Trump budget slashes public health programs

Public health officials caution that President Donald Trump's most recent budget proposal would leave the nation vulnerable to disease outbreaks or unable to adequately respond to emergencies for years.

"We're going to have a disaster, and no one is going to be able to respond," said Dr. Georges Benjamin, executive director of the American Public Health Association.

The president's proposed fiscal 2018 budget would reduce federal spending by $3.6 trillion over 10 years, including billions from various health agencies. In some instances, the administration aims to not only generate significant savings to the federal budget, but shift more responsibility to the states.

Agencies slated to receive the most significant cuts include the Centers for Disease Control and Prevention, whose budget would be reduced by $1.3 billion, or 17%, over 2017 funding levels.

Hardest hit would be the CDC's Chronic Disease Prevention and Promotion program, which would lose $222 million. The agency's National Center for HIV/AIDS, Viral Hepatitis, STIs and TB Prevention program, which has an annual budget of approximately $1 billion, would lose $186 million over the next year if the Trump budget is enacted.

The administration argued that cutting the disease prevention and promotion budget will allow CDC to focus on "programs that implement evidence-based strategies and improve results across a variety of health outcomes." The budget document also suggested that block grants will allow states to do targeted interventions.

Trump's budget leaves in a proposal to create a federal emergency fund designed to rapidly respond to public health crises, which was included in a blueprint released in March. Public health experts have called for creating such a fund in order to speed the release of resources during a public health emergency. But the budget proposal does not dedicate any money toward the fund, instead stating that HHS could transfer "up to one percent of any HHS account, without any limitation on the total," to respond to an emergency.

"You have a savings account for emergencies, but there's no money in it?" Benjamin said.

Cuts also include $136 million from the CDC's Office of Public Health Preparedness and Response, which coordinates local and state responders during disasters and provides training and resources to help those entities maintain their emergency preparedness.

"I fear that if these cuts went through, we would not have the public health capacity to respond to a terrible tragedy like the one we saw in Manchester (England) as effectively as we would have liked," Benjamin said, referring the bombing Monday evening that had killed as many as 22 people as of Tuesday afternoon.

Among the other programs that would be cut under the Trump budget include $65 million from the National Center for Emerging and Zoonotic Infectious Diseases, which is tasked to prevent foodborne illnesses, vector-borne diseases, such as Zika, and hospital-acquired infections, such as pathogens that are resistant to antibiotics.

Antimicrobial resistance has been a growing concern among health officials over the past decade as the number of such pathogens has increased while the supply of antibiotics able to effectively treat such infections has dwindled. The problem cuts across the jurisdiction of several agencies, including the Food and Drug Administration and the National Institutes of Health, both of which would see decreases in funding under Trump's budget.

"New cuts in that area would have the effect of impairing the agencies' ability to carry out the programs that they developed," said Allan Coukell, senior director of health programs at the Pew Charitable Trusts.

The budget proposal seeks to soften some of the blow of the proposed cuts by shifting funding from the Prevention and Public Health Fund, which makes up about 12% of the CDC's total budget. But that's only if the fund continues to exist. Created by the Affordable Care Act, the fund is in jeopardy of being eliminated under congressional health reform efforts. If the fund goes away, then it is unclear where money to offset the proposed cuts would come from, or how states and local public health departments would make up the more than $620 million they receive annually from that fund.

"In essence, the proposed budget would force CDC to fight epidemics and health threats with both hands tied behind their back while wearing a blindfold," John Auerbach, president and CEO of Trust for America's Health, said in a written statement. "From Ebola to Zika to opioid misuse to diabetes to heart disease, the CDC is on the front lines keeping Americans healthy."

Critics say the budget cuts funding in some areas while proposing to add money to address the same problem in other areas, resulting in a zero-sum effect.

In terms of the opioid epidemic, the administration proposed more than $27 billion toward drug control policy, including increasing funding for treatment by 2% over the fiscal 2017 continuing resolution level. However, the budget of the Substance Abuse and Mental Health Services Administration is slated to be cut by $400 million next year, including $116 million from SAMHSA's Community Mental Health Services Block Grant program and $73 million less for substance abuse prevention efforts.

All of that is on top of more than $610 billion in Medicaid cuts the budget proposes over the next 10 years and additional cuts proposed in the House GOP's American Health Care Act, which would result in the loss of coverage and access to substance abuse treatment for millions.

The proposed cuts come as the CDC is operating with close to 700 vacancies and the approach of summer brings the threat of an outbreak of Zika, which causes birth defects in children of infected mothers.

"It's a pretty devastating budget," Benjamin said. "The coherence of this budget doesn't make sense."