HIV (global/domestic) & Hepatitis in Budget
Reported by Jules Levin, Feb 2 2010
from Jules: I tried to capture HIV & hepatitis in the proposed Obama budget issued yesterday. There is essentially no increase for viral hepatitis at the CDC and HIV is reported below.
The HHS Budget in Brief [PDF - 113 Pages]
"President Obama on Monday proposed a $5 billion increase in the State Department's 2011 budget, most of which is intended for programs in Afghanistan, Pakistan and Iraq - the only three countries to also benefit from an additional $4.5 billion this year."
"Global health and development aid overseas will go up significantly in the fiscal year beginning in October, while the biggest decreases will affect the fight against HIV/AIDS and migration and refugee assistance."
"PROTECTING AT-RISK POPULATIONS HIV/AIDS: The request includes $2.3 billion, a $40 million increase, for HIV/AIDS treatment activities authorized by the Ryan White CARE Act of 2009. This funding supports a comprehensive approach to address the health needs of persons living with HIV/AIDS, including medical treatment, life saving medications, and access to care. The program addresses the unmet health needs of persons living with HIV by funding primary health care and vital health-related support services that enhance access to and retention in care. The program reaches over half a million individuals each year, making it the Federal government’s largest program specifically for people living with HIV/AIDS.
"$900 billion proposed for HHS.....almost a 10% increase from the current fiscal year under President Barack Obama's proposed federal budget for fiscal 2011"......"9% increase in funding for global health......by 2014, including getting 1.6 million more people into drug treatment for HIV/AIDS.....Some AIDS and other health advocacy groups said the amounts the administration was asking for weren't sufficient for it to achieve the goals it has laid out. Of particular concern was a small proposed increase in spending for HIV/AIDS programs for the second year in a row.......threatens the momentum gained in a scale-up of HIV treatment in recent years......"This is a very big disappointment," Jeffrey Sachs......Kenneth Mayer, ".....this budget proposal could imperil the fragile gains made over the last decade in treating HIV. It could also force a Sophie's Choice between prevention and treatment."
"Preventing and Treating HIV/AIDS: The Budget includes more than $3 billion, an increase of $70 million, for CDC and the Health Resources and Services Administration (HRSA) to enhance HIV/AIDS prevention, care, and treatment. This increase includes $31 million for CDC to integrate surveillance and monitoring systems, address high-risk populations, and support HIV/AIDS coordination and service integration with other infectious diseases. This increase also includes $40 million for HRSA’s Ryan White program to expand access to care for underserved populations, provide life-saving drugs, and improve the quality of life for people living with HIV/AIDS."
"Allocating $3 billion for HIV/AIDS prevention and treatment, with the goal to develop a national HIV/AIDS strategy to reduce HIV incidence, increase access to care, improve health outcomes, and reduce HIV-related health disparities."
"CDC budget for viral hep is $21,107,000, which is an increase of $1,848,000 (+10%) CDC HIV is $343,062,000 which is up 30,560,000 (+4%). Within HIV there is an increase of 14,175,000 for health depts. And $18,061,000 for improving program effectiveness STD is up 4%. TB is cut slightly by $1.2M"
"Strengthening the Centers for Medicare & Medicaid Services (CMS): The Budget includes $3.6 billion, an increase of $186 million."
"The budget includes an extra $25 billion in Medicaid funding for states"
"Funding for the Department of Health and Human Services will increase “in the range of inflation or less,” according to Politico. But NIH funding would grow by about $1 billion, or 3%. Community health centers, Head Start and a teen pregnancy program would also see increases, Politico says."
"President Barack Obama’s budget boosts global health initiatives 9 percent to $8.5 billion, expanding child and maternal health programs that piggyback on AIDS relief programs in the world’s poorest countries."
"The budget for global AIDS treatment and prevention increased about 2 percent to almost $7 billion, while the global health budget for the U.S. Agency for International Development, which provides humanitarian assistance, jumped 25 percent to $3 billion. The increase is primarily for health programs in poor countries that will build on U.S.-funded efforts to combat AIDS, said Jenny Peterson, spokeswoman for the Office of the U.S. Global AIDS Coordinator."
