Concerns Over Federal Funding Cuts and Public Health

A recent report from the Healthcare Nonprofit Trust for America’s Health (TFAH) raises alarms about the potential impacts of federal funding cuts on public health systems.

The report, titled “Public Health Infrastructure in Crisis,” includes insights from public health officials across major states, including the director of the Alabama Department of Public Health.

TFAH is recognized as a nonpartisan, nonprofit organization focused on public health policy research and advocacy.

During a media briefing held Wednesday prior to the report’s official release, panelists discussed the anticipated effects of reduced funding and staffing, alongside ongoing reorganizations within the U.S. Department of Health and Human Services (HHS).

The panel featured TFAH’s president and CEO, Dr. Nadine Gracia, along with Dr. Joseph Kanter, CEO of the State Association of Territory Health Authorities, and Lori Tremmel Freeman from County and City Health Departments.

“For over two decades, TFAH has produced an annual report tracking public health funding. This year, we focused more on the scale, scope, impacts, and proposed actions affecting the public health system,” Gracia explained.

The report specifically examines HHS funding directed towards the Centers for Disease Control and Prevention (CDC).

TFAH noted that 80% of the CDC’s domestic budget is allocated to states, health systems, tribes, and community partners.

Furthermore, the report emphasized the White House management office’s proposal for a drastic 53% cut in CDC funding compared to the previous year, alongside a 52% reduction in the CDC’s Public Health Emergency Response Program.

Gracia remarked, “These cuts come at a time when the frequency and intensity of public health events are increasing. This will hinder communities’ preparedness for natural disasters like hurricanes and wildfires.”

The report indicated that the proposed budget reductions from the Office of Management and Budget (OMB) amount to an estimated net reduction of around 39% in CDC resources.

In contrast, the Senate and House Budget Committees have suggested smaller cuts than those proposed by OMB in their budget plans for Health and Human Services.

For example, the House suggested a $1.7 billion cut to the CDC, bringing total funding to $7.4 billion, whereas the Senate proposed a budget close to $9.2 billion, reflecting a smaller reduction of $70 million.

Conversely, the White House’s plan aims to allocate roughly $4.3 billion to its agency for the fiscal year 2026.

Additionally, during the Trump administration, there were suggestions to shift about 26% of the CDC’s and ATSDR’s funding to the new HHS division called the Healthy American Administration.

“The structure and capability of these entities remains unclear,” Gracia noted, adding that the proposed restructuring could cut staffing across the sector by 16%, even with the establishment of the new administration.

“We’re already noticing the impact of federal funding cuts on public health nationwide,” Gracia expressed.

The TFAH report also highlighted the closure of $12 billion in previously approved COVID-19 ERA grants in March, aimed at bolstering pandemic responses and enhancing public health infrastructure.

Alabama Health Officer Dr. Scott Harris shared insights about how federal cuts have directly impacted his department. “We rely on federal funds for about half of our budget, with around 90% coming through Medicaid,” he said, noting that state funding constitutes less than 10%.

Earlier this year, when asked about necessary cutbacks due to federal fund revisions, Harris indicated that his department often needed to adapt but managed to secure alternative grants. However, the sudden end of key grants resulted in significant funding shortfalls.

“In April, we faced about a $190 million cut without warning. We arrived at work one Tuesday and learned that multiple grants had been unexpectedly discontinued, affecting around 140 full-time equivalent positions,” he explained.

“These were essential grants, not only for COVID but also for managing infection control and testing capabilities,” he elaborated. “We were actively collaborating with nursing homes and hospitals on infection prevention.”

Harris cautioned that budget cuts could severely affect both essential services and future preparedness for health emergencies.

“It’s clear we’re not ready. Much of our work occurs behind the scenes,” he remarked. “People rarely think about food safety or the quality of drinking water until something goes wrong. All these factors rely on public health.”

“Should we lose our funding for these initiatives, the repercussions could be dire,” Harris added.

He expressed concerns about how diminished funding would impact emergency preparedness statewide. “History teaches us that a significant public health response will inevitably be required. While we can’t predict what it will be, we need to be prepared,” he stated.

Harris hopes that by 2025, there will be improved communication from the federal government regarding restructuring and the movement of CDC programs.

“Whenever there’s a national leadership change, priorities are bound to shift, and that’s just part of the system,” he acknowledged.

As president of the State Territory Health Association in 2025, Harris has encountered similar concerns from fellow state health officials about the possible implications of changing CDC guidelines and funding allocations.

“There’s significant worry about vaccination guidance and how newly formed institutions will manage programs traditionally led by the CDC,” he explained. “It’s uncertain which experts are still with CDC, or the funding arrangements that might accompany these new programs.”

“It’s quite daunting to think that our state could ever replace the federal funds we might lose,” he remarked when asked about greater state independence in public health matters.

“Yes, states should become more self-sufficient, yet it feels like a continuous decline,” he said.

The TFAH report warns that proposed budget cuts and reorganization efforts might exacerbate health disparities and particularly affect rural and underserved populations.

When discussing the ramifications for rural communities, panelists emphasized the vital role of public health funding in closing accessibility gaps.

“The threats from foodborne and infectious diseases are just as prevalent in rural areas, yet the available resources to safeguard these communities are often insufficient,” Kanter said.

He explained how state health departments strive to address health disparities through public health clinics and partnerships with local health providers.

“These efforts are crucial, especially when the public health structure remains unstable,” he noted, expressing concerns about the ongoing challenges faced by health departments in rural regions.

“Our rural communities are especially vulnerable, given the current instability of our public health infrastructure and funding,” Kanter added.

Freeman also emphasized the significance of federal funding to address healthcare disparities in rural areas.

“Rural communities require just as much attention as larger urban areas, given their unique challenges with chronic diseases and access to care,” she said. “We need to ensure that these regions don’t fall behind in service delivery, which often requires more resources to keep up.”