FY 2013 Appropriations/Continuing Resolution – On September 13 the House passed a six month Continuing Resolution (CR) funding all of the Federal government through March 27, 2013. The Senate is expected to pass the CR without substantive change prior to adjourning for the six week election break. With very few exceptions, all government programs are funded during this six month period at the FY 2012 level, plus 0.612 percent. This modest increase is, however, largely irrelevant as the CR also includes standard language directing that agencies not fund any “new starts” and that they allocate funds only to maintain existing activities at the “current rate” of operations. Agencies have very limited discretion in distributing funds.
The House and Senate Appropriations Committees have expressed their desire to return to finish the bills either during the lame duck session in December or early next year. This seems unlikely. The more likely scenario is that early next year Congress will extend the current six month CR for the remainder of FY 2013. It should be expected, however, that once a full year CR becomes inevitable that the pressure for exceptions will expand exponentially. This pressure will become extraordinary if all 2013 programs are subjected to the 8 to 10 percent sequestration discussed below. It is important to remember that this is a zero sum game and any relief provided to one program will come at the expense of all other programs.
Ironically, while a full year CR is a lousy way for the Congress to do the “people’s business,” it is not a bad outcome for the advocacy agenda of ASPH which, with the exception of NIH, asks Congress to maintain 2012 funding level. The CR fully restores cuts proposed by the President for HRSA’s Public Health Training Centers and CDC’s Prevention Research and Preparedness Centers and the NIOSH ERC and Agriculture programs. It also maintains level funding for the public health traineeship program which the Senate bill eliminated. Finally, the $1 billion in the ACA Prevention Fund for 2013, which the House bill repealed, is preserved. This situation could change but, for now, SPH priority programs which were at-risk seem to have dodged the bullet in terms of reductions for FY 2013. (see chart on last page)
FY 2013 Sequestration – The Office of Management and Budget (OMB) on September 14th issued a report mandated by the Sequestration Transparency Act (STA) on the impact of January's scheduled sequestration as mandated by the 2011 Budget Control Act. OMB estimates that under the assumptions required by the STA, the sequestration in January would result in an 8.2 percent reduction in nondefense discretionary funding. It cannot be overemphasized how damaging the implementation of this level of reduction can be to virtually all federal partnership programs. Specific cuts include:
· For NIH, the report indicates that $30.711 billion in discretionary budget authority would be subject to the 8.2 percent sequester, equal to $2.518 billion, and an additional $150 million in mandatory budget authority (for diabetes research) would be subject to a 7.6 percent cut, equal to $11 million. The total cut to NIH would equal $2.529 billion.
· CDC would be cut by $464 million and HRSA by $510 million.
· Funding for the Agency for Healthcare Research and Quality (AHRQ) is exempt from sequester since it is provided through the evaluation tap as opposed to direct appropriations. However, the Patient-Centered Outcomes Research Trust Fund (which funds the Patient-Centered Outcomes Research Institute) would be subject to a 7.6 percent cut, amounting to $30 million from the $390 million fund in FY 2013.
· Funding for the VA Health Administration is exempt from sequestration.
“No amount of planning can mitigate the effect of these cuts. Sequestration is a blunt and indiscriminate instrument. It is not the responsible way for our Nation to achieve deficit reduction.” OMB September 14, 2012
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OMB in the report calls these cuts hugely destructive and threatening to critical defense and domestic programs. But, while almost every elected official and both Presidential candidates are opposed to the cuts, there is no agreement on an acceptable alternative, and the President has indicated publicly he would veto a delay of the sequestration without offsetting savings. Despite this bleak outlook, Congressional leaders from both parties as well as senior White House officials are thought to be discussing privately the possibility of a six month delay of sequestration as well as the tax increases which occur on January 1
st while the president and the new Congress attempt once again to enact a major deficit reduction plan. Such a delay would be accompanied by $150-$200 billion of immediate cuts to pay for the resulting increase in the debt. This is far from a done deal. Odds for the sequester are probably still 50/50.
Should a sequestration occur, there will be substantial risk to ASPH priorities which seem relatively safe under the CR. Agencies would likely use all flexibility that is legally available to them to more adequately fund their highest priorities at the expense of lower priorities. The President’s 2013 request has made clear that a number of SPH federal grant programs are not considered CDC’s and HRSA’s highest priorities. Congress would have little influence in these decisions.
