Doing More with Less (and Less): Public Health in the Age of Austerity & What YOU Must Do About It...
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Doing More with Less (and Less): Public Health in the Age of Austerity & What YOU Must Do About It Emily Holubowich, MPP Senior Vice President, CRD Associates June 12, 2013
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Transcript of Doing More with Less (and Less): Public Health in the Age of Austerity & What YOU Must Do About It...
Doing More with Less (and Less):
Public Health in the Age of Austerity&
What YOU Must Do About It
Emily Holubowich, MPPSenior Vice President, CRD Associates
June 12, 2013
Federal Spending, FY 2022
Sequestration(Look Ma, No Hands!)
• Effective March 1 • Cuts $1 trillion between FY 2013 - FY 2021
– $85 billion in FY 2013 • 5.1% cut to public health, other nondefense
discretionary• 5.7% cut to mandatory spending
– $109 billion annually thereafter• Social Security, Pell Grants, Medicaid exempt
Nondefense Discretionary Spending Under Current Law
Source: Congressional Budget Office
Fiscal years
Public Health in the Crosshairs
• Federal cuts 5% to date, “prequestration”– Wide variation across HHS
• CDC base budget cut by 18% since FY 2010• Lowest level in 10 years
• Sequestration in FY 2013 alone…– $2.5 billion cut to public health– $290 million cut to CDC
• Not all cuts created equal
• Impact of future sequestration unknown– It will get worse
Prevention Fund: Double Edged Sword• Created by Affordable Care Act to support
new, innovative strategies• Supplanting, not supplementing
– Used to support core public health activities• Epi and lab capacity grants, workforce
– Blessing?• Public health safety net• Austerity’s true impact masked
– Curse?• Politically unpalatable • Politically vulnerable• Sequestrable!
The Incredible Shrinking Fund
Cuts Have Consequences• Federal funding is largest share of state health
department budgets– 45% in FY 2009 (state general funds just 23%)
• Public health infrastructure erosion– 87% reported budget cuts– 91% reported job losses– More than half reported furloughs– Almost half cut services (pre-questration)
• All imposed cost-cutting strategies
• Impact on health outcomes remains unknownSource: ASTHO
The Worst of Times
The New Normal
• Fierce competition for limited resources– Must do vs. nice to do– Cannibalization of health
• Doing what’s “right” isn’t enough– Emphasis on evidence, impact
• Advocacy more important than ever– Squeak loud and often
Do Something (Anything!)
• You can (and should) do this– No excuses
• Something for everyone– Opportunities abound
• Policymakers do listen• Power in “n = 1”
– Anecdotes matter
