Are essential health and behavioral health services a priority for our elected officials? We got a clear picture when House leaders offered their 2011 continuing resolution and President Obama proposed his 2012 budget this past week.
Both the continuing resolution to fund federal agencies for the current fiscal year and the President’s budget proposal for next year cut billions of dollars from the federal budget. Some essential health services are surprising targets.
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| Cost Per Person to Restore Proposed Health Cuts |
For a total savings of $2 billion, or just over six dollars a person, would we choose to slice what they chose to slice, or would we make health services a bigger priority?
The continuing resolution proposed to cut $1.3 billion from community health centers. These centers are located in every state. They provide comprehensive primary care to everyone, regardless of their ability to pay. They employ doctors, dentists, nurses, counselors, and other health professionals.
They treat a lot of elders, people with disabilities, and lower income working families because they accept Medicare and Medicaid in addition to private insurance. They provide high quality services, and meet a significant consumer demand. According to the National Association of Community Health Centers (NACHC), they served 20 million Americans in all income ranges last year.
NACHC responded that the proposed cut would cost 3.3 million Americans their care during the next few months, worsening the health care crisis in our country and driving up costs for everyone.
The continuing resolution also proposed a $500 million cut to mental health and substance abuse services, reducing the federal Substance Abuse and Mental Health Services Administration (SAMHSA) budget from $3.7 billion to $3.2 billion. This is a 10% reduction from actual FY2010 funding. It affects hundreds of thousands of children and adults with serious behavioral health problems.
Elected leaders are betting that reducing services won’t backfire and leave more people with behavioral health problems without any treatment. However, in providing the justification for her budget request, SAMHSA Administrator Pamela Hyde noted that over 10 million Americans already have unmet mental health needs and mental illnesses cost our economy over $100 billion per year, making this at best a risky, pound-foolish bet.
Essential health services weren’t spared by President Obama in his proposed 2012 budget either.
The President proposed taking $133 million from prevention by eliminating funding for the Preventive Health and Health Services Block Grant and halving funding for the Healthy Environment program aimed at preventing asthma and other chronic conditions.
Though asthma has become one of the most common chronic conditions in our country, the President’s budget seems to be throwing in the towel on asthma prevention. In justifying the cut in his proposed budget, his budget office writes “there are currently limited proven means of asthma prevention. In asthma care, the key intervention is to increase use of inhaled corticosteroids...” This is an uncharacteristic and remarkably one-sided rationale for emphasizing treatment at the expense of – instead of in concert with – prevention.
Each state decides how to allocate the prevention dollars it receives through the Preventive Health Block Grant, choosing 265 programs of local importance to support.
In Florida, for example, the block grant has been used for chronic disease prevention programs, water fluoridation activities, and services for victims of sexual violence. In Connecticut, it has funded childhood lead poisoning prevention, youth violence prevention programs, older adult fall-related injury prevention, and cardiovascular disease prevention. In Texas, it has been used for sanitation services in rural border counties, support for a trauma registry, and support for local public health services.
While the President argues that there are other prevention services available, the long-standing problem in this country is not that we fund too many prevention services, but too few.
Funding for this block grant is already $50 million less than it was in 1994, and it should come as no surprise that our health status as a nation has declined across a number of indicators since that time.
What if we said no to cuts to these community health centers, behavioral health services, and prevention programs? The $2 billion this would cost would add up to approximately $6.19 per person for the year. Spending this $6.19 would result in the retention of hundreds of prevention programs across the country, up to 11 million physician visits, and services to over 200,000 adults and children with behavioral health problems.
Have our nation’s resources really become so scarce that we can’t afford $6.19 a person to buy all this?
Maybe so, but I suspect the real answer lies in our priorities. They spend this much every week on the war in Afghanistan, and both the President and Congressional leaders have made Afghanistan their continuing priority. It’s past time for some new ones.
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