to develop and evaluate cutting-edge practices in bioterrorism preparedness and create tools that will enable other departments to replicate their successes.

The briefing, the first such event sponsored exclusively by NACCHO, was organized to educate Congressional staff, the press, and representatives from the Administration and various other stakeholders about the essential local role in preparedness. The briefing "put a face" on local preparedness by presenting examples of innovative and exemplary local programs to help prepare communities respond to and recover from a major act of bioterrorism or other public health emergency. Attendees learned about novel preparedness programs that can be replicated in other cities and counties, new tools and resources to prepare public health first responders, and continuing challenges faced by local health departments in preparing for a biological attack.

NACCHO Executive Director Patrick Libbey moderated the briefing and gave an overview of the APC program. The three Advanced Practice Center (APC) speakers were: Bill Stephens from the Tarrant County (TX) Public Health Department, who described a large-scale disaster preparedness drill coordinated by the APC; Kay Aaby from the Montgomery County (MD) Department of Health and Human Services, who spoke on addressing preparedness needs for special populations; and Dorothy Teeter from Public Health—Seattle and King County (WA) who spoke on planning for isolation and quarantine. A lively question-and-answer session followed the presentations.