What Would the President's Proposed Budget do to AZ Public Health?

Last week the President released the Executive Branch's FY18 proposed budget... called“A New Foundation for American Greatness.” The proposal outlines the administration’s funding priorities for the upcoming fiscal year... but it's Congress that has the authority to actually set the budget.  

In a nutshell, the President's budget requests an additional $54B in military spending next federal fiscal year (about a 9% increase) and proposes paying for the increase with cuts to other domestic discretionary programs (including core public health programs) by the same amount ($54B). 

Obviously, if it were to be enacted by congress as proposed, it would mean pretty substantial reductions in public health spending at the national, state and local level as the cuts would significantly impact public health grant funds to state (and local) health departments here in Arizona. 

Below is a breakdown of the proposed cuts to the CDC & HRSA and here's a link to the President's proposed budget:

https://www.whitehouse.gov/sites/whitehouse.gov/files/omb/budget/fy2018/budget.pdf 

Centers for Disease Control & Prevention

The executive budget proposes cutting the CDC's budget by 17% (from $7.2B to $5.9B) with large specific cuts to several programs.  I've broken down the proposal by public health service category below.

Chronic Disease Prevention and Health Promotion

The proposal completely eliminates several line items in the CDC's budget including:

  • tobacco prevention and cessation ($204M cut);
  • nutrition, physical activity and obesity ($50M cut);
  • heart disease ($103M cut);
  • diabetes ($140M cut); and many other line items.

The proposed budget reduces the CDC's Immunization and Respiratory Disease program by 10%; from the current $782M to $701M.

The proposal calls for cut by 17% funding for HIV/AIDS, Viral Hepatitis, STIs and TB Prevention programs; from the current $1.1B to $934M. In addition, the budget calls for decreases HIV/AIDS Prevention and Research Program by $147M.

A cut of 11% is proposed for Emerging and Zoonic Infectious Diseases; going from $579M to $514M.

The Executive budget completely eliminates the Preventive Health and Health Services Block Grant. Arizona currently over $1.85 million in FY16 from this Block grant, which allows AZ to address our unique public health needs in innovative and locally defined ways.

The budget does propose the creation of a $500M fund called the America’s Health Block Grant to provide flexibility for each state to implement specific interventions to address its population’s unique public health issues. States could theoretically use this funding to support interventions such as tobacco prevention and control; diabetes; heart disease and stroke; nutrition, physical activity and obesity and arthritis.  However, this new Block Grant is slated to be funded via the Prevention and Public Health Fund, which is completely eliminated by the American Health Care Act as passed by the House of Representatives.

Birth Defects, Developmental Disabilities, Disability and Health

The proposed budget eliminates 18 current categorical programs in the birth defects center and directs the CDC to focus its birth defects and developmental disabilities portfolio on core public health activities that "align with CDC’s mission and have proven interventions to make an impact on America’s health.”  It calls for 26% cut to the total programs in this category going down from the $135M to $100M.

Public Health Scientific Services are slated to be cut by $30M to $460M from the current $491M; Occupational Safety and Health is slated for a dramatic 41% cut to $200M from the current $338M.  Public Health Preparedness and Response is slated for a 9% cut ($136M), bringing preparedness funding down to $1.2B including a cut of $107M to the Public Health Emergency Preparedness Cooperative Agreement.

Environmental Health

The budget proposes eliminating the Amyotrophic Lateral Sclerosis Registry and reducing the Environmental and Health Outcome Tracking Network by $9M.  Environmental programs are slated to be cut to $157M, a decrease of $59 million from the current $217M.    

Injury Prevention and Control

Eliminates the elderly falls program and the injury research control centers. It does plan for level funds for opioid abuse and overdose prevention at $74M but cuts total injury prevention by 8% going from to $216 million from the current $235M.

Health Resources & Services Administration (HRSA)              

The executive budget proposes cutting HRSA's budget to $5.5B from the current $6.15B with large specific cuts to several programs among rural health and primary care.  I've broken down the proposal by public health service category below.

Primary Health Care

The budget proposes the elimination of HRSA primary care programs for area health education centers; training diversity; training in primary care medicine; oral health training; public health and preventive medicine programs and other workforce programs.

HRSA workforce programs would be cut by 33% from $1.15B to $771M. I couldn't tell from the line item whether this represents the match funding for state loan repayment programs for primary care incentives in rural areas or not.

Overall, this category of the HRSA budget would be $5B. There are proposed increases in mandatory funding for Community Health Centers by $89M.

Rural Health

The proposed budget eliminates the rural hospital flexibility (FLEX) grants and the state offices of rural health grants (like our Arizona Center for Rural Health). The Rural Hospital Flexibility Grants and State Offices of Rural Health are discontinued "to prioritize programs that provide direct services". 

The total HRSA rural health budget would be cut by 50% with whatever funding remaining targeted toward the Rural Health Outreach Network and Quality Improvement Grants, Rural Health Policy Development, and Telehealth.

Maternal and Child Health Bureau

The proposed budget envisions cutting this Bureau within HRSA by $35M to $1.2B. It increases funding for the Title V Maternal and Child Health Block Grant by $30M and increases funding for the Healthy Start program by $10M but eliminates the sickle cell demonstration program; autism and other developmental disorders; heritable disorders; universal newborn hearing screening and emergency medical services for children.

Ryan White HIV/AIDS Program is slated for a $59M cut from the current $2.3B; eliminating the AIDS Education and Training Centers Part F and the "special projects of national significance"

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Remember, these proposed FFY 18 budget cuts by the President are just that, proposed.  Congress is the branch of government that's authorized to set spending levels, so it'll be important for us to continue to follow the budget conversations over the coming months and add our voices to others that will be advocating for the protection of important public health programs.

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