"The White House budget plan submitted to Congress on Monday would provide millions of dollars to upgrade the region's troubled Metro system, clean up the Chesapeake Bay and limit the spread of HIV and AIDS in the Wash DC District.....The budget provides $5 million to support the D.C. Department of Health's efforts to ensure counseling, testing and treatment in the city's high-risk, high-poverty areas and to continue outreach campaigns. A report last year determined that HIV/AIDS affected about 15,000 adult residents, or at least 3 percent of the city's population -- the highest prevalence rate in the nation."
HRSA Health Centers and National Health Service Corps: The Recovery Act provides $1.5 billion to modernize, renovate and repair health centers. These funds will also be used for the acquisition of health IT systems. An additional $500 million supports the establishment of 127 new health center sites and service areas, and increased services at over 1,100 existing sites.
Obama's Proposed Budget: More Money for Health IT, Medicare, Medicaid, NIH
http://www.healthleadersmedia.com, Janice Simmons, for HealthLeaders Media, February 1, 2010
The Department of Health and Human Services (HHS) would see almost a 10% increase from the current fiscal year under President Barack Obama's proposed federal budget for fiscal 2011 released today. Included in the budget are numerous areas promoting healthcare reform, including additional funding for health information technology and comparative effectiveness research.
Of the $900 billion proposed for HHS, the lion share is targeted toward Medicare at $489 billion, after recouping an anticipated $722 million through revamped efforts to detect waste, fraud, and abuse. States would receive $290 billion for Medicaid, which includes an additional $25.3 billion to extend by six months those increases included under last year's economic recovery act. Both amounts represent about a 9% increase from 2010.
Many of the items in the proposed budget appear to make reference to continuing White House attempts to reform the $2.5 trillion healthcare system. On Monday, Office of Management and Budget Director Peter Orszag said that many of the long-term fiscal gaps are being driven by healthcare costs. "That's one the reasons why the Administration has been focused on comprehensive healthcare legislation."
"Not only would it reduce the deficit over the next decade, but place the infrastructure and policies that will help to constrain costs and improve quality in the decades thereafter," he added. A section is included in the proposed budget that notes an "allowance for health reform," with a $23 billion decrease in the budget deficit noted for fiscal 2011.
One area receiving particular emphasis in the budget is health information technology, with $110 million proposed for continuing efforts to "strengthen health IT policy, coordination, and research activities."
Among other proposals are:
* Increasing the investment in comparative effectiveness research to $286 million to build on the expansion of this research begun under the economic stimulus legislation last year.
* Providing $2.5 billion for health centers for primary and preventive care to underserved populations, including the uninsured. This amount is aimed at allowing health centers to continue to provide care to the 2 million patients added through the economic stimulus legislation, and to support approximately 25 new health center sites.
* Reducing fraud, waste, and abuse by including $250 million in additional resources through expanding the Health Care Fraud Prevention and Enforcement Action Team (HEAT) initiative, a joint effort by HHS and Justice.
* Improving access and quality of healthcare in rural areas by including $79 million for an initiative focused on regional and local partnerships among rural healthcare providers. The goal is to increase the number of healthcare providers in rural areas, and improve performance and financial stability of rural hospitals.
* Allocating $3 billion for HIV/AIDS prevention and treatment, with the goal to develop a national HIV/AIDS strategy to reduce HIV incidence, increase access to care, improve health outcomes, and reduce HIV-related health disparities.
* Reducing childhood obesity rates by budgeting $1 billion to improve children's access to healthy meals through reauthorization of the school meals program and other child nutrition programs.
* Expanding the budget at the National Institutes of Health by $1 billion from the previous year. The NIH budget will include $6 billion to support a range of new cancer studies, including the initiation of 30 new drug trials in 2011.
* Including $222 million across HHS to expand research, detection, treatment, and other activities related to improving the lives of individuals and families affected by autism spectrum disorder.
* Increasing the number of primary healthcare providers through investing $169 million in the National Health Service Corps (NHSC) to place providers-including physicians, nurse practitioners, and dentist-in medically underserved areas.
* Including $10 million in a federal employee workplace initiative to implement prototype wellness programs with a goal of healthcare promotion and lower healthcare costs.
