For full coverage of sequestration's impact on states and localities, click here.
March 1 is the deadline for President Barack Obama and congressional Republicans to reach an agreement to avoid the automatic federal budget cuts, known as ‘sequestration’, that both signed off on as part of the 2011 Budget Control Act. If those cuts are allowed to take full effect, an across-the-board slash of 8 percent to non-defense discretionary spending, public health advocates warn that the impact could be devastating to the country’s safety net.
Now, that’s a big ‘if’ -- the president and Congress could quite easily reach an agreement on, say, March 5 or even 15 that is retroactive to March 1, and the effects would be minimal. But there is some concern among local officials that if the cuts, intended to reduce the federal deficit by $1.2 trillion over the next 10 years, are officially enacted, the politicians in Washington might let them stay. After all, they’ve been supposedly working to avert sequestration for more than a year and haven’t been able to do it.
But if that happens, and the cuts extend through the end of the year and into the next decade, they’re going to have real consequences for public health efforts across the country. “We're at the bottom of the food chain. The federal government gets its money, take its cuts, then it goes to the states, and they take their cuts. Then it finally gets to the local level, and there’s not much left,” Laura Hanen, chief of government and public affairs at the National Association of City and County Health Officials (NACCHO), told Governing in December. “We’ve already been on the chopping block, and we know we will continue to be.”
How bad would an 8 percent loss in federal funding for public health be? Some of the numbers below, pulled from a U.S. Senate report on the impacts of sequestration, offer a preview.
5 million fewer families served through the Maternal and Child Health block grant. Roughly 1 million in New York and Texas alone. That funding supports a variety of services, including prenatal care, infant mortality prevention, oral health care and school-based health programs.
659,476 fewer people tested for HIV. Grants awarded to states through the Centers for Disease Control and Prevention (CDC) pay for HIV prevention efforts. The Senate report notes that 20 percent of those currently infected with the disease don’t know that they are.
221,958 fewer children vaccinated. Cuts to the Child Immunization Grant program would limit states’ ability to deliver vaccines that they traditionally have for poor and uninsured children.
33,816 fewer women tested for breast and cervical cancer. The feds fund state programs that extend those services to low-income, uninsured or underinsured women.
$48.3 million. The anticipated cuts to the Public Health Emergency Preparedness grants. That money pays for state and local governments to prepare for disease epidemics, natural disasters and biochemical attacks. Those resources are already stretched thin. In the midst of the fungal meningitis outbreak last year, Paul Etkind of NACCHO told Governing: “We are so lucky that we're not dealing with competing emergencies, because I think then we would see the worst and just how threadbare the system has become."
169,375 fewer admissions for substance abuse treatment. Another state-based grant program that funds treatment of alcohol and drug addiction. The Senate report notes that some research suggests that every $1 spent on quality substance abuse treatment yields $12 in savings from reduced criminal justice and health care costs.
17 million fewer meals served to seniors. State-administered senior nutrition programs provide home-delivered meals to needy seniors who lack access because of limited mobility or because they live in isolation.