Bush Budget Calls for Cuts in Health Services

By ROBERT PEAR

New York Times

February 5, 2005

WASHINGTON, Feb. 4 - President Bush's budget for 2006 cuts spending for a wide range of public health programs, including several to protect the nation against bioterrorist attacks and to respond to medical emergencies, budget documents show.

Faced with constraints on spending caused by record budget deficits and the demands of the war in Iraq, administration officials said on Friday that they had increased the budget for some health programs but cut many others, including some that address urgent health care needs.

The documents show, for example, that Mr. Bush would cut spending for several programs that deal with epidemics, chronic diseases and obesity. His plan would also cut the budget of the Centers for Disease Control and Prevention by 9 percent, to $6.9 billion, the documents show.

The cuts are part of an attempt to control the federal deficit, while increasing spending on certain priority programs. Administration officials have said that in the budget, to be unveiled on Monday, Mr. Bush will propose that overall domestic spending, aside from entitlements, grows less than the rate of inflation next year.

But the administration is proposing to increase the Pentagon budget by 4.8 percent, to $419.3 billion in the 2006 fiscal year, according to Defense Department budget documents obtained by The New York Times. That sum does not include the costs of operations in Iraq and Afghanistan, now running about $5 billion a month. Within a few weeks, the administration is expected to request about $80 billion to cover those costs.

The president's approach to domestic programs is illustrated in the way he balances competing claims at the Centers for Disease Control.

Mr. Bush requests money to expand a national stockpile of vaccines and antibiotics. But the public health emergency fund of the centers, which helps state and local agencies prepare for bioterror attacks, would be cut 12.6 percent, to $1 billion.

In the event of an attack, states could use that money to distribute drugs and vaccines from the stockpile - for example, by conducting a mass immunization campaign against smallpox, anthrax or other infectious agents.

Kim A. Elliott, deputy director of the Trust for America's Health, a nonprofit advocacy group, said, "It's robbing Peter to pay Paul when you build up the national stockpile at the expense of bioterrorism preparedness activities at the state and local level."

Administration officials acknowledged that some of the proposed cuts would affect high-priority programs. But they said that the budget this year was exceptionally tight and that, in some cases, several programs served the same basic purpose.

Over all, the president's budget would reduce the Department of Health and Human Services' discretionary spending - the amounts subject to annual appropriations - by 2.4 percent, to $68 billion. According to documents, obtained from budget analysts who opposed the cuts, those figures do not include Medicare costs, which will increase sharply with the addition of a prescription drug benefit in 2006.

A Public Health Service program for "chronic disease prevention and health promotion" would be cut by 6.5 percent, to $841 million in 2006. The program finances efforts to prevent and control obesity, which federal health officials say has reached epidemic proportions.

The president's budget would also eliminate a block grant that provides $131 million for preventive health services. Under federal law, the money is used to "address urgent health problems," which vary from state to state.

Under the president's request, the budget of the National Institutes of Health, which doubled from 1998 to 2003, would rise by 0.7 percent, to $28.7 billion next year. That is much less than what would be needed to keep pace with the costs of biomedical research, which are rising more than 3.5 percent a year.

For the National Science Foundation, Mr. Bush will request $5.6 billion in 2006, an increase of 2.4 percent, budget documents show. Mr. Bush requested an increase last year as well, but Congress ended up making a small cut in the agency's budget for this year.

At the Food and Drug Administration, buffeted in recent months by concerns about drug safety, the budget would increase by 4.5 percent, to $1.9 billion. Most of the $81 million increase would go toward the evaluation of prescription drugs and the inspection of food shipments.

Mr. Bush says he wants a community health center in every poor county. The budget would increase spending for such clinics by 17.5 percent, to $2 billion. Budget officials said these clinics would care for 16.4 million people next year, up from 14 million this year.

The president is also seeking $718 million for a new effort to enroll more children in Medicaid and the Children's Health Insurance Program. Millions of uninsured children are eligible but not enrolled.

Budget documents also include these domestic proposals:

¶The budget for training nurses, dentists and other health professionals would be cut 64 percent, to $160.5 million in 2006. The president would cut $100 million, or 33 percent, from a $301 million program that trains doctors at children's hospitals.

¶Mr. Bush seeks a $38 million increase in programs promoting sexual abstinence, which would bring the total to $192.5 million in 2006, an increase of more than 50 percent since 2004.

¶The Low-Income Home Energy Assistance program, which helps people pay their heating bills, would be cut 8.4 percent, to $2 billion. High prices for home heating oil make this a particularly contentious proposal.

¶The Centers for Disease Control would receive $306 million, a 4.2 percent increase, for global health activities, including work on AIDS.

¶Mr. Bush requests $120 million to deal with the threat of a global flu epidemic. That represents an increase of 21 percent.

The budget would also eliminate a $9 million program for the treatment of people with traumatic brain injury and a $9.9 million program to collect stem cells from blood found in the umbilical cord after childbirth. Scientists say such cells may prove useful in the treatment of many diseases, and do not raise the ethical issues involved in taking stem cells from human embryos.

Mr. Bush said Friday that he would curb spending for political as well as fiscal reasons. "People in Congress on both sides of the aisle have said, 'Let's worry about the deficit,' " he said in Omaha as he campaigned for his Social Security plan. "I said, 'O.K. we'll worry about it again.' My last budget worried about it. This budget will really worry about it."

Echoing a vow made in his State of the Union address, Mr. Bush said: "We're going to eliminate or vastly reduce 150 programs that aren't meeting needs, aren't meeting priorities and are not getting the job done. It's time to be wise with the people's money."

At the Treasury Department, Mr. Bush is seeking an increase of $500 million, or 7.8 percent, to police compliance with the tax laws. That would increase the enforcement budget of the Internal Revenue Service to $6.9 billion. The Treasury said the additional money would be used to examine more tax returns, collect past due taxes and investigate cases of tax avoidance.

The Defense Department is proposing to cut $55 billion from various programs over the next six years, with most of the reductions in the later years. Even so, the Pentagon budget is projected to exceed $500 billion by 2011.

The Pentagon intends to buy fewer FA-22 fighter jets, DD(X) destroyers, Virginia-class attack submarines and LPD-17 amphibious ships, used by the Navy to transport marines. It also plans to retire one of the Navy's 12 aircraft carriers, which Navy officials have said will be the carrier John F. Kennedy, based in Mayport, Fla.

The cuts are partly offset by $25 billion in increased spending for the Army, as it restructures its forces to rely on more readily deployable brigades instead of much larger divisions.

Eric Schmitt contributed reporting for this article.