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Emily Holubowich, MPP Senior Vice President, CRD Associates June 12, 2013

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. EXTREME MAKEOVER: DEFICIT EDITION. Federal Spending, FY 2022. Sequestration (Look Ma, No Hands!).

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Emily Holubowich, MPP Senior Vice President, CRD Associates June 12, 2013

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  1. 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

  2. EXTREMEMAKEOVER: DEFICIT EDITION

  3. Federal Spending, FY 2022

  4. 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

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

  6. 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

  7. 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! Prevention Fund: Double Edged Sword

  8. The Incredible Shrinking Fund

  9. 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. The Worst of Times

  11. 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 The New Normal

  12. You can (and should) do this No excuses Something for everyone Opportunities abound Policymakers do listen Power in “n = 1” Anecdotes matter Do Something (Anything!)

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

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