Public Health Funding And OMB Director Mulvaney’s “Taxpayer First” Test

This was originally published on Health Affairs on June 8, 2017 at

By Vinoth Chandar (Flickr: Capitol Hill — Washington, DC) [CC BY 2.0 (], via Wikimedia Commons

The first formal budget of the Trump era — billed as a “Taxpayer First” budget — contains some very bad news when it comes to the health of the American public. It proposes dramatic cuts in federal investments that keep us healthy and protected from harm, including a $1.2 billion cut from the budget for the Centers for Disease Control and Prevention (CDC). This is on top of the catastrophic cuts that will occur with the loss of the Prevention and Public Health Fund if the Affordable Care Act is repealed.

It is the opposite of both what American taxpayers have asked for and what is owed to them.

Office of Management and Budget (OMB) Director Mick Mulvaney describes this as a “Taxpayer First” budget, based on the criterion that federal spending needs to be responsive to what, the administration says, hardworking taxpayers want. Programs need to be effective to avoid ripping off taxpayers, and they need to provide value for the dollar to those who are paying. The Mulvaney budget flunks the test on both of these grounds and instead puts the health and pocketbooks of Americans — taxpayers — at risk.

Prevention works — it saves lives and can save money. For example, vaccine programs — including rapid response initiatives that address measles outbreaks like we’ve seen at Disneyland and, more recently, in the Somali population in Minnesota — return up to $16 for every $1 invested. Yet, the administration’s budget proposes a cut of $89.5 million to vaccine programs.

Chronic conditions like diabetes and heart disease threaten to overwhelm our health care system, accounting for the bulk of rising health care costs. Yet the only serious investments in prevention of such diseases — the CDC’s chronic disease prevention programs — would be slashed by $222 million, while the remaining funding for chronic disease prevention would be lumped into grants without a defined scope or performance accountability. This would likely eliminate programs like “Tips from Former Smokers” (from an abandoned tobacco budget line), which has been shown to be a cost-effective way to help people quit smoking, with significant downstream savings in health costs.

Even funding to state and local governments for emergency preparedness and response — the front lines of protection against both natural threats (for example, food safety or pandemic influenza) and intentional threats (for example, mass casualties or bioterrorism) — is reduced, dumbing down our ability to mount an effective defense.

These prevention and emergency preparedness investments aren’t giveaways. Rather, they help sustain healthy communities, protect workers, generate economic activity, and shield us from infectious disease threats. They are investments in our children and our economy, and our only real hope of achieving the goal of lower health insurance premiums. These investments protect us all because health threats like pandemic influenza, Zika, and Ebola don’t discriminate by party affiliation or tax bracket.

What is more perplexing: it’s not like taxpayers have asked for these programs to be reduced. To the contrary, investments in public health enjoy bipartisan support. The CDC is consistently among the most trusted federal institutions, with a “taxpayer” approval rating typically at more than 70 percent.

Polling shows that 75 percent of Americans support more federal spending on prevention and for addressing health threats. Americans even respond positively when asked if they are willing to pay more taxes for stronger public health preparedness and medical research (see page 7).

It’s important that we continue to evaluate public health programs and make informed choices to fund only those that are the most effective. Undeniably, we share OMB Director Mulvaney’s determination to fund only programs that provide value to the taxpayer. But in pursuit of budget reduction targets, the president’s request to reduce funding for public health programs seems to have abandoned such evidence as the guiding principle.

At the de Beaumont Foundation, we focus on helping state and local health departments be more effective. We work in partnership with governmental public health agencies, and our grant making is designed to help the system move forward with better data, a stronger workforce, and more effective partnerships across sectors. But no amount of philanthropic interest can overcome large reductions in funding for the CDC and other federal health agencies because they are the primary source of funding for public health.

Let’s really put American taxpayers first, and make sure they have the public health protections they deserve.

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