Congressional Research Service: CDC Funding Overview (Part 1 of 2)
The report was written by health policy analyst
Here are excerpts:
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SUMMARY
The
This report divides
1. a core public health program level that funds most of the agency's main public health programs. This is made up of discretionary and mandatory appropriations that are mostly provided or allocated through the Departments of Labor,
2. other mandatory programs that include several
From FY2011 to FY2021,
In
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Contents
Introduction ... 1
Understanding
Core Public Health Program Level ... 4
Other Mandatory Programs ... 8
FY2022 and FY2023 Budget and Appropriations ... 9
FY2022 ... 10 FY2023 ... 10
Pandemic Preparedness Proposal ... 11
Other Legislative Proposals ... 12
Funding Table ... 12
Trends in Core Public Health Program Level ... 14
Supplemental Appropriations for Public Health Emergencies and Other Incidents ... 16
State and Local Funding for Public Health ... 19
Trends ... 19
Other Funding-Related Challenges ... 21
Figures
Figure 1.
Figure 2.
Figure 3. Example of
Figure 4. Example of
Figure 5. Example of Prevention and Public Health Fund Allocations ... 7
Figure 6. Trends in Core Public Health Program Level ... 15
Figure 7. Inflation-adjusted Trends in State Spending on Public Health by Category Per Capita from Alfonso, Leider, and Resnick, et al. (2021) ... 20
Tables
Table 1. Centers for Disease Control and
Table 2. Appropriations History to the IDRRRF Account ... 18
Contacts
Author Information ... 23
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Introduction
The
In addition to its role supporting ongoing public health activities, the agency has played a major role in the federal response to the Coronavirus Disease 2019 (COVID-19) pandemic and in other disease outbreaks and public health emergencies. The
Two features characterize
Four
Given
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1
2
3 For example, PHSA Section 301 (42 U.S.C. Sec.241) authorizes the HHS Secretary to conduct and support health-related research and investigations. PHSA Section 317 (42 U.S.C. Sec.247b) authorizes the Secretary to award grants to states for preventive health programs, and PHSA Section 319 (42 U.S.C. Sec.247d) authorizes the Secretary to respond to public health emergencies.
4 Explicitly authorized
5 Among numerous others, PHSA Sections 317A et seq. authorize lead poisoning prevention activities, and PHSA Title XXXIII authorizes the World Trade Center Health Program.
6 See
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A large portion of
This report reviews the
ATDSR appropriations are included within the overall discussion of
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Figure 1.
Source: Adapted by CRS from
Notes: HIV = Human Immunodeficiency Virus; STD = Sexually Transmitted Disease; TB = Tuberculosis.
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Understanding
This CRS report divides
* core public health program level, funded mostly by annual discretionary Departments of Labor,
* other mandatory programs, including health services or compensation-related programs funded by program-specific mandatory budget authorities. In addition,
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7 For the purposes of this report,
8 In FY2020,
9 This report draws from prior year Congressional Budget Justifications and relevant appropriations laws and accompanying reports. See
10 For the purposes of this report,
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CRS has divided
The other mandatory programs excluded from the core public health program level have funding levels that are mostly controlled by their program authorizations. The two largest programs - the Vaccines for Children (VFC) program and the World Trade Health Center Program (WTHCP) - primarily finance specific health services for eligible populations. Changes in annual funding reflect usage and demand for the program services. These programs' funding levels are therefore presented separately from
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11 See
12 See, for example,
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Figure 2.
Source:
Notes: Acronyms:
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Core Public Health Program Level
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13 See
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Discretionary Appropriations.
As an example, the Injury Prevention and Control account funds activities at
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Figure 3. Example of
Source: Consolidated Appropriations Act, 2021 (P.L. 116-260) Division H, Title II. 134 STAT. 1571.
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Appropriations report language accompanying
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14 For a general overview of appropriations report language, see CRS Report R44124, Appropriations Report Language: Overview of Components and Development.
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Figure 4. Example of
Source: "Explanatory Statement Accompanying Consolidated Appropriations Act, 2021," Congressional Record, vol. 166 (
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This CRS report focuses on account-level funding in Table 1.
Mandatory Appropriations from the
The PPHF has its own appropriation (provided by its authorizing law) and its own account within the
See Figure 5 for PPHF allocations from FY2021 appropriations.
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15 See
16 42 U.S.C. Sec. 300u-11(a).
