Public Health
Budget Highlights
Fiscal Year 2006 Request

March 3, 2005

Analysis prepared by Committee on Energy and Commerce Democratic Staff

The public health portions of the budget have come under significant criticism. For example, under the President's plan the CDC budget would be reduced by $550 million. While the Nation's top three causes of death are chronic diseases -- heart disease, cancer, and stroke -- the President proposes cuts in CDC's chronic disease prevention and health promotion program of 6.5 percent, or $60 million. Reductions include programs aimed at fighting childhood obesity, trauma care, health professions training, food and drug safety, disease prevention, and substance abuse prevention. The American Public Health Association (APHA) has said these cuts are emblematic of the Administration’s shortsighted approach to public health in general.

The budget also includes a 64 percent cut to a program for training nurses, dentists, and other health professionals through the Health Resources and Services Administration and a proposal to cut bioterrorism preparedness funding 12.6 percent. According to APHA’s Executive Director, “There is no doubt that the bioterrorism funding of the last few years has strengthened the nation's preparedness capability and our ability to deliver public health services. But after suffering decades of neglect, cuts will jeopardize the initial progress we made. Funding must be sustained to rebuild our public health system and to better protect Americans."

Similarly, the Association of State and Territorial Health Officials (ASTHO) has said that the proposed cuts in the Administration’s FY2006 budget “would weaken the ability of state and local public health to respond to bioterrorism, emerging infectious diseases, or other public health threats and emergencies.” ASTHO expressed concern with proposed cuts in funding to the CDC and the Health Resources and Services Administration for state and local public health preparedness at the same time that public health agencies are being asked to expand their role in disease surveillance, food safety and security, related mental health issues, and the distribution of Strategic National Stockpile pharmaceuticals.

Specifically, ASTHO points out that the budget calls for elimination of the Preventive Health and Health Services Block Grant, which provides $131 million to the states to meet unanticipated public health emergencies, such as have been encountered with West Nile virus, E. coli outbreaks, and SARS, or to implement prevention programs against injury, heart attack, stroke, and other chronic diseases. ASTHO also expressed concern with “insufficient funds to cover the rising costs of vaccines for underserved children and adults and to develop the necessary infrastructure to support adult immunization programs, such as those needed to address any new pandemic influenza outbreak.”

According to ASTHO “Federal funds have been pivotal in helping state public health agencies improve their response capabilities . . . . Previous budgets have supported our efforts to rebuild a system that has suffered more than two decades of neglect. We have serious concerns that reductions in public health funding are being proposed at a time when we truly need a sustained federal commitment to our nation’s public health . . . . Strong support for enhanced immunization programs, terrorism response planning, and chronic disease prevention is critical to the states’ abilities to protect the nation’s health.”

The full text of the APHA and ASTHO statements with respect to the FY2006 budget are on their respective Web sites. Citations to these as comments of other public health advocates are found at the end of this memorandum.

The Administration’s budget continues a pattern of “interagency transfers” of funds, which makes it difficult to analyze the true level of support for certain programs. For example, the entire budget of the Agency for Healthcare Research and Quality (AHRQ) is funded by a transfer of funds from the National Institutes of Health (NIH). The full extent of such interagency transfers is not known at this time.

Agency for Healthcare Research and Quality

One of the major concerns with the AHRQ budget is the level of support for the comparative effectiveness research program that was specifically authorized in the Medicare Modernization Act. The $15 million requested falls far below the level that some view as adequate for realization of this program’s potential. The AHRQ budget also includes part of the Administration’s health information technology (IT) program. The aggregate health IT level of effort in the budget again falls far short of what some consider adequate. Health IT holds the promise for increasing health quality by reducing medical errors, and for decreasing health care costs.

Centers for Disease Control and Prevention

As has already been noted, the FY2006 budget proposal for the CDC calls for elimination of the Preventive Health and Health Services block grant. The Administration contends the block grant duplicates and overlaps other CDC programs. Major state and local public health organizations do not agree. CDC’s chronic disease prevention and health promotion budget would be cut significantly under the Administration’s proposal. The justification for this cut is that a specific media campaign aimed at childhood obesity is a demonstration whose time has expired, but the health community would disagree. The Administration does not propose any new programs to fight obesity. Finally, the CDC budget proposes cuts in programs for funding bioterrorism preparedness.

Food and Drug Administration

The Administration points to some modest increases in some post market safety programs. Whether a particular function is slated for a modest increase, freeze, or cut, as a whole the proposed budget for FDA does not allay concerns over the adequacy of FDA’s resources to support its capacity to do more safety data collection for products such as drugs, devices, food, and dietary supplements. Devotion of adequate resources to this function would help reduce adverse events and would assist consumers with making more informed choices for themselves and their families.

An article that appeared in USA Today on February 15, 2005, highlights some of the key concerns with the proposed budget for FDA. According to Julie Appleby:

“The Food and Drug Administration's proposed budget for next year includes cuts to nearly all its inspection programs, from checks on imported food to reviews of overseas plants that make prescription drugs bound for the USA. If Congress approves, the number of domestic food safety inspections made next year would fall by 5%, foreign drug plant inspections would drop 5.8% and checks on the nation's blood banks would be cut 4.7%, compared with estimated 2005 inspections.