Increased NIH Advocacy and “Celebration of Science” Event – During a 3 day “Celebration of Science” event September 7-9, more than 1,000 scientists, advocates, political leaders, and media personalities gathered together in DC to hear stories of past biomedical breakthroughs, hear about the most critical and dramatic science now being supported by NIH, and to hear from leaders of both parties in Congress about support for federal funding of biomedical research. Nancy Pelosi, Harry Reid, Eric Cantor, Ben Cardin, Chris Van Hollen, and Steny Hoyer all made speeches emphasizing that NIH funding should be viewed as an investment rather than an expense. Over 40 panel presentations featuring scientists and patients were organized as well as major celebration dinners and a concert at the Kennedy Center. The entire event was hosted at no cost to attendees by the new Faster Cures NIH advocacy organization funded by Michael Milken. While the event had a long term purpose as a “pep rally” for NIH and its intramural and extramural scientists, the immediate mission was to focus attention on the fiscal crisis in NIH funding, and, in particular, the devastation which would be caused by a $2.5 billion cut in NIH funding in 2013 if sequestration happens. Whether this will result in NIH getting significant increases this year remains to be. Mike Stephens from ASPH and Mark Mioduski from Cornerstone attended significant portions of the event and continue to meet with NIH leadership and Faster Cures to offer our support to the effort.
2012 Election Update
With only 46 days remaining until Election Day, November 6, campaigns are in full swing across the country. All 435 Members of the House of Representatives are up for re-election, but only a limited number are competitive races. Latest estimates have only 53 House seats, or 13%, as being “toss ups” or “leaning” one way or the other.[1] The generic House ballot currently has the Democrats with a 2.2% lead.[2] Of the 34 Senate seats that are up for re-election this year, 9 are held by Republicans and 25 by Democrats. 15 of these races are currently viewed as competitive, with many races currently polling within the margin of error. Highlighted amongst these races are battles in key swing states, such as Florida, Ohio, and Virginia. Also polling within the margin of error is the race for the Montana Senate seat currently held by Sen. Jon Tester. Running against him is the current Chair of the House Labor, HHS Appropriations Subcommittee, Rep. Denny Rehberg. Finally, in the Presidential election, President Obama maintains a lead in the polls over Mitt Romney: 48%-45%. In addition, the President is currently holding on to small leads in the swing states of Ohio, Virginia, Florida, New Hampshire, Iowa, and Colorado.[3] The polls are likely to prove volatile in the remaining days before the election, and with three Presidential debates, and one Vice Presidential debate, scheduled for the month of October, look for these poll to continue to fluctuate on a consistent basis.
Review of the Presidential Candidates Policy Positions -
In September, the ASPH Staff conducted a review of the major party positions for the current election cycle. The conclusions were based on the platforms published by the parties as well as the acceptance speeches of the presidential and vice-presidential candidates. The platforms and the speeches lack specifics and cannot be relied upon to show what a candidate would do if elected. However, they do provide general guidance of what may occur. It is clear that each Party enters the election with a mandate to reduce federal spending, though the Republicans are more adamantly focused on this issue than the Democrats. Each Party supports continued biomedical and other science related research. Republicans place a greater emphasis on neuroscience-related research and personal responsibility in health care while Democrats focus more on HIV/AIDS and infectious disease research as well as obesity and public health related measures. Each party wants to make the research and development tax permanent. The full staff analysis is available upon request.
2012-2013 Policy Fellows - On September 24th ASPH’s new 2012-2013 Policy Fellow, Michelle Moses-Eisenstein, a 2012 graduate of the Columbia School of Public Health, began her rotation to the staff of the Secretary of HHS where she will work on discretionary appropriations issues. This assignment will continue until January 20 after which she will move to the office of Congresswoman Barbara Lee , who is a senior member of the House Appropriations Subcommittee with jurisdiction over health funding. This “split-assignment” is the first for an ASPH Policy Fellow combining both executive branch and legislative experience. ASPH expects great things from Michele over the years.
ASPH Advocacy Agenda and the Spring 2013 “ASPH Hill Day” – It is clear that the early months of 2013 will be a critical period for ASPH advocacy. The perfect storm combination of a potential sequestration, finalization of the 2013 base appropriations, and the likely negotiation of a massive deficit reduction plan creates unprecedented challenges. While our advocacy will build on continuing partnerships and a strong base of support, we will be dealing with a new Congress and potentially a new President. Even under the current most likely scenario of an Obama reelection and a divided Congress, there will be many new players including a new Republican Chairman of the House Labor-HHS Appropriations Subcommittee. Given the uncertainties about the election and the 2013 Congressional calendar, it is not yet clear when the Legislative Committee deans should come to Washington to make their case. For planning purposes we have penciled in February 14-15, but it may be prudent to wait until later in the Spring if the November election results in a delay of the normal legislative and budget cycles. In the interim, Chairman Raskob and potentially other members of the Committee may be called upon for individual advocacy meetings beginning with a set of meetings for Dean Raskob with key Congressional and HHS budget staff on October 23-24.