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Testimony

Statement to Senate Labor-HHS-Education Appropriations Subcommittee on FY 2003 Funding Recommendations for the U.S. Public Health Service Agencies and Programs

April 15, 2002

Coalition for Health Funding Submitted Testimony
Subcommittee on Labor, Health and Human Services and Education Appropriations
U.S. Public Health Service Agencies

"We are a Nation at risk. We face a world of new threats and ancient foes."
Centers for Disease Control and Prevention, Public Health's Infrastructure: Every health department fully prepared; every community better protected.
Report to Congress, March, 2001

The Coalition for Health Funding is pleased to provide the Subcommittee with testimony recommending FY 2003 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 9/11, 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. The events also have dramatically demonstrated the extent to which the nation's public health infrastructure has been allowed to deteriorate. The Coalition for Health Funding applauds the extraordinary Congressional response to this serious deficit and supports the President's FY 2003 request for continued public health infrastructure enhancement.

But while government agencies at the local, state and federal levels have a leading role in preparing for and responding to the terrorist challenge, all aspects of our health and public health system are critical to the success of this effort. It is relatively easy to understand the importance of strengthening the ability of local, state and federal public health agencies' ability to detect and respond rapidly to a deliberately released infectious agent, such as anthrax or smallpox. The importance of addressing racial and ethnic health disparities and access to essential medical care services in the context of the threat of bioterrorism may seem less clear - but populations at higher risk for both chronic diseases and naturally occurring infectious diseases and with less access to health care services are both more vulnerable to deliberately introduced diseases and less visible to the health care system when hours count. Similarly, it may be easy to understand the need to train more public health professionals, such as epidemiologists and public health lab technicians, to prepare and respond to terrorism. But who will take care of those who fall ill, or who need emergency vaccinations, or preventive medicines when we are facing serious shortages in the number of nurses, pharmacists, and allied health professionals? These and many other activities supported by the PHS agencies and programs, such as vaccine research conducted at the National Institutes of Health, medical errors research conducted at the Agency for Healthcare Research and Quality, and food and drug safety review conducted by the Food and Drug Administration, are clearly related to bioterrorism preparedness and response and need strong support. At the same time, even those activities that cannot be linked to bioterrorism, such as preventing birth defects, heart disease, or HIV/AIDS, are essential in our preparedness efforts because a healthy America is a strong America.

The whole continuum of public health activity must be strongly supported to achieve both optimal terrorism preparedness and optimal health outcomes for the American people.

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 '03, the Coalition is recommending $51.7 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 and the Food and Drug Administration, which are not within the jurisdiction of this Subcommittee, but are important federal public health agencies. The Coalition appreciates that these funding levels, 15.7 percent over FY '02, and $4.5 billion (9.5 percent) over the President's request, may appear excessive, but they reflect both the professional judgment within the various agencies as well as our own members' assessment of community and national needs. The Coalition presents these recommendations 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 and quality of life for all Americans.

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 the President's request for $27.3 billion in FY 2003 for the National Institutes of Health and applauds the Members of the Subcommittee for leading the national effort to double our investment in the promising research supported and conducted by the NIH. The Coalition recognizes that the doubling goal has been, and continues to be, difficult to achieve in the context of many unmet health care needs, and that improved health outcomes are only achieved with the translation of NIH research discoveries into practice. This is effectively achieved, for all Americans, through a strong investment in other federal public health agencies and, in turn, state and local health agencies and community-based programs. Therefore, the Coalition cautions that the increase for NIH in FY 2003 must not come at the expense of other public health programs.

The primary reasons for a continued major investment in the NIH include the many health challenges that still confront us, the burgeoning scientific opportunities that are now available, particularly as a result of the scientific achievement of sequencing the human genome, and the large economic benefits that accrue as we make progress against diseases. Recent NIH investments have helped create new diagnostic methods, new treatments, new vaccines, and new cures. Just a few of these examples include Hepatitis B, Haemophilus influenzae Type B, pneumococcus and pertusis vaccines with the potential to save millions; the development and FDA approval of Gleevac for use in treating chronic myelogenous leukemia; and newly developed medications for schizophrenia that have reduced hospitalizations by 30 percent and saved $1.7 billion in annual hospital costs.

The Coalition also appreciates that medical research is a vision not a precise blueprint. It must be flexible enough to respond to society's changing health care needs and dynamic enough to open the way to ever more promising frontiers of fundamental research. 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 $7.9 billion for CDC in FY 2003. This amount is $1.1 billion more than the FY 2002 funding level. The Coalition believes this is the amount needed to enable CDC to carry out its vital mission of disease prevention and health promotion.

The Coalition is extremely pleased that Congress provided $2.3 billion in FY '02 to the CDC to continue, and greatly enhance, the process of re-building the nation's seriously eroded public health infrastructure in order to prepare for bioterrorism and other terrorism threats. The Coalition supports the President's FY 2003 request to provide $1.636 billion for public health infrastructure and bioterrorism preparedness, including $940 million for state and local health departments. The Coalition further recognizes that this level of funding will need to continue for the foreseeable future to truly re-build our public health system at the local, state and federal level.

