U.S. Department of Health and Human Services (HHS) Secretary Tom Price told members of Congress on Wednesday that the nation’s emergency preparedness and response ranks high on the federal funding list at his agency.
The goal of the Trump Administration is not to deconstruct HHS, Price assured House members, despite President Donald Trump’s “America First “ Budget Blueprint for FY 2018, which reduces overall discretionary spending at HHS by more than $15 billion over 2017 continuing resolution (CR) monies.
“Targeting resources to emergency preparedness and response” is among two other areas — addressing the nation’s mental health and substance abuse crisis and ending childhood obesity — considered “top priorities in addition to the ongoing health care reform effort under way,” Price told House Appropriations subcommittee members during a budget hearing on Wednesday.
However, when asked specific emergency preparedness questions related to the president’s proposed budget for FY 2018 discretionary spending, Price provided few details.
That’s because earlier this month, Price, along with others working in the Trump administration, received a memo from the director of the Office of Management and Budget (OMB) instructing them against answering specific questions from Congress beyond what’s included in the blueprint proposal released March 16. The memo meant Price couldn’t offer comments about specific programs or account-level amounts. OMB said that since the “skinny budget” isn’t the final, completed document, if witnesses did say anything during their testimonies, it could be considered speculation unless OMB approved their remarks beforehand.
So Price stayed on point, infuriating several subcommittee members who asked about specific programs outside Price’s aforementioned top three priorities.
Specific worries cited
Generally, the president’s 2018 budget requests $69 billion for HHS, a $15.1 billion or 17.9 percent decrease from the 2017 annualized CR level.
Specifically, Trump’s so-called “skinny budget” would reduce the National Institutes of Health’s (NIH) spending relative to the 2017 annualized CR level by $5.8 billion to $25.9 billion.
The budget includes a major reorganization of NIH’s institutes and centers “to help focus resources on the highest priority research and training activities,” including consolidations and structural changes across NIH organizations and activities. The budget also would reduce administrative costs and rebalance federal contributions to research funding. Price said the plan is to “get the most bang for the taxpayers’ investment.”
Some subcommittee members worried that such a behemoth cut to NIH could negatively impact areas like research, particularly for universities and other NIH grant recipients that are working to develop medical countermeasures for chemical, biological, radiological and nuclear threats, as well as future threats like emerging infectious diseases, synthetic biology and engineered diseases.
U.S. Rep. Mike Simpson (R-ID), for instance, noted that NIH has done “vitally important work,” particularly in making biomedical research advances.
Since the budget blueprint mentions a reorganization of NIH, Simpson asked Price: is this a reorganization in NIH’s structure or funding priorities for research?
“I think it’s both. But we haven’t made a presupposition about the end point in this yet,” Price said.
The secretary said he “was struck by the amount of money that goes out for indirect costs that isn’t actually used for research. We need to look at that.” If there are greater efficiencies to be found, Price said, then more research grants could be made with those savings.
Additionally, the blueprint budget would provide funding to create a new Federal Emergency Response Fund to rapidly respond to public health outbreaks, such as the Zika virus. The budget also would reform the Centers for Disease Control and Prevention (CDC) through a new $500 million block grant to increase state flexibility and focus on the leading public health challenges specific to each state.
Price said that in reforming key emergency preparedness programs, for example, the budget would restructure similar HHS preparedness grants to reduce overlap and administrative costs. The budget would also direct resources to states with the greatest need.
“People don’t realize how much work HHS does behind the scenes to assist our local responders to prepare for and respond to natural disaster and other crises,” Price said.
For example, when a natural disaster cuts off a community from power sources, state and local officials rely on HHS to let them know which households in their community are energy-dependent and in need of rescue or additional assistance, he said.
“These requests for federal support are routine and rarely make headlines, but for, say, the snowed-in senior citizen who requires supplemental oxygen, the work HHS does could be a lifesaver,” Price said. “People need to know what we do.”
Fighting viruses
As a note, words such as countermeasures, biomedical, biological and pathogen do not appear in the president’s FY 2018 blueprint budget.
U.S. Rep. Tom Cole (R-OK), chairman of the Labor, Health and Human Services, Education, and Related Agencies subcommittee, said viruses like Zika and H7N9 highlight the need for the American public’s protection from biological threats. Cole said that Congress in FY 2016 approved more money for the Biomedical Advanced Research and Development Authority (BARDA) and Project BioShield to help in this area.
Cole asked Price for details on how HHS planned to maintain the work that’s been done thus far if it has less money in 2018.
“Emergency preparedness and response is absolutely critical and Americans expect us to do our job and keep them safe,” said Price, adding that it’s important to ensure that BARDA and BioShield receive resources to continue their missions.
Price added that HHS “continues to closely monitor the Zika situation, especially as we enter another mosquito season in the southern United States.” And in coordination with other federal agencies, HHS also continues to “actively monitor the progression of the H7N9 influenza virus in China,” he said. “We are considering options to ensure the safety of the American people.”
Ranking member of the full House Appropriations Committee U.S. Rep. Nita Lowey (D-NY), wasn’t happy about anything in the administration’s blueprint budget, nor in any of Price’s comments.
She said the massive proposed HHS cuts could endanger biosecurity, as well as the nation’s ability to combat diseases and epidemics.
“Death by a thousand cuts is not going to happen,” Lowey told Price. “I hope this won’t be your only visit.”
Price said he plans to return in May when the full budget proposal is slated for release.