On July 10, the House Appropriations Committee passed the Fiscal Year 2025 (FY25) Labor, Health and Human Services, Education, and Related Agencies Appropriations bill out of committee on a party-line vote of 31-25, with all Republicans voting for the bill and all Democrats opposed. The bill includes significant cuts to health programs providing a total of $107 billion for the Department of Health and Human Services (HHS), which is $8.5 billion (7%) below the FY24 enacted level and $14 billion below the President’s budget request. A topline overview of the bill was published by NACCHO on June 27 following the initial release of the bill text. Additional details from the Committee report were released this week, and a summary of what local public health needs to know is below.

In response to the passage of the bill, Labor, Health and Human Services, and Education Subcommittee Chairman Robert Aderholt (R-AL) said, “This bill ensures the continued success of critical programs needed by Americans across the nation, while implementing common sense reforms to the appropriations process by reducing and eliminating many programs with expired authorizations, ultimately saving taxpayer dollars.”

On the other side of the aisle, Ranking Member Rosa DeLauro (D-CT) stated in her opening remarks, “This Republican majority’s bill harms women’s health, children’s health, and public health. The bill would surrender the safety and wellbeing of the American people to multiple ongoing health crises.”

Members of Congress on both sides of the aisle have acknowledged that this bill is unlikely to pass in its current form and the Senate has yet to release its own FY25 bills. While these proposed cuts are concerning, and we anticipate a challenging federal funding season, it is a long way to the FY25 finish line. Congress is expected to pass a Continuing Resolution (extending current funding levels for a set period) before the end of the fiscal year on September 30 to push final FY25 negotiations past the November elections.

Ahead of the House Appropriations Committee markup, NACCHO sent a letter to the Committee expressing concern about the impact the proposed cuts would have on local health departments and the nation’s overall health. NACCHO Government Affairs has provided a detailed analysis of the bill below and will continue advocating for the highest possible funding for public health programs in FY25.

Centers for Disease Control and Prevention

If enacted, the proposed FY25 bill would significantly reduce funding for the Centers for Disease Control and Prevention (CDC) by $1.8 billion (22%) to $7.4 billion which is $2.3 billion less than the President’s budget request.

Some key programs for local health departments would receive flat or slight increases from FY24:

• Public Health Infrastructure and Capacity, $360 million (+$10 million, specifically directed to support Tribes)
• Public Health Data Modernization Initiative, $175 million (no change)
• Public Health Emergency Preparedness Cooperative Agreements, $735 million (no change)
• 317 Vaccine Program, $681.9 million (no change)

Funding for other CDC centers and programs would be eliminated under the proposal including:

• National Center for Injury Prevention and Control (funded at $761 million in FY24)
  • Opioid Overdose Prevention and Surveillance (approximately $500 million in funds moved from this program at NCIPC to SAMSHA to administer as a block grant)
  • Rape Prevention
  • Suicide Prevention
  • Firearm Injury and Mortality Prevention Research
  • Tobacco Prevention and Control
  • Climate and Health Program
• Center for Forecasting and Outbreak Analytics (CFA)
• Ending HIV Epidemic Initiative (EHE)
• Preventive Health and Health Services Block Grant

Along with the specific funding allocations, committee report language gives context to the funding appropriations and shows Congress’ intent and expectations for the use of federal funds. The accompanying report included language championed by NACCHO to strengthen local public health:

• Local Health Departments. — Federal funding intended for both State and local health departments does not consistently reach local health departments beyond those directly funded by CDC. The Committee encourages CDC to require States to fund local health departments when programmatically appropriate. The Committee urges CDC to publicly track and report to the Committee how funds provided to State health departments are passed through to local health departments, including the amount and date funds are made available, per grant award, by local jurisdiction.

Other notable language that would strengthen local public health in the report included:

• Data Modernization. — The Committee is pleased to see progress towards the implementation of CDC’s data modernization efforts and encourages the agency to continue to invest in the five key pillars of data modernization: (1) electronic case reporting; (2) laboratory information management systems; (3) syndromic surveillance; (4) electronic vital records systems; and (5) the national notifiable disease surveillance system. The Committee also recognizes CDC’s efforts to engage with States, Tribes, localities, and territories through data use agreements for core data sources as well as key recommendations from the Advisory Committee to the Director Data and Surveillance Workgroup. The Committee directs CDC, within 90 days of the enactment of this Act, to provide a report regarding how these efforts are advancing the agency towards the development and implementation of enterprise-level public health data systems.

