The public health community is abuzz after this month’s release of the Institute of Medicine (IOM) public health funding report. At the request of the Robert Wood Johnson Foundation, the IOM convened a committee to consider three topics relevant to population health: data and measurement, law and policy, and funding. This third and final report, For the Public’s Health: Investing in a Healthier Future, “assesses both the sources and adequacy of current government public health funding and identifies approaches to building a sustainable and sufficient public health presence." Specifically, the IOM recommends we double the federal investment from $12 billion to $24 billion. To support the expansion in federal funding, the IOM recommends a national tax on all health care transactions to generate revenue for public health activities. A copy of the executive summary is available here. The unfortunate reality, however, is that the nation’s fiscal health remains the number one priority of policymakers, and they have no appetite for increasing public health (or any other aspect of federal spending) or imposing new taxes, as the IOM recommends. Quite the contrary, policymakers are reducing federal spending wherever and whenever they can. That is not to say that members of Congress are opposed to public health and health research, per se. But in an election year, with the deficit on voters’ minds, no discretionary program is safe from cuts, whereas revenue raisers (e.g., tax increases) are seemingly off the table. The reality is that the U.S. Department of Health and Human Services (HHS) budget has been cut by 5 percent since fiscal year 2010. The Centers for Disease Control and Prevention (CDC) and the Health Resources and Services Administration (HRSA) have borne the brunt of cuts as well, reduced by 12 and 13 percent, respectively. The Agency for Healthcare Research and Quality (AHRQ) was cut by 6 percent in fiscal 2011, and another 1 percent in fiscal 2012. The National Institutes of Health (NIH) saw a less than 1 percent reduction in fiscal 2012. Although small, the NIH decrease is particularly noteworthy as it is the first time NIH—often referred to as the infallible “crown jewel” of HHS—has seen any real cuts. Looking forward to fiscal 2013, the outlook seems no less bleak. The president has proposed even deeper cuts in the budgets for health agencies, including another 12 percent reduction to CDC and a 10 percent reduction at AHRQ. As we wait for the unveiling of the appropriations bills from Congress later this spring, more painful cuts are surely on the horizon. Recognizing that cuts to discretionary spending will only go so far toward deficit reduction, members of Congress are looking outside the annual appropriations bills for additional savings. Among the items under consideration:

  • The Prevention and Public Health Fund—established by the Affordable Care Act (ACA) to provide a mandatory, sustained investment in public health—remains a prime target. It is ironic that on the heels of the IOM’s recommendation to double public health investments, the House Energy & Commerce Committee yesterday approved a deficit reduction package that is expected to, among other things, eliminate the Prevention Fund. In addition, on Friday the House will vote on a bill to take $6 billion from the Prevention Fund to offset the cost of postponing the scheduled interest rate doubling on student loans. This is not unfamiliar territory for the Prevention Fund; since its inception, there have been multiple attempts—in Congress and the administration—to repeal, reduce, and/or redirect the Fund’s $15 billion. Earlier this year, the Prevention Fund was reduced by $6.25 billion to offset a temporary fix to Medicare physician payments (staving off a 30 percent reduction). As this temporary extension expires at the end of December 2012, advocates fully expect the Fund to take another hit, if it is not zeroed out before then.
  • The Patient-Centered Outcomes Research Trust Fund established by the ACA provides a mandatory, sustained investment in comparative effectiveness research at the new Patient-Centered Outcomes Research Institute (PCORI). The Trust Fund is supported through a transfer from the U.S. Treasury, and fees assessed on the users of this research—Medicare and private health plans. This public-private funding stream could result in $2.6 billion for this research between now and 2019, according to the Congressional Budget Office. And while the “public” contribution if rescinded would have a negligible impact on the federal deficit, members of Congress are looking for any opportunity to eliminate programs they perceive as duplicative of other government functions. Already, one bill (H.R. 3827) has been introduced in the House of Representatives to repeal the PCORI provisions of the ACA.
Contributing to the federal preoccupation with deficit reduction is the looming sequester. The Budget Control Act (BCA) was enacted last summer to offset the cost of raising the nation’s debt ceiling. The BCA capped discretionary spending with essentially no opportunity for growth over the next 10 years, and directed a bicameral, bipartisan “Super Committee” to identify another $1.2 trillion in savings through either spending cuts, revenue raisers, or a combination of both. The failure of the Super Committee to reach agreement on a comprehensive last fall triggered the BCA’s sequester. Unless Congress can agree to a $1.2 trillion deficit reduction plan before January 2013, the sequester will result in a 7.8 percent across the board cut in all domestic spending. This would be in addition to the cuts public health and health research has already sustained. In this environment of fiscal austerity, it’s easy to become discouraged by the lack of progress and the rolling back of funding gains built over decades. However, the field needs your voice and your energy more than ever. To help give you the tools you need to speak up for the value of federal investments in research to improve health care and public health systems, and to speak out on the devastating impact of further cuts, AcademyHealth is establishing a new Advocacy Interest Group (IG). The IG will be a community of health and public health services research “super advocates” who are able to communicate the value of health services research and public health services research to decision makers in both the public and private sectors. Specifically, advocates will stress the importance of increased federal funding, better access to data and information to use in research, and more transparent dissemination of research results. You can be a super advocate for health services and public health services research. On Monday, June 25, at 7:00 a.m., the Advocacy IG will host its inaugural meeting. With Lou Rossiter as acting chair of the IG, attendees will discuss the overriding purpose of the IG as well as its role within AcademyHealth. Anyone interested in advocating for the field is welcome to attend. Contact Lindsey Horan for more information.