May 2005

Proposed Public Health Cuts Grab Attention on Capitol Hill
There has been much talk, but no action since the last Notes from Washington, about the President’s proposed budget cuts for public health programs. The President’s budget released in February proposed a 14% cut in state and local bioterrorism preparedness funds and complete elimination of the Preventive Health and Health Services block grant. These proposals, the largest proposed program cuts in the CDC budget, have not gone unnoticed by the House and Senate appropriations committees that will make the final spending decisions. Members of both parties have asked pointed questions of CDC Director Julie Gerberding, whose job it is to defend the Administration’s CDC budget proposals.

The Chair of the House health appropriations subcommittee, Rep. Ralph Regula (R-OH), expressed concern about the impact on health departments of the complete and abrupt elimination of the block grant program at an April 6, 2006 hearing on CDC’s budget. Dr. Gerberding’s response was that CDC would work with state health departments to find other ways to compensate for the loss of those funds. Rep. Regula suggested that a better approach might be to phase down the program, rather than eliminate it completely in one year.

CDC and other Administration officials have also been questioned about the proposed 14% cut in bioterrorism preparedness funds, which the Administration wants to use instead for more drugs, vaccines and equipment for the Strategic National Stockpile. Dr. Gerberding’s response at the April 6 hearing was that Congress has already given state and local health departments over $3 billion, and that it is essential to expand the stockpile. A larger stockpile, she said, would also benefit state and local preparedness.

An April 12, 2006 hearing on pandemic influenza held by the same subcommittee raised the same issue. Dr. Gerberding and other HHS officials testified that enhanced disease surveillance and response capabilities were important in preparing for any eventual mutation of the avian influenza virus to enable human-to-human transmission. Rep. Regula and his Democratic counterpart, Cong. David Obey (D-WI) noted that the proposed cuts in bioterrorism preparedness funding were inconsistent with that need.

This line of questioning demonstrated a clear understanding by the Subcommittee that preparedness for an act of bioterrorism and for a naturally-occurring disaster such as an avian influenza outbreak require the same systems for detection and response. While the public health community has been making that case for years, it has been accused by some policymakers of using bioterrorism funds to conduct activities necessary to the routine course of public health business, rather than to prepare for bioterrorism. The current great concern about avian influenza appears to have increased understanding about the multiple uses for bioterrorism preparedness funds, thereby surmounting this misconception, at least for now.

Another myth on Capitol Hill has been states and localities have been excessively slow to spend the bioterrorism preparedness funds and that large percentages remain unspent. Former HHS Secretary Tommy Thompson often used this allegation to justify cuts and reprogramming of bioterrorism preparedness funds. Moreover, there has been much current adverse publicity about the high percentages of unspent funds from the Department of Homeland Security (DHS). While Congressional appropriators understand the distinction between HHS and DHS funding streams for terrorism preparedness, others in Congress do not. Public health advocates must regularly explain the difference.

The Government Accountability Office (GAO) released a report in early April that definitively debunks this myth. GAO studied state and local expenditures and was careful to distinguish between obligated and unobligated funds. GAO found that a substantial amount had indeed been spent and that just 14% of the FY 2002 funding remained unobligated as of August 2004. The report, which includes state-by-state tables showing spending levels, can be found at
http://www.gao.gov/new.items/d05239.pdf.

In this time of extraordinarily tight budgets, however, good arguments in favor of federal spending are not enough. The appropriators must still find the money to restore the President’s proposed cuts. At the moment, they have no idea how to do that. The next significant event will be action by the House health appropriations subcommittee, which will produce a spending bill for consideration by the full House Appropriations Committee and ultimately the full House of Representatives. Subcommittee action is planned sometime in June and the House GOP hopes to have the bill passed by mid-July. The timing for Senate action remains uncertain.