Politics and the Future of Public Health Science and Biomedical Research

Public Health Grand Rounds

University of Oklahoma

Tony Mazzaschi, ASPPH Senior Director for Policy and Research Mike Stephens, Cornerstone Government Affairs Senior Consultant

April 23, 2014

1

ASPPH Policy and Advocacy Team

• Tony Mazzaschi Senior Director for Policy & Research

• Mike Zwolinski Policy & Legislative Analyst

Cornerstone has represented ASPPH interests on the Hill and Executive Branch since 2004

Cornerstone Government Affairs

Mark Mioduski Founding Partner

Amy Ford Souders Founding Partner

Erik Fatemi Vice President

Max Kanner Legislative Assistant

Mike Stephens Senior Consultant

ASPPH Legislative Committee Membership

Steve Wyatt, Chair (Kentucky) Mike Klag (Johns Hopkins)

Marjorie Aelion (UMass) Bill Mase (Cincinnati)

Rob Amler (NYMC) Bob Meenan (BU)

Paul Brandt-Rauf (UIC) Max Michael (UAB)

Jim Curran (Emory) Martin Philbert (Michigan)

Sue Curry (Iowa) Gary Raskob (Oklahoma)

John Finnegan (Minnesota) Laura Rudkin (UTMB)

Linda Fried (Columbia) Ed Trevathan (St. Louis)

Howie Frumkin (Washington) Phil Williams (UGA)

Lynn Goldman (GWU) Liana Winett (Oregon MPH)

Jody Heymann (UCLA)

*in thousands

NIH $864,351

CDC $213,639

HRSA $109,186

AHRQ $14,407

EPA $12,134

USAID $52,589

Department of Defense $19,387

Other Federal $147,099

Total $1,1432,792

Why Is Policy & Advocacy Important? Grants Account for a Very Large Portion of School & Program Operating Budgets

Preliminary 2013 School Data; Program Data Not Yet Available

Strategic Priorities, 2014-2015

• Provide timely strategic intelligence.

• Strengthen analytic case for Association policy positions.

• Manage relationships with federal agency partners.

• Advocate for schools and programs directly and through contract lobbyists.

Strategic Priorities, 2014-2015

• Manage relationships with public health advocacy partners.

• Protect and expand funding.

• Raise public awareness of schools and programs.

• Follow ACA implementation issues.

Strategic Priorities, 2014-2015

ASPPH Federal Funding Priorities, FY 2015

(Dollars in thousands, includes funding from Prevention and Public Health Fund)

FY 2012

Final

FY 2013

Final (Post Sequester)

FY 2014

Final

FY 2015

President’s Budget

FY 2015 ASPPH

Recommendations

HRSA Public Health Training Centers

25,000,000 (37)

4,029,000 (37)

9,864,000 (11)

13,064,000 (11)

$23,000,000 (increase number of PHTCs)

HRSA Public Health Traineeships

862,000 0 2,500,000 0 $5,000,000

(increase number and size of traineeships) CDC Prevention Research

Centers

27,869,000 (37)

23,424,000 (37)

25,000,000 (26)

25,000,000 (26)

$35,000,000 (increase number of PRCs)

CDC Centers for Public Health Preparedness

7,564,000 8,000,000 8,000,000 0 $8,000,000

(restore to FY 2014)

NIOSH Education and Research Centers

24,268,000 23,005,000 27,000,000 0 $27,000,000

(restore to FY 2014)

NIOSH Agricultural Forestry and Fishing Centers

25,681,000 24,365,000 24,000,000 0 $24,000,000

(restore to FY 2014)

NIH - Total 30,623,259,000 28,926,000,000 29,926,000,000 30,126,000,000 $32,000,000,000

(+ 6.9% over FY 2014)

(NIH Prevention Research Implementation)

- - - -

(Allocate $5 million within NIH total for implementation of new NIH Strategic Plan for

Prevention Research)

Tobacco-Free College Campus Initiative

Following the example of schools like Oklahoma, ASPPH has partnered with HHS to move our campuses to become tobacco-free.

You can watch the recorded webinar here.

The Political and Policy Environment

National Health Expenditures and the GDP 2012-2021 (dollars in billions)

$2,809 $2,915 $3,130 $3,308

$3,514 $3,723 $3,952

$4,207 $4,487

$4,781

$0

$1,000

$2,000

$3,000

$4,000

$5,000

$6,000

2012 2013 2014 2015 2016 2017 2018 2019 2020 2021

17.9% 17.8% 18.2% 18.2% 18.3% 18.4% 18.6% 18.9% 19.2% 19.6%

SOURCE: Kaiser Family Foundation calculations using NHE data from Centers for Medicare and Medicaid Services, Office of the Actuary, National Health Statistics Group, at http://www.cms.hhs.gov/NationalHealthExpendData/ (see Projected; NHE Historical and projections, 1965-2021, file nhe65-21.zip).

