Prevention and Public Health Fund: In Brief

January 8, 2024 R47895

Prevention and Public Health Fund: In Brief
January 8, 2024
Congressional Research Service
https://crsreports.congress.gov
R47895

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n 2010, Section 4002 of the Patient Protection and Affordable Care Act (ACA. P.L. 111-148,
as amended) established a new Prevention and Public Health Fund (PPHF).1 Prior to
I enactment, public health advocates had sought a guaranteed federal investment in prevention
and wellness that was not subject to the annual appropriations process.2 The PPHF ACA Section
provides a permanent annual mandatory appropriation,3
to provide for expanded and sustained national investment in prevention and public health
programs to improve health and help restrain the rate of growth in private and public sector
health care costs.
This CRS report provides an overview of the PPHF since ACA enactment, including its
legislative and policy history. The report also provides an analysis examining whether the PPHF
has provided for expanded investment in public health and prevention as authorized in statute.
PPHF appropriations are mandatory spending meaning that the authorizing law that establishes
the PPHF also provides an appropriation of funds each fiscal year. The annual appropriation is
permanent, meaning that the law is to provide an annual appropriation each fiscal year without a
termination date.4 As enacted, the law began with $500 million appropriated in FY2010 with
increasing amounts each subsequent fiscal year until $2 billion was to be appropriated in FY2015
and each year thereafter. Subsequent amendments have reduced the actual annual appropriations
amounts (see Table 1).
Per the authorizing statute, the fund is to be administered through the Department of Health and
Human Services (HHS) Office of the Secretary. The Secretary is to transfer fund amounts to
increase funding over the FY2008 level for “prevention, wellness, and public health activities
including prevention research, health screenings, and initiatives, such as the Community
Transformation grant program, the Education and Outreach Campaign Regarding Preventive
Benefits, and immunization programs.”5 Since FY2014, annual appropriations laws have limited
this transfer ability as discussed in this report.
For FY2010 through FY2013, the HHS Secretary determined the distribution of PPHF funds,
transferring the majority of total PPHF appropriations for those years to the Centers for Disease
Control and Prevention (CDC) as shown in Table 2.
For FY2013, the Secretary used almost half of the available PPHF appropriation to implement
ACA insurance exchanges, prompting objections from both supporters and opponents of the
fund.6 Since FY2014, Congress has determined annual PPHF allocations using the annual
appropriations process, providing most of each annual appropriation to the CDC also shown in
Table 2.

