Public health advocates say federal budget deal undermines preventive medicine

The sweeping budget deal passed by Congress early Friday morning gave public health programs a slight bump but advocates remain concerned about some long-term efforts that remain woefully underfunded.

The continuing resolution that funds the government until March 23 provides more than $7 billion for community health centers over the next two years. It's been more than four months since the Community Health Center Fund, which makes up nearly one-fifth of annual revenues for more than 1,400 community health centers across the country and accounts for more than 70% of all federal grant funding centers receive, expired on Oct. 1.

The fund previously has enjoyed bipartisan support. But efforts to repeal the Affordable Care Act placed refunding community health centers on the backburner. In December, Congress allocated $550 million in short-term funding to last until the end of March, but the uncertainty of future funding led many providers to cut services and staff.

One program that has long been the target of Republican lawmakers and yet was not eliminated in the resolution was the ACA's Prevention and Public Health Fund.

A budget proposed by the House and revealed earlier this week called for a $2.85 billion cut to the fund over the next 10 years. The Prevention Fund makes up 12% of the Centers for Disease Control and Prevention's budget and pays for initiatives such as providing immunizations for low-income children.

The agreement that passed on Friday slashes $1.35 billion from the fund over 10 years, but those cuts won't start for a few years.

"That may create an opportunity for it to be restored before we get there," said John Auerbach, president and CEO of Trust for America's Health.

Auerbach and other public health advocates said this continuing resolution once again sacrificed preventive efforts over current public health issues.

The CR had $90 billion to aid recovery efforts in Puerto Rico, Texas, Florida and California, which were all hit by natural disasters. A total of $6 billion over the next two years will go toward funding opioid prevention and treatment programs, "law enforcement activities" related to substance and mental health programs, as well as an additional $2 billion over that same period to fund opioid research by the National Institutes of Health.

That doesn't nearly equal the $32 billion a year spent to combat HIV/AIDS, of which, 62% is discretionary spending.

"What we are looking for is new, sustained funding that directly to local jurisdictions that are the hardest hit like Baltimore," said Dr. Leana Wen, Baltimore City public health commissioner. "We have to take into account not only the cost of treatment but the cost of doing nothing."

Other provisions include a five-year extension to the Maternal, Infant and Early Childhood Home Visiting Program, which provided maternal health support to 160,000 families in 2016 to help low-income mothers with their at-risk pregnancies.

The bill includes $310 million for each of the next two years to fund the National Health Service Corps., which offers scholarships and loans to clinicians for providing primary health services to underserved communities. A total of more than $250 million over two years has been allocated for the Teaching Health Center Graduate Medical Education program, a medical residency training program based in community care settings, such as community health centers.

"We are frustrated that Congress continues to see the value of funding healthcare, but doesn't necessarily see the value of funding prevention and public health," said Laura Hanen, interim executive director and chief of government affairs for the National Association of City and County Health Officials.