Legislative Update April 4, 2006

1. Legislative UpdateApril 4, 2006 Prepared for NACCHO Committee Meetings Memphis, TN

2. $$$$$$$$$$$$$$$$$$$$$$ President’s Budget and Public Health • Full impact of FY 2006 cuts not yet felt • CDC is planning various “taps” on program funds for FY 2006, the magnitude and impact of which are still murky. • FY 2007 proposal continues pattern of cutting domestic discretionary spending • Administration budget proposes to cut CDC by 2.1 to 4.5%, depending on how the denominator is defined. • Administration budget, if enacted, would cut CDC by 8.1% from FY05 to FY07.

3. Public Health Preparedness Funding • FY 2006: Congress cut overall state/local capacity funds by 10%. Academic centers and APC’s remain level, so cut in next cooperative agreement funds likely to be about 12%. • FY 2007 proposed: Same as FY 2006: $824 million • Pandemic influenza funding: Administration will submit specific request later, but put a $2.3 billion “placeholder” in FY 2007 budget. No one believes it will include more for health depts.

4. Environmental Health Funding Administration budget proposes: • 5.9% cut for FY 2007 in CDC EH budget ($141 million), most of which comes from a 15% reduction in environmental health activities other than laboratory, asthma, and childhood lead poisoning. • Level funding for ATSDR ($75 mill)

5. The Budget on Capitol Hill • What’s a Budget Resolution and Why Does it Matter? • Congressional budget resolutions set caps on discretionary (non-entitlement) spending. They determine the overall size of the fiscal “pie”. • The Appropriations Committees have the job of slicing up the pie. If the pie contracts in size, their ability to add spending is limited. • Appropriators have told public health advocates to pay attention to the budget resolution because it ties their hands, no matter how sympathetic they are.

6. In the Senate…. The Senate passed its Budget Resolution on March 16, 2006 HHS Appropriations Subcommittee chair Sen. Arlen Specter (R-PA) and Ranking Minority member Sen. Tom Harkin (D-IA) proposed an amendment to add $7 billion to domestic discretionary funding for health and education programs. After an enormous effort by a large number of constituencies, the Senate passed the amendment by a vote of 73-27. What this means: Theoretically: Nothing In practice: Senate HHS Subcommittee “pie” will undoubtedly be larger than it would otherwise have been.

7. In the House of Representatives • The Budget Resolution with the Administration’s numbers will go to the floor this week. • Moderate GOP putting pressure on leadership to increase domestic spending • A deal could be cut or the process may halt. • It’s better to have no budget resolution than a bad budget resolution.

8. This Year is UGLY • Second time in current memory that President has presented a net-negative budget for HHS discretionary spending, $1.5 billion (2%) less than FY 2006. • Two additional big pressures this year: LIHEAP and earmarks. • Make that three – there’s an election. • Further across-the-board erosion in funding is the only solution other than big program cuts or elimination of programs, because appropriators’ hands will be tied by budget caps.

9. We’re Keeping an Eye On… • Reauthorization of Public Health Security and Bioterrorism Preparedness and Response Act of 2002 (Frist-Kennedy) • New Land Use/Health Impact Assessment legislation (Obama) • Supplemental funding for pandemic influenza • Homeland Security Act revisions relating to public health and medical response.