September 2005

Katrina and Public Health Funding
Last time, it was a terrorist attack in New York City. This time, Mother Nature herself is altering the political dynamics in Washington. Last time, a tragedy opened the way for dramatically increased investment in public health, in the name of responding to terrorism. This time, although the devastation of hurricanes on the Gulf Coast surely justifies greater attention to public health emergency preparedness, as well as to the roles of public health in meeting the enormous needs of the victims, the outcome is less certain.

At this writing, public health professionals on the Gulf Coast are preparing for Rita at the same time that many are still dealing with the consequences of Katrina. An evacuation of unprecedented scale is underway. The demand on Capitol Hill to hear their stories is great, but politicians must wait until moments of crisis have passed and rely for now on CNN. Later there will be time to review lessons learned and absorb the consequences.

But politicians can be impatient sorts and, in addition to finger-pointing and blaming, they are actively addressing now what will be needed to help the Gulf Coast and its people recover. In so doing, many are jettisoning earlier vows to restrain spending. A conservative core in the House of Representatives has proposed a large number of dramatic spending cuts to offset the costs of hurricane recovery (including a huge bite out of CDC’s budget), but word is that they’d be lucky to get 40 votes. There is no doubt that the President’s budget and the spending limits to which Congress has bound itself will be busted.

In August, it was possible that health spending bills, and perhaps even some Medicaid reforms, would pass in a timely manner. Now, talk is about expanding, not cutting Medicaid. There is discussion about increasing the role of military in domestic disaster response, which adds to the already highly controversial and difficult issues about relationships among federal agencies in emergencies. Our whole federal approach to emergency management, which includes public health emergencies, could be up for grabs.

By the time this is published, the new fiscal year will have begun and Congress will have passed a Continuing Resolution (known as a “CR”) to keep federal funding flowing to existing programs. However, it is possible that the funding will be at lower levels than FY 2005. It is unclear whether Congress will be able to pass all its FY 2006 funding bills by Thanksgiving, or whether it will postpone action until after Thanksgiving or even until early 2006. The likelihood that all the remaining funding bills, including public health, will be combined in an omnibus measure has increased.

Meanwhile, the state of play for public health funding remains unchanged from late July. The House has passed its funding bill for the Department of Health and Human Services. The Senate Appropriations Committee has reported out its version, which awaits action by the full Senate. The House and Senate Appropriations Committee both rejected the Administration’s proposed elimination of the Preventive Health and Health Services block grant, instead giving it $100 million (compared to $131 million in FY 2005). The House mitigated the proposed cut in funding for upgrading state and local public health preparedness from
14% to 8%, while the Senate Appropriations Committee went along with the full 14% cut.

There are excellent arguments why this is a particularly terrible time to cut any public health programs. NACCHO is making them vigorously. However, the prospects for increasing these numbers seem slight, in view of the costs of hurricane recovery. Moreover, there is concern among public health advocates that, in an effort to find at least some offsets for new hurricane-related spending, Congress will turn to the ever-popular across-the-board cut. Such an approach affects all programs equally, whittling away funds that, in the case of public health, have been suffering “death by a thousand cuts” for a number of years.

Please watch NACCHO’s Legislative Action Center at http://capwiz.com/naccho/home/. This fall, anytime is a good time to advocate for restoration of public health funding cuts.