1. 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

4. Federal Spending, FY 2022

5. 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

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

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!

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

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. Emily J. Holubowich, MPP eholubowich@dc-crd.com Follow @healthfunding Visit www.nddunited.org