Back HIV Policy & Advocacy Obama Budget Boosts U.S. HIV and Hepatitis Funding, Cuts Global AIDS and TB

Obama Budget Boosts U.S. HIV and Hepatitis Funding, Cuts Global AIDS and TB

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President Obama's proposed $4 trillion budget for fiscal year 2016 would increase funding for CDC's viral hepatitis and HIV prevention efforts, boost spending for HIV research, and allocate more to combat antibiotic resistance. The proposal would also change the law to allow Medicare to negotiate prescription drug prices, which could potentially save billions of dollars. But the plan would cut overall global health funding, including support for the Global Fund to Fight AIDS, Malaria, and Tuberculosis. 

Domestic Funding

The domestic portion of the FY2016 proposal includes a $44 million increase for the National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention. The Division of HIV/AIDS Prevention saw a $6 million increase.

A majority of this new funding -- $31 million -- would go to the Division of Viral Hepatitis, which would double its budget. Advocates have contended that hepatitis B and C, which affect more people, have been underfunded relative to other diseases such as HIV.

"President Obama and his administration have shown tremendous leadership in the fight against hepatitis B and C by proposing badly needed increased resources," said Ryan Clary, executive director of the National Viral Hepatitis Roundtable. "Funding in the president’s budget would dramatically expand lifesaving hepatitis testing, linkage to care, and prevention services around the country."

Overall Ryan White Programfunding will remain stable. However, the budget proposes to eliminate Part D, which supports services for women, children, and youth. According to a press release issued by the Positive Women's Network, more than 90,000 women, children, and their family members access Part D services each year. The money saved would instead go to Part C, which funds early intervention services.

"The President is clearly aligning his budget with the National HIV/AIDS Strategy -- which failed not only to prioritize women in its metrics, but even to mention issues that significantly impact the health and wellbeing of women living with and vulnerable to acquiring HIV, such as sexual and reproductive health, intimate partner violence, and trauma," said PWN-USA executive director Naina Khanna.

The FY2016 budget includes a big increase in funds for combating antibiotic resistance, to be shared by multiple agencies including the CDC and NIH.

The Infectious Diseases Society of America (IDSA) applauded the new funding, which will support development of new antibiotics and diagnostics, promotion of appropriate antibiotic use, and improved surveillance and data collection of antibiotic use and resistance patterns.

"Each year that passes without increased action on antimicrobial resistance puts further strain on the healthcare system and costs lives," according to an IDSA press release. "We know that in the U.S., in excess of 2 million people contract antibiotic-resistant infections and 23,000 die annually. The actual numbers are likely far higher given current gaps in our surveillance capabilities. Additionally, greater than $20 billion in increased healthcare expenditures are attributed to these infections each year."

The proposed budget aims to reduce spending on Medicare and Medicaid, in part by making beneficiaries pay a greater share of their costs. It would also cut funds for medical education and payments to teaching hospitals and nursing homes. But a proposal to allow Medicaid to negotiate drug prices -- which is currently prohibited by law -- could lead to substantial savings estimated at$116 billion. The plan would also curb deals to delay availability of generic drugs.

Finally, the National Institutes of Health (NIH) would receive a small increase, including $3.1 billion (out of a total of $31.3 billion) for HIV/AIDS research.

"We strongly support the President’s proposal to increase NIH funding by $1.2 billion in 2016, including 3.1 billion for AIDS research," stated HIV Medicine Association chair Adaora Adimora. "Sustained increases in research NIH funding are critical to train the next generation of scientists and support the next breakthrough discoveries that hold promise for an HIV vaccine and a cure. 

"We applaud the president’s proposal to allow the use of federal funding for syringe access programs, a cost effective public health intervention that prevents HIV and HCV infections among injection drug users and offers a pathway to addiction treatment services," the HIVMA statement added. "We strongly urge Congress to put science first by supporting this policy in the FY2016 appropriations cycle."

Global Funding

USAID global health funding for HIV/AIDS would remain the same at $330 million. Funding for malaria and reproductive health remain roughly similar, while maternal and child health spending -- including money for the GAVI Vaccine Alliance -- would increase. Tuberculosis funding, in contrast, would decrease substantially, falling from $236 to $191 million. Global Health Program spending would total $8.1 billion, a 3% decrease from FY2015.

The allocation for the President’s Emergency Plan for AIDS Relief (PEPFAR) would remain about the same -- more than $4.6 billion -- and would include a new "Impact Fund" to help partner countries address regions and populations with high HIV incidence. Support for the Global Fund would decrease by $243 million (18%) to 1.1 billion, but this is in keeping with Obama's pledge to provide $1 for every $2 from other donors, as well as a law that limits the U.S. contribution to one-third or less of total donations.

"[T]he White House fails to heed the lesson reinforced by the West Africa Ebola crisis over the last year, that an infectious disease neglected anywhere poses perils everywhere," said co-chair Kenneth Mayer in a statement from the IDSA's Center for Global Health Policy. "We call upon Congress to recognize that while this country's investments in global health have yielded unprecedented progress in recent years, defeating HIV and tuberculosis will require aggressive action. We urge Congress to exceed last year’s allocation to the President’s Emergency Plan for AIDS Relief and to U.S. tuberculosis programs, to honor our commitment to the Global Fund to Fight AIDS, Tuberculosis and Malaria, and to avoid a sequestration of funds that will weaken efforts to make this a healthier and safer world."

The FY2016 domestic and international health spending plan reflects an overall shift toward more funding for social services and infrastructure improvements paid for by higher taxes on wealthy individuals and corporations. But the proposal will have to overcome strong congressional opposition and is likely to be modified substantially before it passes. Republicans are expected to release their own budget counterproposal next month.

2/5/15

Sources

Kaiser Family Foundation. White House Releases FY16 Budget Request. Kaiser Daily Global Health Policy Report. February 2, 2015.

R Aziz. White House FY 16 Budget Proposal cuts PEPFAR, cuts $45 million — 19 percent -- from current TB funding. Science Speaks. February 2, 2015.

National Coalition of STD Directors. Resource: National Coalition of STD Directors’ Message on President Obama’s Fiscal Year 2016 Budget Proposal. February 2, 2015.

National Viral Hepatitis Roundtable.President Obama Demonstrates Strong Commitment To Fight Viral Hepatitis In Fiscal Year 2016 Budget. Press release. February 3, 2015.

Positive Women's Network. Services for Women and Youth with HIV Gutted Again. PWN-USA Responds to the President’s Budget Proposal to Eliminate Ryan White Part D. Press release. February 3, 2015.

Infectious Diseases Society of America. IDSA Applauds Focus on Antibiotic Resistance in President’s FY 2016 Budget Request. Press release. February 2, 2015.

HIV Medicine Association. President Sustains Commitment to Addressing Domestic AIDS; Falls Short Globally. Statement. February 2, 2015.

Infectious Diseases Society of America Center for Global Health Policy. Infectious Diseases Society of America Center for Global Health Policy Response to Fiscal Year 2016 Proposed Budget. Statement. February 2, 2015.