Originally published by The Hill
Public health advocates are sounding the alarm over President Trump’s decision to divert nearly $200 million from health programs to fund the detention of unaccompanied migrant children who crossed into the country illegally.
The Department of Health and Human Services (HHS) on Wednesday notified Congress that it intends to transfer up to $186 million from elsewhere in the agency to pay for housing a growing number of migrant children.
Experts say that money should be spent on cancer research, vaccines for rare diseases and other health priorities.
“Separating children from their parents at the border unnecessarily, coupled with proposed changes in policy to detain families indefinitely, all have long-term costs and consequences,” said Emily Holubowich, executive director of the Coalition for Health Funding.
“This situation is particularly concerning because there doesn’t seem to be a plan to deal with those long-term costs, and tapping already underfunded public health programs is not a solution,” Holubowich added.
Rep. Rosa DeLauro (D-Conn.), ranking member of the House Appropriations subcommittee that deals with HHS, also slammed the administration for the funding shift, saying the White House is simply trying to cover up its own “failed policies.”
"The Trump administration should not rob funds from vital health and human services initiatives to make up for their failed immigration policies,” DeLauro said in a statement.
"If the Trump administration needs additional funding to carry out their failed policies, like the government-sanctioned child abuse that resulted from their 'zero-tolerance policy,' they should request an emergency supplemental package from Congress instead of hiding behind transfers.”
The health programs targeted in the transfer include $16.7 million from the Centers for Disease Control and Prevention, $9.8 million from Medicare and Medicaid program operations and $87.3 million overall from the National Institutes of Health.
The cost of caring for and housing migrant children has ballooned in recent months, and experts believe the costs will rise further as HHS has been struggling to keep up.
On Sept. 12, The New York Times reported there were 12,800 children in federal custody — a record number. Just a week later, on Wednesday, Yahoo News reported there were 13,312 immigrant children in federal custody.
In the letter notifying Congress of the transfer, HHS Secretary Alex Azar acknowledged that children are not being released quickly, and that he anticipates that trend continuing.
“The number of unaccompanied alien children in HHS custody has increased steadily, and existing shelter capacity is nearly full," Azar wrote in the letter. "Based on this growth pattern, and an increased length of time needed to safely release unaccompanied alien minors to sponsors, HHS is preparing for the trend of high capacity to continue."
The administration has been housing children in so-called “influx” shelters, which cost about three times as much as traditional shelters, said Mark Greenberg, a senior fellow at the Migration Policy Institute.
Greenberg worked at the Administration for Children and Families, which includes HHS’s refugee office, from 2009 to 2017, and was acting assistant secretary during the last three years of the Obama administration.
“We are not seeing a dramatically, historically high level of apprehensions,” he said. However, he added, “we are seeing a historically high level of children in shelters” who are not being quickly released.
The slow release “appears to be closely related to policies that make it more difficult for children to be released to parents, relatives, and that make sponsors afraid to come forward because of immigration enforcement,” Greenberg said.
This is not the first time HHS has transferred money into its refugee office from elsewhere in the agency. Greenberg said it also happened during the Obama administration, but that $167 million transfer in 2016 was to deal with a massive influx of arrivals at the border.
Azar defended the transfer as just a small part of the agency’s overall budget. During a briefing with reporters, he said the cuts come from across the board, but key priorities such as combating the opioid epidemic and funding mental health priorities will be protected.
"It's not disruptive to the programs. This is very consistent with past practices with end of the year funding," Azar said.
Azar said the “broken immigration system,” rather than any administration policy, is driving the need for the transfer.
"The simple fact is, we at HHS do not control the number of children who come into the country and are referred to us. It [funding] is not appropriated on a per-child basis ... so sometimes this is necessary,” Azar said.
HHS has some authority to shift funding between accounts or between programs whose funding levels are specified in law.
These types of requests are not new. Similar transfers of money are used in times of public health emergencies, such as the Zika virus outbreak in 2016.
David Harvey, executive director of the National Coalition of STD Directors, said he understands HHS transferring money is perfectly legal, but he fears what the practice could mean in the future.
“We’re not faulting the rule, but we think it’s a bad precedent to establish and these funds are desperately needed in the public health system,” Harvey said.
The money being transferred was not yet allocated for the current fiscal year, which ends Sept. 30. Still, Harvey said he thinks the funds taken from public health programs would have been spent if Azar had given it more time.
“We think those funds would have been spent on higher priority items. These are not dollars to sneeze at,” Harvey said.
Still, Joe Grogan, director of health programs at the White House Office of Management and Budget (OMB), defended the decision, and said whenever there’s a need to shift money across different departments, the OMB makes sure there won’t be negative impacts.
“We pressure test where they are going to move money from various accounts,” Grogan told reporters at a health policy event in Washington, D.C., on Thursday. “Sometimes it’s easy to pick a talking point, and say this money is coming out of this account, but we figure out at OMB, can this money be spent practically, is there a legal reason why it can’t be spent on its intended purpose.”