Home

Members

Board of Directors

Testimony

Correspondence

Public Health Continuum

Public Health 101: The leading Challenges
for the U.S. in the Coming Decade

Testimony

Submitted Testimony Senate Subcommittee on Labor, Health and Human Services and Education Appropriations

March 30, 2004

"Health is a primary public good because many aspects of human potential such as employment, social relationships, and political participation are contingent upon it. In view of the value of health to employers, business, communities, and society in general, creating the conditions for people to be healthy should be a shared social goal." Institute of Medecine, 2003. The Future of the Public's Health in the 21st Century (Pre-publication copy.) Washington, D.C.: National Academy Press, p. 2.

The Coalition for Health Funding is pleased to provide the Subcommittee with testimony recommending FY '05 funding levels for the agencies and programs of the U.S. Public Health Service. Since 1970, the Coalition's member organizations, representing 40 million health care professionals, researchers, lay volunteers, patients and families, have been advocating for sufficient resources for PHS agencies and programs to meet the changing health challenges confronting the American people. The Coalition for Health Funding is the nation's oldest, most broadly based alliance focused on the breadth of discretionary health spending. One of the important principles that unites the Coalition's members is that the health needs of the nation's population must be addressed by strong, sustained support for a continuum of activities that includes biomedical, behavioral and health services research; disease prevention and health promotion; health care services for vulnerable and medically underserved populations; ensuring a safe and effective food and drug supply; and education of a health professions workforce in adequate numbers to address the breadth of need.

Since the terrorist attacks of September 11, 2001, and the subsequent anthrax attacks, the public is acutely aware of the role of public health in protecting them from the consequences of terrorism involving biological, chemical, or nuclear agents. While government agencies at the local, state and federal levels have a leading role in preparing for and responding to this challenge, all aspects of our health and public health system are critical to the success of this effort.

But the challenges facing us in the public health arena are broader, deeper, and even more complex than the very real challenge of preparing for terrorist attacks involving biological, chemical or radiological agents. The Centers for Medicare and Medicaid Services (CMS) recently reported that health care spending in the United States rose to $1.6 trillion in 2002, up from $1.4 trillion in 2001 and $1.3 trillion in 2000. Health expenditures per person averaged $5,440 in 2002, up from $5,021 in 2001 and $4,670 in 2000. Significant factors driving this increase are the aging of the U.S. population, and the rapid rise in chronic diseases, many caused or exacerbated by obesity, tobacco use or substance abuse, environmental exposures, or injury. Nearly 125 million Americans are living with one or more chronic conditions, like heart disease, cancer, diabetes, kidney disease, arthritis, asthma, mental illness and Alzheimer's Disease. At the same time, our increasingly global economy exposes the population to a panoply of continuing and emerging infectious disease threats, some of which are becoming increasingly resistant to drugs designed to treat them. All of these health challenges depend on persistent vigilance by a robust health and public health system that is technologically equipped for rapid analysis and communication, and staffed by adequate numbers of well-trained, diverse health and public health professionals and workers. Today, none of these public health needs and challenges is being fully addressed and yet stronger investment in all have the potential for significantly slowing the unsustainable growth in health care expenditures. The Federal government is currently spending approximately $50 billion on public health agencies and programs. This is three percent of all health care spending, according to CMS, and less than ten percent of all Medicare and Medicaid spending. We can and must do better, not only to prepare for terrorist attacks, but because a healthy America is a strong America.

Each year, the Coalition for Health Funding works with other health alliances to determine an appropriate level of federal support for health discretionary programs. For FY '05, the Coalition is recommending
$56.4 billion be provided for the major programs and agencies of the U.S. Public Health Service. The Coalition's recommendation also includes funding for the Indian Health Service, the Food and Drug Administration, and the Agency for Toxic Substances and Disease Registry which are not within the jurisdiction of this Subcommittee, but are important federal public health agencies. The Coalition appreciates that this funding level, which is 12 percent over FY '04 and $5.9 billion over the President's FY '05 request, may appear excessive, but it reflects both the professional judgment within the various agencies as well as our own members' assessment of community and national need. The Coalition presents this overall recommendation, as well as recommendations for the individual public health service agencies, to the Subcommittee in the hope that it will view them as important targets in our efforts to achieve our mutual goal of improving the health, safety, and quality of life for all Americans. On the other hand, the Coalition is very concerned that the President's overall FY '05 request for public health programs provides virtually no increase and does not provide enough funding to maintain the level of current services. Within this constraint, selecting certain programs for increases results, necessarily, in cuts, many severe, for other public health programs.

