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Tuesday, November 26, 2013

Public Health Service Agencies: Overview and Funding

Amalia K. Corby-Edwards
Coordinator, Analyst in Public Health and Epidemiology

Within the Department of Health and Human Services (HHS), eight agencies are designated components of the U.S. Public Health Service (PHS): (1) the Agency for Healthcare Research and Quality (AHRQ), (2) the Agency for Toxic Substances and Disease Registry (ATSDR), (3) the Centers for Disease Control and Prevention (CDC), (4) the Food and Drug Administration (FDA), (5) the Health Resources and Services Administration (HRSA), (6) the Indian Health Service (IHS), (7) the National Institutes of Health (NIH), and (8) the Substance Abuse and Mental Health Services Administration (SAMHSA). This report gives a brief overview of each agency and summarizes its funding for FY2010 through FY2013, as well as its FY2014 budget request.

The total amount of funding available to the agencies (i.e., total program level) includes discretionary budget authority provided in annual appropriations acts—plus additional funding from other sources, including user fees and collections from third-party payers—and mandatory funding. Mandatory funding for PHS agencies is provided in laws other than annual appropriations acts, notably the Patient Protection and Affordable Care Act (ACA, P.L. 111-148). Five of the PHS agencies are funded through the Labor, Health and Human Services, and Education (Labor-HHS-ED) appropriations act, and those agencies are subject to the PHS Program Evaluation Set-Aside. Set-aside funds are distributed to evaluate program implementation and effectiveness based on amounts approved by appropriators.

AHRQ and NIH are primarily research agencies. AHRQ conducts and supports health services research to improve the quality of health care. NIH conducts and supports basic, clinical, and translational biomedical and behavioral research. Three PHS agencies—IHS, HRSA, and SAMHSA—provide health care services or help fund systems that do so. IHS supports a health care delivery system for American Indians and Alaska Natives. HRSA funds programs and systems to improve access to health care among the uninsured and medically underserved. SAMHSA funds mental health and substance abuse prevention and treatment services. CDC and ATSDR coordinate and support a variety of population-based programs to prevent and control disease, injury, and disability. FDA regulates drugs, medical devices, food, dietary supplements, and tobacco products.

In 2011, Congress and the President enacted the Budget Control Act (BCA, P.L. 112-25) in response to concerns about the growth in the federal deficit. The BCA established limits on overall discretionary spending and triggered annual across-the-board spending reductions—a process known as sequestration—beginning in FY2013. These deficit-reduction measures have also affected PHS agency discretionary and mandatory funding. For FY2013, each agency’s postsequester total program level funding was as follows:

• AHRQ, which is funded by PHS set-aside and mandatory transfers: $429 million, which is $24 million (5.9%) above the FY2012 amount.

• NIH, which is almost entirely funded by discretionary appropriations: $29.151 billion, which is $1.709 billion (5.5%) below the FY2012 amount.

• IHS, which is funded by a combination of discretionary appropriations, mandatory appropriations, and collections: $5.258 billion, which is $160 million (3.0%) below the FY2012 amount.

• HRSA, which is funded by a combination of discretionary appropriations, ACA mandatory appropriations, PHS set-aside funds, and user fees: $8.1 billion, which is $105 million (1.3%) below the FY2012 amount.

• SAMHSA, which is funded largely by discretionary appropriations, also receives some PHS evaluation funds: $3.355 billion, which is $214 million (6.0%) below the FY2012 level.

• CDC (including ATSDR), which is funded by a combination of discretionary appropriations and mandatory appropriations: $10.258 billion, which is $935 million (8.4%) below the FY2012 level.

• FDA receives an increasing proportion of its funding from industry user fees, and also receives discretionary appropriations: $4.031 billion, which is $199 million (5.1%) above the FY2012 amount.

Date of Report: November 12, 2013
Number of Pages: 56
Order Number: R43304
Price: $29.95

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