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On June 30, 2022, the House Committee on Appropriations held its markup of the FY23 Labor, Health and Human Services, Education and Related Agencies appropriations bill.

On April 4, 2022, the U.S. Senate indicated that they have reached an agreement on a $10 billion bipartisan emergency supplemental funding bill for the federal COVID-19 response.

On March 28, 2022, the White House released President Biden’s FY23 proposed budget. The budget outlines the Administration’s funding priorities for the upcoming fiscal year. Congress has the authority to approve, reject, or modify the budget’s recommendations.

A collection of written and oral Congressional testimonies from ASTHO members and public health leaders on leading public health issues.

Scott Harris Testimony Regarding Sustainable and Predictable Public Health Funding Testimony Title Scott Harris 20250409 On behalf of the Association of State and Territorial Health Officials (ASTHO), I respectfully submit this testimony on FY26 appropriations for the U.S. Department of Health and Human Services (HHS). ASTHO is the national nonprofit representing state and territorial public health agencies. ASTHO's members — the chief public health officials of these agencies — are dedicated to formulating and influencing sound public health policy and assuring excellence in public health practice. We respectfully request that Congress provide sustained and predictable federal funding from the Centers for Disease Control and Prevention (CDC), the Health Resources and Services Administration (HRSA), and the Administration for Strategic Preparedness and Response (ASPR) for state and territorial health departments. The funding requests mentioned below are illustrative of the ongoing needs of our jurisdictions; we acknowledge that these levels may not be achievable in the next fiscal year. I am sincerely grateful to Congress for providing resources in FY25 to support and maintain investments in public health, ensuring our nation’s preparedness for current and emerging health threats. As a former state health official once eloquently stated, “The U.S. public health system is not a singular entity but a decentralized, uneven patchwork of federal agencies and state, local, tribal, and territorial public health authorities. As a result, the collaborative endeavor for public health is only as strong as the weakest link.” State health department budgets are a mix of state and federal funding streams. For some states, up to 80% of all funding comes from federal sources, with CDC being the single largest funder. Any disruption or decrease in federal funding will result in a significant impact on the ability of state and territorial health departments to protect and promote the health and safety of our population. Public health officials remain deeply concerned that our country faces significant challenges, including, but not limited to, the ongoing opioid overdose epidemic, chronic disease, preventing the spread of infectious diseases, rising health debt, access to health care in rural areas, and mental health crises. Furthermore, the recent abrupt cancellation of grants totaling as much as $11 billion caught state and territorial health departments by surprise; unfortunately, these actions will significantly impact our public health preparedness and response activities. Although the majority of this funding had already been spent, it was appropriated by Congress and obligated to health departments with work plans, budgets, and timelines approved by federal agencies for ongoing activities. These funds were intended not only for pandemic response, but also for mitigating key health security vulnerabilities that became apparent during the pandemic as well as strengthening our preparedness and response framework for the future. With congressional and executive branch support, these funds were being used to modernize data systems, bolster laboratory capacity, improve electronic case reporting of time-sensitive infectious disease outbreaks, improve H5N1 avian influenza and measles testing, and enhance biomedical terrorism preparedness, to name just a few examples. To meet not only the next public health emergency threat but also address our current challenges, it is critical that Congress invest in a stronger public health system by providing sustained and flexible funding that meets the needs of state, territorial, and local public health departments. America’s state and territorial public health departments work in partnership with CDC toward this goal. CDC plays a vital role in supporting communities to expand the capacity of our nation’s frontline of public health defense: our country’s state, tribal, territorial, and local public health departments. Regardless of the politics in our individual jurisdictions, state and territorial health officials are united in our mission to protect the health of our country. As the committee and incoming administration consider modernizing the federal government infrastructure, we respectfully request the following: Congress must work to sustain investments to state and territorial health departments: As Congress grapples with reducing our nation’s debt and deficit, the savings or return on investment generated by investing in public health has long been documented. Moreover, our membership