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 View From Washington

Shutdown Dysfunction and the Morale of Public Health Workers 

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

As I write this column, the federal government is back to work after a 15-day shutdown. While this is good news, for more than two weeks most of our federal colleagues working for the U.S. Department of Health and Human Services were locked out of their offices and blackberries, placing the three legged stool of federal-state-local public health badly off kilter and our nation’s health at risk.

Moreover, four weeks into this fiscal year, public health program administrators literally have no idea what their budgets will look like for 2014 and little indication on how and when those funding levels will be decided. Last July, the Senate Appropriations Committee passed a bill showing proposed FY 2014 health program funding levels that actually included a small increase for the Title V MCH Services Block Grant. But the House Appropriations Committee never even released a draft of their bill, which was surrounded by rumors of deep health program cuts and outright program eliminations. Until now, there has been no effort to reach agreement between the two chambers. As others have observed, anyone trying to operate a business under such uncertainty could not reasonably be expected to succeed.

We at AMCHP focused primarily on two main issues during the shutdown: 1) We kept a finger on the pulse of state MCH programs to assess if the shutdown negatively impacted state and local MCH services. Fortunately, to date the state and local impact on MCH services has been minimal; although many states indicate that temporary solutions might have run out if the shutdown lasted for more than a month. 2) We also watched closely to guard against proposals that stipulated the price of reopening the government to include further cuts to public health and non-defense discretionary spending. At press time, it is still unclear whether any deal will lock in a second year of sequestration, and if that would require additional cuts beyond those imposed already. We will share those details once they are clearer.

In the meantime, a third longer term impact I am deeply concerned about is how the shutdown might impact the interest of future workers to consider a career in governmental public health or even public service at large. In essence, who would seek out a career in government when its workers are so easily denigrated and used as pawns, as in the recent shutdown?

A former boss of mine once shared the observation that ever since the administration of John F. Kennedy, leaders of both parties have actively campaigned against the federal government and Washington with the predictable result that the ideal of public service has been diminished. JFK’s term famously started with the trumpet call to “…ask what you can do for your country.”

Since then, however, we heard in Ronald Reagan's first inaugural address, "In this present crisis, government is not the solution to our problem; government is the problem." Bill Clinton, in his 1996 State of the Union address declared, “The era of big government is over,” and added, "Today our federal government is 200,000 employees smaller than it was the day I took office as President."

In a larger sense, tension over the size and scope of our government goes back to debates begun at the founding of our country. But it is important to remember that those founders moved forward because they were able to forge compromise and find accommodation – two values so sorely lacking in Washington today. So let us all continue working to promote the compromise needed to break the current impasse, and let’s look forward to a time when Kennedy’ words from 50 years ago ring true again:

Let the public service be a proud and lively career. And let every man and woman who works in any area of our national government, in any branch, at any level, be able to say with pride and with honor in future years: 'I served the United States government in that hour of our nation's need.'