FY 12 Budget I: Public Health: "a serious error in judgment"
[Note - We're going to cover yesterday's release by Governor Patrick of the FY2012 budget recommendations in two blog posts. This entry focuses on the cuts to public health]
The startling statement from Senator Richard Moore, chair of the Health Care Financing Committee, is stark and pointed:
What is surprising in this budget proposal though is the 'penny-wise, pound foolish' cuts in public health prevention and other health accounts that save money and, most importantly, save lives. If our goal is to cut health costs - and indeed it is – then we must continue the fight for infection prevention, patient protection, and the research needed to measure quality and safety in our health care system. The cuts levied today to the Department of Public Health and to Adult Day Health programs are a serious error in judgment!"
Health Care For All appreciates the need to make deep cuts in a budget that reflects the loss of hundreds of millions in federal funds and the slow growth in tax revenue. It is because of the need to lower health care costs now and for the long-term that we find the public health cuts so perplexing. As we are acknowledging in the payment reform process that lower costs and better care can come from moving our system towards prevention and wellness, this budget moves in the opposite direction.
The MPHA statement (pdf) provides the details and context, so we'll just quote at length:
Governor Patrick’s fiscal year 2012 budget proposal released this afternoon slashes $25 million in public health funding, continuing a trend of disinvestment from our state’s public health infrastructure as we face a $1.8 billion deficit. The proposed cuts to the Department of Public Health (DPH) follow on the heels of more than $90 million in cuts over the last three years, representing a cumulative loss of more than a quarter of state funding for DPH community-based programs in the last 3 years.
The Commonwealth’s infrastructure to prevent, monitor, and respond to chronic and infectious disease is in jeopardy. Programs which regulate and monitor healthcare quality, food, air, and water safety, and programs which provide critical family support to overcome food insecurity and promote learning and health for children with disabilities are being undermined by these unrelenting cuts. Initiatives which help to reduce skyrocketing healthcare costs through prevention and early detection of disease are being abandoned.
Some of the most troubling cuts proposed by the Governor include:
- Elimination of $12 million in funding for Health Promotion and Disease Prevention, forgoing millions in federal funds. The Governor’s proposal would eliminate $6 million in state funding for programs which prevent and detect disease early, reduce disability, and prevent healthcare costs. This cut would result in the loss of $6 million in federal matching funds from four federal grants, for a combined loss of $12 million in funding.
As the state struggles to support the health of hundreds of thousands of residents that suffer from chronic diseases and reduce health care costs that are rising at unsustainable rates, it is foolish to cut these funds and walk away from federal money that is available to help us tackle these serious health issues.
These cuts would result in the elimination or curtailing of numerous initiatives, including: loss of breast and cervical cancer screening and care coordination for 15,000 under- and uninsured women at 28 community health centers; elimination of state funding for Mass in Motion grants that are currently funding 13 communities as part of the state’s signature obesity-prevention initiative; elimination of colorectal cancer screenings for 1500 hard-to-reach individuals; and elimination of grants to 26 communities to improve community health and promote health equity.
- More than 20% cut to DPH Core Services. This $3.7 million cut would result in the elimination of more than 50 positions across DPH and a have a devastating impact on the services they provide, including emergency preparedness, environmental health assessments, implementation and enforcement of regulations, reducing disparities in health care, and monitoring and inspections of nursing homes, food safety, and water quality.
- 27% cut from Early Intervention Services. Early Intervention provides integrated supports to families of children 0-3 with developmental difficulties to improve health and learning.
- More than 20% cut from the Women, Infants, and Children (WIC) program. The WIC program provides services to pregnant and parenting women and children under 5, including financial support to purchase food, nutrition information and consultations, and referrals for medical and dental care, health insurance, child care, housing and fuel assistance, and other services that can benefit the whole family.
- 16% cut to School Health Services. This funding supports school-based health centers, school nurses, equipment, and screenings. This cut follows $5.5 million in cuts in the last three years, and brings the total funding down by more than 40% from fiscal year 2009.
- More than 20% cut to Family Planning Services. This funding supports reproductive health services to at risk consumers including adolescents and the under- and uninsured, services which prevent unintended pregnancies, HIV and other sexually transmitted diseases, and cervical and breast cancer.
In the few glimpses of good news, we appreciate the Governor’s proposal to invest in youth development and youth violence prevention programs, including a $1.5 million increase in funds for Youth At-Risk Matching Grants and additional investments in the Shannon Grant to prevent gang violence.
We also applaud the proposed expansion of the state’s bottle bill to include non-carbonated beverages, estimated to raise $20 million that can help offset additional painful cuts.
Other cuts proposed by the Governor include:
- 6% cut to HIV/AIDS Prevention and Services
- 21% cut to Family Health Services
- 13% cut to Domestic Violence and Sexual Assault Prevention and Services
- 21% cut to community health center services
- Elimination of Center for Primary Care Recruitment and Academic Detailing Program
- 21% cut to Infection Prevention and Control
- 21% cut to Pediatric Palliative Care
Programs proposed to be funded at current-year levels, including:
- Tobacco Prevention and Cessation
- Teen Pregnancy Prevention
- State Lab and Communicable Disease Control
- Substance Abuse Prevention and Services
- Sexual Assault Nurse Examiner Program
- Oral Health
- Compulsive Gambling
- Health Care Quality and Improvement
- Suicide Prevention
- Universal Immunization Program