NHE as a Share of GDP:

Source: Congressional Budget Office.

Analysis • The CBO’s latest projections claim that the net 2013-2023 cost of the ACA will amount to $1.2 trillion, $0.1 trillion below the $1.3

net ten-year cost projected in May 2013 • Experts continue to debate why the law is proving less expensive than projected; the ACA’s new regulations may decrease the cost of

healthcare, or the law may simply benefit from a secular trend towards lower premium growth

Projected Net Cost of the Affordable Care Act (Net of Offsetting Receipts, in Billions)

Projected Cost of the ACA Continues to Decline

Health Care Spending

The Federal Budget

Outlays – CBO (2/14)

Federal Deficit – CBO (2/14)

The Congressional Line-Up

113th Congress November 4 Election

SENATE • Democrats 53 20 • Republicans 45 13 • Independents 2

HOUSE • Democrats 199 199 • Republicans 233 233 • Vacant 3 3

Research Champions

Rep. Nita M. Lowey (D-NY)

Rep. Hal Rogers (R-KY)

Majority (R) (29) Minority (D) (22)

Harold Rogers, Ky. - Chairman Nita M. Lowey, N.Y. - Ranking Member Frank R. Wolf, Va. Marcy Kaptur, Ohio Jack Kingston, Ga. Peter J. Visclosky, Ind. Rodney Frelinghuysen, N.J. José E. Serrano, N.Y. Tom Latham, Iowa Rosa DeLauro, Conn. Robert B. Aderholt, Ala. James P. Moran, Va. Kay Granger, Texas Ed Pastor, Ariz. Mike Simpson, Idaho David E. Price, N.C. John Culberson, Texas Lucille Roybal-Allard, Calif. Ander Crenshaw, Fla. Sam Farr, Calif. John Carter, Texas Chaka Fattah, Pa. Ken Calvert, Calif. Sanford D. Bishop Jr., Ga. Tom Cole, Okla. Barbara Lee, Calif. Mario Diaz-Balart, Fla. Adam B. Schiff, Calif. Charlie Dent, Pa. Michael M. Honda, Calif. Tom Graves, Ga. Betty McCollum, Minn. Kevin Yoder, Kan. Tim Ryan, Ohio Steve Womack, Ark. Debbie Wasserman Schultz, Fla. Alan Nunnelee, Miss. Henry Cuellar, Texas Jeff Fortenberry, Neb. Chellie Pingree, Maine Tom Rooney, Fla. Mike Quigley, Ill. Chuck Fleischmann, Tenn. Bill Owens, N.Y.

Jaime Herrera Beutler, Wash. David Joyce, Ohio David Valadao, Calif. Andy Harris, Md. Mark Amodei, Nev. Martha Roby, Ala. Running for Other Office Chris Stewart, Utah Announced Retirement

House Committee on Appropriations

Rep. Henry Waxman (D-CA)

Rep. Fred Upton (R-MI)

Majority (R ) (30) Minority (D) (23) Rep Fred Upton (MI) Rep Henry Waxman (CA) Rep Joe Barton (TX) Rep John Dingell (MI) Rep Ed Whitfield (KY) Rep Frank Pallone (NJ) Rep John Shimkus (IL) Rep Bobby Rush (IL) Rep Joe Pitts (PA) Rep Anna Eshoo (CA) Rep Greg Walden (OR) Rep Eliot Engel (NY) Rep Lee Terry (NE) Rep Gene Green (TX) Rep Mike Rogers (MI) Rep Diana DeGette (CO) Rep Tim Murphy (PA) Rep Lois Capps (CA) Rep Michael Burgess (TX) Rep Mike Doyle (PA) Rep Marsha Blackburn (TN) Rep Jan Schakowsky (IL) Rep Steve Scalise (LA) Rep Jim Matheson (UT) Rep Bob Latta (OH) Rep G.K. Butterfield (NC) Rep Cathy McMorris Rodgers (WA) Rep John Barrow (GA) Rep Gregg Harper (MS) Rep Doris Matsui (CA) Rep Leonard Lance (NJ) Rep Donna Christensen (VI) Rep Bill Cassidy (LA) Rep Kathy Castor (FL) Rep Brett Guthrie (KY) Rep John Sarbanes (MD) Rep Pete Olson (TX) Rep Jerry McNerney (CA) Rep David McKinley (WV) Rep Bruce Braley (IA) Rep Cory Gardner (CO) Rep Peter Welch (VT) Rep Mike Pompeo (KS) Rep Ben Ray Luján (NM) Rep Adam Kinzinger (IL) Rep Paul Tonko (NY) Rep Morgan Griffith (VA) Rep Ralph Hall (TX) Rep Phil Gingrey (GA) Rep Gus Bilirakis (FL) Rep Bill Johnson (OH) Rep Billy Long (MO) Running for Other Office Rep Renee Ellmers (NC) Announced Retirement

