Fiscal Year 2016 Appropriations Summary
For the first time in six years, the House and Senate Appropriations Committees have passed bills appropriating funds for the Departments of Labor, Health and Human Services and Education. The fiscal year 2016 spending bills are each $3.6 billion below last year’s enacted bill and $14.5 billion below the President’s request. During the committee mark-ups, appropriators of both parties called for a new budget deal that lifts the current budget spending caps. It is unlikely that the bills will be considered by the full House or Senate. Eventually, a conference committee will try to reconcile the two bills, with or without a new spending agreement.
National Institutes of Health
FY 2016 House $31.184B (+$1.1B)
FY 2016 Senate $32.184B (+$2.1B)
FY 2016 Request $31.084B (+$1B)
FY 2015 Enacted $30.084B
The Association supports the FY 2016 recommendation of the Ad Hoc Group for Medical Research Funding of $32 billion for the NIH. The Association also is seeking an appropriation of $12.91 million for the NIH Office of Disease Prevention (ODP), a $3 million increase over the Administration’s request. Although the Senate version of the appropriation’s bill provides NIH with more than our request, maintaining that level of funding in the conference committee negotiations will be difficult. Neither the House of the Senate versions of the bill allocate funds for the ODP.
Centers for Disease Control and Prevention
FY 2016 House $7.010B (+$140M)
FY 2016 Senate $6.655B (-$215M)
FY 2016 Request $7.010B (+$140M)
FY 2015 Enacted $6.870B
The Association supports the FY 2016 recommendation of the CDC Coalition of $7.8 billion.
Prevention Research Centers (PRCs): The House provides $24 million (-$1.46 million) and the Senate provides $25.461 million, the same level as in FY 2015. The Association is seeking $32 million for the program. The House report asks the Government Accountability Office to review the PRC Special Interest Projects (SIPs). The Committee said “it remains concerned that SIP funds made available through Prevention Research Centers are not being competed from all qualified entities.”
Workplace Wellness Network: As part of its FY 2016 budget submission, the Administration is proposing to defund the CDC Workplace Health Research Network, funded as a Special Interest Project (SIP) under the Prevention Research Centers program. The funding for the Network ($1 million in FY 2015) comes from a separate Workplace Health line item in the CDC budget. The Administration is proposing to kill all Workplace Wellness funding. ASPPH supports the Network program and is opposing the proposed budget cut. The Senate bill deleted the Workplace Wellness line. The House provided $7.5 million, but did not specify whether the Network would be funded.
Academic Centers for Public Health Preparedness: The House provides $8.2 million (+$0.02 million) for the Centers, the level advocated by the Association. The Senate did not fund the program.
NIOSH Education and Research Centers: The House provided $28.5 million for the Centers (+$1.05 million). The Senate provided $27.445 million, the amount advocated by the Association
NIOSH Agriculture, Forestry, and Fishing: The House provided $27 million (+$3 million) for the Centers, $3 million above the Association’s recommendation. The Senate did not fund the program.
Health Resources Services Administration
FY 2016 House $6.049B (-$299M)
FY 2016 Senate $6.241B (-$106M)
FY 2016 Request $6.462B (+$115M)
FY 2015 Enacted $6.347B
Public Health Training Centers and Public Health Traineeships: The House report states that $10 million has been provided for Public Health Workforce Development but is silent on which programs are to be funded. The Senate provided $4.932 million (-$4.932M) for the Public Health Training Centers. The bill approved by the Senate Labor-HHS-Education Appropriations Subcommittee provided $10 million for the PHTCs. At full committee mark-up, Senator Tom Udall (D-NM) offered an amendment to allocate 50 percent of the budget line for preventive medicine residency programs. The amendment was accepted. The Senate didn’t fund the Public Health Traineeships program.
