Sequestration and Public Health: Unwelcome Bedfellows
On July 25, 2012, Tom Harkin, the Democratic Senator from Iowa who chairs the Senate Appropriations Subcommittee on Labor, Health and Human Services, and Education, produced a report assessing the potential impact of the fast-approaching sequestration. Sequestration refers to the automatic, across-the-board budget cuts, totaling nearly 8%, imposed after a bi-partisan workgroup failed to implement sweeping budgetary reforms that were included in the Budget Control Act of 2011. The cuts imposed by the sequester are scheduled to take effect on January 2, 2013, and the potential affect on public health appears to be staggering.
Federal grant funds contribute directly to programs including HIV prevention and testing, maternal and child care, breast and cervical cancer screening, family violence prevention, licensure of long term and assisted living facilities, public health preparedness, childhood immunizations, and substance abuse treatment and prevention. While the scope of the cuts is troubling, so is the scale. Maryland stands to lose nearly 24 million dollars in public health-related grant funding in 2013.This is how that multi-million dollar budget cut could impact Maryland residents:
- 54,877 fewer women, children, and families receiving maternal and child health assistance
- roughly 23,000 fewer people tested for HIV
- 1405 fewer women screened for cancer
- 3,204 fewer children receiving MMR, Tdap, flu and Hepatitis B vaccinations
- 22,439 fewer low-income individuals served through the Community Services Block Grant
- 1,252 domestic violence victims not served and 3,475 local crisis calls not answered
- 3,560 fewer admissions to substance abuse treatment programs
State and local governments are experiencing their own financial crises that will all but preclude them from offsetting much of the lost grant funding to provide these essential services. Certain provisions of the Affordable Care Act will help to offset the loss in grant funding, including the optional Medicaid expansion. Medicaid and Medicare cuts are limited to the much lower rate of 2% in the current sequestration plan. However, in 3 years, state governments will begin to share in the financial burden of this expansion and thus will be further impeded in their abilities to offset the cuts in other programs.
Public health organizations, such as the National Association of County & City Health Officers (NACCHO) and the non-profit Center for Public Health Funding, have begun to de-cry the potential impacts of sequestration and solicit feedback from members. Similarly, in Washington, D.C., there are undertones of discontent amongst both parties about the broad nature of these cuts, driven mostly by concerns over impacts of the cuts to the Department of Defense. However, with the election rapidly approaching, there is not a lot of time or inclination to reach the type of sweeping compromise that would have averted the need for sequestration in the first place.
Fiscal responsibility is critical. However, understanding the human health impact of those financial decisions is no less important. Americans need to make some clear decisions about their priorities and ensure that those priorities are being appropriately reflected by their elected and appointed officials. At the end of the day, there are no easy answers and there are a lot of hard choices, but when considering paths, it’s important to understand the consequences, both positive and negative, of how we choose to spend or not spend our national wealth.