Policy Round-Up: FY2018 Appropriations

By Emily McCloskey July 21, 2017

Yesterday, the House Appropriations Committee passed the FY2018 Labor, Health and Human Services, Educations and Related Agencies Appropriations bill out of Committee by a party line vote of 28-22.

Representative Barbara Lee (D-CA) offered an amendment to restore funding for the Secretary’s Minority AIDS Initiative Fund and funding to the Minority AIDS Initiative at the Substance Abuse and Mental Health Services Administration (SAMHSA), as well as other minority health programs, all of which were cut in the Subcommittee’s bill. While the amendment failed 29-23, six Democrats expressed their support for the program. Congresswoman Martha Roby (R-AL) expressed her support for minority health programs, but did not vote in support of the amendment.

Information about the funding levels and bill language are detailed below. 

Centers for Disease Control and Prevention (CDC)

The mark flat funds the CDC’s National Center for HIV, Viral Hepatitis, STD and TB Prevention (NCHHSTP), for a total request of $1.12 billion.  The President’s FY2018 Budget decreased funding by $186.0 million for a total of $934.0 million for CDC/NCHHSTP. 

Division of HIV Prevention

The bill funds the Division of HIV/AIDS Prevention at $788.7 million, which is flat funding from FY2017. The President’s FY2018 Budget requested a decrease of $147.0 million for domestic HIV/AIDS prevention and research programs at CDC. The breakdown of funding includes:

Program

FY2017

FY2018

HIV Prevention by Health Departments

$397.2 m

$397.2 m

HIV Surveillance

$119.9 m

$119.9 m

Activities to Improve Program Effectiveness

$103.2 m

$103.2 m

National Regional, Local, Community, and Other Organizations

$135.4 m

$135.4 m

School Health – HIV

$33.1 m

$33.1 m

 

Division of Viral Hepatitis

The bill flat funds the Division of Viral Hepatitis, for a total request of $34.0 million. Report language on hepatitis and liver health is included:

Hepatitis B.—The Committee is concerned that even though the hepatitis B vaccine is more than 90 percent effective, there are over 50,000 new hepatitis B virus (HBV) infections each year and more than 10 deaths each day due to this disease in the U.S. As a result of the opioid epidemic, infection with HBV has spiked in many parts of the nation with, for example, acute HBV infections increasing 114 percent from 2006 to 2013 in three states that have suffered from widespread opioid overuse (Kentucky, Tennessee, and West Virginia). The Committee notes that the link between HBV infection and primary liver cancer is well-established, with up to 60 percent of global liver cancer cases caused by HBV. Many of these liver cancer cases are preventable with early detection of, treatment of, and vaccination for HBV. An innovative public health effort to reduce HBV-related disease burden would move the U.S. into a global leadership position likely to benefit U.S. relations with countries in Asia, Africa, and other global regions where HBV infection and its severe complications are endemic.

Liver Health.—The Committee commends CDC for its efforts to increase national awareness of viral hepatitis B and C, and requests that CDC support liver health and wellness activities in an effort to reduce morbidity and mortality for persons infected with viral hepatitis who develop liver disease, cirrhosis, liver failure, and liver cancer.

STD Prevention

The bill flat funds STD prevention at the FY2017 level, for a program total of $152.3 million. The President’s FY2018 Budget cuts STD funding by $22.0 million from the FY2017 level for a total of $130.0 million.  

TB Prevention

TB Prevention is funded at $142.3 million, the same level as FY2017. The President’s FY2018 Budget proposed a $12.0 million cut to TB funding.

Global Health

The bill flat funds CDC’s Global Health program and the contribution to PEPFAR.  The President’s FY2018 Budget proposal cut $58.6 million from CDC’s global HIV/AIDS program. 

CDC Programs

The bill cuts Chronic Disease Prevention and Health Promotion by $74.0 million and Immunization and Respiratory Diseases by $50.0 million.

Health Resources and Services Administration (HRSA)

Ryan White Program

The House Appropriations bill flat funds all parts of the Ryan White Program. While the President’s FY2018 Budget eliminated Part F Special Projects of National Significance (SPNS) and AIDS Education and Training Centers (AETCs), the Appropriations Committee retained funding for these programs.

340B Drug Pricing Program

The bill requests flat funding of $10.0 million for the Office of Pharmacy Affairs (OPA). It also includes the following report language:

The Committee recognizes that the 340B Drug Pricing program was designed to help safety net providers maintain, improve, and expand patient access to healthcare services generally. Since its enactment in 1992, the 340B program has lowered the cost of outpatient drugs to Government funded health clinics, as well as nonprofit and public hospitals that serve a disproportionate share of low-income patients or rural communities.

The Committee is aware that the 340B statute requires HRSA to make 340B ceiling prices available to covered entities through a secure website and continues to be concerned that OPA has failed to meet deadlines to complete work on the secure website. The Committee urges OPA to complete the development of a secure website. The Committee directs OPA to include an update on the status of the secure website in the fiscal year 2019 budget request.

Title X

The bill eliminates funding for Title X Family Planning Services.

Substance Abuse and Mental Health Services Administration (SAMHSA)

Minority AIDS Initiative

Funding for Minority AIDS Initiative (MAI) activities at SAMHSA were cut by $17.4 million from FY2017, for a funding total of $98.6 million. Specifically, Mental Health Services Minority AIDS was cut by $5.0 million and Substance Abuse Prevention Minority AIDS was cut by $12.4 million over FY2017 levels. Substance Abuse Treatment Minority AIDS was level funded.

Department of Health and Human Services

Secretary’s Minority AIDS Initiative Fund

The bill eliminates $53.9 million in funding for the Secretary’s Minority AIDS Initiative Fund (SMAIF).  NASTAD currently receives two awards via SMAIF funding: our HRSA Center for Engaging Black Gay Men Across the Care Continuum (CEBACC) and our HRSA HCV/HIV co-infection elimination grant.  SMAIF funding was also eliminated in the President’s FY2018 Budget.

Teen Pregnancy Prevention Program

The bill eliminates funding for the Teen Pregnancy Prevention Program.

Earlier this week, the House Appropriations also passed the Transportation, Housing and Urban Development, and Related Agencies Funding bill which funds the Housing Opportunities for People With AIDS (HOPWA) program. HOPWA was level funded at $356.0 million.

NASTAD will continue to advocate on behalf of HIV and hepatitis programs. A detailed appropriations chart, including the HIV community requests is attached.  We will send out further budget and appropriations information as it becomes available.  Please contact Emily McCloskey if you have any questions.

NASTAD Appropriations Chart