Agency for Healthcare Quality and Research
FY 2016 House $0 (-$363M)
FY 2016 Senate $236M (-$128M)
FY 2016 Request $363M (same)
FY 2015 Enacted $363M
The House would not fund AHRQ and would transfer the Prevention Public Health Task Force to the Office of the Assistant Secretary of Health. The Association supports the recommendation of the Friends of AHRQ that the Agency be provided with an appropriation of $365 million. AHRQ receives additional support from the Patient Centered Outcomes Research Trust Fund.
Other Provisions of Interest
- The House bill prohibits funds from being used for patient-centered outcomes research.
- The House bill sets the Salary Cap at Executive Level III (currently $163,700) rather than at the current Executive Level II (currently $183,300). The Senate bill maintains the cap at the Executive Level II rate. ASPPH has signed a letter to key legislators opposing the move.
- The House would rescind $6.8B from the Center for Medicare and Medicaid Innovation (CMMI) within CMS.
- The House report encourages the Office of Human Research Protections to work with other agencies “to adopt an exception to the Common Rule for situations where individuals or entities are collecting identifiable patient information, but are not engaged in direct human subject intervention and interaction and are following all the applicable requirements of the HIPPA regulations…”
Summary of Current Coalition Activities
Coalition for Health Funding (CHF): The “oldest and largest nonprofit alliance working to preserve and strengthen public health investments in the best interest of all Americans.” In addition to supporting increased investment in life sciences research, CHF has taken the lead in fighting sequestration and related budget caps. It formed NDD [Non-Defense Discretionary] United to advocate for expanded non-defense discretionary spending and against NDD caps. CHF is a supported by membership dues. Its daily newsletter is an essential information sharing resources for CHF members.
Actions: ASPPH has participated in various CHF-organized congressional visits and briefings. ASPPH has signed on to CHF-organized letters related to the budget resolution and sequestration. ASPPH co-sponsored the Faces of Austerity briefing on Capitol Hill, at which a related publication produced by the Coalition was released.
Ad Hoc Group for Medical Research Funding (Ad Hoc Group): The Ad Hoc Group is a coalition of more than 200 groups supporting increases in funding for the National Institutes of Health (NIH). For FY2016, the Ad Hoc Group recommended a funding level of at least $32 billion for NIH. The Association of American Medical Colleges (AAMC) serves as the secretariat for the Ad Hoc Group.
Actions: ASPPH endorsed the Ad Hoc Group’s recommendation and signed several joint letters to appropriators. ASPPH also participated in several town halls organized by the Ad Hoc Group, often involving key NIH, Administration, and Hill leaders.
CDC Coalition: The CDC Coalition’s mission is to support a funding level for the federal Centers for Disease Control and Prevention (CDC) “that enables it to carry out its mission to protect and promote good health and to assure that research findings are translated into effective state, local and community programs.” For FY2016, the CDC Coalition recommended a $7.8 billion funding level. The American Public Health Association (APHA) serves as the CDC Coalition’s secretariat.
Actions: ASPPH has participated in various CDC Coalition-organized congressional visits and briefings. ASPPH has signed on to several CDC-Coalition-organized letters related to the CDC budget.
Friends of HRSA: The Friends of HRSA is an advocacy coalition of more than 175 national organizations that support the Health Resources and Services Administration (HRSA). The Friends of HRSA recommended providing $7.48 billion for discretionary HRSA programs in FY2016. APHA serves as the Friends of HRSA’s secretariat.
Actions: ASPPH endorsed the Friends of HRSA’s recommendation and was listed as an endorsing group in the Friends’ testimony.
Friends of AHRQ: The Friends of AHRQ is a voluntary coalition of more than 250 organizations that support the Agency for Healthcare Research and Quality (AHRQ). The coalition recommended that Congress and the Administration provide the agency $375 million in budget authority in FY2016.
Actions: ASPPH endorsed the Friends of AHRQ’s recommendation and was listed as an endorsing group in the Friends’ testimony. ASPPH also signed a letter to the Senate objecting to the proposed 35 percent cut in AHRQ’s budget proposed by the Senate Appropriations Committee.