17 Prior to FY2014, the HHS Secretary determined uses of the PPHF funding. See CRS Report R44796,
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Figure 5. Example of Prevention and Public Health Fund Allocations, From FY2021 LHHS Appropriations
Source: "Explanatory Statement Accompanying Consolidated Appropriations Act, 2021," Congressional Record, vol. 166 (
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As shown in Figure 5, most of the FY2021 PPHF allocation went to
Other funding.
Transfers. In some years,
In some years,
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18
19 The NEF permits HHS to transfer unobligated balances of expired discretionary funds from FY2008 and subsequent years into the NEF account. Statute authorizes use of the funds for capital acquisitions, including information technology (IT) and facilities infrastructure (42 U.S.C. Sec.3514a).
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Recent LHHS Appropriations Acts have established the higher maximum percentage for the set-aside and have distributed specific amounts of "Tap" funding to selected HHS programs. As shown in Figure 6,
Smaller mandatory appropriations for public health programs. Some smaller
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Supplemental Appropriations
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Other Mandatory Programs
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20 Social Security Act (SSA) Section 1139(e)(8).
21 See, for example, funding for the
22 VFC is funded by mandatory Medicaid appropriations that are transferred annually to
23 See "State Table: Vaccines for Children" in
24
25 See CRS Report R42640, Medicaid Financing and Expenditures.
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The Energy Employees Occupational Illness Compensation Program (EEOICP) provides compensation and medical benefits to eligible civilians (or their survivors) who have performed duties related to the nuclear weapons production and testing programs of the
The World Trade Center Health Program (WTCHP) provides medical monitoring and treatment to eligible individuals directly affected by the
User fee programs.
FY2022 and FY2023 Budget and Appropriations
The following provides an overview of the budget and appropriations for
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26
27
28 See, for example, in FY2021 LHHS appropriations, 134 STAT 1571 of Division H, Title II, P.L. 116-260.
29
30 "The Vessel Sanitation Program (VSP) at the
31 The respirator certification program conducts assessments and NIOSH approval of particulate filtering facepiece respirators. 42 C.F.R. Part 84. See also
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FY2022
*
*
*
*
The requested FY2022 program level would have represented a
In
*
*
*
The FY2022 enacted funding level represented a
FY2023
*
*
*
*
*
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32 Letter from
33 This report uses budget request numbers from Congressional Record, vol. 168, No. 42, (
34 The final funding level reflects post-appropriations transfers and other adjustments.
35
36
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This requested FY2023 core public health program level, including the new mandatory public health preparedness funding, represents a
In addition, the request proposes a significant change in how annual discretionary funding is appropriated to
The budget request's proposed LHHS discretionary appropriations legislative text would provide the
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37 Accounts consolidated would include: Immunization and Respiratory Diseases, HIV/AIDS, Viral Hepatitis, STI and TB Prevention, Emerging and Zoonotic Infectious Diseases, Chronic Disease Prevention and Health Promotion, Birth Defects, Developmental Disabilities, Disability and Health,
38 See 123 Stat 3241 in Consolidated Appropriations Act, 2010, P.L. 111-117.
38
39 See 123 Stat 3241 in Consolidated Appropriations Act, 2010, P.L. 111-117.
40
41
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Pandemic Preparedness Proposal
The FY2023 request proposes an HHS-wide total of
Other Legislative Proposals
* Vaccines for Adults Program. According to the request,
* VFC program modifications.
Funding Table
Table 1 provides an overview of
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42
43
44
45
46 FY2021 final funding level reflects post-enactment transfers and other adjustments.
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Table 1. Centers for Disease Control and
Source: FY2021 final amounts, FY2023 request amounts, and mandatory program amounts for all years are from
Notes: Individual amounts may not add to subtotals or totals due to rounding. Final amounts for FY2021 differ from enacted funding levels due to transfers and other adjustments. Acronyms: HIV = Human Immunodeficiency Virus; AIDS = Acquired Immunodeficiency Syndrome; STI = Sexually Transmitted Infection; TB = Tuberculosis.
a. The FY2023 request proposes consolidating 13
b. The Extending Government Funding and Delivering Emergency Assistance Act (P.L. 117-43), one of the FY2022 continuing resolutions, provided an additional
c. Provided separately in the Interior/Environment appropriations act. FY2022 enacted amount from Congressional Record, vol. 168, No. 42, (
d. FY2022 and FY2023 amounts are estimates for VFC. WTCHP, User Fees, and Vaccines for Adults.
e. Per the FY2023 budget request table, all amounts for EEOICPA reflect sequestration and therefore differ from appropriated funding levels.
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Continues with Part 2 of 2
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The report is posted at: https://crsreports.congress.gov/product/pdf/R/R47207
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