May 2004

Plugging Public Health in a Partisan Environment

“Iraq sucks the air out of everything else.” —Senior Congressional Appropriations staff member, noting scant attention now paid on Capitol Hill to funding for ongoing domestic programs

Presidential election year politics are ubiquitous, as usual. However, their effect on this year’s enormous federal budget dilemma is different than it has been in many previous election years. Normally, Members of Congress have sought to please voting constituents by “bringing home the bacon.” Spending bills tended to be even more generous than usual. Passage of popular spending bills before the election was a sure thing.

This year, however, those who frequent the halls of Congress advocating more funds for this or that federal program perceive a difference. It appears that the movement to cut back on government spending (with the notable exception of defense) is predominating. This year may test whether Members voting for bills that cut programs on which at least some of their constituents rely will be punished or rewarded at the polls for their votes. If Congress sticks with current proposals to cut overall domestic non-defense spending and passes bills that take noticeable bites out of federal domestic programs, and if the general public doesn’t demonstrate at the polls that it cares, that will signal a fundamental shift in political dynamics.

Congress has not completed final action on the FY 2005 budget resolution, which will set spending caps on all discretionary federal programs, including public health. However, the appropriators, those who take the money available and divvy it up among programs, already are pondering the grim situation before them. Currently, overall domestic discretionary spending (this excludes Social Security, Medicare and other entitlements) is slated to be cut by about three percent below the current fiscal year. Funding for public health is “lumped” in a bill with funding for three major federal departments, Labor, Education, and Health and Human Services (HHS).

Currently, there is a $4.5 billion gap between what the budget resolution would provide for FY 2005 and what would be required to maintain current program levels in those three departments. Appropriators recognize that this amount of cutting in funding for jobs, health, and education will probably prove untenable even to the most conservative Members of Congress, but no one knows how to deal with the problem.

At the same time, Congressional leadership and the Administration are said to be planning a $50-60 billion emergency supplemental spending bill to pay for action in Iraq and Afghanistan. Emergency supplemental funding is not subject to budget caps. If such a measure materializes – and it may be split into pre-election and post-election bills – it will present an opportunity for appropriators to move some defense and homeland security spending into that bill. That, in turn, would create some additional room for restoring funding to other programs.

One certainty is that people running public health programs won’t know for sure what their FY 2005 federal funding will be for a long time. It is virtually inconceivable that the HHS appropriations bill will pass before the election. Programs will be maintained at FY 2004 levels by a temporary measure and the new Congress will need to address it again early in 2005. It is equally likely that, as has happened the last few years, public health funding will be rolled into a huge omnibus bill that covers most of the federal government.

Meanwhile, representing local health departments, NACCHO doggedly continues to insist that public health is not a partisan issue. That’s our story and we’re sticking to it.

NACCHO's Board of Directors adopted four new resolutions at its February 26, 2004 meeting in Washington, DC. As the body of policy for NACCHO, these resolutions represent the best thinking available within the organization about a variety of public health topics. Each adopted resolution is the product of a thorough process of review by NACCHO's advisory committees and Board of Directors.

As NACCHO works to promote local public health, the resolutions assist and guide us. We use these resolutions to educate and inform lawmakers, officials, other organizations, and the public about our positions on important public health issues. Also, the resolutions help us to formulate priorities for our pubic health advocacy. As important as the resolutions are to our work in Washington, they can also play a key role in promoting policy in your community. NACCHO's resolutions may help support a position you are taking with your Board of Health, or your city, county or state government. They may be useful as you formulate your own positions. We encourage you to use them.

All of NACCHO's resolutions are available online at www.naccho.org/advocacy/positions/index.cfm. The most recent resolutions on supporting universal health coverage; preventing and controlling injuries; supporting strong FDA regulations of tobacco and nicotine products; and supporting efforts in the prevention and treatment of obesity and overweight are highlighted as “new.”