Kimberly Randall | August 15, 2023
Background
Each year, the House of Representatives and Senate pass a series of legislation that determine the funding for the federal agencies operating in the US government. Funding is broken down into two categories – mandatory (63%) and discretionary (30%) – determined by whether the funding is tied to specific laws. The remaining budget is dedicated to interest repayment on federal loans.
The budget discussions traditionally begin with the President’s Budget Request (PBR), a formalized plan from the executive branch outlining the President’s suggested funding and taxes for the following fiscal year. Then, respective House and Senate committees produce budget bills that will be discussed, reconciled, and voted on in committee before being sent to the chamber floor. According to the Congressional Budget Act of 1974, the budget is to be voted on by April 15th for the following fiscal year, which begins on October 1st. However, many times this process takes longer.
For the fiscal year 2024 (FY24), President Biden officially requested $144 billion in discretionary spending, an 11.5% ($14.8 billion) increase from FY23, for Health and Human Services, through which the majority of public health funding is funneled. The official budget statement claims that the budget increase is expected to expand healthcare access, lower medical costs, increase funding for cancer research, increase access to behavioral health programs, support rural health programs, and improve nutrition and food safety.
Proposed Legislation
As Congress begins budget discussions for FY24, the House Appropriations Committee released the Fiscal Year 2024 bill for the Labor, Health and Human Services, Education, and Related Agencies Subcommittee. In the draft, several federal agencies are suggested to see a decrease in funding. The bill, named the Fiscal Year 2024 Labor, Health and Human Services, Education and Related Agencies Appropriations Bill, contains significant spending cuts to programs related to public health infrastructure and eliminates federal funding for family planning, HIV prevention, and gun violence research.
According to the Appropriations Chair, Kay Granger (TX), the proposed budget legislation is intended to “restore fiscal responsibility and reduce the scope of social spending by $60.3 billion from the FY23 enacted level, eliminating 61 (support) programs” in addition to funding biomedical research on cancer, Althzeimers, opioid use, and other chronic and rare diseases. The legislation also looks to increase funding in rural health by way of telehealth programs, healthcare workforce recruitment programs, and specialized education funding.
| FY23 Enacted Budget (millions) | FY24 Presidential Request (millions) | FY24 Proposed Budget (millions) | |
| Immunization and Respiratory Diseases | $919 | $1,256 | $326 |
| HIV/AIDS, Viral Hepatitis, STI, TB | $1,391 | $1,545 | $1,171 |
| Emerging and Zoonotic Infections Disease | $751 | $846 | $708 |
| Chronic Disease Prevention and Health Promotion | $1,430 | $1,814 | $797 |
| Birth Defects, Developmental Disabilities, Disability and Health | $206 | $223 | $205 |
| Environmental Health | $247 | $421 | $130 |
| Injury Prevention Control | $761 | $1,352 | $730 |
| Public Health Scientific Services | $754 | $962 | $654 |
| Occupational Safety and Health | $363 | $363 | $247 |
| Global Health | $693 | $765 | $370 |
| Public Health Preparedness Response | $905 | $943 | $735 |
| Crosscutting Activities and Program Support | $724 | $1,039 | $231 |
| Buildings and Facilities | $40 | $55 | $40 |
Impact
In the United States, most public health activities are carried out by state and local government agencies, and a large portion of the CDC’s annual budget is distributed via grants and cooperative agreements to these departments. In FY19, over 55% of the CDC’s annual budget was granted to state and local public health agencies and has significant influence on state and local budgets.
In 2022, the Alabama Department of Public Health received $129,863,407 from CDC grants, with millions more going to The University of Alabama, The University of Alabama at Birmingham, Auburn University, and Tuskegee University for research in various areas. Reductions in the federal CDC budget will trickle down to impact local programs, including child vaccinations, staffing, and research. The table below represents a hypothetical look at the budget differences between funded programs in 2022 and a proportional budget in line with the FY24 proposed House budget.
| FY23 Grants Awarded (Alabama) | Proportional Budget Estimate | |
| Immunization and Respiratory Diseases | $4,500,225 | $1,597,580
(-64.5%) |
| HIV/AIDS, Viral Hepatitis, STI, TB | $13,988,137 | $11,776,613
(-15.81%) |
| Emerging and Zoonotic Infections Disease | $2,248,081 | $2,096,864
(-5.72%) |
| Chronic Disease Prevention and Health Promotion | $13,587,018 | $7,573,404
(-44.26%) |
| Birth Defects, Developmental Disabilities, Disability and Health | $6,557,429 | $6,524,642
(-0.5%) |
| Environmental Health | $404,616 | $212,990
(-47.36%) |
| Injury Prevention Control | $7,174,096 | $6,882,110
(-4.07%) |
| Public Health Scientific Services | $727,445 | $630,986
(-13.26%) |
| Occupational Safety and Health | $1,949,377 | $1,326,356
(-31.96%) |
| Public Health Preparedness Response | $9,437,092 | $7,664,806
(-18.78) |
| Crosscutting Activities and Program Support | $5,528,735 | $1,764,219
(-68.09%) |
The potential budget cuts come on the tails of a significant loss of funding following the Fiscal Responsibility Act of 2023, where an estimated $1.7 billion in secured funding was recessed. The CDC released a statement that multi-year funded projects would not receive the remainder of their grants: “We can confirm that the last two years of funding is no longer available to CDC for jurisdiction awards. Funds previously awarded are not impacted.”
Next Steps
The House of Representatives Appropriations Committee will continue to debate the contents of the bill, amending as necessary. Once the committee agrees on the House bill, party leaders will meet to reconcile it with the Senate bill.
The Senate Appropriations Committee has already passed an appropriations bill for FY24 in a 26-2 vote, providing $117 billion in funding for the Department of Health and Human Services. The Senate released an official statement in late July regarding the sister legislation in the House:
It is unclear how this legislation will proceed through the legislative process, given vastly different topline funding levels under consideration in the Senate and House, which has yet to advance its version of this legislation through the full House Appropriations Committee.
A full list of House Appropriations Committee members can be found here, two of which represent Alabama.
Stay Informed
Want to learn more about public health policy, funding, and advocacy? Check out the Advocacy Portal on the American Public Health Association’s website.
Official updates from Congress can be found on the House of Representatives Appropriations Committee website.
