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Holding Pattern for NCHS

Emily J. Holubowich, Senior Vice President at CRD Associates, is NAPHSIS's Washington representative and leads our advocacy efforts in the nation's capital.

Happy New Fiscal Year!

Before leaving town to campaign, late last week lawmakers passed a continuing resolution to keep the government open until December 9—narrowly avoiding a government shutdown. That means the National Center for Health Statistics (NCHS) and other federal agencies will function on autopilot long past the general election in November. Until then, NCHS remains in a holding pattern.

To review, earlier this summer the House and Senate Appropriations Committees approved spending bills for the Department of Health and Human Services (HHS). The House bill proposed holding NCHS funding flat at $160.4 million, while the Senate proposed a $4.4 million cut for the agency. Based on conversations with staff, this proposed cut was not in response to anything NCHS has done (or hasn't done); it is simply a function of an austere funding environment where difficult choices must be made about how best to invest limited resources. As a positive note, both bills included language directing NCHS to prioritize vital statistics and the modernization of birth and death data reporting, which indicates that lawmakers continue to value this work even if they lack the resources to fund it.

Since July, lawmakers have taken no further action on the HHS spending bills, and they aren't expected to before the end of the year. Instead, between now and December 9, congressional staff under the direction of lawmakers will work to reconcile the differences between the House and Senate appropriations bills and draft an "omnibus" spending bill, that is, a massive spending package that includes funding for all federal agencies. NAPHSIS has joined other organizations from the public health and statistical communities in asking appropriators to provide NCHS at

least $160.4 million in final spending legislation for fiscal 2017. As we write:

We greatly appreciate the Congress's longstanding leadership in securing steady and sustained funding increases for NCHS, including your most recent efforts to modernize the National Vital Statistics System—moving from paper-based to electronic filing of birth and death statistics—with a $5 million increase in FY 2016. Because of your efforts, NCHS has funded states and territories to speed the release of birth and death statistics of public health importance, including infant mortality and prescription drug overdose deaths…

Nevertheless, NCHS purchasing power is down considerably; current base funding remains below FY 2010 levels, adjusted for inflation, and the agency is unlikely to recover the roughly $25 million in supplemental Prevention and Public Health Fund dollars lost in 2013. NCHS also faces increasing costs on the horizon associated with state and vendor contracts and other infrastructure challenges related to survey redesign and systems improvements that will require additional resources far beyond current levels. Additional cuts—however seemingly minor, as proposed by the Senate Appropriations Committee—have a demonstrably negative effect on the agency's programs, survey data, and staff.

Your leadership has helped NCHS rebuild after many years of underinvestment and stabilize the collection of essential health data. Cuts to NCHS's budget now will only undermine progress made over the last decade.

If past is prologue, it's very likely that lawmakers, despite their best efforts, will be unable to negotiate final spending levels for federal agencies in the lame duck session and will simply pass a continuing resolution to keep the government running through September 30, 2017. In the last two general election cycles, Congress was unable to complete its work and ultimately passed year-long continuing resolutions for HHS agencies, programs, and projects. Under that scenario, NCHS funding will remain essentially flat—minus a small cut that all agencies will bear to ensure spending complies with caps on 2017 spending. However, in real terms the agency will lose purchasing power given increased costs associated with inflation and contractual obligations.

The appropriations end game (and more!) will come into clearer focus after the November 8 election. Before to check back for our post-election analysis!

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