1 The original Patient Protection and Affordable Care Act (P.L. 111-148) was subsequently amended by the Health
Care and Education Reconciliation Act of 2010 (HCERA; P.L. 111-152) a week later. The laws together are commonly
considered the Affordable Care Act (ACA).
2 Michael Fraser, “A Brief History of the Prevention and Public Health Fund: Implications for Public Health
Advocates,” American Journal of Public Health, vol. 109, no. 4 (April 2019), pp. 572-577.
3 42 U.S.C. §300u-11(a).
4 For more information, see CRS Report R44582, Overview of Funding Mechanisms in the Federal Budget Process,
and Selected Examples.
5 Language under current law. See ACA Section 4002(c) [42 U.S.C. §300u-11(c)].
6 See for example “HHS Takes $454 Million from Prevention Fund for Insurance Enrollment,” Inside CMS, April 17,
2013. https://insidehealthpolicy.com/inside-cms/hhs-takes-454-million-prevention-fund-insurance-enrollment, and
Avik Roy, “Obamacare’s Slush Fund Fuels a Broader Lobbying Controversy,” Forbes, May 30, 2013.
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Congressionally determined PPHF allocations for specific HHS programs have remained fairly
consistent since FY2014 as shown in Table 3.
The PPHF currently provides one source of budget authority for certain HHS agencies that also
receive discretionary budget authority. In this report, CRS explores whether the PPHF has
effectively increased federal public health funding since enactment. Using CDC as a main
example, CRS analysis shows that the CDC has not seen an overall increase in its program
funding level after FY2010 when adjusting for inflation. From FY2011 though FY2023, the
percentage of CDC’s program level comprising PPHF transfers has ranged from 7.3% to 12.7%.
Prevention and Public Health Fund: Current Status
Table 1 provides a legislative history of PPHF appropriations, beginning with appropriations as
enacted in the ACA, funding levels as amended, and then a summary of appropriations under
current law. Current law amounts do not reflect reductions due to budget sequestration (see Table
2 for a summary of sequestrations).7 The rightmost column shows final PPHF total transfers made
available each fiscal year after sequestration.
Table 1. Legislative History of PPHF Appropriations
Budget authority in millions, by fiscal year
Total Appropriation
ACA,
P.L.
P.L.
P.L.
P.L.
P.L.
P.L.
111-
112-
114-
115-
115-
117-
148,
96,
255,
96,
123,
328,
Current
Final
Fiscal Year
2010
2012
2016
2017
2018
2023
Law
Transfers
2010
500
—
—
—
—
—
500
500
2011
750
—
—
—
—
—
—
750
2012
1,000
—
—
—
—
—
1,000
1,000
2013
1,250
1,000
—
—
—
—
1,000
949
2014
1,500
1,000
—
—
—
—
1,000
928
2015
2,000
1,000
—
—
—
—
1,000
927
2016
2,000
1,000
—
—
—
—
1,000
932
2017
2,000
1,000
—
—
—
—
1,000
931
2018
2,000
1,250
900
—
—
—
900
841
2019
2,000
1,250
900
800
900
—
900
844
2020
2,000
1,500
1,000
800
950
—
950
894
2021
2,000
1,500
1,000
800
950
—
950
896
2022
2,000
—
1,500
1,250
1,000
—
1,000
943
2023
2,000
—
1,000
1,000
1,000
—
1,000
943
2024
2,000
—
1,700
1,700
1,300
—
1,300
NA
2025
2,000
—
2,000
2,000
1,300
—
1,300
NA

7 White House, The Budget for Fiscal Year 2024, HHS Appendix, p. 476, https://www.whitehouse.gov/wp-content/
uploads/2023/03/hhs_fy2024.pdf.
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Total Appropriation
ACA,
P.L.
P.L.
P.L.
P.L.
P.L.
P.L.
111-
112-
114-
115-
115-
117-
148,
96,
255,
96,
123,
328,
Current
Final
Fiscal Year
2010
2012
2016
2017
2018
2023
Law
Transfers
2026
2,000
—
—
—
1,800
1,525
1,525
NA
2027
2,000
—
—
—
—
1,525
1,525
NA
2028
2,000
—
—
—
—
1,725
1,725
NA
2029
2,000
—
—
—
—
1,725
1,725
NA
2029 and
2,000
—
—
—
—
—
2,000
NA
each
subsequent
fiscal year
Source: Prepared by Congressional Research Service from texts of laws cited. Current law is as of January 2,
2024. Final amounts based on Table 2 and accompanying sources.
Notes: Current law amounts do not reflect reductions due to sequestration. Final transfer amounts reflect total
PPHF transfers for each fiscal year. NA= not available.
As shown in the table, in three years did PPHF receive the same funding level as originally
enacted. In most years, PPHF has received less funding than originally enacted.
Congress has further specified PPHF allocations through annual appropriations laws in recent
years. Figure 1 shows PPHF allocations for FY2023 as directed in the explanatory statement
accompanying the FY2023 Departments of Labor, HHS, and Education and Related Agencies
(LHHS) appropriations law.
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Figure 1. PPHF Allocations in FY2023 LHHS Appropriations
From the Explanatory Statement Accompanying FY2023 appropriations

