Sequestration And Its Impact on Public Health
While sequestration continues to conjure up a great deal of discussion and frustration, the media’s focus on thisFriday’s deadline has been relentless. To explain the automatic trigger of $85 billion in annual federal spending cuts, Politifact.com offered these details:
Unless a deal is struck, most types of federal spending must be cut by a uniform amount — tentatively 7.9 percent for most types of defense discretionary funding and 5.3 percent for non-defense discretionary funding. (Certain programs are shielded from sequestration cuts entirely, including Social Security, federal retirement payments, veterans compensation, Medicaid, Pell Grants, food stamps, Supplemental Security Income, and veteran’s health programs. Medicare would be cut by 2 percent.)
The uniform cuts must be applied to any “program, project or activity” that isn’t otherwise exempted. However, within a given program, officials don’t have to cut every line item equally. They have discretion to move money around within a program.
While the White House released state-by-state fact sheets to detail the depths of cuts (see links below), we have to acknowledge that there will be significant challenges to public health programs as they deal with pending funding decreases.
In addressing cuts to immunizations, administration officials pointed to a report released by the Senate Appropriations Subcommittee on Labor, Health and Human Services, Education and Related Agencies. The report addresses possible cuts to the Section 317 immunization program, a grant program to states and cities which provides vaccines to underinsured children and adults. According to the subcommittee, it would serve 211,958 fewer children if the sequester takes effect.
Additionally, under the budget control law (PL 112-25), it appears that the Centers for Disease Control and Prevention will face uniform across-the-board cuts in 12 of its budget categories, translating into an estimated $350 million reduction in its $6 billion budget over the next seven months.
In a recent telephone interview with HealthBeat, Thomas R. Frieden, MD, MPH, Director of the CDC, explained,“Sequestration would impact every CDC program and could increase the risk of disease outbreaks.”
He offered his assessment of how the sequester would impact a variety of CDC programs, to include the following.
Less funds available to train people on the state and local level.
“More than two-thirds of our budget goes out to boots-on-the-ground work at the state and local level to find and stop outbreaks and other health threats,” explained Dr. Frieden.
As an example, he referred to a recent meningitis outbreak where the entire staff of the Tennessee Health Department who dealt with the outbreak was trained and funded by the CDC. In fact, the CDC laboratory had trained the Virginia laboratory that first identified the rare fungus that caused the meningitis to spread. Dr. Frieden added:
“We helped 23 health departments notify 14,000 people in days so people didn’t get so severely ill. We convened all of the experts in how to treat meningitis from fungi and gave up-to-the-minute treatment recommendations to doctors around the country. That’s the kind of activity that would be threatened by the sequester.”
A reduction in the number of disease control specialists.
Frieden elaborated on the cuts by explaining that there would be 2,000 fewer disease control specialists who help find and stop food-borne disease outbreaks, meningitis, pneumonia, flu, HIV, other critical health problems.
In fact, in a February 13th hearing of the Subcommittee on Oversight and Investigations, Dr. Frieden explained that if the sequester cuts were put into effect, the CDC
“would have less capacity to detect, respond, and develop better [flu prevention] tools in the future.”
He also explained that if the cuts were implemented, “there would be no alternative but to reduce funding” that CDC provides to state and local governments for essential flu prevention services.
Limited ability to impact global diseases that spread into the U.S. with costly consequences.
In addressing the need to reduce global diseases, Dr. Frieden uses the case of measles as an example, explaining,
“Globally our work in measles vaccination over the past decade has resulted in more than 4 million fewer children dying around the world.”
Frieden lamented over the possibility that, if the CDC has to cut back on measles vaccination abroad, childhood fatalities will occur and the impact will be felt here in the U.S. He states that there were more than 200 cases of measles in the U.S. last year,“every one of which ultimately came from another country.” He added in regard to those 200 cases,
“every single one of them can cost hundreds of thousands of dollars to contain. You have to hospitalize people, you have to do treatment, you have to vaccinate, you have to do a big investigation.”
His example defines how budget cuts “can cost lives in other countries and dollars in this country.”
As we consider the impact of sequestration in the days ahead, Dr. Frieden’s concerns regarding the future of public health will remain top of mind:
“We are facing more drug resistance, more globalization, emerging diseases, and to have to stand down in some of the programs that we’re running to keep people safe is very unsettling.”
For more information of how you may be impacted by sequestration, check out these resources:
The state by state impacts of sequestration: http://www.washingtonpost.com/wp-srv/special/politics/sequestration-state-impact/?hpid=z2
White House State fact sheets:
District of Columbia<http://www.whitehouse.gov/sites/default/files/docs/sequester-factsheets/district-of-columbia.pdf>