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University of Maryland expert outlines federal budget choices that could shrink public-health grants and reorganize agencies
Summary
William Levy (University of Maryland) told the Prince George's County Board of Health that federal proposals include program eliminations, consolidations and criteria that prioritize state/local responsibility — shifts that could place pressure on smaller public-health grants used locally.
A University of Maryland faculty member and former state health official told the Prince George's County Board of Health that proposed federal budget and reorganization plans would target many smaller public-health grants and could shift costs to state and local governments.
Dr. William Levy said on June 17 that the administration's proposal includes program eliminations, consolidations (including a proposed new "Administration for Healthy America" to move certain programs out of HRSA and CDC) and criteria that would de-prioritize funding for programs the administration says could be funded at state or local levels. "No matter what happens and what this administration proposes to do and how successful they may or may not be, we have a deficit problem," Levy said, adding that the structure of mandatory spending limits the federal government's discretionary ability to absorb cuts.
Why it matters: Levy told the board that many of the small line-item grants that counties and community organizations rely on were specifically enumerated in federal proposals; eliminating or consolidating them could remove targeted supports for minority health, maternal and child health programs, and community-based HIV services. He cautioned that even when large programs remain, the loss of smaller line items would reduce locally tailored funding streams.
Details from the presentation: Levy showed that the federal budget's share of mandatory spending has grown over decades and that many health and social programs are politically difficult to change. He listed four criteria he interpreted from the administration's proposals for selecting reductions: shifting programs to state/local responsibility, removing targeted support for special populations, folding duplicate programs together and eliminating services the administration does not prioritize (Levy cited family planning as an example). Levy also noted that the complexity of federal line items — dozens within CDC, HRSA and SAMHSA — makes predicting local impacts difficult until final appropriations occur.
Board response: Council members thanked Levy and asked for follow-up briefings; Levy said local health programs should prepare for budgetary pressure and consider where to prioritize limited resources.
