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Post-BCA Advocacy Update April 2013

I have no relevant financial relationships with the manufacturer(s ) of any commercial product(s ) and/or provider of commercial services discussed in this CME activity Katie Schubert, MPP Adrienne Hallett. Post-BCA Advocacy Update April 2013. Katie Schubert, MPP Vice President

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Post-BCA Advocacy Update April 2013

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  1. I have no relevant financial relationships with the manufacturer(s) of any commercial product(s) and/or provider of commercial services discussed in this CME activity • Katie Schubert, MPP • Adrienne Hallett

  2. Post-BCA Advocacy UpdateApril 2013 Katie Schubert, MPP Vice President CRD Associates Coalition for Health Funding www.publichealthfunding.org Follow me @healthfunding!

  3. The Worst of Times

  4. Overview • What do we do? • Why is it important within the budget process? • What are the numbers? • How has advocacy changed post BCA? • Why should we care? • Coalition for Health Funding’s Advocacy efforts

  5. Background • Founded in 1970 • Largest nonprofit alliance to preserve and strenghten public health investments • 80+ member organizations • Advocate for the public health continuum • NIH, CDC, HRSA, SAMHSA, AHRQ, FDA, etc.

  6. Mandatory vs. Discretionary • Discretionary spending is at Congress’“discretion” • “Defense” discretionary is military spending • “Nondefense” discretionary or “NDD” is everything else • Research, education, food/drug/airline/public safety • Mandatory spending enacted by law • Entitlement Programs (e.g., Medicare) • To change spending, must change eligibility rules

  7. Absent reforms, debt WILL skyrocket in the coming decades % of GDP Debt breaches 100% of GDP in 2027 Note: Unlike current law, the Bipartisan Policy Center’s Plausible Baseline assumes that the 2001, 2003, and 2010 tax cuts are extended, the AMT is indexed to inflation, Medicare’s physician payment rates are maintained at their current rate (the “doc fix”), the looming sequester from the Budget Control Act of 2011 is lifted, and troops stationed overseas decline to 45,000 by 2015 Sources: Congressional Budget Office (January 2012) and Bipartisan Policy Center extrapolations

  8. Health care costs are the primary driver of the debt % of GDP Sources: Congressional Budget Office’s Alternative Fiscal Scenario (January 2012), additionally assuming that troops overseas decline to 45,000 by 2015; Bipartisan Policy Center extrapolations

  9. Revenue Under current policies simply will not be enough Revenues Averaged 20% of GDP When the Budget Was Balanced… …and that Was Before the Baby Boomers Arrived %of GDP 2012-2022 Average Fiscal years Source: Congressional Budget Office alternative fiscal scenario (January 2012)

  10. The First Cut Is The Deepest?Federal Spending Cuts 2011-2014 Adrienne Hallett Majority Staff Senate Appropriations Committee

  11. Background

  12. Can we cut our way to prosperity?

  13. Deficit Reduction to Date • FY 2011 and FY 2012 bills lowered discretionary spending by $550 million over 10 years. • The Budget Control Act (BCA) further lowered discretionary spending by $900 billion. • The American Taxpayer Relief Act (ATRA) cut discretionary spending by another $14 billion. • ATRA raised $617 billion in revenues. • Interest savings from these 3 actions = $300 billion

  14. Total Deficit Reduction $2.4 trillion BEFORE SEQUESTRATION $1.7 billion in cuts to discretionary spending $700 billion in raised revenue

  15. Let’s Talk About Sequestration for a minute….

  16. Details Matter… On Friday, HHS published operating plans that include Sequestration cuts for each program…

  17. AAP Priorities FY 13 - 14

  18. Details Matter How much of the cut will be absorbed internally? How much will be taken out of new grants vs continuations?

  19. Sequestration here to stay? The Senate Budget resolution replaces sequestration with a mix of spending reforms and revenue provisions. The House Budget resolution implements sequestration BUT: • Moves the defense cuts to the non-defense budget.

  20. Competing Visions of the Future

  21. Details Matter…. In current law, there is an $12 billion emergency fund for major natural disasters. The House Budget eliminates that fund, so any major emergency responses in the next 10 years would need to be offset with additional discretionary cuts.

  22. Close Up on FY 2014

  23. House of Representatives House budget for non-security spending: • a 16% cut from FY13 (-$77 billion) AKA • an 11% cut (-$55 billion) below the FY13 level after sequester is already subtracted (-$22 billion). For comparison: • HRSA’s discretionary budget is $6 billion. • The entire cost of operating Medicare and Medicaid for a year is $3.8 billion.

  24. Three Goals of theSenate Appropriations Committee “Regular Order” Bipartisan bills Bills that do not lock in sequestration

  25. Timeline for Action…. • May – July: Appropriations Committees mark up bills • May-August: Breach debt ceiling in May. Emergency measures last 6-12 weeks. • Grand bargain? • Fiscal Year 2014 begins Oct 1, 2013

  26. Back to Kathryn….

  27. Fiscal Discipline = Advocacy Conundrum • Post-BCA World • Game changer for appropriations advocates • No sacred cows • Lowering the bar for measuring success • Where money comes from now matters • Free lunch is over • Deficit/debt is crisis, requires action now • Associations face tough choices • Actions to save one priority may undermine another

  28. What We’re Doing About It • Budget Control Act defines us as community • “All for one” approach to advocacy • CHF developed the NDD Summit as ad hoc “network of networks” • United we stand, divided we fall • We need a balanced approach; no more NDD cuts!

  29. 2013/FY2014 Advocacy - CHF • General education/lobby days • Budget Process • Appropriations Process • Information sharing join the conversation: #NDDunited

  30. 2013 Advocacy - NDD • Inside Beltway • “NDD 3200” Letter • Media visibility • Days of Action • Meetings, meetings and more meetings! • Outside Beltway • “NDD United” Toolkit on www.publichealthfunding.org • State/district visits • Site visits (with media) • Local editorials • Media advisory template

  31. Tools to Engage • Grassroots Toolkit available at www.publichealthfunding.org; www.NDDUnited.org • “Deficit Reduction and You” video tutorial • Sequestration FAQs • Tips for Editorials • With sample Op Ed, letter to editor • Town Hall Tip Sheet • Sample questions & flyer for distributing at events • Press Event Tip Sheet

  32. Katie Schubert (kschubert@dc-crd.com) www.publichealthfunding.org Click “NDD United” for news, reports & resources Follow us @healthfunding!

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