House and Senate Committee Action on the FY 2017 Appropriations Supports ASPPH’s Priorities
The October 2016 budget agreement between the Administration and Congress established fiscal year 2017 spending limits, which most observers thought would simplify enactment of the twelve FY 2017 spending bills. The enacted agreement provided a $30 billion increase in domestic discretionary spending in FY 2017 over the level set by the Budget Control Act of 2011. However, House Freedom Caucus (aka Tea Party) members resurrected their objections to the increase and have successfully blocked consideration of an FY 2017 budget resolution.
With no budget resolution in hand, the House and Senate Appropriations Committees on April 15 started considering appropriations bills, using the budget agreement allocations as a base, even in the absence of a budget resolution. As of July 15, none of the twelve fiscal year 2017 appropriations bills has been enacted. However, both the House and Senate Appropriations Committees have approved all of their bills.
The Senate Appropriations Committee approved the FY 2017 Labor-HHS-Education bill (S. 3040; Senate Report 114-274) on June 9. The House Appropriations Committee approved their version on July 13 (draft bill, report, and amendments). The bills are not expected to go to the House or Senate floor, but rather serve as the basis of negotiations during a “lame duck session” conference committee after the presidential elections. Between the start of FY 2017 on October 1 and the election, a continuing resolution is expected to allow federal agencies to continue operating.
The Senate committee’s bill allocates $161.9 billion in discretionary spending, $270 million below the FY 2016 level. It is the first bipartisan Labor-HHS bill to clear the subcommittee and committee in seven years. The bill includes no “poison pill riders.” The bill includes a $2B increase for NIH (+6.3%), a $118M decrease for the CDC (-1.6%), a $32M decrease for HRSA (-0.5%) and a $10M decrease for AHRQ (-3.0%).
The House committee’s bill allocates $163.1 billion in discretionary spending. The bill contains numerous “poison pill riders” and received no Democratic support at the subcommittee or full committee level. The bill includes a $1.25B increase for NIH (+3.9%), a $605M increase for the CDC (+8.4%), a $218.5M decrease for HRSA (-3.4%) and a $53.7M decrease for AHRQ (-16.1%).
Within the CDC appropriation, both the House and the Senate Committees provide $25.461M for the Prevention Research Centers, the same amount the program received in FY 2015 and FY 2016 and the amount recommended by the President. The Senate did not fund the Academic Centers for Public Health Preparedness in FY 2017, but the House provided $9M. The Administration also did not propose funding for the program. The Senate bill level funds both the NIOSH Education and Research Centers and the NIOSH Agriculture, Forestry, and Fishing (AFF), but the House increased both programs by $1M. The Education and Research Centers receives $28.5M in funding in the Senate and $29.5M in the House. The AFF program received $25M in the Senate and $26 million in the House. The Administration had proposed not to fund the two center programs. Within HRSA, both the House and the Senate Committees approved the President’s request of $17M for the Public Health Workforce budget line in FY 2017, compared to the $21M enacted in FY 2016. Of that amount, the Senate panel said that the funds should be allocated as requested by the Administration: $9.864M for the Public Health Training Centers, the same amount the program received in FY 2016. The House did not express its intent, but the same division of funds is expected. The Administration proposed consolidating the Preventive Medicine and Integrative Medicine residency programs and to fund them at $7.136M in FY 2017, down $4 million from last year’s level. The Senate panel explicitly accepted that recommendation.
A detailed table of ASPPH’s legislative priorities in the bill is available online.
Zika Supplemental Funding Request Stalled
In February, President Obama asked Congress to provide $1.9B in emergency supplemental funding to address the Zika virus threat. Members of the House Tea Party immediately called for the funding to either be transferred from funds targeted for Ebola activities or be allocated from other budget cuts. After months of wrangling, the Senate on May 17 approved $1.1B in emergency spending with no offsets (amendment 3900). The House subsequently approved $622M in funding (H.R. 5243), but did not classify it as emergency spending. Instead, it cut Ebola and other HHS spending to fund the bill. Both provisions were eventually included in the FY 2017 Military Construction-VA appropriations bill, traditionally the first and easiest of the appropriations bill to clear Congress.
In late June, House and Senate Republicans announced they had reached agreement on $1.1B in Zika funding (House Report 114-640), with $750M in funding offsets. House and Senate Democrats were excluded from the negotiations. The GOP members of the conference committee included three “poison bill” riders in the bill: a prohibition on Planned Parenthood family planning spending, a provision waiving EPA regulations on pesticide use, and a provision reinstating authority for VA cemeteries to fly the Confederate flag. As a result of the riders, Senate Democrats blocked the bill (52-48) on June 28 and by vote of 52-44 on July 14. Sixty votes were necessary under the procedural votes. The conference agreement passed (239-171) in the House on June 23 with almost no Democratic support. With Congress now in recess until after Labor Day, the funding stalemate will continue into the fall campaign season.
On April 4, the National Cancer Institute announced a Blue Ribbon Panel of scientific experts, cancer leaders, and patient advocates “that will inform the scientific direction and goals at NCI of Vice President Joe Biden’s National Cancer Moonshot Initiative.” The panel will serve as a working group of the presidentially-appointed National Cancer Advisory Board (NCAB) and will provide scientific guidance from thought-leaders in the cancer community.” Barbara Rimer (UNC), Alumni Distinguished Professor and Dean, University of North Carolina Gillings School of Global Public Health, was named to this important panel. A former top official at NCI, Barbara Rimer is the current chair of the President’s Cancer Panel. The Blue Ribbon Panel is expected to report in August, based on their posted timeline. Meanwhile, the chairs of both the House and Senate Labor-HHS-Education Appropriations Subcommittees have announced that they will not dedicate funds in the fiscal year 2017 appropriations bill for the Moonshot Initiative.
In a letter to Vice President Biden and Congressional leaders on March 21, more than 70 deans and directors of schools and programs of public health expressed concern that the Cancer Moonshot initiative “may be undervaluing the vital role that public health and prevention have played — and must continue to play — in reducing cancer incidence and mortality.” The academic public health leaders wrote, “We urge you to pay careful attention to the balance between treatment and prevention-related investments. The development of new and innovative therapeutic cancer interventions is vital, but history has shown that the greatest impact in reducing cancer mortality rates has come from preventing cancers. While curative treatments often appear more exciting to the public, investments in public health and prevention research hold even more promise for both short- and long-term reductions in cancer incidence and mortality rates. Developing cancer cures is essential, but controlling cancer is also a policy and public health challenge. We must operate on both fronts.”
The letter, organized by ASPPH, concluded, “Investments in public health and cancer prevention can make an enormous impact on reducing cancer incidence and mortality and should be a priority of the Cancer Moonshot initiative.” The letter was subsequently published in Lancet Oncology.