Agency for Healthcare Research and Quality

The FY 2004 budget request represents an increase in FY 2003 requested levels, but represents a decrease in enacted funding from FY 2003. In FY 2003, the Agency for Healthcare Research and Quality reached enacted funding levels in excess of $303 million, yet the Administration’s FY 2004 requested budget levels fall short of $280 million, representing approximately a $24 million cut in funding between FY 2003 and FY 2004. The budget documents claim that this "reflects the Department’s priority on improving patient safety and reducing the number of medical errors . . . " but actually is a reduction in spending compared to FY 2002 as well as a reduction in spending compared to enacted levels of funding in FY 2003. AHRQ has a history of doing excellent work that supports the mission of many health care programs. The Administration's lack of commitment to the organization, which provides important information on the costs and quality of health programs, can be seen in this recent move to cut AHRQ’s already small budget.

Centers for Disease Control and Prevention

The budget requests increases for chronic disease programs, but the FY 2004 proposal follows an FY 2003 proposed cut in these programs. Additionally, appropriators provided greater FY 2003 support than the Administration had requested in FY 2003, so the FY 2004 request is more modest than it appears in the budget documents. Chronic disease prevention programs received $85 million more than was requested by the Administration in FY 2003, so the Administration’s FY 2004 request amounts to a mere $39 million increase in funding between FY 2003 and FY 2004, instead of the $124 million stated in the Administration’s budget request.

The Administration does not seek to increase funding for all chronic disease programs and the budget fails to recommend support levels sufficient to fully fund chronic disease programs in every state. Chronic diseases -- including cancer, heart disease, stroke and diabetes -- are responsible for more than 70 percent of all deaths and more than 70 percent of all health care expenditures in the United States. The President's budget provides a $10 million increase in the breast and cervical early detection and screening program, but States are still only able to reach 15 percent of the eligible population. This amount will not address the millions of women who need these services, but cannot obtain access to them due to insufficient resources. Similarly, heart disease and stroke are the Nation's leading killers, taking the lives of 950,000 Americas each year, but the President's budget only provides a modest $3 million increase in funding for programs in these areas. Sixty one million Americans live with the effects of heart disease or stroke.

In its quest to cut funding for influential and beneficial public health programs, the President’s FY 2004 budget proposal asks for an $11 million cut from enacted FY 2003 levels of funding for programs that help support States in the prevention of birth defects and developmental disabilities (such as spina bifida). These significant cuts would harm programs such as the National Center on Birth Defects and Developmental Disabilities (NCBDDD) at the Centers for Disease Control and Prevention (CDC), which seeks to promote optimal fetal, infant, and child development; prevent birth defects and childhood developmental disabilities; and enhance the quality of life and prevent secondary conditions among children, adolescents, and adults who are living with a disability.

Additionally, the budget requests further, but minimal, funding for programs such as the "Youth Media Campaign" program, which enables CDC to maintain a collection of proven effective media messages that target and encourage America’s youth to become more physically fit and active. This program, which at its inception was funded at $125 million, was effectively zeroed out in 2003. So, while there was an increase in funding in FY04, the meager $5 million is actually a cut of approximately $120 million in less than ten years.

The Administration’s budget also cuts the Public Health Improvement program. This program seeks to eliminate racial disparities in health in areas including chronic and infectious diseases. The grants are part of the agency's Racial and Ethnic Approaches to Community Health (REACH 2010) initiative, which targets HIV/AIDS, infant mortality, breast and cervical cancer, heart disease, immunization coverage, and diabetes. The funds are distributed to programs in 15 states that assist African American, Native American, Asian American, Hispanic American, and Pacific Islander populations. The President’s proposal seeks to further cut funding for a program aimed at addressing pervasive disparities in health care.

The FY 2004 budget request for state and local bioterrorism capacity grants of $940 million, which is the same level as last year, falls short of what is needed for the Nation’s communities to plan, prepare, prevent, and respond to domestic terrorism. Virtually all of the input being received from affected public health entities indicates that a substantially greater commitment of Federal resources will be needed before the Nation is adequately prepared to meet domestic terrorism challenges.

Food and Drug Administration

The budget for FDA generally fails to fully fund the agency’s capacity to do more post- market data collection for products such as prescription drugs, medical devices, and dietary supplements. Better information of this kind would help reduce medical errors, and it would assist consumers with making choices for themselves and their families.

Food safety programs are slated for a less than one percent increase. There are thousands of food-borne illnesses and deaths each year in the United States. As many as 9,000 Americans -- mostly the very young and elderly -- die each year, and millions more are sickened, as the result of food-borne illnesses. Many of these cases are preventable.

