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CHICAGO Burried in the cuts to science and
public health in President Trump’s newly released budget
blueprint is a longtime conservative proposal to award lump sums
of money to states – block grants – to let them decide how to
respond to public health issues such as the Zika virus.
That proposal is “a really bad idea,” according to Dr. Tom
Frieden, who until this past January was director of the U.S.
Centers for Disease Control and Prevention.
Currently, the CDC experts work with state and local
governments to devise evidence-based plans to respond to public
health issues, such as foodborne and infectious disease
With a block grant, states can use the federal money to
replace their own spending in certain areas or spend the money
unwisely, “and never have to report what they have done or be
held accountable for it,” Frieden said.
Although the president’s 2018 budget – a slimmed down
blueprint of his spending goals – provides no specifics, the
Association for Public Health Laboratories, a national group
representing state and municipal public health laboratories,
estimates that, if approved by Congress, it could cut as much as
$1.8 billion from CDC’s budget from various programs, which was
$7 billion in 2016.
The cuts were part of a wider push by the administration to
beef up defense spending by $54 billion and slash spending at
many other domestic agencies, such as the Environmental
Protection Agency and the State Department. The blueprint would
also cut $5.8 billion, or some 18 percent, in funding for the
National Institutes of Health, a proposal that was met with
widespread opposition by health and science advocates.
The proposal does not specify where the $500 million in
public health block grants to states would come from. Frieden
said in an email he believes the intent is to cut existing CDC
grant programs and pass them along to the states.
Frieden said block grants are often a precursor to funding
cuts. Such was the case in the 1980s, when block grants for
tuberculosis control programs gave rise to “deadly outbreaks of
drug-resistant tuberculosis that cost more than a billion
dollars,” he said, spending that could have been prevented.
Rob Smith, an analyst with Capital Alpha Partners, sees the
block grant proposal as part of an overall theme in the Trump
White House “to get healthcare out of the hands of D.C.
bureaucrats.” The proposal is similar to the Republican’s
Obamacare “repeal” bill being considered by the U.S. House of
Representatives that gives states a set amount of money to cover
people on the Medicaid program for the poor.
In public health, however, Smith said allowing states to
devise their own response to infectious disease threats, such as
Zika, could mean it takes longer to get an outbreak under
Although the Trump budget does create a new public health
emergency fund to allow the United States to quickly respond to
outbreaks, such as Zika, it does not say where those funds would
come from, and some groups, including the Infectious Diseases
Society of America, fear that money would also be taken from the
Frieden lobbied hard for the emergency fund after a
nine-month struggle least year to get U.S. lawmakers to approve
$1.1 billion in emergency funds for Zika, a delay that experts
said hurt the U.S. effort to fight the virus.
He said it was good to see the Emergency Response Fund in
the Trump budget, but added, “the devil will be in the details.”
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