Source: “Explanatory Statement Accompanying Consolidated Appropriations Act, 2023,” Congressional Record,
vol. 168 (December 20, 2022), p. S8895.
Note: ACL= Administration for Community Living; CDC= Centers for Disease Control and Prevention;
SAMHSA= Substance Abuse and Mental Health Services Administration.
As shown, most of the post-sequester PPHF funding went to CDC ($903.3 million total) with
smaller amounts for the Substance Abuse and Mental Health Services Administration (SAMHSA;
$12 million) and the Administration for Community Living (ACL; $27.7 million total).8 The
FY2023 appropriations law required the Secretary to transfer FY2023 PPHF funds in accordance
with the table in the explanatory statement and prohibited further transfers.9

8 The Substance Abuse and Mental Health Services Administration (SAMHSA) is the federal agency primarily
responsible for supporting community-based mental health and substance abuse treatment and prevention services. See
CRS Report R46426, Substance Abuse and Mental Health Services Administration (SAMHSA): Overview of the Agency
and Major Programs. The Administration for Community Living (ACL) is focused on maximizing the “independence,
well-being, and health of older adults, people with disabilities across the lifespan, and their families and caregivers.”
See ACL, About ACL, https://acl.gov/about-acl.
9 Consolidated Appropriations Act, 2023, P.L. 117-328, Division H, Title II, Section 222.
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Prevention and Public Health Fund: History
Before and During Enactment
Public health advocates had previously sought a guaranteed federal investment in prevention and
wellness that was not subject to the annual appropriations process.10 Prior to enactment of the
ACA, a House-reported health care reform bill (H.R. 3200, 111th Congress) would have
established a prevention and wellness trust that authorized annual appropriations for specific
activities. Additionally, the Senate Committee on Health, Education, Labor had Pensions (HELP)
had originally proposed $80 billion in mandatory appropriations over the first 10 years for the
PPHF in the committee-reported bill (S. 1679, 111th Congress). The final ACA text included $15
billion in mandatory appropriations over the first ten years.11 The final ACA text was not
accompanied by committee reports in each chamber that would have further clarified policy
intentions for the PPHF.
FY2010-FY2013: HHS Secretary Determined Allocations
From FY2010 through FY2013, the HHS Secretary determined how PPHF funds were allocated
as shown in Table 2.
As noted earlier, the PPHF authorizing statute allowed the HHS Secretary to allocate funds for
“prevention, wellness, and public health activities including prevention research, health
screenings, and initiatives, such as the Community Transformation grant program, the Education
and Outreach Campaign Regarding Preventive Benefits, and immunization programs.”12 The
statute also granted the House and Senate Appropriations Committees authority to transfer funds
for eligible activities authorized in the PPHF statute.13
The Secretary generally used the PPHF to fund a mix of preexisting activities and activities newly
authorized under the ACA. For example, in FY2012, the HHS Secretary allocated some of the
PPHF funding to CDC programs that predated the ACA, including viral hepatitis programs ($10
million), immunization programs ($190 million), and tobacco use prevention programs ($83
million), among others. The Secretary also allocated funding towards new ACA programs, for
example, in FY2012, HHS allocated $226 million of the PPHF towards CDC Community
Transformation grants authorized in ACA Section 4201.14 Through this program, CDC funded
state and local health agencies and organizations to implement community intervention projects
that involved cross-sectoral approaches to improving health, such as through promoting better
sidewalks for safe walking or by supporting local farmers to increase access to healthy food.15