This makes no sense as the nation faces the challenges of an aging population with increasing rates of chronic diseases, an aging healthcare workforce already in short supply, the need to prepare for a range of terrorist threats, a global economy that brings a host of infectious diseases to our doorstep, and growing numbers of Americans who do not have access to basic healthcare services. We should be investing in the prevention and mitigation of diseases and disabling conditions, not divesting. In the end it will cost America more.

The following is a partial list of the Coalition's findings and recommendations; the attached table provides the Coalition's recommendations for all the public health agencies:

National Institutes of Health (NIH)

The Coalition supports $30.6 billion in FY '05 for the National Institutes of Health, a 10 percent increase over the FY '04 funding level, to provide sufficient resources to sustain the momentum of the recently completed campaign to double the nation's investment in the promising research supported and conducted by the NIH. The President's request to provide $28.6 billion, or a 2.6 percent increase over FY '04, is inadequate to fully reap the research opportunities that the doubling campaign have made available. NIH is engaging the next generation of biomedical research to integrate and aggregate basic research, computational capabilities, and clinical evidence into new cures. Transforming America's health for the 21st century will require a longstanding commitment from our country and its leaders. The pace and intensity of this transformation is critical. Health improvements will only be possible if the medical research enterprise runs smoothly. Recent discoveries NIH supported research has made possible include: lifestyle intervention can reduce the onset of Type II diabetes as occurred in 58 percent of those at risk in a recent trial; islet cell transplantation has reduced the need for insulin for 250 individuals with juvenile diabetes; low-cost diuretics are as effective as newer, costlier drugs in lowering high blood pressure that affects one in four Americans, potentially saving money and enhancing compliance; newer antidepressant medications are more targeted to specific brain function resulting in fewer side effects and enhanced compliance; great advances in understanding the genetic factors in Alzheimer's Disease holds promise for treatment for the growing number of Americans afflicted with this devastating disease; new vaccines have been developed against Haemophilus influenzae type b, pneumococcal disease, Hepatitis A and B and a new Ebola vaccine is currently in trial.

Scientific discoveries are the result of a series of incremental steps that pave the way for future breakthroughs. This process needs sustained support. With it, and support for other public health partners, we will be ready to meet the challenges of the future.

Centers for Disease Control and Prevention (CDC)

The Coalition for Health Funding recommends an overall funding level of $8.1 billion for CDC in FY '05. This amount is $1 billion more than the FY '04 funding level and $1.2 billion more the President's request for FY '05. The Coalition believes this is the amount needed to enable CDC to carry out its vital mission of disease prevention and health promotion and reflects CDC's professional judgment. This is more evident than ever with the advent of SARS and avian flu and their worldwide threat to human health.

The Coalition opposes the President's request to cut $105 million from State and Local Preparedness grants and shift the funds to a new biosurveillance initiative. BioSense, the largest aspect of the new initiative, is not developed enough to command new resources and none of the three-part initiative should be funded at the expense of State and Local Preparedness. State and Local health departments are in the second year of expanded funding for terrorism preparedness. The effect of an 11 percent cut will seriously jeopardize momentum in addressing critical capacity needs. Funding should be restored, at least, to FY '04 levels and the commitment to rebuilding the nation's neglected public health infrastructure resumed and sustained.

The Coalition is pleased that the President's budget request increases funding $62 million, 7.3 percent, for chronic diseases, with an emphasis on obesity, diabetes and asthma through Steps for a Healthier US - all conditions which have reached epidemic proportions in the general U.S. population. This is an important investment across the U.S. Public Health Service with CDC as the lead agency. Chronic diseases constitute the nation's most costly health problems accounting for over 70 percent of health care costs. However, the Coalition feels that all aspects of chronic disease, such as heart disease and stroke, kidney disease, cancer, arthritis, tobacco related pulmonary diseases, and oral health, need on-going support and in many instances increased support. Much of the increase for "Steps" comes at the expense of level funding for these other chronic disease programs and particularly through a cut of $30 million (86 percent) for the youth media campaign which has a proven track record in altering health risk behavior of children and adolescents.

