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 View From Washington

Making Super Predictions

By Brent Ewig, MHS
Director of Public Policy & Government Affairs, AMCHP

Sometimes I think a big part of my job is to act like a human Magic Eight Ball – the kind you shake up and look in the little window for the thing to float up with a concise prediction. I’ve been joking a lot lately that during the debate on the Affordable Care Act I was foolish enough to offer several predictions on "what happens next," and since most of those turned out wrong I should take the hint to get out of the predictions business.

However, since another major part of my job is helping our state members anticipate how what happens in Washington, D.C. will impact what you are doing in the states, I’m going to climb out on a limb here and convey a prediction about the Select Committee on Deficit Reduction (commonly known as the Super Committee). So here goes – if this committee does not come up with an agreed upon savings plan before their Nov. 23 deadline, it will be bad for state MCH programs because additional automatic discretionary spending cuts to domestic discretionary programs totaling $400 billion over 10 years will start in 2013. If they do come up with a plan it will also likely be bad for MCH programs because all indications are that the proposals on the table all seek at least an additional $200 billion in unspecified cuts to the domestic discretionary spending.

This is significant because the discretionary spending portion of the federal budget is a small sliver compared to the major deficits drivers in the entitlement accounts of Medicare, Medicaid and Social Security. In others words, it appears that politicians are looking to cushion specific cuts to these politically popular programs by further shifting some additional, but unspecified, deficit reduction burden onto the already tightly capped domestic discretionary category. This is the category that funds the Title V MCH Services Block Grant and virtually the entire budgets of agencies such as the Health Resources and Services Administration and the Centers for Disease Control and Prevention. While spending for these agencies has unquestionably grown at a good clip over the past decade, these are not the programs driving the federal deficit. Instead, these agencies run the programs that if adequately funded give us the best opportunity to prevent avoidable health care costs and human suffering, in the process relieving some pressure on Medicare and Medicaid. (For examples of the cost effectiveness of many common MCH services, click here.)

So, either way it appears that additional cuts are likely coming but here is the most difficult part. In order to gain agreement on a plan, Congress is not specifying which domestic discretionary programs should be cut. In this sense, they are providing themselves an out to say "I never voted to cut children’s programs," when in fact the additional budget caps they are imposing make that outcome almost certain. And here is why we should be worried: in this past year, when the Senate Appropriations Committee had to put together a bill with necessary cuts to meet the very first application of relatively generous caps, the Title V MCH Block Grant was at the top of their list of cuts. Next year, the caps will only get tighter, and the Super Committee appears to be looking to ratchet them down even tighter.

So what is to be done in this environment? First thing, make sure every elected official understands what is at stake and stands to be lost when they vote to further cut discretionary spending. We need to make sure they understand that what appear to be amorphous budget caps are already resulting in a loss of services and break down of systems serving MCH populations. Mostly, they need to hear that cuts have consequences and that years of work to improve MCH status is at risk of dramatic reversal if support is not sustained. So, if you haven’t checked out our new action center that allows you to easily customize an e-mail message to your elected officials, click here and stay tuned for additional AMCHP Legislative Alerts as the Super Committee deadline approaches.