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President's 2008 budget plan proposes further health cuts.

In a repeat of recent years, some of the nation's core public health programs and agencies could take a major blow if President Bush's 2008 federal budget proposal becomes a reality--and once again, health advocates are looking toward Congress to save proven public health programs now on the chopping block.

Released Feb. 5, Bush's fiscal year 2008 federal budget proposal recommends cutting overall funding to the Centers for Disease Control and Prevention and Health Resources and Services Administration. At the same time that CDC is facing increased responsibilities and public health threats, Bush's proposal would decrease its funding by more than $162 million below estimated 2007 levels. HRSA's budget, which includes many of the programs that sustain a robust public health infrastructure, such as professional development for health care workers, could face a more than $1 billion cut when compared to estimated 2007 levels. At press time, Congress was still working to finalize fiscal year 2007 appropriation levels.

"The president's rhetoric about protecting the safety and health of our communities does not match his actions," said APHA Executive Director Georges Benjamin, MD, FACP. "This budget proposal is an attempt to balance the nation's fiscal woes on the backs of our most vulnerable populations by eliminating and severely cutting proven health programs that save lives and money. Now it is again up to Congress to fix this shortsighted proposal."

How much legislators will be able to achieve remains to be seen. While the new Congress is expected to place a high priority on health issues, the overall federal budget remains tight. Nevertheless, public health advocates will be working to make sure funding is adequate, and APHA members are being asked to help (see Page 18).

While CDC would see some increases for emerging threats under Bush's proposal, such as an additional $158 million increase for pandemic flu preparedness, such added funding comes at the expense of the agency's core prevention and health promotion programs, many of which have been targeted for elimination by the administration during the past few budget cycles as well, said Don Hoppert, APHA's director of government relations. Among the CDC programs threatened are the Preventive Health and Health Services Block Grant, which the president's proposal would eliminate completely. The block grant is a key stream of public health funding that allows states to tailor activities to their community's specific needs and can be used to fill in funding gaps or address unforeseen public health threats. Block grant money goes toward a myriad of activities, from anti-obesity programs to emergency volunteer training to newborn hearing loss tracking. Bush's budget recommendations would also eliminate much of the Steps to a Healthier U.S. program, which addresses the nation's rising obesity rates. The proposal comes on the heels of last year's elimination of CDC's Verb program, a proven and highly successful media campaign aimed at childhood obesity.

Other CDC cuts Bush proposed include an almost $17 million cut to West Nile virus control grants, about $125 million in cuts to state preparedness grants, elimination of the newborn hearing screening program, a half million decrease in CDC's health marketing program and a $143 million cut to the Vaccines for Children Program. On the positive side, the president's budget requests an increase of $93 million for HIV/AIDS testing, of which $63 million is targeted toward areas with the greatest rates of new infections, and $30 million is slated to help states purchases rapid HIV tests. At HRSA, Bush recommended cuts to health professions work force funding, such as nursing education, the National Health Service Corps and the Children's Hospitals Graduate Medical Education Program, as well as a $143 million cut to rural health programs. While the budget would increase funding for the Ryan White Comprehensive AIDS Resources Emergency Act, which assists low-income people living with HIV/AIDS, by $95 million, health advocates warned that the increase would do little to ensure the program keeps up with demand.

According to a CDC budget request summary, the agency has experienced an influx of funding since 2002 to address emerging threats such as terrorism, but funding for chronic disease work has stayed about level, despite rising costs and health impacts on life that chronic diseases continue to inflict. At a Feb. 7 meeting of the CDC Coalition, an advocacy group managed by APHA, CDC Director Julie Gerberding, MD, MPH, told attendees that while emergency funding has increased, core funding for infectious disease science is being eroded. CDC is facing a number of new responsibilities as well as new and old health threats, but federal funding isn't coinciding with the expectations being put on the agency, Gerberding said.

"We may very well be at a point where we have to say 'sorry, we can't do this,'" she said.

Federal health agencies aren't the only ones taking a hit in Bush's budget proposal. Medicaid and the State Children's Health Insurance Program, both of which depend heavily on federal funding and commitment, would face major cuts that would substantially impede the ability of states to expand health coverage to low-income children and families.

Even though it currently provides coverage to more than 53 million low-income people in the United States, including more than 28 million children, Bush's 2008 budget proposal would slash the Medicaid program by $26 billion over five years. Bush also called for reauthorization of SCHIP, which expires this year, but his budget recommendation would only provide an additional $5 billion above SCHIP's current baseline funding over the next five years. However, because health advocates estimate it would cost an additional $15 billion to just maintain current SCHIP enrollment levels--now at about 6 million children--Bush's proposal could result in states cutting back SCHIP services and dropping children from their programs, said Courtney Perlino, MPP, an APHA health policy analyst. Bush's budget proposal would also likely attach a requirement to federal SCHIP matching funds that mandate the funds only be used to assist children in families with incomes up to 200 percent of the federal poverty level. The proposal is in stark contrast to many health advocates' hopes that SCHIP's reauthorization would present an opportunity to expand coverage to the 9 million U.S. children now living without health coverage, Perlino said.

Other highlights in the Bush proposal include a $159 million decrease to the U.S. Substance Abuse and Mental Health Services Administration, $66 billion in Medicare cuts and a $212 million increase for the Indian Health Service. However, the IHS proposal would eliminate the successful urban Indian health program, even though statistics show that about 70 percent of those who identify themselves as of American Indian and Alaska Native heritage now live in urban areas.

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Title Annotation:CDC, HRSA programs threatened
Author:Krisberg, Kim
Publication:The Nation's Health
Geographic Code:1USA
Date:Mar 1, 2007
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