White House Budget Plan Shows Some Investment but Inadequate Commitment to Sustained Public Health Responses
The president’s fiscal year 2020 budget proposal released Monday is responsive to some of our nation’s most urgent public health challenges. The proposal, however, also neglects, and even deeply undermines critically needed investments in both immediate and long-term responses to infectious disease threats.
Providing $58 million to the U.S. Centers for Disease Control and Prevention to address infectious disease impacts of the national opioid epidemic, the budget offers $18 million more than the amount authorized by the 2018 SUPPORT (Substance Use–Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities) Act. While additional funding is likely to be needed, this proposed investment enables immediate responsive action. The administration plan also would provide $100 million in base funding for CDC’s global health security activities, a welcome investment in essential efforts to stem the spread of infectious diseases where they surface. Similarly, the $50 million provided in the budget for the CDC Infectious Disease Rapid Response Fund reflects recognition that our nation must maintain readiness to detect, prevent, and contain outbreaks at home.
These investments, however, fall short of those needed to build response capacities that can stop outbreaks where they originate and quickly contain to major outbreaks at home. The investments proposed by the White House fall even further short of need when viewed in the context of the plan in its entirety.
In evident denial of the continuing threat posed by emerging infections and the growing dangers posed by antibiotic resistant infections, the plan proposes an overall decrease of$4.7 billion in funding for National Institutes of Health. That reduction includes a drop of $769 million for biomedical research at the National Institute of Allergy and Infectious Diseases, and an $11 million cut in funding for worldwide projects identifying disease challenges and solutions through the Fogarty International Center. These cuts, if enacted would gravely challenge our ability to develop innovative diagnostic tools, medicines and vaccines to meet current and emerging disease threats, and to build the next generation of researchers.
Additionally, in the wake of 2018 data indicating that antibiotic-resistant infections comprise the third leading cause of death in this country, the budget plan proposes a $103 million reduction in funding for the National Center for Zoonotic and Infectious Diseases that includes $31 million cut in funding for the Antibiotic Resistance Solutions Initiative.
The proposal evidences equal inattention to the role domestic and global public health programs play in protecting Americans. The plan proposes a $750 million cut in overall CDC funding, that includes a $39 million cut to CDC’s Center for Global Health. At the same time, the plan would deliver a $460 million cut in funding allotted to our Global Fund to Fight AIDS, Tuberculosis and Malaria contribution, as well as a $970 million cut to the President’s Emergency Plan for AIDS Relief. These cuts would come at a time when ending the worldwide public health threat of these leading infectious disease killers is within sight. These proposed cuts stand at odds with the administration’s stated goal to “end HIV here and everywhere.”
This proposal does not include details on the administration’s plan to create a Medicare Priority Care payment for providers who are eligible to bill for evaluation and management services and who provide ongoing primary care to Medicare beneficiaries, a critical issue to IDSA membership, for whom evaluation and management accounts for 90 percent of the healthcare services we provide. IDSA will continue to highlight the need to ensure Medicare billing codes reflect the value of care provided, and is adequate to protect both the future of the infectious diseases workforce, and patient access to that specialized care. In addition, more information is anticipated regarding proposed changes in the administration’s budget to Medicare payments to providers based on patient characteristics rather than site of care.
The Infectious Diseases Society of America will continue to monitor the details of the administration’s budget proposal, and to urge Congress to produce a bipartisan and comprehensive budget that protects and prioritizes our nation’s health.