May 2008

The two hottest topics on Capitol Hill have been the “farm bill” and a measure to provide additional funding for the war in Iraq.  Each has components directly relevant to public health.

Farm Bill Expands Nutrition Assistance. Both House and Senate agreed upon a final version and passed the farm bill, or the “Food, Conservation and Energy Act of 2008” by large margins, enough to override a threatened Presidential veto.  While issues concerning agricultural subsidies grab the headlines, the bill also provides an increase of $10.36 billion for nutrition programs.  It changes the rules for eligibility and benefits for the food stamp programs in ways intended to end erosion in benefits caused by inflation and requires use of electronic benefit transfer (eliminating paper coupons).  It also changes the name to the “Supplemental Nutrition Assistance Program” (a SNAPpier term?).  Recognizing shortages afflicting food banks, the bill increases funding for The Emergency Food Assistance Program (TEFAP) by $1.26 billion. 

Provisions to promote better child nutrition include a $1 billion increase for the USDA Snack Program, enabling its expansion to all 50 states, a demonstration project to evaluate obesity prevention strategies in low-income communities, and $5 million annually for innovative Community Food Projects.  The measure also establishes a “Healthy Urban Food Enterprise Development Center” and provides $3 million to help bring fresh foods into urban areas where they are scarce or unavailable.

War Funding Bill. Includes Medicaid Rule Moratorium Legislation to continue funding the Iraq war and is acknowledged by both parties as “must pass” legislation due to estimates that the military will run out of funds in mid-June.  Such measures often become magnets for a host of unrelated provisions.  However, both House and Senate have drafted “war supplemental” bills that set a high bar for inclusion of extra non-defense spending and very little is proposed.  Nonetheless, bills to be considered on the floors of both bodies include a moratorium on seven widely-opposed regulations proposed or promulgated by the Centers for Medicare and Medicaid Services that would result in large cuts for state Medicaid programs.  These include a regulation restricting Medicaid reimbursement for Targeted Case Management that NACCHO has particularly opposed due to its projected adverse impact on local health departments that receive such reimbursement.  At this writing (mid-May), it is clear that much political jockeying over the war supplemental will take place between the White House and Capitol Hill, because a Presidential veto of any measure that addresses domestic spending has been promised.

Next Stop: Fiscal Year 2009. After the war supplemental has been passed, House and Senate will turn their attention to regular FY 2009 funding.  Agreement on the cap for domestic spending is expected by late May.  This will enable the House and Senate Appropriations Committees to divide up that funding among all the subcommittees, including those that craft the bill for the Departments of Labor, Health and Human Services, and Education.  NACCHO has joined a large coalition in urging the highest possible allocation for that bill, due to several years of consistent erosion in health and public health funding.

Restoration of cuts that the President has proposed for FY09 (such as the Preventive Health and Health Services block grant and the public health emergency preparedness program)is realistic. However, Congressional aides are advising that any increases, or restoration of cuts taken in FY08 or earlier, will be highly limited.  The reason can be explained with simple arithmetic.  The total amount for all domestic discretionary spending  available will be about $20 billion higher than the President’s budget for FY09.  About $10 billion is already “spoken for” by increases that are clear necessities, including restoring White House-proposed cuts, sustaining the Pell grant program for educational assistance, and funds needed for program administration of Medicare and Medicaid.  That leaves what is a relatively nominal amount in federal budget terms, $10 billion, for a huge number of competing domestic priorities, including veterans, social services, education, and labor programs, in addition to public health programs.  The outlook for FY 2009, therefore, is not much better than it was for the current fiscal year.  Holding the line in public health programs will be a good outcome.

Both House and Senate Appropriations Committees plan to act on all their funding bills in June and July.  NACCHO continues to advocate funding priorities for local public health, in anticipation of this action.  It is likely that most further action will wait until House and Senate leaders reassess the budget and political situation after the election.