Cuts aim to prevent Congressional axing
Expert: Leftovers on the plate invite big trouble
What drove the Centers for Disease Control and Prevention to trim $6 million in carryover from money awarded to cooperative-agreement recipients was the fear that Congress might enact much bigger cuts of its own, says a CDC official.
There’s supporting evidence that so many leftovers on TB controllers’ plates might have had that effect, says Patty Simone, MD, chief of the field services branch of CDC’s division of tuberculosis elimination.
"Federal immunization programs had the same thing happen to them," Simone says. "They had a huge increase in funding, and they also had a ton of carry-over. Congress looked at that and said, Forget it. We’re going to cut your money.’"
That’s why funding the CDC awarded to cooperative agreement recipients for fiscal year 1999 has been trimmed, just as the CDC warned would happen, by $6 million. With the news of next year’s funding cuts finally in hand, TB controllers throughout the nation now are scrambling to assess how the cuts will affect local programs.
New money awarded to the CDC by Congress is "level," which is government-speak for "lower," and doesn’t provide for cost-of-living increases many state and county programs are obligated to pay their employees. Therefore, the carry-over cuts have arrived at an especially unwelcome time, TB controllers say.
Past practice has dictated using carry-over funds to replace some of the "new" money that otherwise would have been awarded to a program. That practice, in turn, has meant more new money to go around, Simone says. "Of course, the states don’t see it that way," she adds. "They just see it as money."
Typically, about half of all state programs wind up with some carry-over at the end of the year, she says. The reason is simple: Because TB rates have risen over the past decade, programs have had to play a fast game of catch-up, racing to build infrastructures to absorb the increase in Congressional largesse.
Carry-over increases pot of new money’
Some states with carry-over were able to devise programs to spend the leftover money before the fiscal year ended. In other cases, the carryover simply was plowed back into the state’s budget for the following year. The use of carryover had the effect of benefiting all programs because it made for a bigger pot of "new money," Simone adds.
To get rid of the telltale carry-over, which amounted to about $12 million in the last fiscal year, two strategies have been devised. First, states with large amounts of carryover have been told to "spend more efficiently," she says. The second strategy took the shape of this year’s $6 million in cutbacks.
In an attempt to minimize the pain, the division of tuberculosis elimination has devised a formula of graduated cuts, Simone explains. Accordingly, programs that receive $500,000 or less in cooperative agreement funds will be "held harmless" and lose nothing. States in the next tier up will sustain cuts of 3% to 4%, while states in the tier above that have sustained cuts of 7% to 8%. New York City, "in a class of its own," will take an even larger cut.
A new formula to award funds
On the plus side, financial awards will be re competed two years ahead of time, by fiscal year 2000, and according to a new formula, Simone says. The new plan calls for dividing funds into two pots: one for top-priority activities, including case control and contact investigation, and the other for preventive therapy programs. Programs that have done a good job in reducing case totals and conducting contact investigations stand to receive less money from the first pot but more from the second, she says.
But even the new two-pot division can’t guarantee a happy ending for everyone, Simone concedes. "There seem to be a lot of programs spending money on screening activities when they haven’t done all they should have been doing on first-priority activities such as contact investigation. Often, there’s a lot of political pressure on programs to do things like that. Until now, we’ve never held them accountable."
Success may lead to big cuts
In addition, programs that used to have high caseloads but have experienced dramatic drops may have to take comparatively big hits when funds are recompeted, Simone says. One reason is that some of the big programs asked for — and received — big increases in 1993. Programs that underestimated their needs and asked for less simply didn’t get as much because the CDC isn’t allowed to award more than programs request.
When the awards are recompeted, programs that have been getting "more than their fair share" may find their funding trimmed substantially, Simone adds.
"But they’ve had the benefit of higher funding compared to some of the other programs. Now it’s time for some of those other programs to get their fair share."
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