Ebola’s global spread is pulling back the curtain and exposing Washington’s cuts to disease prevention funding over the past several years. These cuts went beyond what was prudent or safe, and now some midterm campaigns are working to make political hay out of the global Ebola crisis. But who is really to blame for these cuts to our national defense?
In April, our blog detailed how former Labor HHS Secretary Kathleen Sebelius responded to a member of Congress’ concerns about public health cuts during a Labor-HHS subcommittee hearing. She said, “[Prevention] services will go on, we just don’t need the money through CDC.”Representative Roybal-Allard (D-CA) was worried - before this outbreak - that the Administration requested a full $1billion less for the Centers for Disease Control and Prevention in 2015 than they did in 2010.
For an agency whose core budget is about $6.5 billion, a billion dollar cut, in such a short time-frame, is massive. By low-balling the CDC budget (and that of NIH and HRSA, too) and for focusing so exclusively on the roll-out of the Affordable Care Act, the Administration and many Democrats in Congress clearly bare some responsibility for cuts to prevention.
But those on the other side of the political divide who might deride our poor public health preparedness have their own albatross to contend with. Under the banner of cutting wasteful programs, Republicans embraced these same deep cuts to the CDC - and wanted more. They went a step farther by denouncing the Affordable Care Act’s Prevention and Public Health fund. Many Republicans are on record, some voting more than 40 times, to eradicate this major source of funding for the CDC. Had conservative efforts to repeal these prevention funds succeeded, the CDC’s budget would have plummeted by almost another $1 billion overnight. That massive 15% cut to an agency already on the ropes would have been a disaster – particularly considering that states have cut an additional 50,000 health department jobs nationwide.
The American public was largely oblivious to these funding cuts to “discretionary” prevention programs. On a recent flight to speak at a public health conference, the woman sitting next to me said something that stuck with me and sheds light on the reason why. While talking about our jobs, I waxed poetic about the amazing world of disease control and prevention. She then said; “Your organization must have a great network of people helping you advance all these critical issues!”
I smiled, and gave this analogy:
It is possible that this flight was rushed through its safety check, that the airline cut back maintenance staff to save money, and that the wing is falling off right now. Still, we are flying because we trust a system is there to prevent that from happening. Really, we have no idea if the airline is cutting costs, if they fired the ground crew last week, or if the person at the helm just flew from China and is utterly exhausted. More to your point - we have never sent a letter to Congress asking them to fully fund air safety even though we both fly regularly and our lives depend on this system we think is in place.
Americans simply expect us to be ready for Ebola-type threats. Yet, Washington let us lose our edge – here at home and overseas. Politicians should stop looking for whom to blame and detail a vision for the future.
Like no other time in recent history, the value of a strong national public health system is in the news. It is clear: the pilot is tired, the ground crew was cut and the systems we depend on are not in good shape.
A true leader will not point fingers, but will call on us to do better. Not just for the sake of fighting this crisis (or the next), but for the long-term health and safety of the nation. Congress, the Administration, and candidates for office should denounce any additional cuts to disease prevention and public health programs. Policymakers should work to rebuild the critical disease control systems this nation needs today and in the future. It is time to focus, in a bipartisan manner, on doubling prevention budgets - just as we did for the NIH several years ago.
Dr. Tom Frieden of the CDC.
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.
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.
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.
Last week Pfizer shared interesting news about healthy aging. This article addresses the growing health concerns for the elderly. Today Americans live much longer but, also suffer long-term, chronic conditions in the last years of their lives. This study focuses on preventative measures such as health screenings, vaccination programs and wellness initiatives. By focusing on these efforts, we can look forward to healthier years and reduced healthcare spreading.
By Bruce Ruscio, DrPH, and Karl Moeller, MPA
Can the federal government save money by spending it? It seems crazy on the face of it, but vaccines are among the most cost-effective ways to prevent disease and reduce health care costs. The human and economic impact of providing vaccines in keeping with the CDC’s current routine childhood immunization schedule prevents more than 40,000 deaths and 20 million cases of disease. It saves more than $10 billion in direct medical costs for each birth cohort vaccinated – costs which we would all pay one way or the other.
