188: Funding the Future of Public Health

ROBERT JOHNSON:

This is Public Health Review Morning Edition for Friday, May 27th, 2022. I'm Robert Johnson.

Now, a special conversation with ASTHO CEO, Mike Fraser. We caught up with him at this week's COVID-19 summit in Washington, D.C. to talk about ASTHO support for public health funding in the next federal budget.

It's that time of the year, again—time to talk to Congress about what public health needs in the way of funding for programs. What is the ask this time around?

MICHAEL FRASER:

So, we're asking for both the sustained funding for state and territorial public health as well as funding to address some of the needs that were identified through COVID. A lot of the money for public health response to COVID was specific to the public health emergency. States have spent a lot of that, and we know we're not going to build lasting capacity through one-time funding for COVID.

So, we're asking top-line for $11 billion for CDC, which would be an increase for the agency. We're asking for $9.2 billion in funding for HRSA—the Health Resources and Services Administration. Those are federal agencies that do a lot of work with the states and pass through a lot of grants to states.

JOHNSON:

What about the issues that have sort of surfaced during the pandemic, like workforce and infrastructure and data modernization? Are those contemplated at all in this latest request?

FRASER:

Yeah, we've specifically asked for $250 million for data modernization. We think that the funding that has been appropriated in the past has helped, but we need to continue to beef that up.

We've also requested $153 million for a social determinants of health grant program at CDC that, again, would pass through to states looking at some of the equity issues and the real drivers of healthy communities. This would give us a down payment on that work.

JOHNSON:

What do you think about the congressional appetite for a request like this? Have you done any assessments? Do you have any thoughts about what you hope they'll do or what they might do?

FRASER:

Well, I mean, I think we're in a really tricky place. We're in an election year and the budget is political. My guess, if I had to guess what'll happen, is we'll just go on a CR—continuing resolution—and be funded at last year's levels.

But we keep asking. And, you know, if there's no appetite to invest in public health now as we come out of COVID or as we transition to a more sustained management of COVID, I don't know what's going to get the attention of Congress.

JOHNSON:

And we talked to a lot of the state health officials about this notion of keeping the public somehow paying attention to COVID—because it's not over, even though everyone would like it to be. Is that the same challenge with lawmakers, to keep them focused on it as well?

FRASER:

Keeping them focused, I think continuing to illustrate why we need sustained capacity. We have this constant panic-neglect funding cycle, boom-bust funding cycle, feast-famine funding cycle, and none of that is sustainable in the long term. So, these data systems we're standing up, the workforce that's being hired for COVID, none of those can be sustained without new money.

And so, we're trying to get that across to Congress that has now—at this particular point in time, you know, half of them don't have any appetite to spend more.

JOHNSON:

Sometimes when communicating to the Hill about budget, there is also discussion about policy. Is there any reference to anything that ASTHO and the members would like to see along those lines coming from Congress in the new fiscal year?

FRASER:

You know, we don't do a lot of legislative work in that regard. We don't do a lot of bill authoring or drafting. We really do focus on appropriations. I don't think we need a lot of new legislation. I think we need to fund the public health system. And that's why we focus on appropriations right now.

There is some work specifically around data modernization, the way that states share data with CDC in particular that we're working on, but nothing firmed up right now.

JOHNSON:

We're talking to you from the COVID Summit that ASTHO hosted recently in Washington. As you're seeing members here and online, what are you asking them to do as it relates to supporting this request? What can they do?

FRASER:

Well, we know our state health officials are influencers—they work closely with their governors, they work closely with their congressional delegations. One of the major things that state health officials can do is tell the story of why these resources are needed, both through COVID but many other lenses. So, it always helps for our members to tell that story, to demonstrate the need, to share some success. I mean, there's lots of good that's happening in public health agencies, but there's a lot more we could do with sustained funding, and that's the story they can tell.

JOHNSON:

That'll do it for today's newscast. We're off Monday for Memorial Day, but back Tuesday morning with more ASTHO news and information.

I'm Robert Johnson. You're listening to Public Health Review Morning Edition. Have a great holiday weekend.