Actions of the 104th Congress and an Outlook for the 105th Congress
During the 104th Congress, the Washington office of the American Social Health Association and other groups have worked aggressively to secure an increase for the STD prevention and research programs of the National Institutes of Health and the Centers for Disease Control and Prevention. In addition, ASHA's Washington office was engaged in efforts to counteract the Clinton administration's Performance Partnership Grant (PPG) proposal. Here is a summary of the appropriations process, the effort to oppose the PPG initiative, and an outlook for the future for STD policy and funding.
The National Institutes of Health was a big winner in both the House-passed Labor/HHS/Education appropriations bill and the bill approved by the Senate Labor/HHS/Education subcommittee. Both bills included a significant increase for the National Institutes of Health. In addition, the bills earmarked funds for the construction of the new clinical research center on the NIH campus in Bethesda.
In the final FY 1997 Omnibus Appropriations bill, the National Institute of Allergy and Infectious Diseases (NIAID) was allocated an 8% increase, whereas the National Institutes of Health was given a 6.9% increase overall. The 8% increase for the NIAID was secured as a result of aggressive grassroots and direct lobbying as well as of support from the Clinton administration for research into emerging infections and human immunodeficiency (HIV).
With this funding level, the NIAID projects that 815 competing grants, 142 more than FY 1996, will be awarded in FY 1997. This will bring the total number of grants funded by the NIAID to 2,832.
Early action on appropriations for STD research and prevention programs of the Centers for Disease Control and Prevention was discouraging. The House of Representatives did not approve an increase above the FY 1996 level for these programs. ASHA and the STD Coalition immediately initiated actions to persuade and encourage the Senate Labor/HHS/Education appropriations subcommittee to approve of the need for a substantial increase for this program. This hard work paid off modestly when the subcommittee approved $106 million for the STD prevention and research programs of the CDC, a $1 million increase over the House-approved level and $3 million above the President's FY 1997 budget request.
Administration's Prevention Partnership Proposal
As reported previously, the Clinton administration has been proposing the consolidation of the 32 categorical CDC grant programs into a limited number of PPGs. These “block grants with strings attached” have been a cause for concern among public health experts. The proposal assumes a reduction in Federal funds based on the assumption that administrative savings would be achieved. Further, the proposal provides for greater state discretion over the allocation of funds. Many fear that STD programs would fare poorly in many states under such an agreement.
This year, the administration altered its CDC PPG proposal. Last year, the proposal included a PPG for HIV, STD, and TB. The new proposal created a separate PPG for HIV, STD, and TB together in a single grant. Despite some Congressional interest in the PPG approach, no legislation was enacted this year, and the final appropriations bill allocated CDC funding to the separate categorical programs. It is unclear whether the Administration will persist with the PPG approach. ASHA will continue to oppose such an initiative.
It is clear that Congressional willingness to champion STD programs is limited. Sexually transmitted diseases lack the kind of patient advocacy effort that has resulted in much attention to—and increasing funding for—other diseases (e.g., HIV, breast cancer). Prospects for increased funding may depend on an initiative from the Clinton administration. ASHA is increasing efforts to convince the administration to request an increase in STD funding for FY 1998. If successful, this will put the STD advocacy community in the position of defending the President's request for additional funds rather than facing an uphill battle to add funding to the administration's proposal.
In the coming year, the participation of STD researchers, clinicians, patients, and advocates who reside in states represented by key appropriators will be critical to our success. If you are interested in becoming active in ASHA's grassroots network, please contact Joan Cates at P. O. Box 13827, Research Triangle Park, NC 27709.