Health Resources and Services Administration

While the Administration boasts a $169 million increase in community health center funding, FY 2003 enacted numbers were significantly higher than FY 2003 requested numbers, making the FY 2004 requests far more modest than they originally appeared to be. The request fails to consider the fact that during the past two years, millions of Americans have lost their jobs and the means to acquire health care for themselves and their families. Community Health Centers are critical providers of care to nearly 14 million people, including 1 in 8 uninsured Americans, 1 in 10 rural Americans, and more than 1 million people over age 65. They are vital resources to communities and patients that do not have adequate access to medical doctors, dentists, mental health providers and other health providers and make health care affordable to everyone, with or without health insurance.

The request for health professions programs, a key source of personnel for medically underserved areas, belies a huge proposed cut in the FY 2003 budget. If appropriators refuse to go along with such a steep reduction in these programs, the FY 2004 request will represent a significant cut in these programs at a time when the Nation faces critical shortages in key health care personnel such as nurses and pharmacists. According to the latest projections from the U.S. Bureau of Labor Statistics, more than one million new and replacement nurses will be needed by 2010. However, the Administration’s FY 2004 budget request recommends a $15 million cut in nurse training programs between FY 2003 and FY 2004. This request fails to take into account the fact that the nursing shortage is projected to intensify over the next two decades with 44 states plus the District of Columbia expected to have RN shortages by the year 2020. Additionally, a study released by the U.S. Department of Health and Human Services shows the number of unfilled full- and part-time drug store pharmacists climbed from 2,700 in 1998 to nearly 7,000 in 2000, and is rapidly rising.

In addition, funding to support health professions training in free-standing children’s hospitals though the Children’s Hospitals Graduate Medical Education Program is being significantly reduced as the Administration’s FY 2004 budget request proposes a $98 million cut from enacted FY 2003 levels.

The Community Access Program has been a successful program that leverages scarce resources among safety net providers. The interest in continuing this program was evident in legislation that provided a specific authorization for this program, which was enacted with virtually unanimous congressional support last year as part of the Health Care Safety Net Improvement Act. This program enjoyed enacted funding levels in excess of $120 million in FY 2003, but if the Administration’s requests are met, this program would experience a $120 million cut and receive no funding in FY 2004.

The program to screen newborns for hearing disorders was slated to be zeroed out in FY 2003 but Congress recognized the importance of this program and appropriated $10 million in funding to the Universal Newborn Hearing program. The Administration’s budget is once again attempting to zero out this program which seeks to protect the 24,000 babies who are born each year in the United States with some degree of hearing loss. Significant hearing loss is one of the most common major abnormalities present at birth and, if undetected, will impede speech, language, and cognitive development.

The "Health Care Access for the Uninsured Program" uses funds to conduct in-depth surveys and other activities necessary to determine the most effective methods of providing insurance coverage for the uninsured. The program has assisted States in the work of collecting and analyzing data, developing options, and working with key constituency groups and the public to create viable insurance expansion options. The FY 2004 budget requests zero funding for this program.

The FY 2004 budget request for the bioterrorism grants, $618 million, represents level funding from the prior year. These grants are a critical part of the collective effort of this Nation to plan, prepare, prevent, and respond to pubic health emergencies. The needs being expressed in the form of requests for assistance from the Federal Government far exceed the amount requested in this budget. Many of the facilities and personnel that are key to an effective counter terrorism effort also provide many of the basic health care services that make up our Nation’s public health system. This dual use also means increased trouble in the form of a sick economy, tight state and local budgets, coupled with heightened alerts to terrorist threats.

Indian Health Service

While the Indian Health Service would receive an increase in funding under the FY 2004 budget proposal, statistics on the health status of Native Americans suggest that much more needs to be done. The IHS provides care to approximately 1.6 million Native Americans and Alaska Natives in the United States. In addition to medical care, the IHS engages in substantial health promotion and disease prevention activities including construction of water and waste disposal systems to serve Native American homes, diabetes prevention and treatment, injury prevention and health education. The IHS provides mental health and alcohol/substance abuse treatment programs. Increased funding needs to be allocated to the IHS in an effort to relieve some of the inadequacies and disparities of our healthcare system. More than 27.1 percent of Native Americans and Alaska Natives lack health insurance coverage. According to population projections, the Nation's Native American and Alaska Native resident population will grow to 4.4 million by 2050.

National Institutes of Health

The NIH will receive an increase of two percent. The amount, however, proposed in the FY 2004 request falls far short of generally accepted goals.

Substance Abuse and Mental Health Services Administration

The FY 2004 budget request suggests a $50 million cut in substance abuse prevention programs, despite a greater need for effective prevention programs. The budget suggests an increase in treatment resources; however, these continue to fall far short of the amount needed to close the gap between those who need treatment and those who receive it. The drug abuse treatment gap was estimated to be five million people in 2001, or 2.2 percent of the total population aged 12 or older, compared with 3.9 million (1.7 percent) in 2000. The treatment gap is not solely a function of ignorance or denial. Many persons who actively seek treatment are unable to obtain access to treatment programs.