Federal funding for medical research, disease prevention, and a host of public health initiatives could be sharply reduced if the congressional super committee fails to agree on a deficit-reduction package and triggers automatic cuts.
Public attention has largely focused on possible cuts to the huge entitlement programs for seniors and the poor such as Medicare and Medicaid, but health advocates are raising an alarm about many other smaller programs they say need to be protected.
The bipartisan panel is charged with cutting at least $1.2 trillion over 10 years. If it can't overcome the enormous political obstacles to a deal, automatic cuts would kick in as of 2013, half coming from defense, the other half in domestic spending. Congress laid out this scenario – dubbed "sequestration" in legislative lingo – when it created the committee in August as part of a deal to raise the debt ceiling and avoid the first U.S. default in history.
While the committee can chop Medicaid and Medicare as part of a negotiated agreement, automatic cuts would not affect Medicaid funding; there would be a 2 percent reduction in Medicare payments to hospitals and other providers. That would make the hit to many other programs all the more severe.
"I don't know if a lot of people have appreciated how big a hit the discretionary health programs" could take if there are automatic cuts, said Richard Deem, senior vice president of advocacy for the American Medical Association. "I think a lot of people are going to wake up to that too late."
At stake is federal money that, among other things, helps HIV patients pay for lifesaving medication, funds biomedical research, and helps prevent and respond to food-borne illnesses and disease outbreaks.
Automatic reductions, for example, could translate into fewer staff to handle food contamination, said Dr. Georges Benjamin, executive director of the American Public Health Association. Recently, Colorado cantaloupes sickened 116 people in 25 states with listeria, killing 23, according to the Centers for Disease Control and Prevention. "Someone has to go into stores and make sure the stuff has been taken off the shelves. I am very worried about what [automatic cutting] does to the public's capacity to be safe,” Benjamin said.
If the full $1.2 trillion in automatic cuts go into effect, funding for non-defense discretionary programs in 2013 could be reduced 7.8 percent, dropping each year to 5.5 percent in 2021, according to Congressional Budget Office estimates. Richard Kogan, a senior fellow at the Center on Budget and Policy Priorities, places the first year's hit at more than 9 percent, however.
Health advocates fear deep cuts will harm the public by reducing services and investment in several areas, including:
- Public health. The Centers for Disease Control and Prevention is particularly vulnerable because it was hit hard in the last round of budget cuts, according to Benjamin. In fiscal year 2011, federal funding for the CDC declined by $740 million. "They’ve already cut deeply into the bone at CDC," he said.
The agency plays an important role in detecting and responding to emergencies such as tornadoes, hurricanes, food-borne illnesses, and infectious-disease outbreaks. It also helps fund state and local public health departments and labs, which Benjamin said is extremely important as states struggle with budget deficits. Since 2007, he said, 44,000 jobs in local and state health departments have disappeared. "What ultimately happens is you do less things. You inspect restaurants less. You inspect wells less,” he said.
The CDC also subsidizes the cost of vaccines for uninsured and underinsured children. The prices of standard childhood vaccines are rising, Benjamin said. "The more vaccines we require kids to have, the less money we have to pay for it. If we discovered tomorrow a marvelous new vaccine, we probably wouldn’t have the resources to put that into place."
- Medical research. U.S. investment in biomedical research is beginning to lag behind some other nations, namely China and India, at a time when robust funding could help with job creation, NIH Director Dr. Francis Collins said at a May hearing of the Senate Appropriations Subcommittee on Labor, Health and Human Services, and Education.
Collins told the hearing that the BGI genome center in Shenzhen, China, can sequence more than 10,000 human genomes a year. “The capacity of that one Chinese institution now surpasses the combined capacity of all genome sequencing centers in the United States,” Collins said.
"This critical area of scientific innovation stimulated by the U.S.-led Human Genome Project is now being developed more aggressively in China than it is here -- a sobering story indeed and one that I hope would inspire our nation to redouble its efforts on the research front."
Congress in recent years has given NIH small increases that haven’t kept pace with medical inflation, advocates claim. Funding actually declined in 2006. Lawmakers are still negotiating funding levels for fiscal year 2012, which began Oct. 1. House appropriators are considering a small increase in NIH funding, while their Senate counterparts are contemplating a small reduction. Reductions in NIH funding "will lessen the chance of research breakthroughs in cancer. It will interrupt clinical trials at the National Cancer Institute," said Dick Woodruff, vice president of federal relations and strategic alliances at the American Cancer Society’s Cancer Action Network.
- HIV/AIDS. About 500,000 HIV-infected people currently get help with expensive care and lifesaving medication through the Ryan White HIV/AIDS Program. Ronald Johnson, vice president of policy and advocacy at AIDS United, says that automatic cuts would be devastating.
Ryan White help is a last resort for many people who are low-income, uninsured, or underinsured. On average, a year's worth of medication costs about $15,000 to $20,000, and total care for an infected person can run about $100,000, according to Johnson. He also fears cuts to federal funding that help states provide free or subsidized HIV testing. The CDC sent $800 million to states in fiscal year 2011.
While the programs' cost may be significant, they have decreased the spread of AIDS, said Johnson. "If a person gets on treatment early and adheres to it, that person on the whole is less infectious, so the chance of transmission is reduced significantly."
- Disease prevention. Prevention funding in the health law is already under fire, by both Democrats and Republicans. Republicans have pushed to repeal the funding and President Barack Obama said recently that he would support decreasing it by $3.5 billion over 10 years. The prevention fund has provided money for programs aimed at reducing obesity and tobacco use, among other public health priorities.
Reductions are short-sighted, said Jeffrey Levi, executive director of Trust for America's Health. "The irony here is that there is so much focus on health care costs, yet there is significant evidence that the kind of prevention programs that the [health law] is supporting can have a positive impact on health care utilization and costs," he said.
While the House and Senate appropriations committees would decide the initial 2013 funding levels for each agency and program, across-the-board cuts in sequestration would occur on top of the initial funding decisions and apply equally to all non-exempt, non-defense programs within an agency, Kogan said.
Many lobbyists, representing all sectors of the mammoth health care system, say they doubt that the committee of 12 lawmakers will be able to reach consensus on issues that have stumped Congress for decades, including overhauling the tax code and reining in fast-growing entitlement spending. The committee's deadline for action is Nov. 23, after which Congress would have until Dec. 23 to approve any deal.
The committee's task is made even harder by a divided Congress, ongoing battles about federal health program funding for fiscal year 2012, and a presidential campaign season that is already in full swing. Whatever Congress cuts this year could be restored in whole or part in the future.
Benjamin says lawmakers should look for acceptable savings in the big-spending Medicaid and Medicare programs. If they don't, "There will be all kinds of unanticipated and unintended consequences" from automatic cuts, he said. "The trade-off will be having to cut something that you really don’t want to cut."
Kaiser Health News is an editorially independent program of the Kaiser Family Foundation.