FY2018 Appropriations Actions

By Emily McCloskey December 22, 2017

Yesterday, the House and Senate have passed a short term continuing resolution (CR) that provides FY2018 funding until January 19, 2018. The President is expected to sign the CR today. 
The short-term CR also includes funding to continue the Children's Health Insurance Program (CHIP) and Community Health Centers through March and waives automatic cuts to Medicare and other programs, which were threatened because of the recently passed tax bill's large deficit increase. The extension is paid for, in part, by a $750 million cut to the Prevention and Public Health Fund (PPHF), beginning with a $100 million cut in FY2019. At this time, it is difficult to determine the level of cuts to state and territorial health programs as a result of losing $100 million from PPHF in FY2019.
The House also approved an $81 billion emergency aid package to help communities in Texas, Florida, Puerto Rico, and California. The bill includes large sums of funding for the Federal Emergency Management Agency (FEMA) and housing and public works programs. The Senate did not immediately take it up amid Democratic objections. Most of the aid is not immediately doled out to states. Instead, it will be distributed through grants over the next few months, after lengthy applications. Congress is expected to resume discussions on this package in January. 
Senators Mitch McConnell (R-KY) and Chuck Schumer (D-NY) have been meeting privately for weeks, along with Speaker Paul Ryan (R-WI-1st) and Minority Leader Nancy Pelosi (D-CA-12th), to craft a two-year spending deal that would raise spending caps for defense and nondefense programs. The Budget Control Act of 2011 set caps for both defense and nondefense spending for the next decade, enforceable by sequestration. These negotiations are expected to continue into 2018 and will set the stage for finalizing FY2018 and FY2019 funding. 

Funding allocations for HIV and hepatitis programs will not be finalized for the remainder of FY2018 until Congress returns in January. NASTAD will continue to advocate for the highest possible funding amounts for HIV and hepatitis programs.  

Congress Passes Tax Bill
 On Wednesday, the House and Senate passed a sweeping revamp of the U.S. tax code. The President signed the bill into law today. The bill repeals the Affordable Care Act’s penalty for individuals who do not have health insurance in 2019.The Congressional Budget Office has estimated this repeal would result in 13 million fewer insured Americans a decade from now. Without the individual mandate, younger, healthy people will have less incentive to sign up for coverage, particularly in the individual market. Without a balanced risk pool of both sick and healthy people, premiums in the individual market will go up, pricing people out of coverage. The individual mandate has also served as an enrollment incentive for Medicaid, without which, fewer people eligible for that program will actually enroll. 
The tax plan will also have a substantial impact on the government’s budget outlook, adding $1.456 trillion to the national debt over 10 years. The massive increase in the deficit will have a significant impact on future funding for programs that provide lifesaving prevention, care, and treatment for people living with HIV and hepatitis, including Medicaid and Medicare. To balance the increasing deficit and pay for the proposed tax cuts, massive cuts to discretionary spending may be proposed. This could have a significant impact on HIV and hepatitis programs. This could also jeopardize the Prevention and Public Health Fund, which accounts for 12% of the Centers for Disease Control and Prevention’s (CDC) budget. These cuts may be triggered by The Statutory Pay‐As‐You‐Go Act of 2010 (SPAYGO), which triggers automatic program cuts as a budgetary enforcement mechanism. While Members of Congress have said they will repeal the SPAYGO Act, no legislation has been introduced. In turn, it is expected Republicans will use the growing debt as a pretext to cut many entitlement programs, including Medicaid and Medicare. 
NASTAD will continue working with our public health and chronic condition/disability partners on advocacy efforts over the coming months to highlight how this bill will be detrimental to our programs and the individuals they serve.  We will keep you posted as further developments occur.
Restricted Word Use
 Last Friday, the Washington Post reported that the Trump Administration barred staff at the CDC from using certain words in its FY2019 budget justification to Congress. NASTAD, in partnership with AIDS United, NCSD, NMAC, and The AIDS Institute, released a statement condemning the reports and sent a letter to the Department of Health and Human Services (HHS) and CDC expressing our concerns. 
In response to the reports, an HHS spokesperson issued the statement below.  
HHS and its agencies have not banned, prohibited or forbidden employees from using certain words. Recent media reports appear to be based on confusion that arose when employees misconstrued guidelines provided during routine discussions on the annual budget process. It was clearly stated to those involved in the discussions that the science should always drive the narrative. Any suggestion otherwise is simply not true.
The Washington Post has updated its story, noting new developments and nuances. While a "do not use list" does not exist, HHS did provide written guidance to agencies about how to better message for the Office of Management and Budget (OMB) audience. 
On Monday, the CDC Facebook page also shared a statement from the CDC Director, Dr. Brenda Fitzgerald, saying ‘there are no banned words,’ while not refuting the reporting.  “You may be understandably concerned about recent media reports alleging that CDC is banned from using certain words in budget documents. I want to assure you that CDC remains committed to our public health mission as a science- and evidence-based institution,” Fitzgerald said in the statement.
This issue was not limited to HHS. Last week, U.S. Department of State employees received a guidance document that provided instructions on how they should develop country operating plans under the President's Emergency Plan for AIDS Relief (PEPFAR) for 2018. The phrase “sexual risk avoidance” is used throughout the document, which has been defined in recent Congressional funding bills as abstinence-only practices until marriage, as the primary form of sex education.
The Association for State and Territorial Health Officials issued this statement and the American Public Health Association sent this letter to HHS about the restricted word use. The Coalition for Health Funding, in which NASTAD is an active participant, also released a statement. NASTAD also joined a letter from public health organizations on this matter. 
NASTAD will continue to advocate that CDC implement scientific and evidence-based programs that address all populations, especially those most vulnerable to HIV and hepatitis infections. 

Please contact Emily McCloskey or Mike Weir if you have any questions.