relies on federal funding to address a myriad of illnesses through targeted interventions with the shared goal of preventing injury and disease. For example, in the fall of 2023, the North Carolina Department of Health and Human Services identified apple cinnamon fruit puree as the likely source of elevated blood lead levels in children. Even low levels of lead exposure in children can have long-lasting health effects, including potential brain damage and permanent reduction of IQ. Following their assessment, FDA issued a safety alert advising parents not to buy or feed the identified brand of fruit puree. Consultation: As the boots on the ground who put federal policy into action on the front lines, it is vital to consult with state and territorial health leaders about the potential impacts of funding reductions and/or administrative changes. Pausing or preventing money from going to states and territories, especially when done with little or no notice, creates disruptions and further harms our ability to rebuild trust with the public. As the recipients of numerous grant programs, we have first-hand knowledge of administrative changes that may actually benefit the system and could help reduce redundancies in the federal government. Flexibility: Federal funding mechanisms are often focused on specific programs, such as lead poisoning or food safety, and cannot be used flexibly to accomplish broad programmatic goals. We are grateful for the subcommittee’s ongoing support for public health infrastructure and capacity by funding this line at $350 million and we respectfully request $1 billion for this program at CDC in FY26. This disease-agnostic, flexible, and sustainable funding will support efforts within agencies that build capacity to detect and respond to threats both domestic and global, while improving and supporting activities in core public health capabilities, including assessment, policy, preparedness and response, community partnership, communications, equity, accountability, and performance management. Moreover, this funding will build a highly trained workforce that can be rapidly scaled to meet local, regional, or national threats. We strongly encourage Congress to prioritize flexibility in programmatic funding wherever possible to ensure the needs of the population can be met. Along with partner organizations, ASTHO supports the Data: Elemental to Health Campaign. Previously, we called on Congress to provide the first-ever dedicated funding for public health data systems and build a 21st-century public health data superhighway. Thanks to the work of this Subcommittee, Congress answered the call and provided annual funding for CDC's Public Health Data Modernization Initiative (DMI). For FY26, we request $340 million for data modernization efforts at CDC, which includes funding for the Center for Forecasting and Outbreak Analytics and the Response Ready Enterprise Data Integration platform. DMI is necessary for building a world-class data workforce and data systems to ensure we can meet the next public health emergency at full capacity. Our state and territorial health departments need robust, sustained, yearly funding to complete the foundational investment in DMI and ensure we are providing resources for public health systems and infrastructure, including at state and local health departments, to keep pace with evolving technology. States use the Preventive Health and Health Services Block Grant (Prevent Block Grant) to offset funding gaps in programs that address leading causes of death and disability. In some cases, this grant serves as seed funding for crucial, innovative projects so a state or territorial health department can meet otherwise unfunded community health goals. ASTHO respectfully requests $175 million for this program. For more than 30 years, the Prevent Block Grant has served as an essential funding source for state and territorial health agencies. CDC’s Public Health Emergency Preparedness Cooperative Agreement (PHEP) provides vital support for public health preparedness and response. ASTHO requests $1 billion for PHEP to sustain and improve governmental public health programs. Established in the aftermath of the September 11 terrorist attacks, PHEP has been a core public health preparedness program that supports 62 state, local, and territorial public health departments. The pandemic response demonstrated the need to invest in these programs to rebuild and bolster the nation’s preparedness capabilities. CDC has refreshed its strategy with critical lessons learned from COVID-19 to support public health jurisdictions with an updated response framework that prioritizes essential areas for the public to prepare for, respond to, and recover from health threats in the next five-year funding cycle that begins in the current fiscal year. Under ASPR, ASTHO is requesting $500 million for Health Care Readiness and Recovery, which includes the Hospital Preparedness Program (HPP) Cooperative Agreement. This includes developing mechanisms for effective patient movement, communicating situational awareness, and providing resource sharing across disparate health care entities. HPP allows individual health care facilities and coalitions to access a truly national response network, enabling the system to save lives and protect Americans from 21st-century health security threats.

