What to Expect from FY25 Appropriations
April 19, 2024 | Catherine Murphy
The Fiscal Year 2024 (FY24) appropriations process had the public health community (and perhaps the whole country) on the edge of their seats. Since September 2023, threats of government shutdown loomed large and last-minute continuing resolutions funded the government at FY23 levels. Last month, Congress finalized FY24 appropriations by passing two spending bill packages. Despite the delay and rhetoric around budget cuts, public health remains a bipartisan priority and most public health programs were level-funded.
CDC and ASPR received small increases, while HRSA and SAMHSA took overall funding cuts, which came from “community projects” rather than core programs. Programs that ASTHO advocates for, including CDC’s Public Health Infrastructure and Capacity and Public Health Preparedness Cooperative Agreements and ASPR’s Hospital Preparedness Program, received funding level with FY23. While the rocky road through last year’s appropriations process has ended, Congress is now gearing up for FY25.
Gazing through the Crystal Ball
What shape might this year’s appropriations process take? In recent years, the process of funding the government has been increasingly turbulent. The last time all appropriations bills passed before the start of the fiscal year was nearly 30 years ago. While a standard timeline suggests that the first draft of appropriations bills might be considered by the House by the beginning of May, first drafts for many FY23 and FY24 bills were not released until July, just two months from the end of the fiscal year.
Hurdles are already looming on the horizon.
Soon after FY24 spending bills passed the House, retiring Appropriations Committee Chair Kay Granger (R-TX) announced her early departure from the committee’s leadership. Earlier this month, Representative Tom Cole (R-OK), Chair of the Appropriations Subcommittee on Transportation, Housing, and Urban Development, was chosen by the Republican Steering Committee to fill her role. Chair Cole brings strong priorities in health policy, is known for working in a bipartisan manner and is well known in the public health community for being one of the cofounders of CDC’s infectious disease rapid response reserve fund. Still, this change in leadership is occurring just as the Committee is working to complete the first draft of FY25 bills.
Speaking of change, voters will not only choose the next President, but also the entire House of Representatives and 34 Senate seats this November. Elections tend to delay appropriations progress; bills are often enacted well into the next fiscal year due, in part, to members spending more time in their districts (there will be month-long recesses for August and October), and majority leadership protecting vulnerable members from contentious votes until elections have ended. This year could see voting on appropriations bills after November, or perhaps not until early 2025. So, it’s likely that Congress will enact short-term continuing resolutions to keep the government operating at current levels.
Despite these hurdles, rest assured that the FY25 appropriations process is underway. President Biden released his budget proposal on March 12, which calls for modest increases or level funding to many public health programs. The House Appropriations Committee has begun holding hearings for FY25, including inviting Secretary Xavier Becerra to testify on the FY25 Health and Human Services budget request. Member questions spanned a broad range of health topics, including women’s health, cybersecurity (referencing the recent Change Healthcare cyberattack), behavioral health, and chronic disease.
Notably, Representative Julia Letlow (R-LA) asked how HHS can “restore faith in our public health institutions and the CDC.” This sentiment is particularly salient as the House Committee on Oversight and Accountability’s Select Subcommittee on the Coronavirus Pandemic has sought answers throughout the 118th Congress on how the government handled the COVID-19 pandemic and where opportunities for improvement may lie. Recent congressional hearings have also covered telehealth, AI, drug shortages and costs, and data privacy. While there is no certain way to know how funding might shake out, health policy will remain a hot topic on Capitol Hill. 2024’s Fiscal Responsibility Act allows for 1% growth in non-defense discretionary spending in FY25, and FY24 funding levels demonstrated that appropriators are supportive of HHS’s crucial mission. We are cautiously optimistic that in FY25, these programs will see at least level funding.
ASTHO’s Role in Supporting Public Health Policy
Another important piece of the appropriations puzzle is advocacy. During ASTHO’s yearly Spring Leadership Forum in February, members met with Members of Congress and their staff to share their expertise and priorities in public health. Throughout the appropriations timeline, ASTHO staff will continue to maintain and build relationships with Congressional offices to serve as subject matter experts on public health. ASTHO has submitted more than 75 funding requests to 34 Members of Congress to share the importance of crucial public health programs.
Our FY25 Public Health Appropriations Book provides a one-stop-shop for ASTHO and affiliate organizations’ funding priorities. It includes each program’s purpose, reach, and utility within state and territorial health departments to provide members of Congress and their staff with insights into how public health funding affects their state health agency. It further covers trends in funding over time and provides suggestions on funding levels to best sustain a robust public health system throughout the nation. This resource demonstrates the necessity of state and territorial public health funding.
No matter what FY25 brings, ASTHO will work with members and partners to track the progress on Capitol Hill, stay on top of the latest news, and work with our federal government to ensure the country remains prepared to promote public health, from the everyday to emergency response.