10 Michael Fraser, “A Brief History of the Prevention and Public Health Fund: Implications for Public Health
Advocates,” American Journal of Public Health, vol. 109, no. 4 (April 2019), pp. 572-577.
11 The original law provided increasing amounts for FY2010-FY2014 and $2 billion for FY2015 and each fiscal year
thereafter. P.L. 111-148, § 4002(b).
12 Language under current law. See ACA Section 4002(c) [42 U.S.C. §300u-11(d)].
13 See ACA Section 4002(d) [42 U.S.C. §300u-11(c)].
14 HHS, “FY2012 Allocation of PPHF Funds,” https://web.archive.org/web/20221209234350/https://www.hhs.gov/
open/prevention/fy2012-allocation-pphf-funds.html.
15 CDC, “Investments in Community Health: Community Transformation Grant Program,” https://www.cdc.gov/
nccdphp/dch/programs/communitytransformation/funds/index.htm.
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Some Members of Congress raised concerns with this use of the PPHF and also with the scope of
the HHS Secretary’s ability to allocate funds.16
Much of the funding in FY2010 through FY2012 went to CDC and the Health Resources and
Services Administration (HRSA) for public health and health workforce programs respectively.
As noted, in 2013, $454 million of the PPHF was allocated to support health insurance enrollment
at the Centers for Medicare & Medicaid Services (CMS).17 According to the PPHF FY2013
report,18
Studies have also shown that insurance coverage can lead to better health. It helps people
obtain the primary care, preventive services, prescription drugs and mental health services
they need to stay healthy, prevent disease before it starts or stop it from worsening. Those
who are uninsured are less likely to get recommended screenings (e.g. mammograms and
colonoscopies) or have a regular source of care, and generally have poorer control of
chronic conditions such as hypertension. New coverage options available in the
Marketplaces will increase access to preventive care and help improve health outcomes for
the millions of individuals who will be able to enroll in affordable health plans. Assisting
these individuals in gaining affordable health care aligns with the purpose of the Prevention
Fund - to support the necessary infrastructure to prevent disease, detect it early, and manage
conditions before they become severe, and help states and communities promote healthy
living.
As noted earlier, CMS’s use of the fund for health insurance program purposes prompted
objections from both supporters and opponents of the fund.19
FY2014-FY2023: Congress Determined Allocations
Starting in FY2014 appropriations, Congress began to direct PPHF allocations through annual
LHHS appropriations laws.20 In FY2014, the congressionally directed PPHF allocations mostly
went towards programs that the HHS Secretary had previously funded using PPHF
appropriations. Congress stopped funding certain PPHF-funded programs, including the CDC
Community Transformation Grants program.21 Since FY2014, Congress has specified PPHF
allocations through report or explanatory statement tables accompanying appropriations laws (see

16 See for example “Repealing the Prevention and Public Health Fund,” House debate, Congressional Record, vol. 157,
April 13, 2011, pp. H2633-H2644.
17 See HHS, “FY2013 Allocation of PPHF Funds,” https://web.archive.org/web/20221209234714/https://www.hhs.gov/
open/prevention/fy2013-allocation-pphf-funds.html. The Consolidated Appropriations Act, 2012, required HHS to
establish a publicly available website to provide detailed information on the use of PPHF funds (P.L. 112-74, §220, 125
Stat. 1085, December 23, 2011). This instruction was carried forward in subsequent appropriations acts. HHS is
required to post on the PPHF website specific information on the program or activity receiving funds; announcements
of funding opportunities; and each grant, cooperative agreement, or contract with a value of $25,000 or more awarded
using PPHF funds. Annual and semiannual reporting requirements also apply. The last reported funding allocation table
was published for FY2016. The website was established at https://www.hhs.gov/open/prevention.
18 HHS, “The Affordable Care Act and the Prevention and Public Health Fund Report to Congress for FY2013,”
https://web.archive.org/web/20221007153727/http://www.hhs.gov/sites/default/files/open/prevention/fy-2013-aca-
pphf-report-to-congress.pdf.
19 See for example “HHS Takes $454 Million from Prevention Fund for Insurance Enrollment,” Inside CMS, April 17,
2013. https://insidehealthpolicy.com/inside-cms/hhs-takes-454-million-prevention-fund-insurance-enrollment and Avik
Roy, “Obamacare’s Slush Fund Fuels a Broader Lobbying Controversy,” Forbes, May 30, 2013.
20 Consolidated Appropriations Act, 2014, P.L. 113-76, Division H, Title II, Section 219.
21 For FY2014 PPHF allocations see Congressional Record, Volume 160, Issue 9, Book II (January 15, 2014), pp.
H1041-H1042, http://www.gpo.gov/fdsys/pkg/CREC-2014-01-15/content-detail.html.
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example in Figure 1) and has prohibited further transfers through general provisions in LHHS
appropriations acts.
As shown in Table 3, congressionally directed PPHF allocations have been fairly consistent since
this practice began. Most of the allocations have gone toward HHS programs within CDC,
SAMHSA and ACL, including some established by the ACA. In many cases, the same programs
that receive PPHF transfers also receive some discretionary appropriations.22 For example, in
FY2023, PPHF transfers accounted for about 27% of the funds for the Garrett Lee Smith suicide
prevention grants to states, administered by SAMHSA.23 For some programs, the PPHF
contribution made up more than half of total program funding in FY2023. Examples include the
CDC immunization program (61%) and tobacco prevention activities (51%). Some programs are
funded entirely by PPHF transfers. For example, the CDC Preventive Health and Health Services
Block Grant program received 100% of its FY2023 funding from the PPHF.24
PPHF Amendments as an Offset
As shown in Table 1, the PPHF has been amended five times since enactment. In most of these
laws, the PPHF amendments were included in “offset” or “savings” portions of the laws. As
mentioned, only one law that amended the PPHF provided increases to the appropriations in some
years, but still had the overall net effect of decreasing future PPHF appropriations (P.L. 115-123,
§53119). In total, these laws have had the effect of reducing total appropriations made available
in the PPHF ACA section as shown in Table 1.
Has the PPHF Increased Funding for Public Health
and Prevention?
Per its statutory authorization, the PPHF is to “provide for expanded and sustained national
investment in prevention and public health programs.” Public health stakeholders have argued
that the PPHF has been used to supplant rather than supplement discretionary appropriations for
the CDC and other HHS agencies.25
Figure 2 shows a CRS analysis of CDC’s core public health program funding levels as adjusted
for inflation from FY2005 through FY2023 with the percentage of the overall program level
comprised of PPHF allocations.26 Because CDC has received the largest portion of PPHF funds
throughout the fund’s history, the agency can serve as a main example for examining whether the
PPHF has provided for expanded investment in public health.

