Investing in Health: The 2020 Labor, HHS, Education Appropriations Bill

At time of writing, the House Appropriations Committee is engaged in its first full-committee markup of a Fiscal Year 2020 appropriations cycle – the Labor, Health & Human Services, Education bill. The fact that Labor-H is first out of the gate in the 2020 process is a change from previous years, in which it typically lagged others, due largely to its high price tag relative to other domestic bills, and the contentious nature of some of investments therein.

The Labor-H bill benefitted from a strong allocation of $189.9 billion in discretionary funding, an increase of $11.7 billion over the 2019 enacted level and $47.8 billion more than the President’s budget request.

That strong allocation allowed Chairwoman Rosa DeLauro to write a bill and report that invest robustly in health priorities, including $41.1 billion for medical research at NIH, an increase of $2 billion over the 2019 level, supporting initiatives like the Cancer Moonshot, the BRAIN Initiative; the “All of Us” Precision Medicine Initiative; Alzheimer’s research; and research to develop a universal flu vaccine. It also provides $8.3 billion for CDC, an increase of $921 million, to modernize public health capacity and data infrastructure, and to address costly chronic diseases. Unlike previous years, the House bill and report do not propose reductions for initiative managed by other health agencies like Health Resources Services Agency (HRSA) and Agency for Healthcare Research and Quality (AHRQ).

The bill and report do not shy away from issues that have proven contentious in the past, providing $50 million in dedicated funding for gun violence research at CDC and NIH, increasing funding for Title X family planning and Teen Pregnancy Prevention, and providing $100 million for Affordable Care Act navigators.

For further details, see the summary, bill, and report prepared by the House majority.

It is tempting to focus on the robust funding, the detailed policy, and the report language in this bill and to ignore the 800lb gorilla lurking around the corner. But without a new agreement raising statutory budget caps enacted in the 2011 Budget Control Act, these health priorities will see a severe decrease in 2020 – not the increases that Chairwoman DeLauro envisions. In fact, without a budget agreement enacted into law, ‘sequestration’ will automatically reduce discretionary spending by $126 billion next year, split between defense and non-defense investments.

Progress in forging a deal to avoid these cuts appears to be nonexistent. President Trump has publicly disparaged the possibility of reaching such an agreement. And when asked today by a journalist how caps negotiations are proceeding, Speaker Nancy Pelosi responded, “Are there caps negotiations?”

It would not be surprising in the least if difficulty reaching a budget agreement results in Congress being forced to pass at least one – possibly several – Continuing Resolutions of some length.

Patients, researchers, health care professionals, and others who rely on investments in public health have a vested interest in realizing the increases that Chairwoman DeLauro envisions, rather than experiencing drastic reductions or another extended federal government shutdown. That will require pressure on all sides to reach a responsible budget agreement and avoid an outcome that will be damaging for public health.

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