“The reductions are included in a $1.9 billion budget that gives the agency an overall 4.5% increase. Increases are earmarked for several projects, including expansion of a network of labs to analyze food for bioterror agents and increasing staffing in the office that monitors the safety of prescription drugs once they hit the market.

“The proposed cuts come amid criticism the FDA failed to inspect often enough a long-troubled British vaccine plant that the United States had counted on for half of its flu vaccine supply. All the plant's vaccine was impounded last year after British regulators discovered serious problems, which were later confirmed by the FDA.

“Some experts fear reducing inspections could make the USA more vulnerable to counterfeit drugs or improperly made products. ‘We don't want to end up with a buyer-beware market for necessary medicines,’ says Sarah Sellers, an FDA adviser, pharmacist and drug-safety expert. In a statement, the FDA said it is targeting inspections where risks are highest: ‘Intelligent, risk-basked inspections are more important than absolute numbers of inspections. (The agency) is committed to carrying out our mandate of promoting and protecting the public health.

“Responding to ongoing criticism of the FDA's role in the vaccine problems this year, a top FDA official last week told Congress the agency will begin inspecting vaccine plants once a year, rather than the once every two years that is required.

“Still, the number of drug plant manufacturing inspections would drop from 1,430 this year to 1,355 next year. The number of foreign drug inspections would fall from 515 to 485. The FDA also inspects companies that process human tissue for medical uses and companies that produce cheese, fish, juice and other foods.”

Health Resources and Services Administration

The Administration increased funding for the Ryan White CARE Act, but, even with these modest increases, many contend there will still be a significant gap between the resources that are needed and those that are provided for prevention and treatment of HIV/AIDS.

The budget calls for zero funding for the health professions programs. It also proposes elimination of programs dealing with traumatic brain injury, emergency medical services for children, and the highly acclaimed Healthy Community Access Program. The budget says these programs are “underperforming.” Again, rather than propose new programs to address the important public health issues in these areas, the administration simply eliminates all support for any programs. Rural health programs are also cut.

National Institutes of Health

The Association of American Medical Colleges states that it is “deeply disappointed that the President's 2006 proposal is a rerun of last year's budget with insufficient federal support for medical research. Specifically, the President's recommended increase of 0.7 percent for the National Institutes of Health for the third year in a row is well below the rate of inflation and is woefully inadequate to sustain the promising pace of medical research. If this funding trend continues, America's position as the world leader in research will be threatened.” Other stakeholders with expertise to assess this part of the budget have expressed similar concerns. The Administration’s budget documents concede that less research will be funded.

Substance Abuse and Mental Health Services Administration (SAMHSA)

The budget requests a substantial cut, $56 million, in resources that go to SAMHSA. The budget acknowledges that the Substance Abuse Prevention and Treatment Block Grant “is the cornerstone of States’ substance abuse financing, accounting for at least 40 percent of public funds expended for prevention and treatment.” Programs of regional and national significance for substance abuse prevention would be cut. This program would get no new money under the budget, which constitutes a cut in resources available for this program. Mental health programs would see a decrease of $64 million under the budget.

Quotes from Statements by Various Public Health Advocates regarding the FY2006 Budget

“Cuts to the Centers for Disease Control and Prevention are emblematic of the administration's shortsighted approach. Under the president's plan the agency loses $550 million. While the nation's top three causes of death are chronic diseases - heart disease, cancer and stroke, the president cuts CDC's chronic disease prevention and health promotion program by 6.5 percent, or $60 million... .” -- American Public Health Association (APHA). To read the APHA’s full statement see their Web site.

“The AAMC is also deeply disappointed that the president's 2006 proposal is a rerun of last year's budget with insufficient federal support for medical research. Specifically, the President's recommended increase of 0.7 percent for the National Institutes of Health for the third year in a row is well below the rate of inflation and is woefully inadequate to sustain the promising pace of medical research. If this funding trend continues, America's position as the world leader in research will be threatened.” -- Association of American Medical Colleges (AAMC). To read the AAMC’s full statement see their Web site.

“The American Nurses Association (ANA) today expressed its disappointment with the funding levels for programs to enhance the recruitment and retention of nurses in President Bush's proposed fiscal year (FY) 2006 budget. The President's budget was submitted to Congress on Feb. 7.” -- American Nurses Association (ANA). To read the ANA’s full statement see their Web site.

“Taken together, the inadequate FY06 investments in research proposed by the Administration would erode the research and innovative capacity of our nation.”
-- Association of American Universities (AAU). To read the AAU’s full statement see their Web site.

“President Bush's FY 2006 budget will again shortchange Americans' health as we battle against our nation's most deadly and costly health threats - heart disease, stroke and other cardiovascular diseases, according to the American Heart Association. The proposed new budget calls for less than a 1 percent increase next fiscal year for the National Institutes of Health (NIH), and a 7 percent cut for Centers for Disease Control and Prevention (CDC) programs, including those aimed at heart disease and stroke prevention.” -- American Heart Association (AHA). To read the AHA’s full statement see their Web site.