As a result of protracted partisanship in Washington, our country is now unexpectedly undergoing a sequester. What exactly is a sequester? It is an automatic reduction to federal spending for a given fiscal year, made possible when Congress passed the Balanced Budget and Emergency Deficit Control Act of 1985.
The threat of a sequester was put in place during the last budget impasse in Washington.
The sequester will adversely affect health care including research, education and services. According to a recent White House Report, effects will include a possible delay or halt of vital scientific projects and the loss of several thousand related jobs. As many as 12,000 scientists and students would be hurt because the National Science Foundation would offer 1,000 fewer research grants and awards.
The Food and Drug Administration could be forced to implement fewer drug approvals and conduct 2,100 fewer inspections at domestic and foreign facilities that manufacture food products.
Cuts to the Mental Health Block Grant program mean that as many as 373,000 adults and children would not receive mental health services. According to the White House report, “This cut would likely lead to increased hospitalizations, involvement in the criminal justice system and homelessness for these individuals.”
A pullback on funding for the AIDS drug assistance program could result in 7,400 fewer patients having access to HIV medications, while the Centers for Disease Control and Prevention could conduct approximately 424,000 fewer HIV tests. Sadly, the National Association of Community Health Centers suggested that as many as 900,000 patients might be turned away from receiving the health care they need.
Provider reimbursement will also contract. According to the Society of Hospital Medicine, providers and insurance plans will face up to a 2 percent cut in their Medicare payments. Graduate medical education, primary care training and payments to other providers would also be affected.
Fortunately, Medicare and Medicaid benefits are exempt, as are funds appropriated to the VA health care system. However, there is concern that the VA system will be overwhelmed from those who would turn to it for care because of cuts in public services.
Health industry and patient lobbying groups are not taking the sequester lying down. Both The Mayo Clinic and American Medical Association are urging Congress to take a “more targeted, rational approach that allows for careful assessment of how to fulfill its long-term commitment to seniors, uniformed service members and their families, and public health and safety priorities.”
On the global stage the sequester might negatively affect U.S. competitiveness, just as other nations are aggressively boosting funding for research and development programs.
Hawaii is not immune. Gov. Neil Abercrombie announced that he is putting together a Sequestration Impact Response Team made up of public and private stakeholders to identify “how we can help our citizens and segments of our community that will be most affected.” The 2013-2015 biennial state budget includes provisions to help deal with continued sequestration.
The full impact of the sequester remains to be seen. While some of the cuts are salutary for the national budget, the sequester will not have a positive impact on health care for the American people.
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Ira Zunin, M.D., M.P.H., M.B.A., is medical director of Manakai o Malama Integrative Healthcare Group and Rehabilitation Center and CEO of Global Advisory Services Inc. Please submit your questions to info@manakaiomalama.com.
