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HHS climate-health office lacks funding and champions

a smokestack with emissions coming out in the shape of a health plus

Illustration: Tiffany Herring/Axios

⚕️ A tiny government office without dedicated funding from Congress has been tasked with selling President Biden’s climate law to a carbon-heavy health care sector.

Why it matters: HHS' Office of Climate Change and Health Equity seeks to use the Inflation Reduction Act and other resources to help decarbonize an industry that's responsible for roughly 8.5% of U.S. carbon emissions.

  • But the office has not been funded in appropriations, forcing it to operate without full-time staff and rely on personnel on loan from other parts of HHS.
  • And the office faces Republican skepticism. “Is HHS in charge of regulating climate emissions? Am I missing something here?" Rep. Dan Crenshaw asked during a March hearing.

How it works: Since opening in 2021, the office has become a resource for health care organizations seeking federal help for climate-related efforts.

  • In an interview, acting director John Balbus said one major success is the working group on climate and health equity, which the office has been able to pull together from various HHS divisions.
  • OCCHE also creates seasonal forecasts with upcoming regional climate hazards and details about how they might affect community health.

Zoom in: One of the office’s most visible accomplishments: a voluntary pledge campaign to get companies and health care organizations on board with reducing emissions.

  • The pledge calls for cutting greenhouse gas emissions in half by 2030 and ultimately reaching net-zero emissions by 2050.
  • The administration initially closed the pledge to new signatures in October but reopened it in March after more organizations expressed interest.
  • So far, 116 groups have signed on. They include CommonSpirit and Ascension, the third- and fourth-largest health systems, and pharma giants Pfizer and AstraZeneca.

Reality check: It's hard getting the health care industry to willingly cut emissions.

  • HHS says only about 15% of the country’s hospitals have signed on so far.
  • Notably absent is the largest health system, HCA Healthcare. It didn't respond to questions about why it hasn't signed the pledge.

What they’re saying: Balbus said the health care sector has been “slower than other sectors to recognize the need” to address climate change.

  • The challenges in pushing it to act, he said, range from the technical — it’s hard to track all of a hospital's produced emissions — to the politics of getting strained facilities to take on anything seen as undue costs.
  • Health care providers are also still emotionally and financially dealing with the fallout of the COVID-19 pandemic, he noted.
  • If OCCHE succeeds in getting health care organizations on board with climate resiliency, Balbus said, it’ll bring about what he called the “mobilization of finance.”
  • “We're creating the resources, the technical guidance exists, but there's going to have to be an investment in this country — just as there is in roadways — in the health system and its resilience.”

$ Threat level: OCCHE’s job is made more difficult by its lack of funding.

  • Biden requested $3 million for the office last year, but Democrats didn’t secure the money when they had full control of Congress. He asked for $5 million this year.
  • Balbus acknowledged “an issue” with money, but brushed off any notion that the coming appropriations season — or new budget caps passed in the debt limit deal — will impact operations.

What’s next: Tammy Baldwin has an opening to fight for funding the office as new chair of the Senate Appropriations subcommittee overseeing HHS.

  • Baldwin’s office declined to comment on individual line items.
  • It provided a statement saying the federal budget tied to the debt deal “lays out a difficult road to investing in all the programs Americans rely on, including the work we need to do to address the health impacts of climate change.”
  • House Democrats have launched their own push. In March, Reps. Nanette Barragán, Lisa Blunt Rochester and 15 others wrote to Labor-HHS appropriations subcommittee leaders urging full funding for the office in fiscal 2024.

Editor's note: This story has been corrected to note that Baldwin's office did provide a statement on her appropriations priorities. An earlier version of the story said it did not.

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