The Coalition is also pleased with the $32 million increase, 8.5 percent, for the National Center for Infectious Diseases (NCID). However, most of the increase is committed to global disease detection, a very important investment, but the U.S. is still only partially prepared for diseases such as West Nile virus and pandemic flu, and has not committed funds to combat antimicrobial resistance commensurate with the scope and severity this problem presents in the U.S. The Coalition's overall recommendation for CDC would increase funding for NCID above the President's request to address these issues as well as to continue building epidemiology and public health laboratory capacity in state and local health departments by expanding the Emerging Infections Program from the current 11 States and three localities and strengthening the Epi-Lab Capacity (ELC) Program.

The Coalition is also pleased with the $14.7 million increase (15%) in the President's budget for the National Center for Birth Defects, Developmental Disabilities, Disabilities and Health. Birth defects are the leading cause of infant mortality in the U.S. and the direct and indirect costs associated with disabilities exceeds $300 billion annually. This is a modest, but welcome increase for a series of activities designed to prevent birth defects and to address the needs of those living with disabilities and the families and communities that support them.

The Coalition is also very pleased with the proposed increase in the President's budget for the National Center for Health Statistics (NCHS). Although all of the funding for NCHS is derived from evaluation tap transfers, it is gratifying to see recognition of the importance of national health data to addressing disease prevention, disability services and health promotion.

Finally, the Coalition is, overall, disappointed that most of CDC is level funded in the President's FY 2005 budget request. This includes critical public health programs such as childhood immunization and HIV/AIDS prevention. We cannot afford, as a nation, to diminish our investment in programs that do so much to achieve improved health outcomes, many by translating knowledge gained through our investment in the NIH. By cutting, or flat-funding, CDC programs that prevent disease and disabling conditions, we harm our overall progress toward building a healthy, strong America.

Health Resources and Services Administration (HRSA)

The Coalition for Health Funding recommends an overall funding level of $8 billion for HRSA in FY '05. This amount is $858 million, or 12 percent, more than the FY '04 funding level, and is $1.4 billion more than the President's request. This is the amount that the Coalition believes is needed to provide adequate resources for the important programs that HRSA administers that address access to needed medical and health care services for medically underserved populations.

The Coalition is pleased that the President has requested a significant 13.5 percent increase for Community Health Centers for a total of $1.835 billion. These centers provide basic health care services for those who are medically underserved in both rural and inner city communities across the nation. With the number of uninsured rising, Community Health Centers are more important than ever.

There are many other areas in the HRSA budget that the President proposes to cut deeply that the Coalition opposes. Chief among these is the elimination of the Title VII Health Professions Education programs. These programs are beginning to document formally what their supporters have long known: that they have a solid track record in recruiting and training the kind of health professionals that practice in, and stay in, medically underserved areas; and they have a solid track record in training needed health professionals in short supply. These now include pharmacists, allied health professionals, dentists, a range of public health practitioners, psychologists, and physician assistants. These shortages will become worse as increasing numbers of the nation's healthcare workforce begin to retire and the babyboom generation requires increased care as it ages.

Despite considerable documentation of the nursing shortage crisis, HRSA's nurse training programs are provided a mere $5 million increase in the President's budget request. This does not constitute an investment in addressing future patient care needs.

The Coalition also opposes the near elimination of the Community Access Program, the $90 million cut to a number of rural programs and cuts in the Hospital Preparedness and Trauma-EMS programs. While the just passed Medicare prescription drug bill includes a number of enhancements for Medicare reimbursement for rural hospitals, this is not a reason to eliminate small, targeted programs designed to improve access to health care services in rural areas, such as Rural Access to Emergency Devices. The $39 million cut for hospital preparedness in conjunction with the elimination of the Trauma-EMS program makes no sense when hospitals have only just begun to receive their first year of implementation funding and conventional weapons terrorist attacks are on the rise globally.