Other report language that could impact local health departments include:

• Public Health Infrastructure. —The Committee notes that the Public Health Infrastructure (PHI) program is intended, as described in the joint explanatory statement that created it, to support public health departments. The Committee includes a new program requirement that 10 percent of PHI funding be designated specifically for Tribes and Tribal organizations. The provision of a stable, disease agnostic funding line will better ensure Tribes and Tribal Organizations are better equipped to coordinate together to save lives. The Committee notes that in the absence of this new requirement, CDC has provided only $5,000,000 to Tribes and Tribal organizations through the PHI program in fiscal year 2024, while providing $255,000,000 to national professional and advocacy organizations. The Committee is concerned that the provision of funds to national organizations and high programmatic assessment by the CDC has undermined the ability of the program to effectively support State, local, Tribal, and territorial public health organizations and again directs that no less than 70 percent of this funding be awarded to health departments.
• Injury Prevention and Control. — “To restore public confidence and better focus CDC on controlling and preventing communicable diseases, the Committee provides no funding for the National Center for Injury Prevention and Control (Injury Center). The Committee remains concerned that CDC, under the Biden Administration, continues to request funding for politically motivated projects at the expense of CDC core preparedness and response activities. While Director Cohen has stated in relation to pandemic preparedness that CDC must ‘‘be ready to respond, and that is our top priority at CDC,’’ the fiscal year 2025 budget request called for $182,000,000 in additional funding for the Injury Center, a 24 percent increase above the fiscal year 2023 level and the largest requested funding increase of any CDC center.”

Note: This language aligns with the Majority’s effort to reduce funding for programs that they have been identified as “socially engineering.” CDC’s National Injury Prevention Center focuses on reducing domestic violence, violence against children, overdoses, and some climate change related programs.

Administration for Strategic Preparedness and Response

The bill includes $3.6 billion for Administration for Strategic Preparedness and Response (ASPR), an increase of $3 million above the FY24 enacted level. It includes the Medical Reserve Corps program at $6.24 million (no change); and the Hospital Preparedness Program at $185.055 million, approximately $120 million below FY24 levels.

Health Resources and Services Administration

For the Health Resources and Services Administration (HRSA), the bill includes $7.4 billion which would be $647 million below FY24 levels, however this comparison excludes Community Project Funding included in the final FY24 enacted bill. Within HRSA, the bill would cut funding for the Ryan White HIV/AIDs program by $190 million, providing $2.38 billion. This includes the elimination of Ending the HIV Epidemic Initiative program. Notably the proposal asks HRSA to revisit its payment formula for Ryan White-funded centers to avoid over- and under-representing some jurisdictions. Unfortunately, no funds were included for the Public Health Workforce Loan Repayment program, a key NACCHO priority.

Substance Abuse and Mental Health Services Administration

The bill also includes $7.15 billion for Substance Abuse and Mental Health Services Administration (SAMHSA), a slight increase of $95.6 million above FY24 levels. This includes approximately $500 million from the Opioid Overdose Prevention and Surveillance program that would be removed from CDC and administered as part of an existing block grant.

While the bill provided an additional $95 million for SAMHSA, the accompanying report did include some concerning language:

• Harm Reduction. — The Committee is concerned that SAMHSA has confused the normalization of illegal drug use with its mission to support prevention and recovery in relation to substance use disorder. The Committee continues to support the availability and provision of naloxone to reduce overdose deaths; however, the Committee provides no funding to support harm-reduction activities related to supporting the continued misuse of controlled substances.

Other Programs

The bill completely eliminates the Agency for Healthcare Research and Quality (AHRQ), which conducts research and education to improve health care practices. In addition, it would zero out funding for the HHS Title X Family Planning Program, which supports clinics at many local health departments, and the Healthy Start program, which works to improve health outcomes before, during, and after pregnancy by pairing clients with care coordinators who develop a personalized plan that can include clinical services, mental health and substance use screening, immunizations, and other services.

More Details

For additional details on what is included in the House FY25 Labor-HHS bill, please refer to chart and linked materials below.

FY25 House Labor-H Report

FY25 House Labor-H Bill Text

FY25 House Labor-H Bill Summary (Majority)

FY25 House Labor-H Bill Summary (Minority)