What's at stake: Budget cuts are eroding the public health infrastructure

By now, it is well known that the state budget has been under severe duress over the past two years. Overall, as we show in the latest version of our Budget Trends and Highlights fact sheet, this year’s state appropriations of $6.714 billion are some $400 million, or 6.1 percent, less than the budget of two years ago. Over half of all appropriated state agencies have absorbed cuts of 15 percent or more over the past two years.

Yet if most people know that there have been overall cuts in funding, what is less clear are the specific measures that agencies have adopted in response to funding reductions and the impact these measures have had on services and programs. Particularly as we face the real possibility of deeper funding cuts next year and, potentially, for several years after that, understanding the impact of acute and extended budget shortfalls on public services will be essential for policymakers and the public alike.

The Oklahoma State Department of Health (OSDH) is among the agencies that has been hard hit by cuts over the past two years. In FY ’09, OSDH received state appropriations of $75.0 million. This amount was reduced by $6.1 million in FY ’10 and an additional $5.2 million in FY ’11, for a total two-year cut of $11.3 million, or 15.1 percent.

At my request, the agency recently prepared a five-page summary of the impact of FY ’10 and FY ’11 budget reductions, which can be viewed here. The summary provides a careful and detailed account of measures OSDH has taken over the past two years to deal with funding cuts, and the impact these cuts have had on programs, services, and clients.  The itemized list of reductions in services enacted in FY ’10 and FY ’11 reveal that budget cuts have impacted four key areas of public health in particular:

1. Children’s health – A cut of over $2 million for child guidance services has led to the loss of 26 FTE and has resulted in approximately 12,800 fewer screening, assessment, intervention and group services to children with developmental delays and behavioral health issues.  Hearing evaluation services for children have been reduced or eliminated across the state. The agency has also reduced contracts for the Children First nurse home-visitation program, leading to the elimination of at least five positions and and 125 fewer first-time mothers receiving services.
2. Preventive health services – A $40,000 reduction in the Oklahoma City Jail Screening contract led to approximately 1,000 persons not being screened for HIV and sexually-transmitted diseases. Cuts to Hepatitis A and B vaccines led to 880 fewer individuals being immunized. Family planning services that provided voluntary vasectomies and tubal ligations have been eliminated.  A $200,000 contract to the Hearts for Hearing program was also eliminated, while contracts for teen pregnancy prevention programs have been reduced.
3. Dental services – The department has terminated contracts with several programs that help serve low-income seniors and persons with disabilities in need of dental care. These programs currently have several thousand persons on their waiting lists. An annual legislative appropriation of $500,000 to support the Dental Loan Repayment Program, which helps train dentists for rural and underserved areas, has also been eliminated.
4. Regulation and inspection – Staff reductions have resulted in 200 (33 percent)  fewer site visits, inspections and investigations of local jails, and 37 fewer surveys of long term care facilities.

The agency’s  assessment of the overall impact of budget cuts on the state’s public health infrastructure provides genuine cause for concern:

State appropriated reductions… continue to erode the public health infrastructure across the state, impacting services that are imperatives of the department.  Specifically, infectious disease control and emergency preparedness and response depend on a minimum level of infrastructure to mount a rapid and effective response.  While the department has been able to meet the challenges presented thus far, erosion in the clinical nursing infrastructure over the past few years has left the department vulnerable.  Continued reductions in this infrastructure may result in reduced response times and the inability of the department to protect the citizenry from natural or man-made disease occurrences and disasters.

This corrosion in the state’s public health infrastructure is especially alarming given Oklahoma’s already poor rankings across a whole range of health measures and outcomes. Rather than focusing on the renewed investments that will allow us to improve Oklahomans’ health, the cuts enacted already during the budget crisis and the potential of even deeper cuts ahead means we we will likely continue to spend the next years struggling to avoid falling even further behind.