January 2, 2012
A story in The Washington Post just before the holidays looked into the hard cold numbers behind Medicare spending. For example, did you know enrollment in the program is expected to nearly double from 47 million today to 88 million by 2040?
And once again, not one policy expert, political party platform or number-crunching expert proposes keeping costs down by focusing on preventing disease and disability. The reporter didn’t mention prevention either, even though 70 percent of Medicare spending is used to treat preventable conditions.
Anyway, here are some great charts from the piece:
December 23, 2011
Last Saturday, Congress sent the president an Omnibus Spending bill giving the Obama Administration more than $1 trillion to spend between now and the end of September, 2012. Several federal departments annual budgets were wrapped up in the massive bill which passed Congress three months behind schedule.
In normal times, media coverage of an annual trillion-dollar spending measure is decent. Reporters dig into the bill for a week or more and write about who won and who lost – but these are not normal times and coverage was sparse. A close friend of mine, an avid newspaper reader who once worked for an appropriations committee chairman, didn’t know the bill had passed Congress and was off to the president for his signature.
It seems an agreement on the spending bill, which ended the excitement of a possible government shutdown, meant the story was over. Reporting quickly re-focused on the new partisan fight between the House and Senate over extended unemployment benefits, a popular middle class tax break and a looming pay cut for doctors who serve Medicare beneficiaries.
But the Omnibus is worth a closer look.
Because our work highlights public health programs, we track the Centers for Disease Control and Prevention’s budget closely. This week we dug into the bill and checked to see how the CDC fared. The resulting graph below plots CDC’s funding trends through FY 2012. The table this is drawn from can be found on our website. [Be sure to scroll to page 2 of that PDF]
THE NUMBERS: An Explanation
This year’s FY 2012 Omnibus bill provides the CDC’s programs with a $76 million more than last year. Only $9 million of this $76 million increase comes from new budget authority.
To put this funding level in perspective, consider that if the agency had simply kept pace with the rising cost of goods and services since 2005, inflation would have driven the CDC’s core discretionary budget up to $7.322 billion in FY 2011. Instead, CDC’s core discretionary programs were funded at $1.67 billion below that mark in 2011. Mandatory funding from the Prevention and Public Health Fund in 2011, along with more than half a billion in department-wide transfers and fees, raised CDC’s program funding to $6.837 billion – still $485 million behind inflation.
The CDC’s budget authority (in blue above) is clearly trending downward as the ever-more important Prevention and Public Health Fund (shown in purple) grows each year. But more on that later.
MORE THAN LEVEL-FUNDING – A WIN!
With the national dialogue focused on deficits and budget cutting, most advocates in Washington are not asking for increased spending. Take, for example, this post from the Policy Watch Blog of the Association for Career and Technical Education after the Omnibus bill passed:
On December 17, Congress finalized a funding package that contains the remaining nine appropriations bills for Fiscal Year (FY) 2012, including the Labor, Health and Human Services, and Education Appropriations bill. The legislation passed the House and Senate with bipartisan support. In this bill, [our key program] is level-funded! This is fantastic news!
These days, advocacy groups in Washington are generally pleased when they avoid evisceration. And the failure of the Supercommittee hints at even more pressure to cut is in the future. The fact that the CDC’s budget was not cut, but actually did slightly better than level funding is a testament to all who advocated on behalf of the public health this year.
THE PREVENTION FUND
The original intent of the Prevention and Public Health Fund was to do more to combat the rising number of patients entering hospitals with preventable chronic diseases. A well written New York Times opinion piece from April 2011 summarized the value of the fund using the words, “boost,” “build” and “bolster” to describe how the Prevention Fund would improve health and save money down the road.
Unfortunately, this block of funding has become the finger in the dike for our nation’s disease control and prevention efforts. So far, the fund has not helped prevention-focused agencies “build” or “bolster” much of anything new. Instead, the Prevention Fund has kept the CDC from being cut to the bone.
If partisan bickering were ever to do away with the prevention fund at this point – as some in Congress have called for - the CDC would suffer a 12% cut to its budget overnight.