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President's 2009 budget plan would set health programs back.

Public health would receive a crushing blow under President Bush's fiscal year 2009 federal budget proposal, which recommends massive cuts to top public health agencies and critical public health programs. In response, advocates are coming together to work with Congress in hopes of reversing what has become a frequent funding trend.

Bush's 2009 proposal, which was released in early February, recommends cutting funding to the Centers for Disease Control and Prevention by more than $412 million--a 7 percent cut below fiscal year 2008 funding and a return to 2003 funding levels. The Health Resources and Services Administration is also slated for considerable cuts in Bush's proposal, which calls for cutting the agency's budget by almost $1 billion, including an almost 70 percent cut to the nation's health professions training program. While many policy experts are describing Bush's proposal as "dead on arrival," it presents a starting point for negotiations that makes it difficult to bring funding to levels that adequately reflect today's public health needs, according to health advocates.

"If enacted, this budget proposal would be devastating to the nation's public health infrastructure, the nation's public health workers and the nation's ever-increasing public health needs," said APHA Executive Director Georges Benjamin, MD, FACP, FACEP (E). "As public health advocates, we cannot be afraid to demand from Congress what we need: A real, long-term commitment to improving public health and making the world's wealthiest nation the healthiest nation as well."

The CDC Coalition, a group of more than 100 public health-related groups, is calling on Congress to fund CDC at $7.4 billion--a request that doesn't include mandatory funding for the Vaccines for Children Program. Minus Vaccines for Children funding, Bush's recommendation for 2009 CDC funding comes to slightly more than $5.9 billion. Friends of HRSA, another advocacy group, is requesting that in fiscal year 2009 the agency receive at least $7.9 billion, compared to the current proposal of a little more than $5.8 billion. APHA manages both the CDC Coalition and Friends of HRSA, both of which set their funding level requests based on 2008 federal funding levels.

As in recent Bush budget proposals, CDC's Preventive Health and Health Services Block Grant, which funds crucial public health programs for which there are no other dedicated funding streams, is slated for elimination. Bush's budget also recommends a $15.5 million decrease to chronic disease prevention and community health promotion programs, a more than $7 million cut to CDC's National Center for Environmental Health Laboratory, a $7.2 million cut to the agency's Safe Water program, an almost $7 million cut to West Nile virus work, a $2.1 million cut to the National Center for Health Marketing, and a more than $135 million cut to the Public Health Emergency Preparedness Program, which provides state and local grants.

In a February briefing with members of the CDC Coalition at APHA headquarters in Washington, D.C., Bill Nichols, director of CDC's Financial Management Office, noted that because of timing changes in how such preparedness grants are distributed, such a cut--if it came to fruition--would not change current funding levels to states. However, he said, the preparedness funding would have to be restored in 2010 for there to be no adverse implications for states.

Proposed increases for CDC's budget include additional funding for more quarantine stations, the strategic national stockpile and the National Center for Health Statistics.

Within HRSA, besides cuts to health professions training, Bush also proposed cutting funds for maternal and child health programs, the National Health Service Corps and the Office of Rural Health, and would eliminate funding to support universal newborn hearing screening, emergency medical services for children, and loan repayment and faculty fellowships for clinicians. Recommended increases are aimed at community health centers, nurse loan repayment and scholarship programs, and HIV/AIDS programs. But according to the HIV Medicine Association, the president's proposal would "spell disaster" for the nation's efforts to respond to HIV/AIDS, noting that when accounting for inflation, the budget proposal amounts to a cut in HIV research, prevention, care and treatment. Also, advocates noted that if deep cuts to HRSA's health professions training program were enacted, it would severely limit any positive outcomes stemming from funding increases for community health centers.

Also slated for cuts under the Bush proposal are the country's main public health care programs: Medicaid, Medicare and the State Children's Health Insurance Program. The budget proposes cutting Medicaid, which provides care to millions of low-income families, by more than $18.2 billion over five years and handing $556 billion in cuts to Medicare over 10 years.

During a Feb. 4 news conference releasing the budget, U.S. Health and Human Services Secretary Mike Leavitt said actions must be taken to slow Medicare spending or the system will be "broke" in the next 11 years, criticizing Medicare for its "price-fixing" mentality and warning that Medicare spending is approaching an "emergency" situation. In its analysis of the budget proposal, the nonprofit Center on Budget and Policy Priorities noted that the Bush administration rejected calls to curb tens of billions of dollars of Medicare overpayments to private insurance companies taking part in the Medicare Advantage program, noting that such insurers are being paid 13 percent more, on average, than it would cost to treat the same patients under traditional Medicare services.

In regard to SCHIP, the Bush proposal recommends funding the successful children's health program at $20 billion over the next five years--$15 billion lower than needed to cover the 4 million additional eligible children who could benefit from SCHIP. APHA and fellow public health groups have consistently called for funding to be at no less than $35 billion over five years. According to acting Centers for Medicare and Medicaid Services Administrator Kerry Weems, who spoke at the HHS news conference, the Bush proposal would also place a "hard" cap on SCHIP eligibility at 250 percent of the federal poverty level. If the cap is enacted, current SCHIP enrollees who earn more than the 250 percent limit would be grand-fathered in until they are ineligible, Weems said.

In other portions of the budget, the Bush proposal recommends a $130 million increase in funding for the U.S. Food and Drug Administration, including a more than 5 percent increase for food safety activities. The Environmental Protection Agency is slated for a more than 4 percent cut over 2008 funding, including proposed cuts to clean water and indoor air activities, and proposed elimination of funding to support EPA's Greenhouse Gas Reporting Registry. The Indian Health Service would receive a more than $20 million cut under Bush's proposal, with funding for urban Indian health programs again slated for elimination. Also up for a funding decrease is the Substance Abuse and Mental Health Services Administration, which would sustain a 6 percent cut, including a 14 percent cut to the agency's mental health programs.

For more on Bush's 2009 budget proposal, visit budget.htm or www.apha. org. For an APHA fact sheet on the importance of supporting health professions training, visit www. facts.
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Title Annotation:CDC, HRSA targets
Author:Krisberg, Kim
Publication:The Nation's Health
Date:Mar 1, 2008
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