By Ceci Connolly
Washington Post Staff Writer
Tuesday, February 14, 2006
President Bush has requested billions more to prepare for potential disasters such as a biological attack or an influenza epidemic, but his proposed budget for next year would zero out popular health projects that supporters say target more mundane, but more certain, killers.
If enacted, the 2007 budget would eliminate federal programs that support inner-city Indian health clinics, defibrillators in rural areas, an educational campaign about Alzheimer's disease, centers for traumatic brain injuries, and a nationwide registry for Lou Gehrig's disease. It would cut close to $1 billion in health care grants to states and would kill the entire budget of the Christopher and Dana Reeve Paralysis Resource Center.
In a $2.8 trillion budget, the amounts involved may seem minuscule, but proponents argue that the health care projects Bush has singled out are the "ultimate homeland security," as Vinay Nadkarni put it. The spokesman for the American Heart Association said he cannot fathom why the administration has recommended eliminating a $1.5 million program that provides defibrillators to rural communities and trains local personnel on how to use the machines to restart hearts that go into cardiac arrest.
"Coronary heart disease is the number one killer in the United States," Nadkarni said. "This is actually something we can arm ourselves with."
To meet his twin goals of taming a rising deficit and increasing spending on national security, Bush proposed $2.2 billion in cuts to discretionary programs elsewhere in the budget. The Department of Health and Human Services would absorb $1.5 billion of that total, in part to direct more money to mandatory programs such as Medicare.
"We had to make hard choices, hard choices about very well-intentioned programs," said HHS Secretary Mike Leavitt.
Sen. Edward M. Kennedy (D-Mass.) said the administration chose "tax cuts for the wealthy and giveaways for the drug industry" over services for needier patients.
Some of the proposed cuts are familiar Bush targets that in previous years were rescued by congressional backers. Others are new and could be harder to restore this year. Leavitt said his team slashed programs that were duplicative or underperforming. But in every case, physicians, patient advocates and policy analysts argue, it will cost taxpayers more in the long run.
The 2007 budget would terminate $12 million in state grants for community-based Alzheimer's care and a $1.6 million "Maintain Your Brain" campaign run out of the Centers for Disease Control and Prevention. Today, more than 4.5 million Americans have Alzheimer's, a number expected to rise to 16 million by mid-century, said Stephen McConnell, vice president for public policy at the Alzheimer's Association.
"It costs Medicare three times as much to take care of somebody with Alzheimer's disease than not," he said. "If we could even just slow the progression of this disease, we could reduce the cost substantially."
HHS Chief Financial Officer Charles E. Johnson defended the cuts, noting that the budget has "a very substantial amount of funding going into Alzheimer's." But total HHS spending on the deadly brain disease would fall from $652 million to $645 million, McConnell said, and that does not include proposed reductions in areas such as the Justice Department's "Safe Return" program, used to find patients who go missing.
In September 2001, the Bush administration was so proud of its decision to underwrite the resource center named after Reeve, the late "Superman" star, then-Secretary Tommy G. Thompson delivered the $2 million check. In the years since, the administration and Congress increased the budget to nearly $6 million, funding a Web site, toll-free hotline, rehabilitation programs and scholarships to help paralyzed people live independently, said the foundation's vice president, Joe Canose.
"Here we are on a roll, growing, doing all these great services; it was surprising we would be caught up in this zero funding," Canose said.
In several instances, officials said they want to terminate funding for projects that could be paid for instead with money from Maternal and Child Health Bureau grants. Programs on the chopping block include a $10 million newborn screening initiative and $20 million in grants to train emergency medical personnel to care for children.
"Here's the glitch," said Karen Hendricks, assistant director of the American Academy of Pediatrics. The block grants for maternal and child health "have not had an infusion of new dollars in several years," she said. "In FY 2006 it went from $724 million to $693 million."
After failing last year, the White House is again attempting to eliminate $99 million in preventive health services grants begun under President Ronald Reagan. In recent years, Texas used the money for a cardiovascular program, Mississippi bought child safety seats for poor mothers, Colorado discovered an E. coli outbreak, and New York identified the first cases of West Nile virus, said George E. Hardy Jr., executive director of the Association of State and Territorial Health Officials.
"It's a small dollar amount -- $100 million is nothing in the federal budget -- but they are critical to a state's ability to meet unmet needs," he said. In virtually every case, states have data showing the projects saved lives and money.
"The public health component of a governor's budget is discretionary," said Kim Elliott, deputy director of the Trust for America's Health, a nonpartisan advocacy group that lobbies for investment in disease prevention. "It is always the public health dollars that get squeezed."