ASTHO CEO Michael Fraser's Testimony in Regards to the U.S. Department of Health and Human Services for the Committee on Appropriations, United States Senate

This page features ASTHO’s legal mapping work to plot the legal landscape for public health priorities.

This map visualizes ASTHO's ongoing public health and healthcare workforce legislative tracking.

This map visualizes ASTHO's ongoing public health and healthcare workforce legislative tracking, and use of artificial intelligence in government.

States are passing legislation to support peer services for overdose prevention and substance use. Explore the interactive map to learn more.

Learn how states and territories are leveraging policy to support overdose prevention and access to medications for opioid use disorder.

Overdose Prevention Center Legislation Map The map below visualizes a longitudinal data set of legislation related to the establishment of overdose prevention centers, which are places where people who use drugs can consume pre-obtained substances under medical supervision from January 1, 2019 - January 1, 2025.  For additional information on these policies, please email ASTHO's OD2A team.  article no False

Scope of Practice Toolkit The Scope of Practice Toolkit addresses key concepts regarding modifying the scope of practice of various healthcare and other practitioners in public health emergency response activities. The toolkit component documents are designed to assist in education, training, and planning activities to prepare for emergencies, as well as to serve as a quick reference resource during an emergency response to an event. The Scope of Practice Toolkit is one of six toolkits in ASTHO’s Legal Preparedness Series. Intended Audiences These documents are specifically designed to address the different needs of discrete audiences within a state health agency: State health officers, agency directors, or other senior governmental officials may find the executive overviews and fact sheets of particular interest. Preparedness directors and other programmatic staff will find the fact sheets, issue briefs, state analysis guides, and resource materials useful in understanding and gaining more in-depth knowledge about particular concepts and legal issues. Legal counsel will find the fact sheets about particular federal laws and regulations, issue briefs, state analysis guides, and citations within the resource materials a good basis from which to conduct additional research and analyze their particular state’s authorities on these issues. Scope of Practice Toolkit Contents All documents are listed alphabetically within each document category   Executive Overviews One-page snapshots of key concepts and issues Scope of Practice Key Issues and Concepts Fact Sheets Short documents addressing fundamental issues or legal authorities Modified Scope of Practice Used by States in the 2009 H1N1 Influenza Pandemic Scope of Practice Issues in Public Health Emergencies Understanding Licensing, Credentialing, Certification, and Privileging Issue Briefs In-depth information and analyses of fundamental issues No issue briefs in the toolkit currently State Analysis Guides Aids to assist states in identifying and analyzing their own statutes, regulations, and policies Scope of Practice Issues (automatic Word document download) website no

Emergency Volunteer Toolkit The Emergency Volunteer Toolkit addresses key concepts regarding emergency response volunteers, including types of volunteers, federal and state laws governing or affecting volunteers, and volunteer registration. The toolkit component documents are designed to be used as a resource to assist in education, training, and planning activities to prepare for deploying volunteers during emergencies, as well as to serve as a quick reference resource during an emergency response. Intended Audiences These documents are specifically designed to address the different needs of discrete audiences within a state health agency: State health officers, agency directors, or other senior governmental officials may find the executive overviews and fact sheets of particular interest. Preparedness directors and other programmatic staff will find the fact sheets, issue briefs, state analysis guides, and resource materials useful in understanding and gaining more in-depth knowledge about particular concepts and legal issues. Legal counsel will find the fact sheets about particular federal laws and regulations, issue briefs, state analysis guides, and citations within the resource materials a good basis from which to conduct additional research and analyze their particular state’s authorities on these issues. Emergency Volunteer Toolkit Contents All documents are listed alphabetically within each document category Executive Overviews One-page snapshots of key concepts and issues Key Emergency Response Volunteer Concepts Key Federal and State Laws Regarding Emergency Volunteers Fact Sheets Short documents addressing fundamental issues or legal authorities   Types of Volunteers Volunteer Licensing, Credentialing, and Privileging and Waiver and Reciprocity Volunteers, Liability and Liability Protections Volunteer Protection Acts and Good Samaritan Laws Volunteer Registration Workers' Compensation and Disability Benefits for Emergency Volunteers Issue Briefs In-depth information and analyses of fundamental issues No issue briefs in the toolkit at this time State Analysis Guides Aids to assist states in identifying and analyzing their own statutes, regulations, and policies Emergency Volunteers (automatic Word document download) website no

This emergency use authorization toolkit addresses key concepts and issues regarding the federal law allowing special uses for drugs, biologics, and devices during specified emergencies.

2025 Legislative Prospectus Series As part of our comprehensive State Health Policy portfolio, ASTHO provides an annual legislative prospectus—a series of briefs summarizing upcoming legislation proposals that impact public health from across the states and territories. The legislative prospectus series anticipates trends in public health law for the next year and provides a short review for public health professionals and legislators alike to help bring them up to speed in time for upcoming legislative sessions. This page contains an archive of the 2025 Legislative Prospectus entries. article yes

ASTHO Legislative Prospectus | Previewing 2025 state legislative actions on maternal and child health.

ASTHO Legislative Prospectus | Prevention 2025 state legislative action on infectious disease control and prevention.

ASTHO Legislative Prospectus | Previewing 2025 state legislative actions on substance misuse and overdose prevention.

A letter from ASTHO's CEO, Joseph Kanter, MD, MPH, about the organization's annual legislative prospectus series.