White House Proposes 9% Increase in Global-Health Funding
By BETSY MCKAY
The Obama administration proposed a 9% increase in funding for global health needs in its fiscal 2011 budget, pledging to spend more to combat preventable diseases and reduce deaths among women and children at a time when it is tightening its belt elsewhere.
The proposal was accompanied by the release of a set of ambitious targets to be achieved by 2014, including getting 1.6 million more people into drug treatment for HIV/AIDS, cutting the prevalence of malaria by 50%, and reducing the number of deaths of mothers and children under 5 years old.
Some AIDS and other health advocacy groups said the amounts the administration was asking for weren't sufficient for it to achieve the goals it has laid out. Of particular concern was a small proposed increase in spending for HIV/AIDS programs for the second year in a row.
President Barack Obama's request totals $9.6 billion for funds for the State Department, the U.S. Agency for International Development, the Department of Health and Human Services, and the Defense Department, the White House said. That compares with $8.8 billion enacted for fiscal 2010.
The bulk of the requested funding, about $7 billion, is for the U.S. President's Emergency Plan for AIDS Relief, the massive program launched by President Bush in 2003. That includes $5.74 billion for bilateral HIV/AIDS programs, a $1 billion contribution to the Global Fund and $251 million for bilateral tuberculosis programs. That compares with $6.8 billion in fiscal 2010, including $5.54 billion for bilateral HIV/AIDS programs, $1.05 billion for the Global Fund, and $246 million for TB.
While the requested contribution to the Global Fund is less than the amount given last year, it is $100 million more than the amount requested last year, officials said.
The new global health initiative reiterated the administration's pledge to put more than four million people on HIV/AIDS drug therapy and prevent more than 12 million new HIV infections by 2014.
The plan also called over the same time period for reducing malaria by 50% for 450 million people in Africa, including expanding efforts into Nigeria and the Democratic Republic of the Congo; reducing tuberculosis prevalence by 50%; saving approximately 360,000 women's lives by reducing maternal mortality by 30% in assisted countries; and saving approximately three million children's lives by reducing mortality rates of children under 5 years old by 35% in assisted countries.
It put timetables on the elimination or partially elimination of three neglected tropical diseases: leprosy, lymphatic filariasis, and onchocersiasis, also known as river blindness.
Under the proposed budget, the State Department and USAID would get $680 million for malaria programs, up from $585 million in 2010. Maternal and child health would get $700 million, up from $474 million, while $590 million would go to family planning, up from $525 million.
Officials said a key element of the new initiative was to integrate health efforts and strengthen health systems on the ground, to give government and private donors a bigger bang for their buck.
"We are trying to integrate programs," said a White House official. "There's a lot of stovepiping, as it's called. There's the PEPFAR program separate from malaria separate from maternal and child health separate from neglected tropical diseases separate from water. That is quite duplicative and inefficient in all sorts of ways – multiple offices, multiple clinics, facilities, different reports for different groups."
The hope is to yield "more effective use of the money so we can reach these pretty aggressive targets," the official said. Under the new plan, the government will also select up to 10 countries by April that will receive more funding and resources "to try to turbocharge this integration on the ground."
Health organizations were still crunching the budget numbers late Monday, but some said they were concerned the small increases in HIV/AIDS program funding threatens the momentum gained in a scale-up of HIV treatment in recent years.
"PEPFAR has been a forceful engine driving down AIDS mortality, heading off new infections, and extending life-saving drugs to millions of HIV patients," Kenneth Mayer, co-chair of the Center for Global Health Policy's Scientific Advisory Committee, said in a statement released Monday night by that organization. "Unfortunately, this budget proposal could imperil the fragile gains made over the last decade in treating HIV. It could also force a Sophie's Choice between prevention and treatment."
"This is a very big disappointment," Jeffrey Sachs, director of the Earth Institute at Columbia University, speaking from Ethiopia on a conference call arranged by the Global AIDS Alliance. "It's pretty much a standstill with maybe tiny changes here and there."
Of particular disappointment, Mr. Sachs said, was that the requested increase in spending to combat malaria wasn't more substantial. "The U.S. government is billions of dollars short of what it should have spent," he said. "Comprehensive control of malaria is now possible."