House Committee on Energy & Commerce

Sen. Barbara Mikulski (D-MD)

Sen. Richard Shelby (R-AL)

Majority (D) (16) Minority (R) (14) Mikulski, Barbara A. (MD) , Chairman

Shelby, Richard C. (AL), Ranking Member

Leahy, Patrick J. (VT) Cochran, Thad (MS) Harkin, Tom (IA) McConnell, Mitch (KY) Murray, Patty (WA) Alexander, Lamar (TN) Feinstein, Dianne (CA) Collins, Susan M. (ME) Durbin, Richard J. (IL) Murkowski, Lisa (AK) Johnson, Tim (SD) Graham, Lindsey (SC) Landrieu, Mary L. (LA) Kirk, Mark (IL) Reed, Jack (RI) Coats, Daniel (IN) Pryor, Mark L. (AR) Blunt, Roy (MO) Tester, Jon (MT) Moran, Jerry (KS) Udall, Tom (NM) Hoeven, John (ND) Shaheen, Jeanne (NH) Johanns, Mike (NE) Merkley, Jeff (OR) Boozman, John (AR) Begich, Mark (AK) Coons, Christopher A. (DE) Announced Retirement

Senate Committee on Appropriations

Sen. Tom Harkin (D-IA)

Sen. Lamar Alexander (R-TN)

Majority (D) (12) Minority (R) (10) Harkin, Tom (IA), Chairman Alexander, Lamar (TN), Ranking Member

Mikulski, Barbara A. (MD) Enzi, Michael B. (WY)

Murray, Patty (WA) Burr, Richard (NC)

Sanders, Bernard (VT) Isakson, Johnny (GA)

Casey, Robert P. (PA) Paul, Rand (KY)

Hagan, Kay R. (NC) Hatch, Orrin G. (UT)

Franken, Al (MN) Roberts, Pat (KS)

Bennet, Michael F. (CO) Murkowski, Lisa (AK)

Whitehouse, Sheldon (RI) Kirk, Mark (IL)

Baldwin, Tammy (WI) Scott, Tim (SC)

Murphy, Christopher (CT)

Warren, Elizabeth (MA) Announced Retirement

Senate HELP Committee

Regular Order

24

In Practice, Continuing Resolutions Now Common

Analysis •A continuing resolution (CR) is a stopgap measure that authorizes continued government funding for federal agencies or specific programs at, above, or below current funding levels when Congress and the president do not pass a regular appropriations bills before the fiscal year begins •CRs can be attractive vehicles for other substantive legislation because they are considered “must-pass” measures, but passing a CR in lieu of a budget resolution also produces budget uncertainty, making it difficult to act on other legislative priorities

Source: Kenneth Chamberlain, “Congress’ Use of Continuing Resolutions Is a Common Practice,” National Journal, Sept. 11, 2013; “Continuing Resolutions: CRs in a Nutshell,” Department of the Treasury, 2012.

Average number of CRs

per year: 4

Omnibus Budget Agreement

Federal Funds to Schools of Public Health: FY11, FY12, and FY13 (Dollars in millions)

798.3

276.9

124.2

13.4

20.1 82.3

15.4

101.2

855.2

271.6

119.2

16.2 14.6 93.1

9.3

142.2

864.3

213.6

109.2

14.4 12.1 52.6

6.1

175.1

NIH CDC HRSA AHRQ EPA USAID State OtherFederal

FY 11 FY 12 FY 13

Preliminary 2013 School Data

Only.

Program Data Not Yet

Available.