There are many other aspects of the President's budget request for the CDC, however, that are troubling. While nearly 60 new FTE's are requested for bioterrorism activities, approximately 150 other FTE's are proposed for elimination. CDC is a critical agency for many program areas and it is difficult to see how it can carry out its other responsibilities in the areas of infectious disease, immunizations, HIV/AIDS prevention, chronic disease prevention and health promotion, birth defects and developmental disabilities activities, and many other programs, without adequate staff. In addition, apart from bioterrorism activities, the President has proposed an overall cut of 4.1 percent for CDC that affects many of these same program areas. We cannot afford, as a nation, to diminish our investment in the programs that do so much to achieve improved health outcomes by translating knowledge gained through our investment in the NIH. By cutting CDC programs, 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 $7.5 billion for HRSA in FY 2003. This amount is $1 billion more than the FY 2002 funding level and 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 8.5 percent increase for community health centers, although this is short of the amount needed to achieve the President's expressed goal of doubling the number of health centers over five years. The Coalition is also pleased to see increased, and new, funding for hospital planning and infrastructure preparedness for bioterrorism threats, as well as support for health professions school curriculum development for bioterrorism training.

However, there are many 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 its supporters have long known: that it has a solid track record in recruiting and training the kind of health professionals that practice in, and stay in, medically underserved areas; and it has 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, physician assistants, as well as nurses.

The Coalition also opposes a proposed 40 percent cut, or $85 million, to the Children's Hospitals Graduate Medical Education program that trains physicians providing direct care for children in free-standing children's hospitals. Similarly, the Coalition opposes the proposed elimination ($120 million) of the Community Access Program designed to help communities address the still massive numbers, over 40 million, of uninsured Americans. When bioterrorism increases are set aside, the President proposes to cut existing HRSA programs by $740 million, or 12 percent.

Also disturbing is the proposed level funding for many other programs. This includes the Ryan White CARE Act programs at time when the U.S. is experiencing an increase in the number of new HIV/AIDS cases. Flat funding is proposed for the Maternal and Child Health Block Grant at a time when many states are facing budget deficits, and 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.

Substance Abuse and Mental Health Services Administration

The Coalition for Health Funding recommends an overall funding level of $3.6 billion for SAMHSA in FY 2003. This amount is $500 million more than the FY 2002 funding level and is the amount that the Coalition believes is needed to provide adequate resources for the agency charged with leading national systems addressing mental illness and substance abuse. Within this amount, the Coalition recommends $952 million for the Center for Mental Health Services (CMHS); $2 billion for the Substance Abuse Block Grant; $360 million for the Center for Substance Abuse Treatment (CSAT) and $360 million for the Center for Substance Abuse Prevention (CSAP).

While the Coalition appreciates the President's request for an additional $66 million for CSAT, as only 20 percent of the 13-16 million people needing treatment services are currently receiving care, this comes at the expense of substance abuse prevention programs which receive a $45 million cut in the request. 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.

CMHS is level funded in the President's request. This is most unfortunate when over 50 million adults in the U.S. are affected by mental illness in any given year and more than 5 million adults and children are diagnosed each year with a severe mental illness, such as schizophrenia. People can and do recover, but recovery depends on getting services when and where they are needed - preferably early in the course of the illness and close to home. CMHS, working with its state, local and private sector partners, is instituting state-of-the-art systems of care for those who suffer from mental illness.

Finally, mental health and substance abuse problems are just beginning to surface in the wake of the 9/11 terrorist attacks and will intensify as we approach the anniversary of the tragedy. This is not the time to essentially flat-fund the federal agency that provides essential resources to a system of mental health and substance abuse services that the overwhelming majority of those suffering from these illnesses depend on.

Agency for Healthcare Research and Quality

The Coalition for Health Funding recommends an overall funding level of $390 million for AHRQ in FY 2003. This amount is $90 million more than the FY 2002 funding level.

The Coalition is very disappointed in the President's request for a $48 million (16%) cut in this agency which is charged with providing critical information on healthcare quality, ways to reduce medical errors, ways to improve access to healthcare services, and ways to more efficiently utilize healthcare resources. A cut of this magnitude will dramatically curtail AHRQ's ability to carry out its mission. It will, for instance, be unable to fund any new research or training grants and funding for current grants for non-patient safety research will be reduced by 50 percent, reducing our knowledge and understanding of how to provide cost-effective, quality healthcare. 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.

The Coalition sincerely appreciates this opportunity to provide its FY 2003 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.

*Reflects Program Level minus user fees and mandatory spending, but does include Bioterrorism funding from PHSSEF
**Reflects Total Budget Authority
***Reflects Office of Public Health Preparedness and Cybersecurity only

©2008 Coalition for Health Funding