22 See, for example, CDC, Operating Plan FY2023, https://www.cdc.gov/budget/documents/fy2023/FY-2023-CDC-
Operating-Plan.pdf to see how PPHF transfers fit within CDC’s overall budget.
23 SAMHSA, Operating Plan FY2023, https://www.samhsa.gov/sites/default/files/fy23-operating-plan.pdf.
24 CDC, Operating Plan FY2023, https://www.cdc.gov/budget/documents/fy2023/FY-2023-CDC-Operating-Plan.pdf.
25 Michael R. Fraser, “A Brief History of the Prevention and Public Health Fund: Implications for Public Health
Advocates,” American Journal of Public Health, vol. 109, no. 4 (April 2019), p. 572–577.
26 In this report, CDC’s “core public health program level” comprises discretionary budget authority for CDC and the
Agency for Toxic Substances and Diseases Registry (ATSDR) and other transfers and one-time mandatory
appropriations the agency received for public health programs. The core public health program level does not include
emergency supplemental appropriations or other one-time appropriations in the American Rescue Plan Act. The core
public health program level does not include other mandatory appropriations that CDC receives for specific health
services, such as for the Vaccines for Children program and the World Trade Center Health Program. For more
background, see CRS Report R47207, Centers for Disease Control and Prevention (CDC) Funding Overview.
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The analysis shows that CDC saw a slight increase in its overall program level in the first year the
agency received PPHF transfers in FY2010, from $9.62 billion in FY2010 compared to $9.45
billion in FY2009. Since then, CDC’s inflation-adjusted program level has varied from year to
year. From FY2011 though FY2023, the percentage of CDC’s program level comprising PPHF
transfers has ranged from 7.3% to 12.7%. During the same period, CDC’s total program funding
level has not exceeded FY2010 levels when adjusting for inflation. Thus, CDC has not seen an
overall inflation-adjusted increase in its program level since PPHF enactment.
Figure 2. Trends in PPHF Funding as a Percentage of CDC Core Public Health
Program Levels, Inflation Adjusted
Adjusted to 2023 dollars with the GDP Deflator