ASPPH Federal Funding Priorities, FY 2015

(Dollars in thousands, includes funding from Prevention and Public Health Fund)

FY 2012

Final

FY 2013

Final (Post Sequester)

FY 2014

Final

FY 2015

President’s Budget

FY 2015 ASPPH

Recommendations

HRSA Public Health Training Centers

25,000,000 (37)

4,029,000 (37)

9,864,000 (11)

13,064,000 (11)

$23,000,000 (increase number of PHTCs)

HRSA Public Health Traineeships

862,000 0 2,500,000 0 $5,000,000

(increase number and size of traineeships) CDC Prevention Research

Centers

27,869,000 (37)

23,424,000 (37)

25,000,000 (26)

25,000,000 (26)

$35,000,000 (increase number of PRCs)

CDC Centers for Public Health Preparedness

7,564,000 8,000,000 8,000,000 0 $8,000,000

(restore to FY 2014)

NIOSH Education and Research Centers

24,268,000 23,005,000 27,000,000 0 $27,000,000

(restore to FY 2014)

NIOSH Agricultural Forestry and Fishing Centers

25,681,000 24,365,000 24,000,000 0 $24,000,000

(restore to FY 2014)

NIH - Total 30,623,259,000 28,926,000,000 29,926,000,000 30,126,000,000 $32,000,000,000

(+ 6.9% over FY 2014)

(NIH Prevention Research Implementation)

- - - -

(Allocate $5 million within NIH total for implementation of new NIH Strategic Plan for

Prevention Research)

STRATEGIC PRIORITY I Systematically monitor NIH investments in prevention research and assess the progress and results of that research. STRATEGIC PRIORITY II Identify prevention research areas for investment or expanded effort by the NIH. STRATEGIC PRIORITY III Promote the use of the best available methods in prevention research and support the development of better methods. STRATEGIC PRIORITY IV Promote collaborative prevention research projects and facilitate coordination of such projects across the NIH and with other public and private entities. STRATEGIC PRIORITY V Identify and promote the use of evidence-based interventions and promote the conduct of implementation and dissemination research in prevention. STRATEGIC PRIORITY VI Increase the visibility of prevention research at the NIH and across the country.

NIH Strategic Plan for Prevention

NIH and Oklahoma

NIH and Oklahoma

$35,745 $36,438

$16,406

$30,362 $27,167

$30,861

$29,151

$30,165

$11,300

$21,080

$17,699

$16,405 $16,651

$0

$5,000

$10,000

$15,000

$20,000

$25,000

$30,000

$35,000

$40,000

1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Dol

lars

(Mill

ions

)

With SupplementalAppropriation (ARRA)Current $ (Millions)

President's Budget

Source: NIH Office of the Director, Office of Budget: http://officeofbudget.od.nih.gov/

NIH Appropriations in Current and Constant Dollars

Success Rates (Excluding ARRA)

Source: NIH Data Book http://report.nih.gov/nihdatabook/index.aspx and supplemental tables available in RePORT

26.8% 31.5%

29.9%

20.0%

17.6% 16.8%

25.9%

32.0%

30.2%

20.7%

18.3% 17.5%

0%

5%

10%

15%

20%

25%

30%

35%

1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

Succ

ess

Rat

e

Research Project Grants (RPG)

R01 Equivalent Awards

Summary of Trends in NIH Funding FY1995-FY2013

FY1995 FY2003 FY2013 % Change since 1995

% Change since 2003

NIH Budget (in millions) $11,300 $27,067 $29,151 158.0% 7.7%

NIH Budget (constant 1995 $ millions) $11,300 $21,003 $16,309 44.3% -22.4%

R01 Equivalent Funding ($ millions) $4,718 $10,102 $10,175 115.7% 0.7%

Total # R01 Equivalent Grants 21,680 29,626 25,069 15.6% -15.4%

R01 Equivalent Applications 22,542 24,634 28,044 24.4% 13.8%

# of R01 Equivalent Awards 5,849 7,430 4,902 -16.2% -34.0%

R01 Equivalent Success Rates 25.9% 30.2% 17.5% -32.4% -42.0%

Changes in the NIH Portfolio - NINDS

Affordable Care Act

Research that benefits persons in “real world settings.” Outcomes that matter to patients, populations, Congress. Faster dissemination of evidence to practice.

Designated appropriations: FY 2012 - FY2019 $150M annually

PCORI Trust FUND: Funding tied to health expenditures

PLUS: Contributions from Medicare Trust Funds, private health insurers and self-insured health plans:

• FY 2013 $1 per capita • FY 2014 $2 per capita • FY 2015 - FY 2019 Indexed by the % increase in the projected per capita

amount of National Health Expenditures • FY 2014 ~ $650 million/year

Challenges

Challenges

Challenges

Challenges

• Proposals for major system changes • Culture change to focus on quality rather than growth • Evaluation metrics that measure impacts and

outcomes that matter to the public • Fierce competition among advocates • Cost shifting efforts • Evidence to drive policy and advocacy

How You Can Help

Faculty, Staff and Students: Be Advocates

• Stay informed • Inform your friends and relatives about the role of federal

funding in your mission activities • Visit your representatives (and their staff) in Washington • Participate in candidate forums – ask questions about your

concerns • Hold the candidates accountable • Vote

Questions?