The CDC’s Section 317 immunization program, which supports critical public health immunization infrastructure and provides vaccine services to low-income and uninsured children, adolescents and adults, is paid for with non-defense discretionary funding. It serves all states, territories and protectorates, and provides vaccines to underinsured children and adolescents. It is also under threat of major cuts after the election. The threat comes from several directions.
Congress can cut funding for the Centers for Disease Control and Prevention, literally, overnight – yet history tells us prevention programs are costly and difficult to re-establish. An effective immunization program is more than just providing vaccine vials to providers. These programs include vaccine management efforts, disease and vaccine expertise, risk communications, disease surveillance, and workforce programs, among other system elements needed to ensure high vaccination coverage levels.
In 2000, an excellent article by Johnson, et al (see footnote)reviewed more than four decades of the Section 317 funding. The study found that when policy makers in Congress and the White House understood a new problem, epidemic or new vaccine, they supported the program with funding and policies. Conversely, when a crisis was resolved, funding contracted until the inevitable next disease crises emerged. What may be new is that these cuts are coming at a time when more and more parents have concerns and questions about vaccinations and when vaccine-preventable illnesses outbreaks of whooping cough and measles are occurring in our cities and towns.
The truth is that steady funding would save more lives and prevent more illness, but underappreciating prevention is a chronic condition among many policy makers. Surely, the current budget cage-rattling is troubling for public health funding, but even more disturbing is the trend for prevention programs generally. We should think long-term and spend now to save later.
Johnson KA, Sardell A, Richards, B. Federal immunization policy and funding: a history of responding to crises. Am J Prev Med 2000, 19:99-112.
Special thank you to CDC Director Dr. Tom Frieden for speaking at the NHANES and Public Health Data Briefing hosted by The CPH Foundation on Thursday, September 20th. Check out our video of Dr. Frieden and stay tuned for more videos to come soon.
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:
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.
June 28, 2012
FOR IMMEDIATE RELEASE
Contact: Karl B. Moeller
Telephone: (202) 898-9060
Supreme Court Ruling a Positive for Public Health and Prevention
The CPH Foundation is pleased with the Supreme Court’s ruling today,” said The CPH Foundation’s Chairman of the Board Evan Jones. “Because the Supreme Court upheld the Affordable Care Act and its Prevention and Public Health Fund, the federal infrastructure we rely on to protect our health remains intact. Work to combat food-borne outbreaks, chronic illnesses, contagious diseases and vaccine preventable illnesses will continue thanks to this Supreme Court decision.”
“The Supreme Court’s close 5 to 4 decision today averts what would have been a major cut to the Centers for Disease Control and Prevention’s already struggling budget,” added Karl Moeller, The CPH Foundation’s executive director.
Currently, more than twelve percent of the CDC’s core program budget is derived from a prevention-focused fund passed as part of the Affordable Care Act. This funding source would have disappeared had the Supreme Court overturned the law, creating an $800 to $900 million shortfall.
Many challenges still lay ahead. In addition to those who still wish to work for a full repeal of the law, the possibility of sequestration faces legislators this January and could result in a $500 million cut to the CDC. Also, some in Washington have argued that many prevention programs are duplicative if all Americans have access to health insurance.
“The huge needs met by vaccination, cancer screening or other public health programs won’t disappear with broader health insurance coverage. Some have proposed dismantling these efforts as a way to cut costs,” Moeller said. “Ending programs that save lives is hardly a good way to save money.”
Yet another challenge to our health infrastructure remains. State and local health departments, facing tight municipal budgets, have lost more than 52,000 health department employees in the past two years.
“Today was a victory in our ongoing effort to make public health and prevention a higher priority,” Jones said. “There is much more to do.”
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: