Public Health Groups Predict $1B Drop in Federal Support Under Trump

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By Alex Ruoff

Public health agencies are bracing for the largest drop in federal funding in more than a decade, potentially killing programs meant to stymie disease outbreaks and reduce health costs nationwide, local health officials told Bloomberg BNA.

Republicans’ Obamacare repeal bill, coupled with requested cuts to domestic spending from the Trump administration, would likely slash more than $1 billion per year from state programs that ensure access to vaccines for poor children and flag disease outbreaks. These cuts, which would start in fiscal year 2018, could be as high as $2 billion per year, potentially forcing states to trim programs or divert local funds.

“We’ve very, very concerned where anyone could find a billion dollars to make up for these funds,” Michael Fraser, executive director of the Association of State and Territorial Health Officials, told Bloomberg BNA May 9.

Cuts to public health program would prove costly in the long run, Fraser said. Many of these programs are designed to prevent expensive chronic diseases, such as obesity and diabetes.

Some public health groups are optimistic that congressional appropriators will continue to fund the HHS and fill the gaps created by repealing the Affordable Care Act.

Prevention Fund Cut

The House-passed Obamacare repeal bill (H.R. 1628) would halt the majority of funding for the Prevention and Public Health Fund, a $10 billion fund created by the ACA that added $324 million to vaccine programs in 2016 and more than $160 million to states in preventive health grants.

Republicans have derided much of the money as a slush fund set up by the Obama administration because it’s not subject to the annual appropriations process. Some complained that programs created under the fund have included urban gardening and massage therapy.

The fund is slated to give nearly $1 billion per year until 2023 to state and local public health programs through the Centers for Disease Control and Prevention, according to federal budget documents. The fund represents 12 percent of the agency’s total program budget.

Additionally, the Trump administration has requested cutting the Department of Health and Human Services budget, which includes the CDC, by nearly 18 percent in fiscal year 2018. These cuts would be likely to continue in coming years.

Just under half of all states have cut funding for public health programs in recent years and have grown largely dependent on the federal government to maintain their disease surveillance and prevention programs, according to the Trust for America’s Health, which monitors public health spending. In 2016, 24 states cut public health funding, according to TFAH.

Some public health funds will be maintained in coming years, although little will go to state health programs.

In passing the 21st Century Cures Act, a 2016 medical innovations bill, lawmakers committed $3.5 billion from the fund to expand funding for the National Institutes of Health and the Food and Drug Administration. A Republican aide told Bloomberg BNA the entire $3.5 billion has already been committed for Cures provisions and won’t be affected by the repeal bill.

Cutting Programs

State public health officials are bracing for budget cuts next year and in 2019, looking at programs that can be scaled back or stopped. States that depend heavily on the federal government may be forced to make major changes.

In Alaska, which receives the highest per-person federal contribution of any state, public health officials are facing slumping state budgets as well, Jay Butler, director of public health for Alaska, told Bloomberg BNA. This could force the state to halt many of its prevention programs, putting added costs onto health-care providers and hospitals, he said.

“We’re putting a lot of money into these downstream programs, dealing with people with health issues,” Butler said. “We’re talking about cutting funding to deal with these costs upstream, when we can spend less.”

Roughly $4.4 million of the state’s $88 million public health budget came from the CDC’s Prevention and Public Health Fund in 2016, according to state budget figures.

Some public health groups expect Congress to fill the gaps created by ending the prevention fund. Rich Hamburg, chief operating officer of TFAH, told Bloomberg BNA that many public health programs enjoy widespread support among lawmakers.

Hamburg pointed out that, despite a request from President Donald Trump to slash the agency’s budget for 2017, Congress approved a slight funding boost for the HHS.

“I can’t imagine these programs don’t have support,” he said.

To contact the reporter on this story: Alex Ruoff in Washington at aruoff@bna.com

To contact the editor responsible for this story: Brian Broderick at bbroderick@bna.com

Copyright © 2017 The Bureau of National Affairs, Inc. All Rights Reserved.

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