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Graph: Prevention & Public Health Fund eats @CDCgov budget. Feedback on our Tumblr site, full story tomorrow.

Earlier today, several federal health directors testified before the US House of Representatives. Many questions focused on sequestration’s possible impact on our federal prevention, research and health care agencies. The graph below may help to inform this continued discussion.

A video of today’s hearing begins at minute mark 0:22:55 here.

image

Click for full page graph

Because of sequestration and cuts in prior years, the CDC’s budget authority is $724 million less today than it was in FY 2005.

The agency’s total budget of $6.5 billion, which includes transfers and the Prevention and Public Health Fund, has grown by only $190 million over that same time.*

These numbers do not tell the full story.

  • Had the CDC’s total budget simply kept pace with the consumer price index since 2005, the agency’s budget would be nearly $1 billion higher than it is today.
  • In constant dollars, CDC’s current FY13 budget authority is $1.53 billion below the agency’s comparable FY05 budget levels.

These cuts come at a time when surveys are finding a 21% reduction in the nation’s total state and local health department workforce.

* Total FY13 budget numbers assume the Prevention and Public Health Fund allocations to the CDC will be lower due to the sequester, but similar to levels provided in 2012. Exact PPHF allocations for FY13 are yet to be determined.

July 25, 2012

Because congressional leaders failed to reach a bipartisan compromise on deficit reduction, the legislative equivalent of a deficit-reducing guillotine now hangs by a tripwire over federal spending. If the guillotine falls on January 2, 2013, every “discretionary” federal program - or 40% of federal spending - will face cuts of 8 percent or more.

To date, the media (and most politicians) have focused on the possible defense industry job losses that could result. High powered dignitaries are parading through the streets of Washington preaching defense job losses and stories of doom and gloom for defense contractors. Little has been written about the impact such cuts would have on non-defense areas of the budget. 

Today, Senator Tom Harkin released a new report, Under Threat - Sequestration’s Impact on Nondefense Jobs and Services. Long a proponent of prevention, Senator Harkin’s report takes a look at what would happen in other areas of federal spending if these cuts take place. The numbers are troubling. Here are just a few:

  • Head start would serve 96,179 fewer low-income children
  • 17 million fewer meals would be served to senior citizens in need 
  • 5 million fewer families would receive a long list of services under the Maternal and Child Health Block Grant
  • More than 12,000 people would lose access to life saving AIDS medications - which, incidentally, were recently shown to also reduce transmission rates
  • Over 211,958 children would lose access to measles, mumps and hep-B vaccines
  • Preparedness and response efforts would be further denigrated - impacting every states’ ability to respond to natural disasters, outbreaks or 
  • The National Institutes of Health would support 700 fewer research grants, meaning fewer discoveries for new medical treatments and cures 
  • Reduced funding for the inspection of transplant and ambulatory surgical centers would equal an inspection rate of one visit every 30 years, rather than the current rate of one visit every 3 to 4 years. 
  • 112,000 fewer domestic violence victims would receive call center services, counseling and/or temporary shelter services
  • 33,816 fewer women would be screened for breast and cervical cancer

Most agree that nothing will happen before November, but if Congress sits on its hands for the few legislative days between the November elections and the fall of the guillotine  in January, social service and health programs will take a devastating hit. 

One odd fact about guillotines - it seems the head is about 8% of the entire mass of the body. And cutting off your brain as a means to lose weight is about as smart as using a 8% sequester to fix a deficit. Congress must find a meaningful compromise so these grim scenarios don’t come to pass. 

July 9, 2012

We keep finding stories of how cuts to public health are backfiring. Given all the politics going on, this line of the Palm Beach Post story made me chuckle; "The CDC sent a $275,000 grant to help pay for the staff needed to contain [the TB outbreak]."

So, let me get this right… 

First, Florida’s elected officials drastically cut their state health department budget. That cut put a wrench in preventing this outbreak. They then justified not telling the Florida public about the worst TB outbreak in 20 years because the outbreak is just among the homeless and mentally ill. 

  • We need to stop here to say we don’t recall any study that found TB checks your wallet before checking into your lungs, but for now we have to skip this. Instead, just help us wish the church groups, volunteers and staff at Florida’s shelters good health.

Anyway, the CDC funding bailout jumped out because on July 2, Florida’s Governor told Newsmax he won’t implement provisions of Obamacare because it will be “devastating” to Florida families and taxpayers. In the same article, he said Florida has, “a very good safety net for our citizens.”

If that is so, why is a guy like me - 680 miles from the Florida border - now paying for Florida’s TB response through my federal taxes?

Anyway, I’m sure Florida is going to pay back this federal money and reimburse any more federal support they utilize as they work to address the TB outbreak in their state, right? They don’t, after all, need any federal support of their state health care system.

This story is focused on the impact of budget cuts to smoking cessation programs, but you could plug in any number of efforts where prevention funds have been cut back and tell the same story - over and over again. Maternal health, vaccination efforts, STI prevention, disease surveillance efforts, food safety…

We may not see the impact of cuts to prevention for years, but eventually we will - and it will cost us.

Today we are “vlogging” for the first time with this response to Congressman Paul Ryan’s budget videos (by TheCPHFoundation)

Enjoy!!

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.