ACT for NIH: Advancing Cures Today: Act for NIH is a non-partisan effort “committed to advancing biomedical research in the United States. Our goal is simple: we seek the immediate restoration of funding for NIH followed by steady, predictable budget support in the future to enhance lifesaving research for patients around the world.” The organization has a well-funded Political Action Committee (PAC) and has focused on ensuring that NIH is supported in any new budget deal.
Action: Tony Mazzaschi of the ASPPH staff serves on the group’s “Kitchen Cabinet” of advocacy professionals committed to enhancing federal resources going towards biomedical research.
The Campaign for Tobacco-Free Kids: The Campaign is a leading force “in the fight to reduce tobacco use and its deadly toll in the United States and around the world. Our vision: A future free of the death and disease caused by tobacco.” ASPPH occasionally participates in the Campaign’s activities when our interests align.
Action: ASPPH signed a Campaign-led letter to the House Agriculture, Rural Development, Food and Drug Administration, and Related Agencies opposing a provision in their FY2016 bill. The provision would weaken the Tobacco Control Act (TCA) and limit the FDA’s ability to regulate currently unregulated and untested tobacco products that are currently on the market. By changing the so-called “grandfather date,” the provision would take away FDA’s ability to review each of these products and evaluate whether their continued marketing will negatively impact public health.
Federation of Associations of Schools of Health Professions (FASHP): FASHP was created in 1968 and is comprised of 14 associations representing a wide variety of health professions schools. In addition to other components, FASHP has a government affairs groups. The group serves as an information sharing network and the group develops joint policies and principles on issues of common interest.
Actions: ASPPH participated in a recent FASHP briefing on Capitol Hill on interprofessional education. ASPPH also participated in the drafting of a principles statement to guide our review of the Higher Education Act reauthorization. The group has been active on graduate student loans and state authorization issues.
Prevention and Public Health Fund Coalition: This informal coalition, organized by the Trust for America’s Health, undertakes coordinated activities to protect the Prevention and Public Health Fund (PPHF), created by the Affordable Care Act, and to urge its allocation for new public health and prevention activities.
Actions: ASPPH has participated in several briefings sponsored by the Coalition. On two separate occasions the Association wrote to key House and Senate leaders in opposition to efforts to raid the PPHF. The effort was coordinated with the Coalition’s activities. ASPPH has been invited by Trust for America’s Health to participate in a smaller group of “brain trust” partners to strategize about how to build on the progress that we have made in advocating for the PPHF. We will meet during the month of September to have strategic discussions of how to best move forward in cultivating Senate champions and broader support for The Prevention Fund.
Other Legislative and Regulatory Activities
Recent ASPPH Comment Letters
- On August 12, ASPPH submitted comments to NIH on the proposed framework for its NIH-wide strategic plan. The plan was ordered by Congress and is due in December. Last month NIH issued a Request for Information (RFI) on its proposed framework for the strategic plan. While supporting the Health Promotion/Disease Prevention opportunity area in the proposed framework, we expressed concern about the illustrative bullets in the proposal. We urged that the plan support a life course approach to prevention and the creation of long-term health. We also expressed concern that there was insufficient emphasis on NIH’s role in advancing translational research and implementation science. We urged an increased emphasis on NIH’s role in ameliorating health disparities, in supporting research on the broad range of social and environmental influences on population health, and in providing policy makers with research findings to help them determine how to best invest in health. We concluded by recommending that NIH explain to taxpayers –with some specificity– how the National Institutes of Health will advance the nation’s collective health and not solely advance scientific knowledge.