Also disturbing is the proposed level funding for many other programs. This includes the Ryan White CARE Act programs when the U.S. is experiencing 40,000 new HIV infections per year. The President's request for Ryan White programs, when compared to FY '04 levels, provides level funding for all titles except for the AIDS Drug Assistance Program which receives a $35 million increase. The Maternal and Child Health Block Grant is a critical safety net program for poor women and special needs children. Flat-funding actually cuts services at a time when there is an upsurge in the number of families needing TANF assistance. Family Planning services, which support 4,600 clinics across the U.S. that provide comprehensive services including screening for cancer, HIV, and other diseases as well as contraception and teen pregnancy prevention, are another critical safety net service that needs increased resources.

Overall, the President proposes to cut existing HRSA programs by $603 million, or over 8 percent, at a time when the combination of severe cuts to many state health budgets and the still sluggish economy is increasing the number of individuals and families turning to federally funded programs for assistance and care.

Substance Abuse and Mental Health Services Administration

The Coalition for Health Funding recommends an overall funding level of $4.1 billion for SAMHSA in FY '05. This amount is $900 million, or 28 percent, more than the FY '04 funding level, and $705 million more than the President's budget request, which includes a 6 percent increase for SAMHSA programs.

The Coalition applauds the President's request for an additional $148 million - the second year he requested a significant increase -- for substance abuse treatment, as only 15-20 percent of the 22 million people needing treatment services are currently receiving care. However, this increased funding is structured as a voucher program that entitles substance abusers to treatment in a variety of settings, including faith-based organizations. The Coalition cautions that substance abusers need the services of credentialed professionals and hopes the new program will encourage access to recognized treatment and also be carefully evaluated. The Coalition notes that while substance abuse treatment is singled out for increases, prevention is slated for a $3 million cut and has been virtually flat-funded in past years. Although treatment saves taxpayers $7 for every $1 invested, prevention can reduce the need for any treatment for many people. Both efforts need increased and sustained resources.

After many years of nearly flat-funding, mental health services receive a very welcome $51 million increase, or 6 percent, in the President's FY 2005 budget request. This increase is provided in response to the findings and recommendations of the President's New Freedom Commission on Mental Health, the first such commission in over 25 years. The commission found that the public mental health system is fragmented and inadequate, and in dire need of transformation. As the nation transitioned from institutionalized care to community-based care over the last few decades, the chronic underfunding of mental health services to be delivered in the community is primarily responsible for this disjointed, disconnected public mental health system. The modest increase in the President's budget will be committed to State demonstration projects to initiate plans to reduce fragmentation for those suffering mental illness across systems such as criminal justice, housing, child welfare and education. However, the Coalition urges that additional funding be provided above the President's request to enable more States to receive planning grants, and to support other critical mental health services within SAMHSA, such as Children's Mental Health Services. Future budgets will need to sustain an increased funding level to permit implementation of State system transformation plans.

Agency for Healthcare Research and Quality

The Coalition for Health Funding recommends an overall funding level of $443 million for AHRQ in FY '05. This amount is $139 million more than the FY '04 funding level, and the President's budget request which provides level funding for the agency.

AHRQ is charged with providing critical information on healthcare quality, developing methods to reduce medical errors, assessing ways to improve access to healthcare services and utilize healthcare resources more efficiently, translating research into practice, and assisting in improving emergency responsiveness. In addition, the recently passed Medicare prescription drug benefit legislation requires the agency to expend $53 million in various new program evaluations. As we move, again, into double-digit medical inflation and face the tremendous challenge of an aging baby-boomer population, the research conducted by AHRQ is more relevant and more needed than ever and needs resources commensurate with its compounding mission.

The Coalition sincerely appreciates this opportunity to provide its FY '05 funding recommendations to the Subcommittee for the agencies and programs of the U.S. Public Health Service. The Coalition's recommendations for all of the public health agencies are provided in the accompanying table. The
Coalition, and its member organizations, look forward to working with the Subcommittee in the weeks ahead to improve the health of all Americans.

Coalition for Health Funding 2005 Recommendations
(In Millions of Dollars)

*Reflects Total Budget Authority
** Reflects Total Program Level (current law)

©2008 Coalition for Health Funding