This week, the Senate adopted a budget resolution that sets in motion the Budget Reconciliation process to enact larger social and health investments without the obstacle of a filibuster. The resolution was introduced on Monday, August 9 by Senate Budget Chairman Bernie Sanders (I-VT) and Majority Leader Chuck Schumer (D-NY). The resolution allocates $3.5 trillion in funding for discretionary non-defense programs and assigns topline numbers to each of 12 Senate authorizing committees to address certain issues within a certain overall spending cap. Notably for public health, the instructions allots the Committee on Health, Education, Labor and Pensions (HELP) $726 billion to be divided among committee priorities. Now that the resolution has passed, each committee will work to flesh out the details of the budget for their bucket.
Majority Leader Schumer called for a vote on the budget resolution on Tuesday evening, starting with a “Vote-A-Rama”, during which any Senator can introduce an unlimited number of amendments and then they vote on the amendments, marathon-style. This lasted nearly 14 hours until the early hours of Wednesday morning, when the Senate finally passed the budget resolution on party lines, 50-49.
The resolution came with reconciliation instructions, which direct the committees on which specific policies to fund with their allocations. Public health priorities outlined in the reconciliation instructions for the HELP Committee include investments in health equity, pandemic preparedness, and workforce development and training. However, the reconciliation instructions give no more detail about what these investments should include, leaving uncertainty about what priorities will be funded. And while the Administration called for $30 billion of such a pot to go towards public health and preparedness it is unclear how many dollars, if any will be available for governmental public health activities, with some news reports saying that total pandemic preparedness spending may only reach $5 billion total.
Disappointingly, the reconciliation framework did not specifically instruct HELP to prioritize public health infrastructure investments, including the Public Health Infrastructure Saves Lives Act (PHISLA). Introduced by Senator Murray (D-WA), Chair of the Senate Health, Education, Labor, and Pensions (HELP) Committee, PHISLA would represent a massive investment in our nation’s core public health infrastructure, by dedicating $4.5 billion annually to health departments to support their core capabilities. The reconciliation instructions are not final, though, and the contents of the bill may continue to change throughout the drafting and scoring processes, leaving room for more definition and inclusion of PHISLA and other NACCHO priorities. Please contact your Senators during August recess and urge them to ensure the inclusion of PHISLA to the reconciliation package.
Over the August recess, committees will continue to hammer out the details of the budget, with a deadline to submit their legislation for review by the entire Democratic conference by September 15. In a press release, Senator Sanders emphasized that the budget will be passed under Senate rules of reconciliation, which allow it to be passed with only a simple majority of 51 votes rather than 60. The House will also need to pass the budget resolution and is planning to take it up the week of August 23. NACCHO will continue to push for the inclusion of PHISLA, substantial investment in public health pandemic preparedness, and other key public health provisions in the final budget reconciliation.