Source: CRS analysis drawing on data from CDC Congressional Budget Justifications from FY2007 to FY2024.
“All Purpose Table”, Accessed at https://www.cdc.gov/budget/congressional-justifications/index.html. GDP Deflator
index values from FRED, Gross Domestic Product: Implicit Price Deflator, Accessed at https://fred.stlouisfed.org/
series/GDPDEF.
Notes: Amounts reflect final appropriations after transfers and other adjustments and may therefore differ from
amounts as enacted. Amounts shown may not reflect all post-appropriations transfers. CDC’s other budget
sources comprise discretionary budget authority for CDC and the Agency for Toxic Substances and Diseases
Registry (ATSDR), other transfers, and one-time mandatory appropriations the agency received for public health
programs. Amounts shown do not include emergency supplemental appropriations (e.g., Coronavirus Disease
2019 supplemental appropriations) or other one-time appropriations such as those provided in The American
Rescue Plan Act. The core public health program level does not include other mandatory appropriations that
CDC receives for specific health services programs, such as for the Vaccines for Children program and the
World Trade Center Health Program. For more background, see CRS Report R47207, Centers for Disease
Control and Prevention (CDC) Funding Overview.
Acronyms: CDC = Centers for Disease Control and Prevention; LHHS = Labor, Health and Human Services,
Education, and Related Agencies appropriations bil ; ATSDR = Agency for Toxic Substances and Disease
Registry; PPHF = Prevention and Public Health Fund; PHSSEF = Public Health and Social Services Emergency
Fund; PHS = Public Health Service.
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Concluding Observations
As with the ACA as a whole, the PPHF has sparked some controversy. In the immediate years
following enactment, there were concerns as to the broad discretion of the Secretary to administer
a sizeable permanent appropriation and also around specific uses of the fund, such as for
community infrastructure projects and ACA health insurance implementation activities.27 As
noted, since FY2014, annual appropriations laws have limited the HHS Secretary’s discretion in
allocating the fund. Since the ACA was enacted in 2010, Congress has considered several
proposals to repeal the fund and rescind any unobligated balance.28
Since FY2014, Congress has directed annual PPHF allocations to HHS agencies. The PPHF
currently provides one source of budget authority for certain HHS agencies that also receive
discretionary budget authority. The programs that have received PPHF funding have remained
relatively consistent since FY2014 as shown in Table 3. In this report, CRS has explored whether
the PPHF has increased public health funding since enactment. Using CDC as a main example,
CRS analysis shows that the CDC has not seen an overall increase in its program funding level
after FY2010 when adjusting for inflation. From FY2011 though FY2023, the percentage of
CDC’s program level comprising PPHF transfers has ranged from 7.3% to 12.7%.
Public health advocates have opposed further PPHF recissions. For example, in September 2023,
a group of 111 health organizations sent a letter to the Senate HELP Committee opposing further
PPHF recissions in proposed legislation (S. 2840).29 The letter stated, “The Prevention Fund
currently comprises more than 10 percent of the Centers for Disease Control and Prevention’s
(CDC) entire annual operating budget. Cuts to the Prevention Fund will translate into funding
shortfalls in programs that states have long relied upon to keep their residents healthy and safe.”
If providing additional support for public health and prevention remains a priority, Congress
could consider whether the PPHF has had the desired effect as currently structured. Congress
could examine whether statutory changes might help the fund achieve intended policy goals, for
example, by further specifying programs eligible to receive PPHF funding. Congress could also
examine the role of agency discretion in the fund’s history, and whether more or less agency
discretion is desirable moving forward. Congress could also consider whether greater oversight
mechanisms might ensure that the fund is spent as intended.
Alternatively, if Congress decides to repeal or rescind PPHF appropriations, Congress could
consider the overall effect on CDC and other HHS agency budgets. In recent years, PPHF has
become one source of budget authority for CDC, SAMHSA and ACL. If repealed entirely or
reduced below FY2023 levels, all else being equal, these agencies would see decreases in their
annual program funding levels relative to current levels.

