BEYOND THE NUMBERS
The reconciliation bill before the House would abolish health reform’s Prevention and Public Health (PPH) Fund because, as Health Subcommittee Chairman Joe Pitts put it, it’s “a slush fund that the Health and Human Services [HHS] Secretary can spend from without any Congressional oversight or approval.” That assertion is baseless.
Since 2014, Congress has exercised detailed control over the fund — which supports programs to advance prevention and public health, improve health outcomes, and enhance health care quality — through the annual appropriations process. Eliminating the fund would create a hole in the budget of the Centers for Disease Control and Prevention (CDC), which gets more than 90 percent of the fund’s resources. The hole would be very hard to fill, as the 2011 Budget Control Act (BCA) annual caps and additional sequestration budget cuts severely constrain funding for appropriated programs.
A little history. Health reform, which established and permanently funded the PPH Fund, invited Congress to delineate specific uses for it each year in appropriations bills and left those decisions to the HHS Secretary only if lawmakers chose not to. Congress initially didn’t exercise its authority over the fund but, beginning with the 2014 appropriations bills, it has consistently given that direction. The 2014 and 2015 Labor-HHS-Education appropriations bills (section 219 of each) — and the 2016 bills approved by the House and Senate Appropriations Committees — all specify the programs and activities for which the fund is to be used and the precise amounts for each.
In fact, the executive has less discretion over the PPH Fund than over regular appropriations, as the 2014-2016 appropriations bills prohibit HHS from transferring any PPH funds. They also impose special transparency requirements, directing HHS to maintain this website with detailed information about uses of the fund.
In 2015, the fund provided (among other things):
- about one-third of the funding for the CDC’s immunization programs;
- all of the funding for a block grant to help states detect and respond to infectious diseases and other public health threats;
- half of the funding for the CDC’s breast cancer and cervical cancer screening program; and
- half of the funding for CDC efforts to prevent heart disease, stroke, and diabetes.
More information on uses of the fund is available here.
For 2016, the House Labor-HHS-Education appropriations bill allocates $914 million from the PPH Fund to the CDC, while the Senate version allocates $893 million. Both amounts are about one-eighth of the CDC’s budget and go to uses similar to those listed above. If Congress abolished the fund, appropriators would probably try to reallocate some funds from elsewhere in the bill to make up part of the shortfall in key CDC programs (as well as to other programs outside CDC that the PPH fund supports). But even if they chose to do so within the current BCA caps as lowered by sequestration, that would open up holes in important programs in other parts of the budget.