By Lyle Dennis, Cavarocchi – Ruscio – Dennis Associates, Consultants to AASLD
It is probably just my own personal limitation, but I am starting to run out of adjectives. I don’t have enough negative adjectives to describe the impact of what could be coming if the mindless, across-the-board budget cuts known as sequestration are allowed to go into effect. And I don’t have enough positive, uplifting, call-to-action adjectives to inspire you to demand responsible action by your elected representatives… but I am compelled to try in both categories.
Barring any last minute miracles, on March 1, every discretionary spending program that AASLD members care about -- NIH research and training funding, HRSA’s Division of Transplantation, AHRQ’s health services research, CDC’s Division of Viral Hepatitis, the VA’s Medical and Prosthetics Research program – will all be cut by about 5.1 percent. This is not optional or variable. The law says that every “program, project and activity” will be cut. A special exception is made for Medicare. It can “only” be cut by 2.0 percent, but that reduction can only impact providers, not beneficiaries. Hospital and physician reimbursement, Graduate Medical Education, and more are on the chopping block.
I would like to tell you that cutting 5.1 percent of an agency’s budget five months into the fiscal year is not a big deal -- but it is. Absorbing that cut at this point in time is effectively a nine percent reduction for the rest of the fiscal year. Using NIH as an example of interest to most AASLD members, the purchasing power of NIH’s appropriation has declined by 20 percent over the last decade. Tack the sequestration disaster on top of that history, and we are clearly moving towards a crisis.
But the madness does not end there.
On March 27, all funding for every government agency will expire. Congress can either extend the current funding levels -- which are an extension of the FY12 funding levels – until September 30 or it can introduce and pass the 12 appropriations bills from the last session of Congress. Or it can do some combination of the two.
I have written before in this space that trying to predict the actions of Congress has a relatively low percentage likelihood of success. But, I am going to do it anyway. If you have to bet, bet that the sequestration will go into effect on March 1; that Congress will then get serious about funding government programs and that by March 27 they will pass a bill that (a) funds the government for the rest of the year (with some specific reductions); (b) suspends the sequestration until next year; (c) closes some tax loopholes to generate a little more revenue; and (d) declares that the crisis has been averted.
There are of course real consequences to this kind of brinksmanship. There are real consequences to cutting funding today for the biomedical research that will pay dividends tomorrow. There are real consequences to not investing in research, and education, or in screening for hepatitis C, or in reducing the need for transplantation, or supporting Medicare and Medicaid providers.
And that is where it becomes essential that AASLD members be ready and willing to act. At key points, we may ask you to send an email or make a phone call to your representatives in Congress. We hope you will do it. We try not to waste your time or unduly burden you. Not everyone can get on a plane and come to Washington for Liver Capitol Hill Day. Not everyone can get a meeting with your members of Congress when they are back home (although you would be surprised how easy that actually is).
But everyone can make a phone call, send an email, tweet a Member of Congress or send them a FaceBook message. Here at CRD Associates, we lobby professionally and we have been privileged to work with AASLD for the last 15 years. We have never seen a time when it was more important for you to be involved. Don’t be hesitant to share your knowledge and your understanding of the impacts of funding and policy decisions with your representatives in Congress.