The National Association of Free and Charitable Clinics (NAFC) would like to express our profound disappointment with the cuts and program eliminations proposed in the House FY2024 Labor, Health and Human Services, Education, and Related Agencies Appropriations Bill.
The bill disregards health equity, women’s health care, and gender-affirming health care, revealing an indifference to the needs of millions of Americans.
As a bipartisan organization committed to the health and welfare of all individuals, the NAFC recognizes the importance of fiscal responsibility. However, this bill is shockingly short-sighted and will have devastating consequences that will reverberate throughout our healthcare system for years.
America’s 1,400 Free and Charitable Clinics serve approximately 2 million uninsured individuals daily. These clinics are staffed by a dedicated workforce of nearly 200,000 volunteers and staff members. Our member organizations do not receive taxpayer dollars to provide access to health care to their communities. Instead, with the support of donations, grants and volunteers, we are on the front lines serving the healthcare needs of individuals whose current healthcare system is the community’s response to healthcare.
Our clinics know firsthand the catastrophic impact that these proposed cuts and program eliminations would have on our patients, many of whom are poor, uninsured, black, indigenous people of color, immigrants, people with low health literacy and English proficiency, women, and part of the LGBTQIA+ communities. Our nation’s most vulnerable would be forced to seek emergency care, leading to an increase in costs to our healthcare system and potentially tragic outcomes.
According to the Kaiser Family Foundation, individuals without health coverage experience higher hospitalization rates for preventable health problems, receive fewer diagnostic and therapeutic services, and face higher mortality rates than those with insurance.
The House Labor-HHS Appropriations Bill sends the message that women, especially uninsured women, and women of color, are not a priority. By eliminating the Breast and Cervical Cancer Screening Program under Title X, this bill further endangers the lives of countless women. A National Institutes of Health report reveals uninsured women and those with public insurance face higher risks of advanced breast cancer, treatment delays, and death. The drastic cuts to the Maternal and Child Health Block Grant, Healthy Start, the Ending HIV Epidemic initiative, and various diversity initiatives within the healthcare workforce undermine our society’s commitment to equitable access to care.
The NAFC is dedicated to building healthy communities and ensuring quality, equitable, and accessible healthcare. We stand for volunteerism, generosity, collaboration, and the intrinsic value of human dignity. Our vision encompasses a just society that upholds the rights of all individuals to a healthy life and well-being, regardless of age, sex, income, education, immigration status, ethnicity, skin color, religion, or sexual orientation.
As Congress continues negotiations on a final Labor HHS bill, we urge all members of the Senate and the House to prioritize people over politics because a healthy population is essential for the success and growth of our nation. The House Labor-HHS Appropriations Bill falls short of what our citizens deserve, and we as a country must do better.
Background on the House Labor Health, Human Services Appropriations Bill
On Friday, July 14, 2023, the House Appropriations Committee conducted a thorough review and marked up the FISCAL YEAR 2024 LABOR, HEALTH AND HUMAN SERVICES, EDUCATION, AND RELATED AGENCIES APPROPRIATIONS BILL.
Please find below a summary of the dramatic cuts to programs in this appropriations bill:
Department of Health and Human Services (HHS) – The bill includes $103.7 billion for HHS, a $17.4 billion– 14 percent cut below the FY 2023 enacted level. Of this amount:
Health Resources and Services Administration (HRSA) – The bill includes $7.3 billion for HRSA, a cut of more than $700 million below the enacted level. (The comparison does not include Community Project Funding in the FY 2023 passed bill.)
- The bill eliminates funding for Title X Family Planning, a cut of $286 million below the enacted level.
- The bill includes $781 million for the Maternal and Child Health Block Grant, a cut of $35 million below the enacted level.
- The bill eliminates funding for Healthy Start, a cut of $145 million below the enacted level.
- The bill eliminates funding for the Ending HIV Epidemic initiative, a cut of $220 million below the enacted level.
- The bill eliminates funding for multiple programs to support diversity in the healthcare workforce, including—
- Health Careers Opportunity Program ($16 million)
- Centers of Excellence ($28 million)
- Nursing Workforce Diversity ($24 million)
Agency for Healthcare Research and Quality (AHRQ) – The bill eliminates funding for AHRQ, a cut of $374 million below the enacted level.
Centers for Medicare & Medicaid Services (CMS) – The bill includes $3.3 billion for CMS administrative expenses, a cut of $798 million below the enacted level.
Administration for Children and Families (ACF) – The bill provides $28.3 billion for ACF, a cut of $4.8 billion below the enacted level. The bill includes $457 million for refugee programs, including Transitional and Medical Services and Refugee Support Services, a cut of $414 million below the enacted level.
- The bill includes $2.25 billion for the Unaccompanied Children program, a cut of $3.3 billion below the enacted level.
National Institutes of Health (NIH) – The bill includes $44.6 billion for NIH, a cut of $2.8 billion below enacted level.
Advanced Research Projects Agency for Health (ARPA-H) – The bill includes $500 million for ARPA-H, a cut of $1 billion below the enacted level.
Centers for Disease Control and Prevention (CDC) – The bill includes $7.6 billion for the CDC, a cut of 1.6 billion below the enacted level.
- The bill eliminates funding for the Ending the HIV Epidemic initiative, a cut of $220 million below the enacted level.
- The bill includes $100 million for Public Health Infrastructure and Capacity, a cut of $250 million below the enacted level.
- The bill includes $75 million for Public Health Data Modernization, a cut of $100 million below the enacted level.
- The bill includes $371 million for Global Health, a cut of $322 million below the enacted level.
Substance Abuse and Mental Health Services Administration (SAMHSA) – The bill funds SAMHSA at $7.1 billion, a cut of $234 million below the enacted level.
Office of the Secretary—General Departmental Management – The bill includes $344 million for GDM, a cut of $258 million below the enacted level.
- The bill eliminates funding for the Teen Pregnancy Prevention Program, a cut of $108 million below the enacted level.
- The bill includes $26 million for the Office of Minority Health, a cut of $49 million below the enacted level.
- The bill includes $28 million for the Minority HIV/AIDS Initiative, a cut of $24 million below the enacted level.
- The bill includes $20 million for the Office on Women’s Health, a cut of $49 million below the enacted level.
Corporation for National and Community Service– The bill includes $661 million, a cut of $652 million below the enacted level.
Policy Provisions
- The bill includes prohibiting funding to conduct or support research using fetal tissue.
- The bill includes a prohibition on funding for Planned Parenthood health centers.
- The bill includes multiple policy riders to block access to abortion services or reproductive healthcare services.
- The bill includes multiple policy riders to block the Biden Administration’s policies to ensure nondiscrimination based on gender identity or sexual orientation.
- The bill includes a rider to amend the Public Health Service Act to create a right to monetary damages in a civil action for violating the Weldon amendment (which allows healthcare providers to discriminate against patients by refusing to provide, pay for, cover, or refer for abortion).