Congress To Defer Final Action on Public Health Spending Until After Election
The months of September and October in a Presidential election year are always a time for extraordinary volatility on Capitol Hill. It is no easier to predict how much of the nation’s essential business will be accomplished than it is to predict how the stock market will move. The temptations are great for both parties to bring up bills not because they might pass, but because they will force Members to vote up or down on highly charged partisan issues, from the minimum wage to gun control, and from drug reimportation to gay marriage.
Spending bills for the fiscal year beginning October 1, 2004 have made little progress since Congress reconvened after Labor Day. Their consideration also has been complicated by the unanticipated need to consider a series of bills adding funds for hurricane relief. Just one of the 13 annual spending bills has been finished – the one for defense. The rest of the government will be funded by a mechanism known as a Continuing Resolution (or “CR”), which extends spending at the current levels for a defined period of time. The likelihood that Congress will return to Washington after the election for a “lame duck” session to finish the spending bills is high. If they do not, they will have to pass a CR to fund the government until at least February 2005.
The House passed its version of the spending bill for labor, health and human services and education on September 9, 2004, while the Senate version cleared the Appropriations Committee September 15 and is awaiting floor action. In a highly unusual move, the Senate Subcommittee that normally considers the bill before it goes to the full Committee did not hold a public meeting to discuss and vote on the bill. Rather, they reportedly voted by telephone to pass it along to the full Committee, which then acted expeditiously. The consequence of such a process is that there was no public discussion or debate about spending on public health (or on any other important social programs included in the bill).
The results of action thus far on public health programs have been mixed. The House bill cuts the Preventive Health Services Block Grant by about 17%, or $23 million, but the Senate bill retains the FY04 spending level of about $131 million. The Senate Committee and House bills both provide level funding for state and local bioterrorism preparedness (rejecting a cut proposed by the Administration). The House and Senate both boosted spending on chronic disease prevention
by six to seven percent, and provided more modest increases for most other Centers for Disease Control and Prevention (CDC) programs. At the Health Resources and Services Administration (HRSA), the House gutted the Community Access Program and various health professions education programs, while the Senate gave them modest increases. Both House and Senate provided an increase of about 15% for community health centers, as requested by the Administration. Perhaps the most dramatic difference from previous years was in House and Senate proposals for the National Institutes of Health. Long accustomed to double-digit percentage increases, NIH would receive only an increase of from 2.5% (House) to 3.9% (Senate).
What is clear from looking at the bottom line over time is that, excluding funding related to homeland security, the budgets for most CDC and HRSA programs are slowly eroding over time, as they receive no increases or increases that do not compensate for inflation in health costs.
Complete details on House and Senate action on FY05 public health spending can be found at thomas.loc.gov/home/approp/app05.html.
NACCHO Members Testify on Capitol Hill about Informatics, Flu Vaccination
NACCHO has been ably represented at two Capitol Hill hearings recently. Former Milwaukee Health Commissioner Seth Foldy testified on NACCHO’s behalf at a mid-July hearing on health informatics. Foldy told members of a Subcommittee of the House Committee on Government Reform that the basic question is, “How can both health care providers, and public health and safety officials get the information they need when, and where, they must make a decision?”
Foldy said, “The health care provider makes decisions regarding an individual patient or family; the public health official about an entire community. In the setting of a communicable disease, a covert bioterrorism attack, or an environmental emergency, poorly informed decisions by either party result in missed opportunities to prevent injury or illness, sometimes on a massive scale.”
County Forum Vice Chair Carol Moehrle testified September 25, 2004 before the Senate Select Committee on Aging. The Committee held a hearing on flu vaccination, and Moehrle described the ongoing concerns about availability and distribution of flu vaccine that worry seniors in her community, as well as local health departments nationwide. Moehrle told the Committee, “We do not believe that anyone has a clear understanding of the reasons for the supply and distribution problems that have arisen so consistently in recent years. Every entity that gives flu shots, from large chain stores to individual physicians to health departments, orders its vaccine from wholesalers and distributors or from the manufacturers directly. There is no discernible rhyme or reason why some who place orders receive ample supplies early, and why some must wait, or receive partial shipments over a period of time.”
The complete text of the testimony of Foldy and Moehrle can be found at www.naccho.org/general977.cfm.
Hurricanes Test Southeastern Public Health Resources
Recognizing the degree of national attention and concern caused by the series of hurricanes that have struck Florida and the Gulf Coast, NACCHO organized a September 21, 2004 audio press briefing to describe the public health role in planning and implementing hurricane response. NACCHO Members Lillian Rivera, director of the Miami-Dade County Health Department, and Jeffrey Goldhagen, MD, MPH, director of the Duval County Health Department, described their hurricane experiences in Florida, emphasizing the critical but poorly understood functions of public health departments. NACCHO President Michael Caldwell, MD, MPH, gave the press a national perspective. The briefing took place after Charlie, Frances and Ivan, but before Jeanne.
The written transcript of the press briefing can be found at www.naccho.org/general1218.cfm.