27 See for example “Repealing the Prevention and Public Health Fund,” House debate, Congressional Record, vol. 157,
April 13, 2011, pp. H2633-H2644.
28 CRS Report R43289, Legislative Actions in the 112th, 113th, and 114th Congresses to Repeal, Defund, or Delay the
Affordable Care Act, out of print; available to congressional clients on request.
29 Letter to The Honorable Bernie Sanders and Bill Cassidy, Chair and Ranking Member, Health, Education, Labor and
Pensions Committee, September 20, 2023, https://www.lung.org/getmedia/1dd82516-6e00-44ba-afe6-f821d5c65ba3/
PPHF-Sign-on-9-20-23.pdf.
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Table 2. PPHF Transfers, by HHS Agency:
FY2010-FY2023
Budget authority in millions, by fiscal year
Agency
% of
Agency
Total
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
2021
2022
2023
Total
2010-
Agency
Actual Actual Actual Actual Actual Actual Actual Actual Actual Actual Actual Actual Actual Actual 2010-2023
2023
ACL
0
0
20
9
28
28
28
28
28
28
28
28
28
28
306
2.4
AHRQ
6
12
12
6
7
0
0
0
0
0
0
0
0
0
43
0.3
CDC
192
611
809
463
831
887
892
891
801
805
854
856
903
903
10,699
82.6
CMS
0
0
0
454
0
0
0
0
0
0
0
0
0
0
454
3.5
HRSA
271
20
37
2
0
0
0
0
0
0
0
0
0
0
330
2.5
OS
12
19
30
0
0
0
0
0
0
0
0
0
0
0
61
0.5
SAMHSA
20
88
92
15
62
12
12
12
12
12
12
12
12
12
385
3.0
Total
500
750
1,000
949
928
927
932
931
841
844
894
896
943
943
12,278
94.8
Transfers
Sequestered
—
—
—
51
72
73
68
69
59
55
56
54
57
57
671
4.6
Sources: Prepared by Congressional Research Service based on HHS agency congressional budget justifications for FY2012 through FY2024, http://www.hhs.gov/budget/
; HHS, “Prevention and Public Health Fund,” funding distribution tables, https://www.hhs.gov/open/prevention; White House President’s Budget Appendices, and Office of
Management and Budget (OMB) Sequestration Reports and Orders.
Notes: All numbers rounded. Individual amounts may not add to totals due to rounding. ACL is the Administration for Community Living. AHRQ is the Agency for
Healthcare Research and Quality. CDC is the Centers for Disease Control and Prevention. CMS is the Centers for Medicare & Medicaid Services. HRSA is the Health
Resources and Services Administration. OS is the Office of the HHS Secretary. PB is President’s Budget. SAMHSA is the Substance Abuse and Mental Health Services
Administration.
CRS-10

