OMB’s Proposed Federal Financial Assistance Rule Threatens the Availability and Accessibility of Vital Health Care Services for Medically Underserved and Vulnerable Communities and Populations

FOR IMMEDIATE RELEASE
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A proposed rule issued by the Office of Management and Budget (OMB) would authorize federal agency leadership to terminate federal funding at their sole discretion, effectively overriding merit review. This marks a significant and troubling escalation in the politicization of the federal grantmaking process. A narrower version of this authority has existed for years, but it was never used until now.

The proposed rule would take that long-dormant provision and make it mandatory across every federal agency while stripping away any right to appeal a dramatic expansion of power that would be difficult to reverse. In practice, this would allow any administration to condition the award of federal grants on ideological alignment rather than community need, program performance, or congressional intent. The rule jeopardizes the stability and future of crucial federal public health programs that offer vital support to vulnerable residents and underserved communities and populations nationwide. 

A coalition of public health and health care organizations, along with public health deans and scholars joining in their individual capacities, writes that the rule would fundamentally threaten a wide array of health care and public health providers and organizations. These include programs that support comprehensive primary health care, community-wide services that promote public health, specialized medical care, mental health and substance use disorder treatment, support services, and preventive reproductive health care in communities in need. Such programs are core to the mission of the Centers for Disease Control and Prevention, the Substance Abuse and Mental Health Services Administration, the Health Resources and Services Administration, and lie at the heart of the nation’s commitment to public health. 

According to commenters, at the center of the proposed rule is an extraordinary plan mandated by OMB, that would allow the political leadership of federal agencies to summarily and unlawfully terminate funding awards without advance notice, the opportunity to object, or access to an impartial hearing or appeal. Furthermore, as the commenters point out, the proposed rule would establish new temporary suspension powers that in turn would allow political leadership to impose 90-day stop-work orders whenever they, in their sole discretion, decide that suspension is in the federal government’s interest. As such, all that would be needed to end the work of an affected program would be a sole, non-reviewable determination that a particular funding award no longer serves program goals, agency priorities, or the national interest as political leadership defines it and regardless of what the laws authorizing such programs require. The commenters note that this “would destabilize grantee operations and jeopardize the continuity of essential services for the most vulnerable and underserved communities.”

“As we’ve already seen the impact of terminated grants for key lifesaving research and critical public health infrastructure, this proposed rule will lead to more unnecessary disruptions and the elimination of essential health services in communities across the country, making the nation less healthy. Politicizing funding will delay care and harden the existing barriers communities are already experiencing, further exacerbating poor health outcomes,” said APHA CEO Georges C. Benjamin.

Sara Rosenbaum, Professor Emerita of Health Law and Policy at the George Washington University Milken Institute School of Public Health added, “a mid-award suspension or termination could trigger a cascade of harms to clinical care and public health workers who have built careers in mission-driven service, to the communities that have nowhere else to turn, and to the governmental financial foundations on which these organizations depend.”

The threat of immediate terminations for political reasons is compounded by recent Supreme Court decisions that have substantially narrowed the avenues for challenging grant terminations in federal court before terminations become final. This means that programs affected by the rule have no practical means of seeking the protection of the courts against wrongful terminations before they happen.  In other words, the damage would be irreparable.

Read the comment. Comments were coordinated by Powers Pyles Sutter and Verville, P.C., counsel to Liberty Health Alliance, on behalf of a broad coalition of primary care associations, public health institutions, and health law scholars. The public health deans and scholars are joining as part of the George Washington University Health Scholars Legal Initiative.

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The American Public Health Association champions optimal, equitable health and well-being for all. With our broad-based member community and 150-year perspective, we influence federal policy to improve the public’s health. Learn more at www.apha.org.