- ASPPH joined with over 170 other organizations on August 24 in writing to leaders of the House and Senate Appropriations Committees urging Congress not to reduce further the salary cap on federal research grants funded by the Labor-HHS-Education Appropriations Bill. The FY 2016 Labor-HHS appropriations bill passed by the House Appropriations Committee on June 24 would reduce the salary limit from Executive Level II to Executive Level III ($168,700 in 2015), a cut of $14,600 (8 percent). The Senate bill would leave the cap unchanged. The groups said that this proposed cut, “which follows a $20,000 (10 percent) cut in the FY 2012 funding bill, comes at a time when research institutions’ discretionary funds from clinical revenues and other sources are increasingly constrained and less available to invest in research. As institutions and departments draw further from internal funds to compensate for the reduction in the salary limit, they will have less funding for critical activities such as providing bridge funding to investigators between grants and supporting seed grants and start-up packages for young investigators.”
- ASPPH on August 14 submitted comments to NIH on the proposed plan for the Environmental Influences on Child Health Outcomes (ECHO) program. The Association voiced its strong support for efforts to continue the study of environmental factors on children’s health. Noting that primary prevention represents the best hope to effectively reduce the global burden of chronic disease for both children and adults, the Association urged that the ECHO program focus data collection and implementation strategies on reducing the impact of environmental influences in utero and during the first two years of infancy. ASPPH said that “ECHO should represent the NIH’s commitment to develop a comprehensive strategy for the primary prevention of chronic diseases and conditions in both children and adults.” ASPPH was responding to a formal Request for Information (RFI) issued on July 13 by NIH on the ECHO program.
- On July 31, ASPPH submitted comments on issues related to the planned NIH Science Vision for Health Disparities Research. The Association urged NIH and the National Institute on Minority Health and Health Disparities (NIHMD) to engage, in addition to NIH institutes and centers, other key federal agencies, such as the CDC, HRSA, and CMS. The letter also suggested that NIH’s review of existing health disparities research be expanded to include research sponsored by other federal agencies, foundations and others. The Association highlighted the interest and expertise or our members in engaging communities in health equity research efforts, as well as in interprofessional education, a critical vehicle for delivering equitable care in the evolving health system. We also asked NIH and NIMHD to consider including in its vision the generation of early career and mid-career awards focused on minority health, noting that in the current fiscal environment it is essential to create career “on-ramps” for academic researchers focused on health disparities issues – and to enable them serve as role models and conveners within their institutions. NIMHD and NIH issued the Request for Information on April 17.
- The NIH Office of Disease Prevention is seeking Office of Management and Budget (OMB) approval for an information collection effort aimed at identifying experts in prevention science methods to include on NIH review panels. In a letter to OMB on Friday, ASPPH endorsed the effort.
- In July, the National Academy of Medicine (formerly the Institute of Medicine) announced a new initiative aimed at proactively developing options and resources for the new Administration to consider as it organizes its health and health care agenda. The co-chairs of the Vital Directions for Health and Health Care initiative, Drs. Victor Dzau and Mark McClellan, are seeking suggestions about issues the initiative’s steering committee should consider. In a response submitted in August, ASPPH made several suggestions, including: addressing the proper alignment of policy, structures, funding and processes to maximize health promotion and prevention; examining the social determinants of health to improve population health and to reduce the demands on the acute care system; mitigating the health impacts of large-scale environmental changes, especially climate change; the national need for a computing and networking infrastructure that permits data from electronic health records to be integrated with other data for population-level analytics that will allow us to better understand, predict and respond to the challenges inherent in sustaining and building health; and developing a pathway to change the focus of Medicare and Medicaid programs toward health promotion and prevention rather than solely on clinical care delivery.
Prevention and Public Health Fund
In recent years, the House and Senate appropriations bills fully allocate the Prevention and Public Health Fund, which was created by the Affordable Care Act. Nonetheless, Hill efforts to repeal the fund have continued. The House voted on June 22 to abolish the Independent Payment Advisory Board (IPAB), rescinding $8.85 billion from the Prevention and Public Health Fund (PPHF) to pay for the cut. The Affordable Care Act created both the IPAB and the PPHF. The bill, H.R. 1190, passed by a roll call vote of 244-154. ASPPH wrote to key Hill leaders opposing the bill and urging Congress to maintain the PPHF. The Administration said the President will veto the bill if it reaches his desk.