Table 3. Congressionally Directed PPHF Transfers: FY2014-FY2023
Budget authority in millions, by fiscal year
Agency/Program
FY2014
FY2015
FY2016
FY2017
FY2018
FY2019
FY2020
FY2021
FY2022
FY2023
ACL Total
27.7
27.7
27.7
27.7
27.7
27.7
27.7
27.7
27.7
27.7
ACL/Alzheimer’s
(14.7)
(14.7)
(14.7)
(14.7)
(14.7)
(14.7)
(14.7)
(14.7)
(14.7)
(14.7)
Disease (non-add)
ACL/Chronic Disease
(8.0)
(8.0)
(8.0)
(8.0)
(8.0)
(8.0)
(8.0)
(8.0)
(8.0)
(8.0)
Self-management (non-
add)
ACL/Falls Prevention
(5.0)
(5.0)
(5.0)
(5.0)
(5.0)
(5.0)
(5.0)
(5.0)
(5.0)
(5.0)
(non-add)
AHRQ Total
7.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
AHRQ/USPSTF (non-
(7.0)
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
add)
CDC Total
831.3
887.3
892.3
891.3
800.9
804.5
854.3
856.2
902.3
903.3
CDC/Hospitals
(8.0)
(8.0)
(8.0)
(8.0)
(8.0)
(8.0)
(9.0)
(9.5)
(9.8)
(9.8)
Promote Breastfeeding
(non-add)
CDC/Cancer (non-add)
(104.0)
(104.0)
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
CDC/Diabetes
(73.0)
(73.0)
(73.0)
(72.0)
(52.3)
(52.3)
(52.3)
(52.3)
(52.3)
(52.3)
Prevention (non-add)
CDC/Epidemiology and
(40.0)
(40.0)
(40.0)
(40.0)
(40.0)
(40.0)
(40.0)
(40.0)
(40.0)
(40.0)
Laboratory Capacity
(non-add)
CDC/Healthcare-
(12.0)
(12.0)
(12.0)
(12.0)
(12.0)
(12.0)
(12.0)
(12.0)
(12.0)
(12.0)
associated Infections
(non-add)
CDC/Heart Disease,
(73.0)
(73.0)
(73.0)
(73.0)
(53.3)
(57.1)
(57.1)
(57.1)
(57.1)
(57.1)
Stroke (non-add)
CDC/Million Hearts
(4.0)
(4.0)
(4.0)
(4.0)
(4.0)
(4.0)
(4.0)
(4.0)
(4.0)
(5.0)
(non-add)
CRS-11

Agency/Program
FY2014
FY2015
FY2016
FY2017
FY2018
FY2019
FY2020
FY2021
FY2022
FY2023
CDC/Early Care
(4.0)
(4.0)
(4.0)
(4.0)
(4.0)
(4.0)
(4.0)
(4.0)
(4.0)
(5.0)
Collaboratives (non-
add)
CDC/Nutrition, Physical
(35.0)
(35.0)
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
Activity, Obesity (non-
add)
CDC/Smoking and
(105.0)
(111.0)
(126.0)
(126.0)
(126.0)
(128.6)
(126.6)
(128.1)
(127.9)
(125.9)
Health (non-add)
CDC/Preventive Health
(160.0)
(160.0)
(160.0)
(160.0)
(160.0)
(160.0)
(160.0)
(160.0)
(160.0)
(160.0)
and Health
Services Block Grant
(non-add)
CDC/Racial and Ethnic
(30.0)
(30.0)
(51.0)
(51.0)
0.0
0.0
0.0
0.0
0.0
0.0
Approaches to
Community Health
(REACH) (non-add)
CDC/Section 317
(160.3)
(210.3)
(324.4)
(324.4)
(324.4)
(320.6)
(370.3)
(372.2)
(419.4)
(419.4)
Immunization (non-
add)
CDC/Lead Poisoning
(13.0)
(13.0)
(17.0)
(17.0)
(17.0)
(17.0)
(17.0)
(17.0)
(17.0)
(17.0)
Prevention (non-add)
SAMHSA Total
62.0
12.0
12.0
12.0
12.0
12.0
12.0
12.0
12.0
12.0
SAMHSA/Access to
(50.0)
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
Recovery (non-add)
SAMHSA/Garrett Lee
(12.0)
(12.0)
(12.0)
(12.0)
(12.0)
(12.0)
(12.0)
(12.0)
(12.0)
(12.0)
Smith Suicide
Prevention (non-add)
Sources: Prepared by Congressional Research Service using explanatory statements accompanying appropriations laws and President’s Budget account tables.
Notes: Individual amounts may not add to totals due to rounding. ACL is the Administration for Community Living. AHRQ is the Agency for Healthcare Research and
Quality. CDC is the Centers for Disease Control and Prevention. PB is President’s Budget. SAMHSA is the Substance Abuse and Mental Health Services Administration.
USPSTF is the U.S. Preventive Services Task Force.
CRS-12

Prevention and Public Health Fund: In Brief

Author Information

Kavya Sekar
John H. Gorman
Analyst in Health Policy
Research Assistant

Acknowledgments
Former CRS Specialist in Public Health and Epidemiology Sarah Lister originally authored some of the
content and analysis in this report.

Disclaimer
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