Hospital Preparedness Program Budget Cuts Could Jeopardize Gains Made in Healthcare and Public Health Preparedness

By Scott Fisher, MPH, Senior Director, Public Health Preparedness, NACCHO, and Nicole Dunifon, MS, Program Analyst, Public Health Preparedness, NACCHO

On Jan. 17, President Obama signed into law a Federal spending bill that included a cut of over $100 million to the Health and Human Services’ Hospital Preparedness Program (HPP). That equals nearly a 30 percent reduction in a program specifically aimed at strengthening healthcare preparedness for public health emergencies. These cuts could have severe and dire consequences on the ability of communities to respond when disaster strikes.

Utah County Medical Reserve Corps volunteers train for hospital surge

Utah County Medical Reserve Corps volunteers train for hospital surge

Specifically, hospitals and other health care facilities and local health departments (LHDs), will have limited capacity to plan for and respond to public health emergencies such as Superstorm Sandy, which required the coordinated evacuation of a large number of patients, and the assistance of public health emergency response teams during and following the storm. While Sandy may have required the largest regionally-coordinated response, there is no shortage of other recent examples that should provide motivation for continued funding in support of HPP. For example, the mass shooting at the Century movie theater in Aurora, CO required seven hospitals to meet the surge of victims from the shooting, and the lauded quick triage of the injured following the Boston Marathon bombings was made possible because of the coordination of hospital response through training and planning supported through HPP.

Maintaining the capacity and capability to effectively evacuate patients, sustain operations during the midst of an emergency, meet the surge from increased volume of patients, and establish systems to reunite family following an emergency are all activities that have been supported by HPP grants. A decrease in funding means a loss in capacity to conduct these critical functions. A loss in funding also means a loss in capacity to exercise and test plans that address these and other functions, and coordinate these plans with other public health emergency response partners, such as LHDs and emergency management.

“Completion of the regional surge plan will be put on the back burner, as I will not have the personnel or capacity to work on it,” said Paulette Valentine, Emergency Preparedness Director for the Southwest Utah Public Health Department. She fears that with the loss in funding her team may not be able to complete, drill, and train on the current surge plans that are already in development. Paulette also believes her department may struggle to purchase regional assets to support medical surge. In the past, the Southwest Utah Public Health Department used HPP grant dollars to purchase a water filtration system, as well as cots and supplies for alternate care sites. Funding cuts are likely to eliminate these types of purchases moving forward. If LHDs no longer have HPP funds to support medical surge plans, LHDs will begin to see reductions in their capability and capacity to respond and protect their communities from the effects of emergencies and disasters, as has already happened in southwest Utah.

LHD officials are not only concerned about how these cuts will affect their community’s healthcare and medical surge planning, but are also considering the impacts to their staff. Many LHDs rely on their preparedness coordinators to organize and convene healthcare coalitions consisting of public health, hospitals, and other medical providers to plan and prepare for public health emergencies. Preparedness coordinator positions are often funded through the HPP grant and could be eliminated due to HPP cuts. With a reduction in staff, the collaboration and relationships built between these healthcare coalitions may be lost. With fewer personnel, “these cuts will make it very challenging for healthcare coalitions to expand and be maintained,” said Steve Alles, Public Health Preparedness Program Manager from the Philadelphia Department of Public Health. In his region, he would like to “integrate additional sectors, such as nephrology, to do better preparedness work,” but may not be able to because of the cuts.

Instead of looking at success stories like Boston as proof that hospital preparedness has been achieved, we should recognized that those success stories are the result of dedicated public health and health care responders with the resources and training they needed to save lives because of grant opportunities made possible through HPP. Without continued funding to provide training and resources, we cannot expect other communities to aspire toward these success stories as achievable examples. For LHDs, medical surge and public health preparedness staffing are just two areas that may be affected by budget cuts to HPP. How do you anticipate that HPP budget cuts of over $100 million will affect your LHD? Let us know in the comment box below.

7 thoughts on “Hospital Preparedness Program Budget Cuts Could Jeopardize Gains Made in Healthcare and Public Health Preparedness

  1. Eli Briggs
    March 12, 2014 at 10:11 am

    Also, the President’s FY2015 Budget proposes to lock in funding at the $255 million level for HPP (more than $100 million cut from FY2013.)
    Eli Briggs
    NACCHO Government Affairs Director

  2. Bill Stephens
    March 18, 2014 at 3:25 pm

    So how was the PHEP budget affected? Worse, better or same?

    1. Nicole Dunifon
      March 18, 2014 at 4:38 pm

      In the FY 2014 spending bill, PHEP received a budget of $640 million, which was an increase of $32 million from FY 2013. However, the President’s FY 2015 Budget proposes that PHEP receives a budget cut of $46 million.

  3. M. Hartley
    March 27, 2014 at 11:24 am

    We were notified yesterday that HPP funding was cut in our state by 39%, while public health preparedness funding was increased by 3%. Our nation’s public health departments have an important, but more narrow mission when it comes to disasters. They are not where people go to be cared for or their lives saved following any kind of disaster/surge event. The truth is that the vast majority of U.S. hospitals are still NOT prepared to deal with most types of surge events, let alone a “Boston bombing”, “Aurora shooting” or “Joplin tornado” type incident. A pending CDC hospital preparedness survey will likely demonstrate this. How the federal government can justify cutting hospital preparedness to this extreme is beyond those of us working in the hospital preparedness trenches every day. Politics, lobbying and misguided prioritization is being allowed to sap our nation’s readiness to care for victims of disasters.

  4. McMillan
    April 6, 2014 at 2:22 pm

    I’m looking at the HHS FY2015 budget here ( and from page 14, it doesn’t look like there is a $100M cut to the HPP program from FY2014 to FY2015. It is also here ( What sources are you citing for these figures Scott? Please clarify.

    1. Nicole Dunifon
      April 7, 2014 at 2:07 pm

      The estimated $100 million cut to HPP is for fiscal year 2014. As you can see on page 17 from the following document (, the HPP budget went from $383 million in FY 2013 to $255 million in FY 2014. As for the FY 2015 budget, it looks as if there will be no change in the HPP budget from FY 2014 to FY 2015.

  5. McMillan
    April 7, 2014 at 3:01 pm

    Thank you for that clarification as it wasn’t clear which fiscal year you were referencing in your article.

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