In the Senate, an amendment offered in mid-May by Senator John Cornyn (R-Texas) to repeal the $10 billion Prevention Fund and to use part of those funds to reauthorize the $10 million Runaway and Homeless Youth Act failed by a vote of 45-53. Sixty votes were necessary to adopt the amendment under an earlier agreement. ASPPH wrote to key Senators in opposition to the amendment, citing the valuable programs funded by the Prevention Fund.
ASPPH is seeking legislation to explicitly include CEPH-accredited schools and programs in the statutes authorizing HRSA’s Public Health Traineeship Program (PHTP) and Public Health Training Centers (PHTCs). These efforts are part of ASPPH’s on-going commitment to ensure that programs are treated equitably and to bring the statutes and Funding Opportunity Announcements into alignment with the Association’s membership. On February 20, ASPPH wrote to the Health Resources and Services Administration (HRSA) advocating that the eligibility criteria for two Maternal and Child Health programs be expanded to include both schools and programs of public health. ASPPH wrote to HRSA “that the objectives of the programs will be enhanced by a more inclusive eligibility criteria.”
On June 23, the Association signed a letter generated by the Campaign for Tobacco Free Kids in opposition to a provision in the House Agriculture, Rural Development, Food and Drug Administration, and Related Agencies appropriations bill that would weaken the Tobacco Control Act (TCA) and limit the FDA’s ability to regulate currently unregulated and untested tobacco products that are currently on the market. By changing the so-called “grandfather date” the provision would take away FDA’s ability to review each of these products and evaluate whether their continued marketing will negatively impact public health. Efforts to lift the rider at the Committee mark-up of the bill on July 8th failed by a vote of 23-26.
In mid-May, the Association co-signed a letter to the leadership of the Senate Health, Education, Labor and Pensions Committee endorsing a proposal by Senator Tom Udall (D-NM) that would designate health education as a core subject in the Every Child Achieves Act or any legislation to reauthorize or restructure the Elementary and Secondary Education Act (ESEA). The letter said, “In so doing, the Senate will strengthen efforts to promote academic achievement and will allow local autonomy in deciding whether or not to use Title I/II funding to provide health education in schools.” The letter was sponsored by the Society for Public Health Education (SOPHE). Senator Udall’s amendment was adopted by the Committee.
Rep. Gene Green (D-Texas) and Rep. Rob Wittman (R-Va.) in April announced the formation of a bipartisan Congressional Public Health Caucus in the House of Representatives. The caucus “will serve as a formal group of members whose mission is to raise awareness of the importance of public health issues, and will provide educational opportunities for Members of Congress and their staff.” The leaders and faculty of schools and programs of public health are asked to encourage their local representatives to join and actively participate in the Caucus. ASPPH has been in communication with Reps. Green and Wittman’s offices offering support for the Caucus’ activities.
Senator Lindsay Graham (R-SC), Richard Durbin (D-IL) and Jerry Moran (R-KS) this spring announced the formation of a Senate NIH Caucus. In June, a House NIH Caucus was was announced. It is being led by Cong. Brian Higgins (D-NY), Rosa DeLauro (D-CT) and Peter King (R-NY).
Congresswoman Louise Capps (D-CA) in April introduced H.R. 1275, the Climate Change Health Protection and Promotion Act. The bill would direct the Secretary of the Department of Health and Human Services (HHS), working through the CDC, “to publish a National Strategic Action Plan to assist health professionals in preparing for and responding to the impacts of climate change on public health.” The bill would also require the Institute of Medicine to issue a report assessing domestic and international climate change and public health needs, and recommend programs to address those needs. ASPPH joined several other public health leadership organizations in endorsing the bill.
ASPPH Priorities (235 KB)