1. Emily Holubowich, MPP Senior Vice President, CRD Associates
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

2. EXTREME MAKEOVER: DEFICIT EDITION2

4. Federal Spending, FY 2022

5. Sequestration (Look Ma, No Hands!)
Effective March 1
Cuts $1 trillion between FY 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
Budgetary tool designed to force compromise

6. Nondefense Discretionary Spending Under Current Law
Percent of GDP
Fiscal years
Source: Congressional Budget Office

7. 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

8. 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! 8

9. The Incredible Shrinking Fund

10. 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 unknown
Source: ASTHO 10

11. The Worst of Times

12. 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

15. 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

16. Follow @healthfunding Visit www.nddunited.org
Emily J. Holubowich, MPP
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