Preventive Health Efforts Could Be Hindered by Proposed Budget
Proposed cuts to the Centers for Disease Control and Prevention (CDC) Prevention Fund and other grant programs in President Barack Obama’s fiscal year 2013 budget have state and local advocates concerned that the administration is undercutting communities’ ability to address their population’s health needs.
Proposed cuts to the Centers for Disease Control and Prevention (CDC) Prevention and Public Health Fund and other grant programs in President Barack Obama’s fiscal year 2013 budget have public health advocates concerned that the administration is undercutting communities’ ability to address their population’s health needs.
Overall, the CDC’s budget would decrease by $664 million in 2013 to $5.1 billion, the largest cut for any division within the U.S. Department of Health and Human Services. The Prevention and Public Health Fund, established under the Affordable Care Act (ACA) to fund a litany of preventive efforts, is funded at near-full capacity ($903 million) for 2013. But, the president recommended cutting the fund by $4 billion over the next 10 years.
Grants dependent on Prevention and Public Health Funds could be cut. Obama's proposed budget suggests slashing Community Transformation Grants (a flexible stream for states and localities to prevent and improve the outcomes of chronic ailments) by $80 million, from $226 million to $146 million. The White House justified the cuts by saying that the $146 million would be enough to fund all continuing and new grants.
Policy analysts are skeptical that enough money is available to address expensive chronic ailments at the local level. “Without solid prevention, we aren’t going to keep costs under control,” Paul Jarris, executive director of the Association of State and Territorial Health Officials, told Governing. “We have to make the case that this is good health policy and good fiscal policy.”
Under Obama’s proposed budget -- which is unlikely to be passed by Congress as written, but still sets a policy precedent for later discussions about spending priorities -- the $79 million Preventive Health and Health Services Block Grant would be completely eliminated. The administration said the block grant’s goals would be addressed by other programs, including the Community Transformation Grants that are already subject to cuts.
“We are underinvesting in an area that can produce immense dividends,” said Georges Benjamin, executive director of the American Public Health Association (APHA), in an interview. "These are cuts to local communities at a time when we're seeing programs fall like dominoes. There is real pain on the local level."
The State and Local Preparedness and Response Capability fund would also take a hit, $16 million, down to $642 million, the second consecutive year of reductions. A December 2011 report by Trust for America's Health (TFAH), a non-partisan advocacy group, detailed the already-decreasing capacity of states and localities to confront health emergencies because of previous CDC cuts. That trend "scares me in terms of our ability to react to a public health emergency," Benjamin said.
Taken together, health advocates say the administration’s proposals would seriously hinder the ability of state and localities to handle the general growth in chronic illnesses as well as major health crises. The reductions were criticized by groups such as the APHA and TFAH in their official responses to the budget.
"Cutting prevention funding is foolish," Richard Hamburg, deputy director of TFAH, told Governing. "Increased investment in prevention in the long term is going to lead to a healthier population. This budget is counterintuitive to the idea of investing in community health."
While recognizing the concerns of those groups, Joy Wilson, health policy director for the National Conference of State Legislatures (NCSL), said in an interview that reductions in discretionary spending are simply a reality given the current fiscal and political environment. "Funding increases and new programs are going to be hard to come by," she said.
Wilson also said the White House likely assumed that, because more people will be covered by insurance under the ACA and that coverage will be required to include preventive services, there would be a decreased need for the supplemental funding from the programs that would be cut under Obama's proposed budget.